The Dr Louise Newson Podcast - 159 - Raising awareness of HRT in the community in Ireland with Pharmacist, Victoria Jones

Episode Date: July 5, 2022

Victoria Jones is a community pharmacist at Bonnybrook Pharmacy in Coolock, Dublin. She received very little education on the menopause when training and became more interested in hormone health after her sister experienced severe symptoms at 40 and began taking HRT. The dramatic return of her sister’s health and wellbeing prompted Victoria to move away from running a chain of pharmacies to set up her own independent pharmacy with a focus on women’s health. When Victoria experienced her own perimenopause and she saw the profound benefits of HRT for herself, her passion escalated and Victoria now takes a very active role in raising awareness in her community with the public and local healthcare professionals, and in educating others through her social media. Victoria’s advice to women: Ask your pharmacist if they’ve done any training on the menopause and if not, mention the resources available such as on balance website and the Confidence in the Menopause course on fourteenfish.com. Find the right pharmacist for you. Don’t be fobbed off by healthcare professionals, if you aren’t listened to the first time, go in more empowered with information the next time. Ask for a specific clinical reason why they will not prescribe HRT, and ask them to write it down for you. Your pharmacist can explain how and when to take your HRT medication if your doctor wasn’t sure, or you didn’t have time to discuss thing fully. Your pharmacist can also help with information on improving health through lifestyle measures such as nutrition and exercise. Victoria’s pharmacy website is www.BonnybrookPharmacy.ie Follow Victoria on Instagram and Facebook @The_menopause_pharmacist

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 my podcast, I've got an amazing pharmacist from Dublin actually who reached out to me on social media and is very active on social media, but also very active on her day-to-day job, spreading the word and helping as

many people as possible. So thanks Victoria for coming today. Thank you so much for having me. So tell me a bit about you then. You're a pharmacist, aren't you? But you're not always. has been so dedicated to the perimenopause and menopause, have you? No, no. I qualified in 2007. I did science degree first and then did pharmacy. And I think I always wanted to be a pharmacist because I love that idea of helping people and you're going into a pharmacy to give you a little jar of something and it makes you feel better, you know, and I always as a child loved going in. So I qualified in 2007, studied in their Royal College of Surgeons in Dublin. And it was a really new course. We were the first year of that

pharmacy course. They normally just did medicine. And so it's a really cutting edge course. And even when I look back, we had very little on menopause, very little on perimenopause, very little on HRT. It was kind of just like a slide or two. You probably won't need to be dispensing this. And actually I've touched base of them recently and they've changing their whole course, which is fantastic. And they're starting now to integrate more sexual health and female health, which will be fantastic. So I suppose I'd then just starting community pharmacy. So in Ireland, that would be working near pharmacies with the local communities. And I went on to run a chain of pharmacies, but I wasn't patient-facing anymore. And I really just didn't find that it didn't fulfill me. And it was more management and I just

didn't see patients anymore. And I really missed that patient-facing role. So in May 2019, I decided to take a big leap of faith and open my own small independent pharmacy in a small corner of Dublin, Kulok, Bonnie Brook Pharmacy. see and with the idea of specialising kind of female health. And I didn't really know at that time what part of female health I wanted to, you know, specialise in. But I thought that's usually who I see most and I'm really mostly interested in. And my sister had had an early peri menopause just after having a baby when she had the baby at Christmas at 39 and turned 40 in the January. She just never was really herself after that. Just she had this constant itching and she was really

intolerant to heat. And she had this crying spell. She was irate. She had a really long fuse normally and she suddenly had this really short fuse. My mom said, you know, did she have postnatal depression or? I didn't know. She sent to doctors and they were all like, no, no, you're fine, you're fine. And a year later, I said to her, this has got out of control like she was tearing her skin. And I said, I think it's hormonal. I said, I think it's heart. I said, I think it's horrible. And the GP said, no, no, sure. You're just acting, not yourself. You just act. And she said, I don't feel myself. I just feel awful. And I'm so happy to have the baby. And she said, no, no, sure, you're just 40. You just had a baby. you're far too young. They did bloods anyway and of course it showed up in her FSA in her bloods. So the doctor rang her back and said, look, I'm really sorry for actually dismissing you, but you have the levels of a postmenopausal woman here. And so we're going to try on some HRT. So I suppose that was my first introduction to HRT and that was probably 10 years ago. And within like three months, she started on tablets and then moved to a patch and some body identical estrogen. But of course, I didn't know that terminology then. And she had a Marina coil in and she just became herself again. And within a short period of time, that was my first introduction. And then I was like, you know, I'd always sparked an interest in that side. But I didn't, as a community pharmacy, I didn't see a whole lot of HRT. And I definitely didn't know the difference between gels, patches and oral formulations.

I just didn't. I knew what the B&S said, which said it gives you breast cancer and risks and cloths and everything else. So I suppose then when I opened the pharmacy, in Kugelak. After about six months, obviously, we had COVID, which was a joy. And I thought I was just feeling very stressed and I had turned 40 myself. And I started getting these feelings where I felt like just before my period, I'd be insane and just feeling emotional and have crying spells. And I couldn't think of any words. I had really bad brain fog. And I couldn't remember anyone's names and I could remember their medication they're on, but they'd walk through the door and I would just have a blank.

And I couldn't remember the word for lawn more. And it took me about two weeks to think of the word for lawnmore for I said to my husband, can you just cut the grass with the, I couldn't think of it. And I thought, maybe I have like Alzheimer's. And so had all these symptoms. And even though I was helping women on a day to day with, you know, when I was getting more information from your websites and from your Instagram posts, I kind of wasn't joining the dots that was actually me.

And I was missing a period here and there. But I thought, oh, that's just because I'm busy or stressed. And we were in the middle of COVID. But so it got to the point where I couldn't really function. And I said to my husband, I think I'm going to have to sell the pharmacy. Like I can't open too many tabs on my brain anymore. I'm really overwhelmed for no particular reason all of the time, driving to work in floods of tears. And like, that's not me.

That is just not me. And I said, so I went to see a GP and they said, look, I think you're depressed. He was some mad's depressants. And I thought, I'm not depressed. But I couldn't even say the words because I just felt like it lost my voice. So a couple of months past, I went to a local GP who specialises in female health and menopause. And she said, oh no, you know, I did your symptom checker. Even though I doing this every day, I think I just lost confidence.

And I filled them all out while crying in the surgery and realized that it was really me. She prescribed some Easter gel. And within five days, four or five days, I was like, oh, my God, it couldn't be this easy. And I just started to feel better and better and better. And within a month, I just thought, oh my God, I just feel me again. And so that really just, I said, that's it. This is what I have to do. And especially in Ireland, we don't have a very good history when it comes to female health

and education about women's health and access to women's health and the correct information. And it's changing. It is changing. So something happened all together. It was a perfect storm. So I was looking at Instagram and I was watching all of your free advice and your fact, sheets and all of the online free advice that you can get. And then the divina effect, obviously. And then we also had a radio program called Joe Duffy. It's a huge radio program over here.

And yeah, it's amazing. So he really started the conversation with Irish women. And really from then it just took off. And I suppose while I was living it, I just, that's where my passion is. Because I see so many women coming through the doors and they might be started on some antidepressants. And they're going to higher levels and higher levels and higher levels. And they're saying to me, I don't feel any better, Victoria. My symptoms are still there. I don't feel any better. I just feel none.

So now we kind of have, we give the Newsome Health symptom checker to every woman that comes in, which is fantastic. Because the GPs, I suppose, like myself, you know, I'm only 14 years qualified, you know, they didn't do a huge amount

on menopause and perimenopause and prescribing HRT. So we do have some fantastic local doctors which are brilliant. And actually, some of the older doctors, the male older doctors, have really embraced it. It's great. It's great. And we kind of do a collaborative approach. They can ring me and say, you know, such and such and what you think. And, you know, at the start, and I'd send them the

attachment to emails with the easy prescribing guide that you've done. And I'd say, look, if you'd ever want to have a chat or know what's in stock with the stock issues, give me a shout. So we're getting there, slowly by slowly. It's amazing, isn't it? And I certainly, some of you listening might know that we're doing a lot of work with pharmacy. as well as with nurses because I feel that, you know, you as healthcare professionals as well as nurses are really integral to improving menopause care and treatment in a big, big way. You know, I get a lot of pushback from GPs. I had one quite openly on Twitter yesterday saying, how dare you be rude about GPs?

How do you understand what's going on? Well, I understand what's going on in menopause. And I'm not out to be rude about anyone. I'm really, you know, we also, we got a letter complaint last week. saying women are now asking for some blood tests to monitor their estrogen or whatever. How dare you even suggest this? And how dare you, you know, women are even asking for HRT now. And this is all because of your work and we'd like you to stop. And it's really quite overwhelming sometimes. But actually, my pushback is, let's just listen to women, actually,

and see what they want. But also let's help. And I know that all sounds very negative. I also get a lot of thank yous from people. Other healthcare professional, to say you've made it so easy because when a woman comes with a, you know, whether they've downloaded the free app or they've just printed it off at either the charity website or the balance website, symptom questionnaire and they come in and say, I've read the information, these are my symptoms, this is what I would like. Actually, then it liberates that doctor-nourced pharmacists with loads of time. But then it's still, a lot of doctors and nurses and prescribing pharmacists get really nervous about how to prescribe what to do. And then with a shortage

that we have at the minute or if availability or if one type of HRT isn't suiting, the knee-jerk reaction can be, oh, let's just stop it then, you know, but actually, as you know, to have somebody who's qualified and experienced and has time, and often pharmacists do have a different sort of time pressure, I suppose, than some of the doctors, it can be really useful. And a lot of the work is a partnership, isn't it? It's not just, you know, one consultation covers everything. Sometimes it's a bit from a nurse, a bit from a pharmacist and a bit from a doctor.

And it should be this joined up care really that we can provide to as many patients as possible. Oh, 100%. And I suppose sometimes, well, it's a definite iris thing. You know, women won't necessarily, you'll go into the doctor and they'll say, how are you? And they'll say, I'm fine. Yeah, I'm granted. Don't want to waste the doctor's time. So then they come out with something that they didn't really need.

And they'll say to me, oh, my God, Victoria, I just couldn't tell them about my vaginal dryness or that sex is painful. and they didn't ask me, so I didn't want to bring it up. And I said, okay, but I said, next time you're going to go in with the symptom checker all filled out and maybe just put a couple of notes on the back and that you've read this documentation and you've read this and you've read this. I said because you are very, I think the more information that the women have, this is the most important thing. They are empowered. Out of everything that you do, I think the free information, there's so much of it. And it's so clear and concise that the patient can be empowered to,

go to the GP and say, you know, I don't necessarily need a 15-minute consultation. There's my symptom checker sheet. I've used the balance. Here is my, you know, what I think is going on. I think it is the perimenopause or the menopause. I would like to try some safe body identical gels or patches. And then, you know, the pharmacist as well can step in there and say, well, you know, we often, with stocks, we've had some very clever prescribing. I've said, well, especially when you had given us the tables to say, you know, two doses of an Easter gel pump is equivalent into a 50 microgram patch and everything else. And that's fantastic because I give that to the doctor and say, write me a couple of things. And if one thing is out of stock, I will absolutely try and swap

it for something else for her. And we have this collaborative approach, which is fantastic. So doctors are getting really clever prescribers. And I'm so proud of them and, you know, how far everyone has come, I think, in Ireland when I see it. But then I do still hear, you know, higher stories of young female GPs who would just tell patients, well, it's just a natural process. you're just going to have to get old, you know, or your mother had breast cancer so you can't take hatred or you had a clot risk so you can't take hatred. So that does upset me and it's very hard when the person is standing in front of you and they're telling you this and not to get angry and you're trying not to show your hand. And then I just give them more information and say,

look, maybe it's time to try a different GP, but in the health system in Ireland, it's either private or public. And if you were assigned a public GP, you might not be able to see someone else. So they're kind of snookers. And there isn't a whole lot of public or private GPs that do specialise in it. So while it's definitely improving, it's getting better, we have a long way to go. Yeah, I do feel bad because I feel a lot of the information that I've been giving out as has been empowering women, but they still can't get what they know they want. And that feels really awful.

But, you know, you're talking so eloquently at the beginning about your sister's experience and your experience does make a difference. And I remember just before the nice guidance came out in 2015, and I was sitting in a menopause clinic because I decided I wanted to specialise more. And I sat in a clinic in London, really inspirational. And I said to the consultant there, how do you tell when someone's perimenopause on? And he said, oh, you just know Louise. And I said, how?

And it was only literally weeks later I started to develop this awful brain fog. And as you say, the inability to string a sentence together, to remember names of things. and this crippling fatigue and this nasty, nasty side of me, this horrible irritability and shoutiness that came out of nowhere. And it's so obvious when you know, but if you don't know and you're in it yourself, even if you do know, it's really scary.

And then I know when I realised after a few months what was going on and I wanted some help and my GP wouldn't prescribe, I felt so vulnerable and so alone and also really scared. thinking, well, I can't carry on like this. What do I do? Do I leave my partner? Do I need my family? Do I need my job? Do I become withdrawn into a shell?

Do I stop my career and not do anything? And I don't know who to go to. And I was lucky because I went back to the consultant who had sat in his clinic a couple of weeks before. And, well, it was a few months before and said, I think I need some help. But that was easy for me. But actually, for a lot of women, like you say, if you haven't got an alternative, practitioner, then I feel it's how do we empower women so they can then seek what they want because we know shared decision making is crucially important. And so the job is you as a pharmacist,

you can prop them up and give them more confidence because lack of confidence is a very common symptom of the perimenopause and menopause as well, isn't it? Oh, absolutely. And I think that what we're doing now is, I'm not sure if the local doctors love or hate me, I think it's probably half 50-50, but what we do now when it happens and they're refusing to give me anybody identically estrogen or, you know, and like these people are like,

you know, 52, 55, like I mean, you know, and their symptoms are screaming. You know, there's no query. And I said to them, okay, well look, try again and ask the doctor, here's my number. If they have any query to give me a shout,

if they need any help. And I say, ask them for the clinical reason why they're not giving it to you and ask them, would they mind writing it down, either in the letter or would they, email it to you. I said because there isn't any. So they can't do it. And that's worked quite well.

I haven't yet had a lady come back with an email or a piece of paper. They do often come back with either sub-therapeutic doses. They're quite low. And then that's fine. It's a starting point. And then we can work on that. And then, you know, maybe reach out to the GP in a few months and say, look, she's not, symptoms aren't getting any better. Maybe could we maybe try this? And they're usually quite open to that. But at least they're trying something. So, you know, the women are coming through the door, I do feel that we're having a big impact, which is great, thanks to all the information that you have. And I suppose, yeah, just empowering women. And in where my pharmacy is in Kuglock, it's a mixture of working class and middle class. So there would be

some issues and some people with might not be up to read or so I'm very conscious of that. So I do try and do on my days off and my evenings. We do a lot on Instagram and Facebook. So everybody has social media. You don't need to necessarily read or write to go on to it. And we would do, we would talk about my own personal experience. And I'd often have maybe a nutritionist on, because I do think it's not just about HRT. I think it is that holistic approach where you really do need to exercise more and you need to cut down on alcohol and all the things that aren't very, you know, sexy to say, very boring, need to exercise more, eat well. You know, they're the truth. So I've kind of had multidisciplinary Instagrams, like with the local girl who's just a social

media person, but she's fantastic. She's a huge following with like 20,000 people. And we both let down and we talked about we're both on HOT, we're both 42, and how we don't look like the person who you think of when you think of perimenopause and menopause. But I had a very strong family history and it just has helped me so much. So I do think it's really important that when you do the Instagrams and you do the Facebooks, it gets so much information out in a short period of time. and it's just amazing how much you how many people do you can reach. It's incredible, isn't it? Because I know I couldn't do the scale of the work I'd do if I was 20 years older,

as in if I was my age now, I know it's 20 years ago, because we didn't have this power of being able to reach people. And I tend not to do Instagram lives now because I'm so busy. But I was doing a weekly one in lockdown and I was just had this thing where I'd have my Sunday lunch with the children and say, right, I'm going off into the study for an hour. and I would talk to myself for an hour and I would have different topics. And initially it was my sort of way of giving back a bit because I felt very guilty really

that I still had a job in lockdown. I could still carry on really enjoying my job, although it was obviously remote rather than face to face. So I felt very privileged. So I thought, well, actually this is a way of giving back to people. But it was amazing actually the feedback and the instant response, but also obviously because it's recorded, people can use it. And I think as healthcare professionals, we sometimes underestimate and forget how much we know.

And I think I've, as you probably know, worked as a medical writer for over 20 years. And when I first did some writing for lay people, so not for healthcare professionals, it was actually some information about breast cancer. And I didn't even really think about the fact that people didn't know what cancer was. They didn't know what lymph glands were. They'd all had them removed as part of their surgery. didn't know what they did in the body, but they were too scared to ask. And this was before the internet, so then they couldn't Google.

But actually, Googling is so dangerous. And when you come to menopause and HLT, there's so many people wanting to give their own. And even on Instagram, I saw somebody this morning on Instagram, and I won't mention her name, but she's quite a well-respected celebrity, and she's popping a pill of some menopause supplement rubbish and saying, these are great and she put on it paid advertisement or whatever. But I'm just thinking, and they're £20 a month, these, whatever they are. And I'm thinking this is dangerous because how are people going to know what's good information and bad information?

And so it's good that we can reach these people, but it can be dangerous for these poor people that want help and they don't know where to go. So I think we're very privileged, aren't we, having qualifications and being able to use them rather than abuse them. in a really empowering way. And I sometimes look at your Instagram, which is so lovely, but the comments that people have have really very supportive and respectful for your work,

which is great, isn't it? Yeah, they are, like I have to say, the community of women, like I got stopped yesterday at the school gates and it was just a beautiful woman, one of the mums. And she was asking me,

you know, I think, you know, some symptoms had returned. And she was asking me something. And I said, well, you know, maybe try a little bit more of your HAT, you're on the pump. So, you know, it's talked to your doctor.

And we're having a chat. And she mess. to me last night and said, God, I feel so much better even having to talk to you because you couldn't get into the GP for, I think it was another eight weeks. And she was saying, you know, even just to say it out loud and to say that I'm not going backwards and just to have that reassurance. And I think like even when I meet people in the shops or when I go out to dinner with my friends, we always talk about premenopause and menopause. And I always say to everyone, like it's the most wonderful feeling when I see the women come into the pharmacy and they are at a loss and they have

just nowhere to turn. They've not been listened to. And they go away with their symptom checker sheet and they go with the balance app and they come back and they're informed. They're on fire. They're like, I'm going to get my body identical estrogen today. And they come back and they hold a prescription and they hold it in their hand and they say to me, I got it. And I say, great. And then, you know, within the months, I just see them transform. And obviously everyone's journey is completely different. But I do have to say, I'm very proud and I see those women's walking tall through my pharmacy doors a month later. They look like different people. They look like themselves again. You know, they're standing taller. They look. Even small things like the woman used to always have to wear a couple of layers of scarfs because she wasn't sure when the sweats would happen and she'd have to keep a change in the scarce. And she came in and said, I'm not wearing any scarfs. Did you notice? You know. It's amazing, isn't I? One of the first patients said to me once, I'm starting to wear lipstick. I feel like myself again. And, you know, just little things. But it's also like you say, it is about the whole person. But often once people, Yeah, the hormones balance, they can think far more seriously about diet and exercise and well-being. And that's where, again, having other healthcare professionals that have a different slant on things can be really, really useful. Because as you say, a lot of patients feel the doctors are only going to do the doctoring as in prescribing. And so a lot of them find it quite unusual actually when I ask them about their diet and exercise because, you know, a lot of them, no one's asked them before or even, you know, their libido or if, they have any urinary symptoms or vaginal dryness. But like you say, to have someone else who's a friendly pharmacist who

be able to talk to them. And also if I'm talking about exercise and then you as a pharmacist is talking about exercise, they've got twice the messaging. So it's twice as likely to make a difference. And, you know, I think the menopause is not about a quick fix. It's a long-term hormone deficiency, as you know, but it's also long-term, will always be menopausal. we feel it or not, whether we have our hormones or not, we'll always have these health risks as we get

older. So how we approach and reduce them is key, isn't it? Really important. And we see a lot of our, even a lot of our patients, they have a lot of handholding initially, but because my clinic is so expensive and I hate the fact that people have to come and pay for it, we spend a lot of energy trying to reduce them coming back. But they need people there still helping. And I'm, I'm amazed. I see a lot of my follow-up patients. They only see them once a year. And often they still come all the way to Stratford. And I said, but you're so well. They said, yes, but it's so lovely just to have more than five minutes to actually talk to somebody. And you think, gosh, really, that's quite something, isn't it?

Just to feel part of somebody and you're having that continuity, which health care can be not just in the UK, it can be so fragmented, can't it? where people just feel like patients and objects, and that's really sad. And I think if you've experienced it, the doctor who prescribed me the antidepressants definitely didn't listen. And I even had, you know, I was like, look, and it's, we're not doctor bathing. I think they do an amazing job and it's incredibly difficult. But that's why if the women go with more information, it will help both. You know, it's a collaborative approach.

But I remember thinking that my backside hadn't really hit the seat for very long. And then she handed me the prescription for the antidepressants, and she stood up and opened the door. and I was like, oh, it's right, that was three minutes. Okay. And I had no questions. There was nothing else. And it was, see how you go now, see in a few months. And I was like, okay.

Even being a pharmacist and knowing and really feeling that this was something to my hormones, I didn't have the voice to say, actually, could you speak to me about, you know, maybe the perimenopause or patriote. So it is that kind of collaborative approach. And I want to live well. I want to age well. I want to, like my joint pain used to be so bad that when I'd get up in the middle of the night, I would literally have to like, bolster myself up and be like, oh my God, I thought I was just getting

older because I stood on my feet all day or because I've two young children. And when it went, when I was on the HAT, I was like, oh, that was a pleasant surprise. So, and, you know, some symptoms just resolved and burning mouth, which had plagued me for a year. Very, very common. So do you find, as a pharmacist, you have people that come to you, with, you know, wanting a treatment for, for example, dry eyes or for itchy skin. And do you find then that you can give them information when they're not expecting it? It depends on the person.

Each person is different. It really does depend. We, I suppose, we've now changed our signage so that we have kind of a menopause pharmacist pharmacy outside and people know they can come in and have a chat, which I think is really important. And they're kind of arming themselves before they go to the GP now, which is great. but also when they see, you know, all of the different symptoms and when they start filling it in, they go, oh, I didn't know that was one. Oh, I didn't know that was one. And it's so variable. And I'm really conscious to say to them, you know, you might have two of these symptoms. You might have 20 of these symptoms. But everyone's journey is different. And just because your friend has something else or, you know, and I always thought my dry was down to having laser, but actually it got much, much worse. And when I started HRG, it's definitely improved. It used to get so dry that my contact lens used to pop out in my eyes. It was so dry. But I just thought, as women do, we just push on. And especially Irish women, I think it's probably the same of the UK. We're just told push through, push through, but actually we need to stop pushing through and just take a few minutes for ourselves. And whether that's, you know, going to the GP, getting the right care, going for a walk, getting some headspace, even if it's a couple of minutes. Sometimes, you know, after work, I might sit in my car for 10 minutes. It's. like a little meditation and it's like a bubble of quiet. Yeah. Oh, like that bubble of quiet. Could

do us some days. So we need a pharmacist like yours in every town and village, don't we? Yeah. That would be great. Are there others that are copying your style? I hope so. I suppose everyone, my staff I train as well. So I have a little training folder and we go through everything. And I think it's really important that all of the staff are trained and that they're also sympathetic and they're also empathic. Anyone who we hire, I say, because it's just me. you know, the pharmacist and I said to them, I need you to be kind and empathetic because sometimes people come in and they're angry and irate and just can't remember what they're in for or whatever the reason. And there's something, there's a reason that we don't know that that person's feeling that way.

So you need to be kind and empathetic and you need to just, you know, keep calm. And I think once you're kind, I can teach you anything else. And so the team we have are amazing. But I definitely think I'm getting more phone calls from the pharmacist saying, you know, where did you find more information? I'm saying 14 fish. I think that's amazing. Such amazing resource. It's so easy I can dip in and out of it when the kids are in bed. I can watch it when I'm on my iPad. Like it's so you've made it like literally

you know, idiot proof. I think it's just absolutely fantastic. So I think that's going to be a game changer. And I think the next cohort of pharmacies coming out of Ireland I'm actually going into my old college in college of surgeons now in a couple of months to talk to the students about my personal journey as well as

yeah and they're really open to it. They're really progressive. And I'm hoping that of thing will happen more and more. And, you know, most pharmacists in Ireland that are qualifying now are female. So it affects us all. So no going back then. No going back. No, well, I really look forward to seeing how things progress and change and actually how it proves not just in Ireland, but the rest of the world as well. And I think this combination of forces by forceful women is it's got to make a difference somehow. So I'm very grateful for your time today, Victoria. But before we end, just three tips really. So I'll actually ask for three.

ways that women who are listening could approach their pharmacists who might be able to help them. So what three tips would you say to women who may be a bit nervous or they haven't got what they wanted from the GP? How could they go to a pharmacist? What would they say to them? I think they would ask to speak to the pharmacist and ask has the pharmacist done any more training maybe on menopause and paramedopause. I think that's really important. And if they haven't, maybe ask the pharmacist to maybe look into it and mention your name. You know, Louise Newson. Now, I always just say if you just Google it even, there's so much evidence-based information there, so accessible. So that's the first thing. Empower yourself with the right information and find the

right pharmacist and it's not one size fits all. You know, some pharmacists are fantastic at one thing and some fantastic at another, just like GPs. So I'd say also don't be fawbed off by anyone else. Don't be put off by your GP. If you fail the first time, just go in more empowered the next time and ask for that reason, that clinical reason why, you know, you can't have what you're asking for. And then with your pharmacist, you know, get them to explain how to take the medication, which is really important. You know, take the eutrogen, nighttime, you know, causes sedation. I often see that being prescribed in the morning.

So that's a really important stopgap for a pharmacist to pick up on and how to apply the gels and where to apply them and when to apply them. So I think that's really important. And then, you know, even though it isn't. part of the pharmaceutical training, I think the holistic approach of maybe, you know, talking about maybe diet and exercise or maybe, you know, looking at, you know, their mental health in the sense that are they getting any time for themselves or maybe do some yoga, something that's going to appeal to that patient as well. So there are the three things. Brilliant. Great advice. So thank you ever so much. And look forward to having you back in a few years and hearing how you get on. So thanks

thanks ever so much, Victoria. Absolutely. It's a pleasure. Thank you so much. For more information about the perimenopause and menopause, please visit my website, balance-manapause.com, or you can download the free Balance app, which is available to download from the App Store or from Google Play.