The Dr Louise Newson Podcast - 150 - The effects of trauma, gender bias and the peri/menopause with Dr Jan Smith

Episode Date: May 3, 2022

Dr Jan Smith is a chartered psychologist, executive coach, author, campaigner and the director of Healthy You Ltd. She has over 15 years’ experience providing psychological support to those affected by injury and clinical negligence. In 2014, Jan developed a birth trauma service and campaigns to improve safety in maternity services for families and staff and provides training in the UK and internationally to maternity students and healthcare professionals on birth trauma and its impact. In this episode, Jan describes to Dr Louise Newson how women can feel after a difficult birth or medical experience, and how trauma related emotions can resurface many years later at peri/menopause when psychological and genitourinary changes occur, often affecting relationships and intimacy. Jan’s 3 pieces of advice: If you had a difficult birth or healthcare related experience that affects how you feel about your genitals and intimacy, it is never too late to get help, even if it is years down the line. Workplaces need to view women’s health as a continuum, not separate stand-alone events like pregnancy or menopause. Think about ‘reaching in’ to help other women going through it – to listen, to validate and let them know they are heard and seen. This can be hugely beneficial for everyone’s mental health. For more about Jan and Healthy You, visit https://healthyyoultd.co.uk/

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 delighted to introduce to you Dr Jan Smith, who's a psychologist who I've recently been interested in her work and especially the work that she does

focusing on women who have had birth trauma, which might seem a bit weird talking about birth trauma on a menopause podcast, but hopefully bear with us and we will reveal why. So hi, Jan, thanks very much for joining me today. Hi Louise. Thanks for inviting me. So tell me this about your work and your background and why you do what you do if that's okay. Yeah. So I am the director of Healthy You Limited, which is an independent psychology practice. And we do lots of work supporting birth and women and people who have been impacted by trauma, which is a really big word. And in birth, we also support people through fertility, loss.

and also, I guess, in that continuum of women's health right through perimenopause, the menopause and postmenopause, and we do lots of work with organisations in support and women's health around those spaces. So a huge amount of work. Yeah, yeah, absolutely. So how did you get into that then? What made you be interested in it? I think I, probably from a personal experience, you know, I had a mum who is,

is very equality, women. And, you know, I grew up in a house with five brothers. And we were all equal. There wasn't a difference between, you know, genders. And my mum done a lot for women within our area to champion and support them. So I think women and supporting women has always been something that has run through the thread of my life. And then when I left university, I done a lot of work in supporting. women who were sex workers and in that space around maternity. And it just kind of evolves. I guess I never

felt like I set out with a plan. No. It just sort of, I'm here now. Yeah. It's interesting, isn't it? I never have a plan, anything that I do. But people might laugh when they hear this. I saw a clairvoyant several years ago. My mother-in-law is very spiritual. And I saw this lady. Actually, we would try to decide, moving house and churning various things and I just really wanted to talk to her actually and she revealed all sorts of things I just don't know how she knew what she knew and at the very end she said oh you're going to do a job where you're helping lots of women and I looked at her and I thought you've got that wrong actually because I'm not interested in gynaecology I'm more interested in disease I can't imagine ever doing a job where I predominantly see women and now look at me all I do is think

about women and so it's interesting how you're you know your sort of focus and and I think it's also I'm very very driven by stories that I hear and I think the more I hear about suffering and women the more determined I am to make a difference actually and it would be really lovely to say that men and women are treated as equal but I don't think they are in a lot of space actually no absolutely not and I think it's very hard sometimes for women to also understand what normal and what's normal because, you know, we're talking about pregnancy, which is a normal process. We're talking about manifolds, which for many women, it's a natural process, but it has absolutely devastating ramifications. And I know when, even when I was pregnant with my first baby,

and I went into labour, and it was a very long, awful labour. And I had to demand a cesarean section. And I was worried about my pelvic floor. And I said to the consultant, I did not want a terrible pelvic floor and to have a section, just do a section. And it was, I've got still some PTSD because it was such a horrible experience having this emergency section. But actually, if I didn't have the knowledge and didn't have the gumption to really demand for something that I knew was right, I know my pelvic floor would have been awful. But then everyone will say, yes, but it will be sore because you've had a baby. And you will expect some stitches and you will have this discomfort. And it won't be the same having sexual intercourse.

So then how do women know how to ask for help? and I'm sure you hear this a lot in your work. You know, what is normal? And what, you know, because women put up with so much, don't they? Yeah, and I think they're expected to, you know, certainly within that pregnancy space as well. And the countless times that I've heard from women, you know, I've gone to the GP or my health visitor and said, you know, I have times where I'm incontinent, even, you know, up to a year postnatally. and are told that's all fine. You've had a baby, what do you expect?

And I think there's a massive stigma around it, do you know, and if it's your first baby, and if none of your friends are saying, you know, sometimes when I laugh, I wee, that can be really, really difficult then, first of all, to know what is expected and also what to do whenever they do experience it. Absolutely.

And I think it is that whole, you know, how do you define normal? And certainly, you know, I've got quite a few friends who don't jog because of their urinary incontinence or they wouldn't go on their child's trampoline, for example, in the garden. They just said, oh, no way. And I, gosh, it wouldn't even cross my mind to think about, because my pelvic floor, thankfully, is very good. But actually, they think it's normal. They think when you reach the 30s, 40s even, still really young, isn't it, that you're allowed to have a bit of incontinence. And that's terrible. Yeah. And especially, I think it can really impact on quality of life or even, do you know, flatulence as well. Do you know, that is another big thing that we see

that really impacts women's confidence and self-esteem. Do you know, I think having a baby irrespective of, if it's your first second or beyond, there is a period of transition with each of those pregnancies, conception and births. And as I said to your trauma is such a big word, isn't it? But if you've had a difficult birth, then that is going to impact on how you feel. And it is very much in the eye of the beholder. You know, it's a very subjective experience. Yes, definitely. And it affects relationships so much, not just intimate relationships with partners,

but also even the relationship with a baby or future births as well. And like you say, sometimes the trauma, whether it's a physical or psychological trauma, and often both, isn't realized until later down the line either, is it? Yeah, absolutely. And I think that's certainly what we see in practice and also, you know, with organisations that we work with around you have people who are in those very early stages of trauma. And then you have those people who are years, sometimes decades down the line. Do you know where they are in that perimenopausal, menopausal or postmenopausal phases? And they're having a lot of physical symptoms around continents or other difficulties. And for the first time then, do you know, all of those dormant feelings or those feelings that they've worked incredibly hard to suppress, then all come to the surface. And actually, they come about their difficulties with menopause, but actually it's trauma. Yes.

Do you know what we're treating is the trauma? I remember seeing one of my first patients in my clinic who came from Wales, actually, and she'd driven. In fact, she hadn't driven. Her brother had driven her. It was about three hours to come to the clinic. And the only way she could come was lying on the back seat. And she hadn't been out of the house. So she had been struggling for quite a few years, mainly with localised symptoms.

So putting on underclothes was impossible for her sitting down was really awful. And she was having some incontinence. So the tissues were very excoriated, very. inflamed, you know, because of this leakage of urine as well, wearing pads was making things worse. The skin was very thin because she was menopausal around the vulva and vaginal area. And she'd been labelled as mad, actually, really. She'd been given a diagnosis of fibromyalgia and chronic fatigue.

She had also, I was on lots of different antidepressants. And because she was housebound, she kept phoning for help and very few people would visit her. So she had this awful label. but actually when she came and I just said to look like there's lots I can do to help you, then she amassed this whole story about when she gave birth and how traumatic and the pain was similar. And there was just so much to unravel actually. And no one had actually, well, I was really shocked us that no one had ever examined her because she'd been housebound. And when I said to her, would you like me to examine because I always offer it.

Some women don't want to examine understandably the first time. they see me, then she said, oh gosh, can you do that? I said, yes, of course. And you realize how vulnerable some women are actually. And I think as a doctor, I feel that we have a lot of power, but it has to be done in the right way. And actually we also, we take a lot for granted. Like I would expect every woman who had bad symptoms,

certainly as too extreme of that would have been examined, whereas a lot of women haven't been examined or they don't want to be examined because it will rekindle maybe a very traumatic examination in the past. Yeah, absolutely. And I think that's something that you are touching on there around examinations are incredibly triggering for some people because actually in that sort of perimenopause menopausal period

where, you know, sexual relationships are changing potentially and they are getting more localised pain. actually some of the pain for those women are the pain that they experienced in those early recovery phase postnatally and so even though they don't want to think about it actually they're in that cycle of or remember this and then starting to feel like

because of their heightened anxiety and depression that they might be experienced because of hormonal changes is they think there's something fundamentally wrong with them. Yes. And I think it is, you know, there's a couple of patients actually that come to mind. One of them is, was, well, she still is a psychiatrist. And I lectured to some psychiatrists a long time ago about mental health and the menopause. And then this lady came to see me and she'd come over from Guernsey.

So she'd actually got a bus, a boat, a train, a tax, a massive journey. And she'd had a hysterectomy about two or three years before I saw her. And she came with a long, floaty skis. again, wasn't wearing underclothes because it was so painful. But she actually thought that her surgeon had mutilated her vulva and clitoris and the areas around because everything had shrunk, everything had changed visibly. And obviously, sensually was very different. She had a lot of pain, a lot of burning, a lot of irritation.

But she was really shocked when she held a mirror and saw, you know, anatomically, everything was different. So she actually had this belief for two years that the surgeon had cut her or done, something without her consent. And this is a medical practitioner. And I examined her and I said, no, you've got symptoms related to vaginal dryness. This is all going to be related to the low estrogen and probably low testosterone in the tissues. You also need HRT. I'm going to give you HRT and some local treatments. And I saw her for a review recently and she's horse riding, which is her passion. She's having the life. But also all the anatomy, it took a while. It took a few months, but it's reversed, so it's come back to normal.

And she said to me, she said a few times to me, gosh, Louise, if I hadn't have sat in that lecture listening to you, I wonder what my life would have become because she was, she's also very anxious because she was menopausal. We know anxiety worsens during the menopause. Women often ruminate and they go round and round and any little obsession gets bigger and bigger and bigger. So she'd had this, she knew it was irrational thinking the surgeon had cut her badly. Of course he hadn't.

But that was all she was worried about. Every morning she'd wake up with the. these fears and it would be exaggerated. And it was controlling her life. She'd given up working as a psychiatrist and she'd become quite recluse in Guernsey, not wanting to go out or do anything. And you think, goodness, how many other women are suffering like this without being able to speak and not knowing what's going on to their bodies as well? Yeah. And I think as well, you know, whenever someone has surgical intervention, so they're going into the menopause then quickly. Do you know, some of those ripple effects psychologically that happens whenever they have

experienced difficulties in birth or trauma is around, you know, feeling like a lack of control, feeling that something is being done to you. And I think that can really, really exacerbate a lot of those symptoms even further. So even people, like I've seen people who have had intervention and support and therapy and has felt that their trauma has resolved within that postnatal period but it can start to resurface again when some of these changes come later on in life

and I think we don't talk enough about it do you know I know I'm Irish and a psychologist so I'm going to say in part that but I just think the stigma is huge and then do you know returning to work and how that looks like then becomes a really, really difficult thing from any women. It's very hard, yeah. I mean, the second patient that I might have mentioned before on a previous podcast actually

was a young lady in her late 30s who had a history of vaginal cancer. So that had resolved in her having a lot of radiotherapy to the area. And so when people have radiotherapy, often the tissues become quite scarred. And her vagina opening was very narrowed. the whole vagina actually was narrowed. And there's a lot of scar tissue around her vulva as well. And she was really struggling with menopausal symptoms. She had been told she was too young to be menopausal,

although she knew that she wasn't having periods, that her treatment had washed on an earlier menopause. And so she came over to talk to me about options, and I offered again to examine her, and she was quite surprised that I'd offered. And she had a lot of radiotherapy burns, but she had been told quite categorically. She'd never be able to have an intimate relationship with her husband,

again. No one had given her any information, nor any treatment. And so I didn't examine her internally because it would have been too painful, but just looking, there was lots of scarring, but there was also a lot of vaginal atrophy as well related to her hormones. And so I said to her, well, let's just give you treatment, but there's always options, you know, and you don't have to have penitative sex to have a sexual relationship. And no one, I know that sounds really obvious to a lot of people listening probably, but actually no one had even told her that. No one even said, you know, there are other things that you can do and explore with your partner. And it's taken her a long time to get over the sort of trauma because she had so many examinations and so much treatment in that area.

It became a very clinical area for her rather than a sexual area, if that makes sense. Yeah, absolutely. And I think when you have things that are done to that area, understandably you're going to have significant associations. you know, it's the same with people with childhood sexual abuse or have had sexual assault encounters experiences. That can be something that also is really difficult for them as well. And I think when couples come, you know, a large part of what I discuss with couples is expand in the range of what intimacy means. Do you know, it's the connection between, you know, to people in that space in which there.

they love one another and what does that look like? And that can generate, you know, the fun back into it. Because I think there's a danger when there's sexual difficulties within a relationship. Understandably, it can feel really serious, you know, and there's the embarrassment and the stigma. And so I think there's something about how to generate that explorative element that lots of us have in those early stages in a relationship. Yes, and it's lost, isn't it?

I mean, most women I see in it have stopped having sexual relationship, which I feel on really sad. But what I find more sad is that they've never spoken about it. And often they don't even talk to their partner about it. And it stopped them having any intimacy because they say, oh gosh, if I held his hand, he'll think that he might be able to have sex later on. I don't know because it's too painful. But actually they're not open. You know, my teenagers are very open about everything, which is great.

And I think I'm very fortunate I've been with my husband since I was 18. So we started off being very open with each other. And I sometimes play mine going, I'm not going to leave him, don't worry, but if I was starting a new relationship age 51, would I be so sort of open with my, I probably would be a bit more reserved actually. And certainly if I had any sort of symptoms or signs of perimenopause or menopause that was affecting, you know, my vulva vagina, I don't know. How would I explain it to somebody? You know, I think it's really difficult, isn't it? I did a talk once for Trekkstock, amazing charity. and there were lots of young women in the audience.

They've all had cancer. And there was someone on the panel with me saying that she had had cancer of her womb. And she had a lot of really awful symptoms because of her menopause. She was only 24. So she said, I've decided to become gay because women don't ask the same questions as men. And I can have different relationships. And I can be open. From the start, I can tell someone about my symptoms.

And I thought, gosh, isn't that? But also, you know, men who have prostate surgery have a lot of cancer. about having erectile problems, problems with intercourse afterwards. You know, there's a lot of counselling with people who have had prostate cancer. Women who have had breast cancer who will either become menopoles because of their treatment or just because of them getting older are given very little information. So there's a, I think us as clinicians have got it wrong actually. It's about men being able to have sex and not about women, whereas we know more women are affected.

I don't know if that comes through with any of the work that you've done. I'm laughing because I think that's like a whole other podcast, isn't it? Yeah, absolutely how the system and how health is very gender-based towards men and supportive of men. And I think that's definitely, you know, we see that massively in the workplace with women and organisations that were asked to go into to support them on how to talk to women. and I think, unfortunately, we're still not seeing that joined-up journey, I guess, that overall umbrella of women's health. It's like, you know, maybe we'll be asked to go in and support them around, how can they support their workforce around fertility or births, transition back after birth, or menopause, you know, or perimenopause. And actually it's not circumscribed, you know, because what we see a lot is that you have women who are maybe undergoing fertility treatment or not, but are having babies later in life. And actually a lot of them when they come back from maternity leave are already in that perimenopausal phase.

Do you know? So they're attributing everything to they've just been on maternity leave. know, and that pressure of I need to really perform, I need to really show that I can still be in this job and that I'm not going to, you know, go off and have a baby and then my performance is massively diminished. So I think that is a very different conversation and discussion that we have compared to when dads who have experienced some trauma or loss in that perinatal journey, that's very different as well. There's so much that needs to be done, isn't there?

Certainly even menopause in the workplace, there's so much about women not being promoted at work, not taking roles. Someone recently said to me, of course I've taken a lesser role. Now I'm menopausal. What on earth, you know, have you not had treatment? Well, no, I wouldn't want treatment because it's a natural process.

Well, actually, it isn't that natural to live without your hormones and maybe you should be signposted to some proper information and get some treatment from a healthcare professional. And so I think women are silenced so much, actually. Yeah. And this is such a shame. And I think also when it's talking about anything that's birth, anything that's urinary, anything that's sex-related, it's almost we feel shame to talking about it.

Yeah. And I'm not quite sure why, really. Because if I had a weeping wound on my arm or a big rash on, my face, I think it would be very easy to talk about it. And people would also want me to talk about it or give me some sympathy. And that's so much harder, isn't it, when it's things you can't see, but they're affecting you in worse ways, actually. Yeah, absolutely. And I think as well, well-meaning people that sometimes, you know, get the language of it wrong. However, there's something about the recipient of that acknowledging that they're making an effort to try.

And we can't know everything, do you know? So I guess it's also based on what does that person need and in that organizational way asking them. We do a lot of leadership programs, particularly women in leadership. and increasingly that perimenopause menopause phase is something that is coming more and more into the work that we're doing because they're saying, okay, so I'm the only female on the board. I've had to work even harder to get here. I'm in my 50s. I'm at the top of my game. And the anxiety that comes not as a result of the men, menopause, but in that anticipatory way of what are the symptoms going to bring and is that going to impact my performance and can you just sort out my mind and then I'll be okay.

Do you know, you can hear that panic in them? Yeah. And it is very hard. I mean, I'm a menopausal woman, but I take HART so thankfully I don't have any menopausal symptoms. But I still, I said to someone this morning actually, I think I would be a listen to a lot more if I was male, some of the strategic, the higher level work. I'm doing. There's still a lot of bullying going on. I get phoned. I get emailed. I have meetings with

usually men actually who are telling me off for doing things and they're things that I'm doing to help other women that I'm not doing it for my own advantage. I'm doing it out of pocket and I've been told off and to the extent I've even cried at meetings, which I'm quite a strong person, but nobody's ever reflected or contacted me afterwards to say, are you okay? And I'm crying because I'm so frustrated. listening to stories and I've explained the reason that I'm because once you start crying you can't stop can you I can't and I said look I'm really sorry I'm crying because I've heard of another suicide and nothing's happening for mental health well Louise you need to compartmentalize yourself Louise it's not your problem well yesterday it's not my problem but it's no one else's problem and I really want to

determine to make a change and I have often reflected and thought gosh if I was male personally you know if I cried I think people would just wouldn't understand at all but actually they wouldn't talk to me in that voice. It's that they're there dear. Never mind dear. It's not, you can't do everything. And it's very patronising, isn't it? Totally, totally. I mean, I've been introduced two boards where I'm going in to deliver leadership as the person who's going to talk about the women's issues. And it's, yeah, I think there is so much in that, isn't there? And, Do you know, I'm in a fortunate position where working independently, you don't have to take on all the work. Yeah.

So you can pick and choose those organisations that have already started some of those changing the cultures and come from a place of genuinely valuing the workforce and the needs of the workforce and to make it better. Yes, and you can really see the difference. We certainly do a lot of work with workplaces and some of them are very interested in the balance app. and now we've got this plus section where people can pay for extra advice about well-being and everything else. But what I really want to do is corporates to pay for it. I really don't want women to have to pay for anything. And, you know, it's taking a little while, but I think it will come and you'll see the good corporates that will do it.

Because my thing is, if everyone pays just a pound for every female employer, you could make a massive difference. Because if we're given the tools to help us as women, we can achieve so much. But what hasn't happened in the past is we haven't been allowed to have the information and the tools and the confidence to do it or to talk about it. So I think things are changing, aren't they? Yeah, and I think awareness is being raised and certainly women are talking more about it. Yes. I just hear it more even just socially women talking about it. Yeah, which is fantastic.

I know if I was doing a men's health clinic, we wouldn't have the same media attraction because men would not talk about how. how painful it is to have sex or how awful it is to forget, you know, various things or how terrible their sleep is, they would not talk about it at all. So women talking is really good. So I feel like we're doing the first stage. The second stage is women receiving the treatment that they so desperately need. Yeah, absolutely. So there's a lot that needs to be done. But, you know, the work you're doing is incredible. And I'm really looking forward to seeing how it shapes and changes and I'd love to have you back at one stage so we can talk a bit more about gender inequality.

This is quite a lot to cover there. So just before we end, I'd really like to just ask you three tips for people who have been listening and thinking, gosh, actually, I wonder if some of my ways that I'm feeling have been related to maybe birth trauma or something that's happened in the past and they've not joined the dots until now. What three ways would you say would be most helpful for them? What I would say is trauma is my word. It might be that you had a birth that you found really difficult.

And if that is the case, it doesn't matter what age you are. You know, the oldest person that I had come into me was in our late 70s. Do you know, there are still things that can be done to support you and work through that. It's not you've left it too late. That's the first thing. I think as well for workplaces to shift the focus that women's health is on a continuum, that it isn't just, you know, conception, pregnancy, menopause, that actually we bring our whole selves to work and all of our experiences.

And I think another thing that we talk a lot, probably more within the mental health space, which is about reaching out, which is fantastic. But I think a huge part of that message that's missing is about reaching in. Do you know, like you said there, if every organisation spent one pound on a woman, the impact that that would have, imagine just in our circle, do you know, if we reached out to one person each day to just say, I've been thinking of you, how are you doing? Do you know, it doesn't mean you have to take on their stuff, do you know, but create that space. where you can hear, you can listen, and you can validate and say, I see you, I hear you,

I think has such a massive impact on women's, anyone's mental health and wellbeing. Yeah, that's so important, such a good way to end. And it is being listened to knowing that you're not a burden, but you're allowed to talk or share, is absolutely key. So thank you so much for your time, Jan. It's been great conversation, and I look forward to having you again in the future. 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.