The Dr Louise Newson Podcast - 174 - World Menopause Day Special with Dr Louise Newson

Episode Date: October 18, 2022

On World Menopause Day, Dr Louise Newson has recorded this special edition of her podcast on her own. She describes her medical career to date and her reasons for doing what she is doing. She discusses her interest as an undergraduate and postgraduate and also talks about her lack of menopause training during this time. Louise has a medical degree and also a degree in pathology which is even more relevant when thinking about the menopause as a systemic condition in which the low hormones, especially estradiol, affect all the cells and organs in the body. During this podcast she talks openly about her reasons for setting up a private menopause clinic and how the clinic has enabled her to finance the free balance menopause app and also the free Confidence in the Menopause education programme for healthcare professionals. She clearly states this is the beginning of her journey and she has much more work to do. It will be very interesting to watch and see how the next year unfolds for menopausal women. Her three take-home tips are Work as a team - communicate with others and share your knowledge and experience Ensure information you receive is evidence based - there is plenty of really good quality information both on the free balance app and the balance-menopause.com website Be positive – working together to make a change will enable women to have better future health

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 is World Menopause Day. It's the 18th of October 2020. And I thought I'd do something different today on my podcast. I would talk myself. So you're just going to listen to me for the

next 20 minutes or so. And I thought I would just talk about why I'm doing, what I'm doing, and also a bit about me. Because my profile's increased, which is good because it means that I'm reaching more women. But actually, there's also a lot of negativity about my work too. So I thought I would just come clean, say all, bear all, and just let you know why I'm trying to do what I'm doing. So some of you might have heard about me before and about my background, but I'll just go back to the basics and then just expand and tell you about myself.

So I live near Strapchapun-Avon, which is where my clinic is in the UK, and I've got a background of being a hospital physician. I actually started at medical school where I met my husband in the first week and not just did a medical degree. I took a year out and did a pathology and immunology degree, which means that you just do a three-year degree in a year. And it was a great privilege to be able to do this, and this made me further my knowledge and understanding of basic human function, but also about pathology, which is the study of disease, and how crucial it is for our bodies and systems to work in tune with each other. We also did some immunology around that time, which is the study of our immune function, which are the cells that fight diseases. And then made me realize how important our immune system is, not just for fighting

infections, but diseases as well, because we have some powerful cells in our body that are constantly fighting anything that's wrong in our body. But when they are genetically programmed or altered in a way, they can become pro-inflammatory. So that means that they can develop and contribute to other diseases occurring in the body. And I'm telling you this, because this is relevant to the menopause and I'll explain more later. So I did my degree, my pathology degree, and then I went back to medical school, finished my training, and wanted to do on actually, which is cancer medicine. But what was interesting is just before I finished, in the final year, we had a project, an eight-week project where we chose anything that we wanted to do to

try and further our knowledge in one area. So of course, I went to a local cancer hospital, the Christie Hospital in Manchester, because I was training in Manchester. And I met the most inspirational person called Professor Tony Howell, who's a preventative cancer doctor who specialises in breast cancer. And so my remit with him for my project was to write some information about tamoxifen, which is a drug still commonly used for women who have breast cancer. And this was in 1992. So for some of you who are younger than me listening, you might not understand, but it was before the internet. So this was a time where Dr. Google didn't exist. It wasn't so easy to search any information about your health. And so I was asked to write some information. And so I was asked to write some

information about tamoxifen, which was great because I was interested in tomoxifen, I'm very interested in breast cancer. But I started to talk to some women and I said to them, what do you think cancer means? And they said, oh, that just means death. And I said, all right. No, it doesn't actually. And then I said, what about chemotherapy? You've had chemotherapy for the last eight weeks. What does that word mean to you? And they said, it means hair loss. It means nausea. It means vomiting. It means feeling tired. I said, well, they're side effects of chemotherapy, but what is chemotherapy? And they didn't really know. They couldn't have an explanation. And then I asked them about their lymph glands, because a lot of them had their lymph glands removed as part of their treatment. And I said,

what do lymph glands do? And they said, we don't know. We've just had them removed, but no one's told us why. So I sort of started reflected and thought, gosh, women are just on this conveyor belt, really. They're being given treatment without knowing what it is. They're being told a diagnosis they don't know what it is. So I went back to Tony Howl and I said, Tony, I'm going to write this booklet on tamoxifen, but I'm going to have to write a series of booklets. And he said, what do you mean? I said, I want to write one just called What is Cancer? And another one about treatments and additional to surgery for cancer. And another one about tamoxifen. And he said, well, why? I said, well, you just ask your next patient who comes in what they think cancer means. And he did. And they

went really pale and quiet and said, I'm just not really sure. I just knew it was something that might cause me to die. And that's why I've gone through with the treatments. And this was a lady he had seen for four or five years, he had done very well with the treatment. And he was then really shocked and he kept asking more people about what the limp glands are, what chemotherapy is. And he realised then that there was this massive void of knowledge from his patients. And then in the 90s, we were a lot more paternalistic with the way that we managed patients. It was very much, you do as a patient what your doctor tells you, you don't ask questions. And he really wanted to explore uncertainties with his patients, but had never really reflected

and thought about it. So we wrote these booklets. I wrote four in the end, and they were distributed widely throughout Christy and actually to some other hospitals, too, with some really great feedback. And it was then in the 90s that I thought, how important. important it is to be empowered as a patient, as an individual who is suffering with a disease. And everybody should have the option to make different treatment choices depending on their individual needs. And so this was a really powerful start to me thinking about the patient

in the middle of everything, but also not forgetting about disease, my pathology degree, about treatments. So there's a lot going on. Anyway, I qualified the thing. the doctor. I then did a year in Manchester and then I went to New Zealand actually and I worked there for a year which was great working with different communities with different people. I did a whole plethora of different hospital jobs and then came back to the UK because I missed my family and friends and the internet was only just starting then so it was a lot harder to be so attached with people who live so far away. And then I decided to do my training. I wanted to do cancer medicine. I wanted to do cancer medicine, as I said, so I had a job down in Southampton. And my husband, we just got engaged

actually in New Zealand then, Paul, was working as a surgeon up in Liverpool. I wanted to work in Southampton because my grandfather had recently died and I wanted to be close to my mother and try and help her because she was an only child. My father had died in the 70s. So she felt quite abandoned because my granny had died a few years before this. So I thought I'd be near her. And I did an oncology job, which I really enjoyed, but then I also felt that I wasn't giving the best of myself because there were a lot of people who were given chemotherapy. The time was very limited as a doctor to the patient. And there were some people who I felt weren't given the right choices.

A lot of people were very poorly and were still given a trial of some chemotherapy, just in case it might help. And some of these women and men I looked at and thought, or if that was me, I would probably want to be at home with my family for my last few weeks rather than having a trial drug as a drip in hospital, being in pain and various other things. And I just sort of reflected and thought, is this really what I want to do for my career? And I decided maybe it isn't. I want to do something that's far more holistic.

And also I'm very keen in preventing disease rather than treating disease. So I went back up to Manchester because I missed my husband, dearly and we started living together and I carried on at Manchester Royal Infirmary doing various medical jobs. I did a job in a leukemia unit and which is very harrowing but also very rewarding as well. I did cardiology job. I did a respiratory job. I did a rheumatology job. I did a dermatology job. So lots of specialties here and I'm telling you all this actually because no one ever taught me about the menopause. Not even with my pathology degree. We'd learnt about hormones, but not about sex hormones. As an undergraduate, no one, I think we had, we had some

mugs and guine, actually, where we delivered babies. I was up in Bolton. It was really great work. Someone mentioned something about the menopause. It's just when period stops and hot flushes, and that was it. And then with all my medical jobs, nobody talked about menopause. I did some casualty work. Many women coming in with palpitations, with headaches, with total body pain, with visual problems, with urinary symptoms, urinary tract infections, joint pains, coming into casualty. Didn't think about the menopause, of course. And then I got married and my husband's a surgeon.

I was going to become a medical registrar. I was trying to decide which specialty would be best. And then I tried to look around for role models in the hospital. And it was quite hard in the 90s and I think it's still quite hard now actually to find really good, solid, robust, inspirational female role models who have excelled in medicine and are happy with their lives. And I always decided I wanted to try and be as happy as I can be because life is so short. My father died when he was 40 and it made me realise that our lives are very fragile actually, as healthy and as strong as we think we are. We don't know what's around the

corner. So I tried to look around for inspirational people and a lot of the professors that I knew who were women were either spinsters or divorced. They didn't seem to be much in between. And then I just looked for male role models, and I found that quite difficult as well. And I said to a few people, I think I might become a GP. And even some of the male doctors,

a consultant said, oh, I wish I'd gone into general practice. I'm really not enjoying what I'm doing now. And this was in the 90s. Medicine was very different to how it is now. The NHS was very different to how it is now. And so I also knew I couldn't do on call. with my husband doing on call, our rotors were always clashing and I thought, well, if we have

children, we'll never see them and I don't want to grow up being an absent mother. So I made the decision to go into general practice and quite a few people were really shocked actually because for some hospital specialties, general practice is always seen as a second rate. It's like, oh, you're not clever enough to be a hospital doctor so therefore you're going into general practice. Oh, you don't want to know too much about one thing. And it was a big thing. And it was a sort of belittling really and I found a GP training practice in Hansworth near Wimslow in Manchester and I met someone called Dr John Sanders who again a very inspirational man and he was really pivotal in looking at the consultation and how we can help our patients as much as possible by listening

to them working out what they need what their concerns are what they want out of their consultation why they've presented with certain conditions and what they were expecting to learn from the consultation and the treatments they were expecting. So he said to me on my first day, Louise, you are actually not going to be very good as a GP. And I went, I don't. And he said, look at you. You've got MRCP, which is the member of the Royal College of Physicians. You've got part one, part two. You pass them first time very quickly. You're obviously very bright, but you're going to be a really bad communicator and a lot of people like you really struggle with the MRCGP exam.

So I looked at him and when someone tells you you're going to do badly, I'm sure most of you who listen would agree that you think, right, I'm going to suss him out, I'm going to show him. So I worked really hard and he was right. Initially I was very bad. People would come in, for example, lady come in with asthma, I would listen to her chest, I would give her an inhaler and I would send her on her way thinking that's the best medical treatment.

But actually what I didn't do is ask her why her asthma might have flared up. Is it because she just recently got her neighbour's dog or her budgery girl that her husband started smoking, which might have triggered her chest or she might have had an allergy to one of these pets? Or what else is going on with her breathing? Is it asthma? Maybe she's more stressed. Maybe something else has gone on that's causing her to be more anxious. Maybe she's got other symptoms as well as her breathing problems.

All these things that I just didn't think about because I was on the conveyor belt of medicine where I would treat symptoms, make a diagnosis, send the women old patients on their way. I also had prescribed medication for her on my green piece of paper that I gave to her to take to the chemist. She'd never seen an inhaler before. She didn't know there was a choice of different inhaler preparations. I didn't look at her inhaler technique when she came back for a review. The first thing I should have asked her was, how are you getting on with the inhaler? just asked her about her breathing. So there are all these things that I learned so much from John

that I'm so grateful for because it made me change the way I am as a doctor. It made me think about what's going on in this person's life. Why has they presented today? And it might just be because the day they could get an appointment. But often there's more to it than that. There's a reason that they're worrying. You know, this lady could be worrying that she had lung cancer because her husband had died from lung cancer a few weeks ago. It might be there. It might be there. you know, she's worried about an inhaler that her grandchild had and it didn't make her asthma better. There's all sorts of things and we don't know until we ask. And the other thing is we can't get a full diagnosis until we've asked the right questions

to really tease out from the patients what's going on. So that was a great year. I really enjoyed it and then I moved down. My husband got a job as a registrar down in the Birmingham area. So we moved down to this area and I had a job as a GP working full time. And I actually found it really hard because it's very difficult in general practice and it's escalated. This was many years ago.

This was in 1999 and things have got a lot harder in general practice. But it was a busy practice. I was seeing lots of patients. I was doing lots of visits. Most days I, when I was visiting, I was seeing eight to ten patients, which is a lot to drive around in between a full surgery in the morning and a full surgery in the evening. I often wouldn't get home till 7, 8, 9 o'clock at night and then start to cook supper and eat quite late. And my lifestyle was, it was good, but it wasn't great. I wasn't really doing any regular exercise.

I then decided that I would try and improve what I was doing. So I decided to stop drinking because I wanted to try for family and I wanted to be the best version of myself before I got pregnant. So I started to do some exercise and did feel a bit better. And then I was very lucky I got pregnant with my first daughter, Jessica. And then I wanted to go part-time as a GP because I wanted to allow myself to be a mother and see my daughter. And I was told at my practice I couldn't go part-time. So I resigned from the practice without another job. And then luckily my own GP said to me, oh, Louise, we really need another doctor working with us, maybe just a couple of days a week.

Why don't you apply? So I did. And when my daughter was about seven, eight months old, I went and worked at a practice. And I then worked for 20 years. And it was a lovely practice, working class practice with great patience, real sort of the earth, lovely, lovely people. And I really enjoyed it initially. I had a great senior partner at Eli Layton, who worked incredibly hard, was very well respected. And we would work very hard to see as many patients as we could, to help them, to listen. listen to them, to treat them in a very holistic way. And it was very, very rewarding. I then had another daughter 20 months later, so it's a bit of a shock coming too so close together. And then I

needed, I wanted to do more in my time. So around the time when I qualified as a GP, I started to do some lecturing and talk about what we refer to as hot topics for GPs. So lots of things that are very relevant. So things like raised blood pressure, heart disease, asthma. raise cholesterol, various rheumatology, think migraines, conditions that people see a lot. And what I would do is read all the evidence and then I would put it in piecemeal chunks so that doctors could just read the headlines really of what was going on. And I wrote a weekly column for a magazine called GP. And then a lot of the articles I put together into a book,

I wrote a book called Hot Topics for the MRCGP, which is the MRCG exam, which I'd passed by this stage with distinction, to sort of suss out John Sanders. And I wrote the book and it was a lot of work. It was when my Jessica was just a baby. But it was actually really well received, lots of great reviews. So then I ended up doing a second to third and a fourth edition over the following years.

I produced one a year to keep it up to date because again, the internet wasn't really a powerful source of information for healthcare professionals. It was just starting to be good for patients to do a bit of Dr. Google work, but it wasn't robust enough for healthcare professionals. So I wrote these books and people really enjoyed them actually. It was a good way for busy training GPs to learn the evidence in a piecemeal way. And so then I didn't carry on with the fifth edition because then the internet was more established, writing a book.

For some of you might know, it was really hard work. So I then filled a lot of my time with doing medical writing. So I wrote for a company called Patients or Info. I did a lot of work with the Royal College of GPs, lots of education. work, e-learning was just starting then, so I would often review courses and update them. I would often review nice guidance, the National Institute of Health and Care Excellence, produce guidelines regularly. So I would read those and I would summarize them and then put out some summary notes and presentations for the Royal College of GPs. And I did this for many years,

and I really enjoyed it actually because it's a way of translating medical evidence into easily digestible pieces of information for healthcare professionals, but patient.info is also about patients. So I wrote a lot about a great assortment of diseases as well for patients, which brought my skills that I'd used for this oncology job when I was writing about tomopsophon and breast cancer. So I actually really enjoyed it, and it gave me flexibility to work from home, which now post-COVID, we're all used to working from home at times, but then it was less common, and actually for doctors to work at home was less common. So I did a couple of days as a GP, and then three days I just worked in school hours so I could be there for my children, writing various articles and so forth.

And then it was more flexible for my husband, with his on call and all his other work commitment. So it worked quite well, but I never felt completely stimulated. I had my third daughter 11 years ago. She's nearly 12 now, actually. And I just kept saying to my husband, I don't want to do this forever. I don't feel stimulated enough. I want to do more. And I just couldn't see a way out.

We had other partners in the practice, the dynamics had changed. The partners I worked with actually don't like HRT, so we'd have stand-up rouse because I would start to prescribe HRT for women who are menopausal and they would say, no, you've got to come off. There's a risk of breast cancer. So we'd have these rouse because I'd go back to the evidence and say, no, I've read from many articles that it lowers risk of heart disease, of diabetes, of osteoporosis, and even there's some evidence about dementia. But more importantly, I said to my partners, these women are really struggling with symptoms and I can't deny them a treatment that they want, even if there is a

small risk of breast cancer in some types. But they wouldn't have it. And so as much as I prescribed HRT, the women were not allowed to repeat prescription and they were being taken off their HRT. And I found this very harrowing and upsetting. Then seven years ago, almost to the day, actually, in November 2015, the nice guidance came out in the men. These were the first menopause guidance and they were very clear, actually, that for most women, the benefits of taking HRT outweigh any risks. So I thought, wow, this is good. This is endorsing what I've been doing for many years as a GP. But my partners wouldn't listen. They wouldn't change. I then was 45 at this stage and some of my friends, when my age, a little bit older, started to experience menopausal symptoms. And they were telling me they were given drugs such as vener vaccine, satyrs, satyr.

Pallam, Certraline. And they said, is this a good treatment for the menopause? And I said, hang on a minute. This is antidepressants. You're not depressed. They said, no, that's all my doctor would give me. But I said, oh, no, this is awful. So then I did some Googling. Couldn't really find much information about menopause then. So I thought I used all my skills. And I will do medical writing. And I'll also do some healthcare professional writing as well. So I developed what was then the menopausedoctor.com.uk website, which started to just have some information. But then my friends couldn't get any other prescriptions. So I said to my mentor at the time when I became a menopause specialist, I'd like to set up a clinic. So I went to different

NHS CCGs, I went to different hospitals, I went to different GP practices and said, look, I'm a menopause specialist. I would like to do just one day a week as a menopause clinic. And they said, no, there's no funding. We've only got funding for heart disease or for asthma or for diabetes clinics. And I said, well, that's a shame because good menopause care will improve the future health of people. And they didn't budge. So the only way I could see some of my friends and help was to set up a private clinic. So I did it one day a week at a local hospital.

And I saw some of my friends and helped them. I saw some other people that I didn't know. And then I launched the website and I started to play a bit with the media because I thought the media have got this wrong about HRT. The message is very clear from the evidence, how safe HRT is. I've read all the evidence. Some of it's very technical evidence, but I'm used to that. But I'm also used to really unpicking basic science. So when I spoke at the beginning about our immune cells being primed to work well, what happens when we have low estrogen? What are immune systems don't work? They don't work very well. They do work, of course, but they don't work very well. And they are primed, and actually they can change the way they function, so they become pro-inflammatory. So with low estrogen levels, our systems become inflammatory, and this increases risk of inflammatory conditions. So not just infections, but important conditions such as heart disease, diabetes,

osteoporosis, dementia, clinical depression. They're all thought to be inflammatory diseases because our bodies are inflamed and not working so well. So isn't that relevant because all those diseases increase in the menopause? So looking at very old studies and some really quite hard to do. digest articles, it's very clear from decades ago how important Easter dial, which is a very biologically active hormone in our body, is for switching on our cells and making us healthy and improving the way our immune system works. And so this is a sort of full circle from my pathology times, but it just shows how important our hormones are. Anyway, I digress. So I did my

clinic. My website I started writing, I also had in my mind that I wanted to train more healthcare professionals because if they knew as little as I did before I did my training, then they would be missing as many people as I probably had. So I started to lecture, I started to write, I started to develop my website. My clinic actually got busier because word of mouth people started to find out of me. And then four years ago, I decided to, with a friend, Rebecca Lewis, who's now clinical direct with me, we decided to open the clinic in Stratford-Pon-Avon. It was madness, actually, because I basically had no proper business plan. I didn't really know what I was doing. One of my friends who is very business-minded, Marcus Daly, said, Louise, I'm worried about you. You're taking big risks.

And I said, but, Marcus, I want to help as many women as possible. So I cleared out my bank account. I cleared out my husband's bank account. I got a loan from the bank. And I decided to open this clinic here instructed upon Ava at Winton House, which is owned by the council. It's a beautiful building that we have refurbed with lots of love and care and started opening it for patients. We just wanted a few doctors working with us. Well, fast forward four years, the story is very different. We now see a lot of women remotely. We see over 4,000 women a month through the clinic. I have over 100 healthcare professionals working with me who I respect and adore. They all work incredibly hard. Most of them are NHS GPs. We've got nurses, we've got pharmacists, we've got physicians

associate. They're all seeing patients. They're all helping them. But I know that's not enough. So I have also been working very hard the last four years to try and reach people who will never come to my clinic. I don't want to see every menopausal women. And how can I see 1.2 billion menopausal women from around the world through my small clinic and Stratford-Pon-Avon? I have big ideas, but they're not that big. So what I have been doing is working with others. It's a massive team effort. But two years ago, we developed the balance app, the free app, and that part is always going to be free. We have worked with some incredible people, and we developed that to allow women to have access to information. So that's now being seen by hundreds of thousands of people in

hundreds of countries as well, but we've got big plans to carry on with that. And so, and we've got big plans to carry on with that. We've also developed a learning program called Confidence in the Menopause for healthcare professionals where we've got lectures we've recorded, we've got videos of consultations with actresses with lots of different scenarios, we've linked to the evidence, we've linked to research, we've linked to guidelines, we've also linked to patient resources. And this is a huge piece of work that we have done over the years and we launched it about 18 months ago. We've had over 26,000 healthcare professionals who have downloaded and accessed it, which is phenomenal, but there's still a lot more that we need to do. We've also starting to develop

research. We're collaborating with lots of different universities. We've got some great research projects, but we're also doing a big dive into our patients here. We're looking at how our testosterone prescribing can improve symptoms more than libido. We're looking at estrogen levels and women who we give different doses of estrogen to. We're looking at women who have had bleeding, looking at seeing what their scan results show. We're looking at future health as well. So all these results will come out soon.

But we're doing a huge amount. All this work that we do is actually not just my work. It's teamwork, but it all costs money. So a lot of people, I'm sure, are thinking, well, where's Louise getting her money from? Well, I can tell you for one thing. It's not from any backhanders. when my father died he didn't have any health insurance so my mother was left with very little money

everything that i do and own i have worked for so that's really important that people know that the other thing that's really important that you all know is that i do no paid work with any pharmaceutical company unlike many other specialties and unlike many other menopause specialists or menopause organizations actually every single one i know receives money from farmer but i don't and nor do any of my team. We also don't have any other conflicts, so I don't work with any organisation that makes menopause supplements

or makes menopause products. Now there are so many different products and I get asked a lot to be behind various things or be a campaign behind, which I won't. So it's really important that people know I don't. So where do I get my money from? Well, I'm very fortunate, aren't I? Because I have a very large menopause clinic.

And I've decided, as the founder of this clinic, that quite a lot of the profits is recirculated. It's going back to help more women who will never come into the clinic, which is a really weird concept for a lot of people. We're helping people who will never be our customers. The goal of my clinic would be to reduce it inside because it means that more women are getting help elsewhere. Until that happens, I'm not going to stop.

And there's a lot of misconceptions that it's a private clinic, We're making lots of money. We're forcing women to be on HRT. There's a lot of brilliant and toxicity, which is absolutely mentally and physically exhausting for me. But I'm not going to stop because I hear the stories all the time. So we've got a board within Newsome Health. We've got some very amazing businessmen, but also clinicians as well.

We've got senior clinicians here. We've got mentors here. But we've also got a medical director, Magnus Harrison, who you'll hear his podcast in the next week, to who's helping shape this, but also shape it in a bigger way. So we can reach more women. We can reduce our costs in a certain ways. But we can also always give women who come to choose to be our patients the best holistic, evidence-based care that they will receive. So our patients are number one. But what our patients are doing is allowing us to help others who are not so fortunate,

who can't afford to come to the clinic, who shouldn't be coming to the clinic. So the reach that we have through the clinic is actually huge. It's worldwide. We're helping men. We're helping women. We're helping workplace. We're helping children. We've got some amazing initiatives going on, including really helping people who are very

disadvantaged, which will reveal all soon. But what I really wanted this podcast to show you is that there's a lot of hard work, There's a lot of determination. There's a lot of bloody-mindedness that's going on here. And it's not without difficulty, actually. It's really hard to be out here, working with the media, sending messages out, and been constantly having stones thrown at me. But I've got my armour on.

I've got my big girl pants on, and I'm keeping on going. And I just want to also say thank you to all of you who listen, for all of you who share our information, for all of you who believe in what we're doing, because we've actually, believe it or not, only just started, I've got a lot of good ideas that are coming to fruition. So I'm really looking forward to seeing what the year is going to happen and what's going to happen next year for World Menopause Day.

So for those of you that have carried on for the whole half hour, listening to me, talk on my own, I'd just like to say well done. And then I suppose I need three take-home tips. So my three tips would be working together. This is teamwork. And whether a woman suffering on our own, whether we are a man watching a woman suffer, or whether we just want more information, don't do it alone. Work with others.

Learn with others. Just start talking together. And once you start talking, the conversation will open. Number two, if you are getting information, get it from a good source. Look at the evidence. Look where it's come from. Balance hyphenopanmenopals.com is full of information. Balance app is full of information.

Just make sure you know what you're getting and make sure it's relevant for you. And then number three, we can all work together to make this a lot more positive. It's essential that my mission is to improve the future health and well-being of all women. By working together and being positive, I feel that we can really make a chance.

so that there is less suffering, personal suffering by women, but also less health suffering as well, so we can prevent and reduce a lot of diseases and conditions by excellent menopause care that all of us as menopause or women strive to receive. So carry on and let's see what the next 12 months brings and thanks again for listening and happy World Menopause Day. 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.