The Dr Louise Newson Podcast - 189 - Joeli Brearley from Pregnant Then Screwed

Episode Date: January 31, 2023

Two important issues for women come together in this episode of the Dr Louise Newson Podcast featuring guest Joeli Brearley. Joeli founded the charity Pregnant Then Screwed after she was fired from her job the day after telling her employers she was pregnant. Joeli wanted to create a space for others to share their stories of discrimination at work, which quickly grew into Pregnant Then Screwed, a charity dedicated to ending the motherhood penalty and campaigning for change. Joeli shares a personal story of her own changing hormones in her late 30s; she recounts her struggle to be listened to by healthcare professionals and to find the right treatment for her symptoms that were exacerbated by progesterone intolerance. Joeli’s three tips for women who think they might be perimenopausal: Talk to other women, it’s a great way to find out really useful information Keep going and don’t give up. Trust in yourself and how you know you’re feeling. Keep pushing for what you feel you need. If you don’t feel well and feel like you’re going mad after having the Mirena coil fitted, tell your healthcare professional. You could have a sensitivity to the progestogen in it and there may be a better alternative method for you. For more about Joeli’s work and her books, visit pregnantthenscrewed.com Follow Pregnant Then Screwed on Instagram or Twitter.

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 going to introduce to you someone who I've very, very recently met actually called Jolie, who I've been reading some of her amazing work over the last few

months and then last week someone alerted me to a post where I was mentioned and read some really harrowing comments actually and I really reached out to her and said, let's do a podcast and here we are on a Sunday morning recording the podcast. thank you ever so much, Jody, for coming today. Thank you very much for having me on this glorious frosty Sunday morning. Yes. So you are the founder of something called Pregnant Then Screwed, which obviously you can't listen to that or read that

without thinking what's going on here. But as soon as you read it, I think most women will know exactly where you're coming from, which is a real shame, isn't it? But talk to me, why did you set this up then? So I set it up seven years ago because when I was former pregnant with my first child, I told my employer that I was expecting. And the next day they sacked me by voicemail. And my employer was a children's charity. So it was quite the shock. And I found myself unemployed without an income and unable to pay my rent or put food on the table. And then I tried to do something about it and discovered

that accessing justice was almost impossible. It was completely taken out of my hands. There was nothing I could do. That's a really long story as to why I weren't going to it. But essentially women often find, you know, we know that 54,000 women a year are pushed out of their jobs for getting pregnant. That's one in nine pregnant. Pregnant women lose their job. It's a woman at 10 minutes gets pushed out of a job because she's dead to get pregnant. And 77% of working moms encounter some form of discrimination in the workplace. And many of them think, you know, oh, well, this is illegal. I'll do something about it. And then they realize that it's almost impossible. It's just so difficult. The justice system does not work for women at all. I was so furious that, firstly, that it had happened, obviously, when I was at my most vulnerable,

my boss had pushed me out. But secondly, that then the justice system completely failed me. And it sort of ate away at me for two years. So I had my baby and I was going to parent-grieved. and talking to other moms and so many other moms had these awful stories. And it just sort of built this rage built inside of me until it was International Women's Day 2015. And I'd come up with the name, pregnant then screwed. It was going to be far worse than that to begin with. I'm sure you can happen. But I decided to slightly tame it down.

And then I sort of launched it as a website on International Women's Day and immediately got loads of attention on it. People's saying, you know, commenting on it, people looking at the website. and then took a while to get a number of stories, which I finally did. And it's just sort of mushroom from this. It was just a blog originally for people to tell their stories of pregnancy, maternity discrimination anonymously. But then, of course, people wanted to help and support. And so slowly I just sort of added these services and different,

as I sort of found solutions to different problems. And now it's a fully blown charity with seven staff, 120 volunteers. It's international. Wow. And we helped 80,000 women get the support that they needed last year. So it's gone from just a blog to this. And it was just, I never meant for this to happen. I mean, I'm very happy that it did.

But it just shows the need that's out there. And the fact that this sort of discrimination happens all the time. And there's very little that women feel they can do to have power in that situation. Yeah, it's so sad, isn't it? And I think the more work I do, it's about women not having a voice or when they have a voice it's not listened to and even I know when I moved down from Manchester a long time ago in 1999 and I went for a job and it was a full-time GP job and I said to them at the interview I probably shouldn't say this but I have been married now a couple of years and

we are planning a family so how would you look at if I went part-time if in the future I became pregnant and they said oh we're so child-friendly here brilliant brilliant you know wouldn't be a problem Louise at all. And I was offered the job, which was great. And then a year or so later, I became pregnant. And I said to them, oh, could I reduce my hours when I come back? And they said, oh, yes, yes, you could just reduce the number of days, but you have to work eight till six 30. And I said, but I can't find a nursery. I live half an hour away that's open, half seven, could I just not, you know, reduce my hours in the day and maybe work, you know, spread them over three or four days and there was just no way absolutely no that's never been done in the history

of the practice can't do it so i just resigned when i was you know 18 weeks pregnant i just saw i can't work for these people regardless of what happens with my pregnancy i just thought this is really you know and you'd like to think things have changed but i i don't think but it it is part of this bigger picture isn't it jolly that we're just women like who cares we're replaceable does it matter and i feel really sad about that because we're individuals and you wouldn't treat men like that and why should anyone be treated like that actually? But it happens when we're pregnant often as you know, but then it also happens when we're perimenopausal and menopausal and we know around 10% of women leave their jobs because of memory problems, anxiety, fatigue,

but also we know from studies we've done, a lot of women are not going for promotion or they're changing their jobs or they're going part-time. And that's just hemorrhaging workforce, isn't it? Yeah, it's really bad for the economy. You know, if you're looking at it through the lens of a government and cold hard cash and you want to rebuild your economy, we've got over 600,000 people who have become economically inactive over the last couple of years. And the Chancellor keeps talking about these economically inactive people and how we can get them back to work. And he never mentions childcare. He doesn't think about this through the lens of mothers and the barriers that they encounter, nor does he mention menopause and the challenges that women face when they get older. It's a complete blind spot with the government's planning. And all of these problems are systemic for women in the labour markets because the labour market was built around there being one income earner in a household. And so there'd be a woman kids and there be a man that goes out to work. And we haven't adapted the labour market to the fact that in almost every family, there

are now two earners in a household. And you have to have two earners to keep a roof over your head. You can't afford to not. And it's similar, I'm sure, with menopause and the fact that there aren't the trials, there isn't their impetus to really understand what is happening with women and their bodies because it's just not seen as important as men's bodies and it's complicated. Well, that's it. You know, it's a bit scary talking to a hormonal woman, isn't it? Because they might shout at you. So, but I think there's all this misunderstanding as well. We know Amanda Pritchard for the NHS put a document together a couple of weeks ago talking about flexible working in the NHS and how we can support women through their menopause. And one of my friends who's a

consultant at Neasatist actually wrote to the telegraph to say, how can I as an inesotist do more work at home? You know, I'm intubating people who are going for surgery. You know, you just can't do it. And actually it's not about reducing hours because that means reduced pay, reduced identity. And even those women who are working part-time, if your brain isn't working, it doesn't matter whether you're doing one hours or 40 hours a week. You're not going to do the same job.

So it's about how to provide the right support and treatment as well, especially when it comes to the perimenopause and menopause and which is just not there. No one's joining up the dots at all. You know, women working part-time, often it's because we're looking after children, but often it's because we're not getting the right help or not being listened to

and not having individualised solutions, because there are ways, aren't there, that we could be far more productive if we could change our hours slightly or change the days that we work. Because, you know, there's no doubt in the term time, a lot of us can work a lot better, a lot more productively than in the holidays.

And, you know, some jobs, obviously you can't change, but others you can, I'm sure. People could do a lot more, couldn't they? Well, yeah, exactly. I mean, and employers often say to me, what should I do? How am I a better employer for mothers? And I say, just listen to them. It's not rocket science. Just like give them a forum to be able to have a conversation about what the problems are that they're experiencing in your workplace so that you can enable those that have less power to contribute to that conversation. So you're getting all levels of staff. And then give them your ear, like a level. them to tell you really honestly and brutally what is going wrong and then fix it. You know, it's

not that complicated and they sort of, you know, employees sort of forget that. They look at, they try and outsource these problems often without actually just talking to the people that are affected by it. And it, you know, again, it tends to be men who are employers. It's men that are in more senior positions within organisations. And there's so much that still. needs to be done in the workplace by the government, in healthcare settings, that it means that women are just sort of a forgotten cohort often and yet we're 50% of the population. Yeah. So just when things get really depressing, that's bad enough talking about that, but just talk me through this post that you put on and had this overwhelming response.

I mean, I know a lot of your post gets responses, but the one that brought me to reach out to you. So I've been on my journey of perimenopause, which started, I mean, I said in the post it started three years ago. I think you probably started even before that. And I was getting really bad symptoms of brain fog and headaches. And they would start after my period. So as soon as my period started, it would start. And it would last for up to two weeks. And at points it got so debilitating that I could barely move.

I couldn't think. I couldn't speak and I spend a lot of time talking to people. I do interviews, I talk in front of big groups of people about the motherhood penalty, you know, radio and TV. And so it was really affecting my work. And, you know, I remember sitting on my sofa a few years ago and just feeling unable to move, unable to really function at all. And then it would pass and then I would feel okay again.

And then the anxiety started quite crippling anxiety where I would feel really, awkward when I saw people that I knew and we didn't really want to go out anymore. And I remember friends coming over here one night and I felt so uncomfortable and so awkward and anxious. I had to put the telly on for a bit to sort of ease myself into the situation and calm myself down before I could even sort of have conversations with them, which was very unusual. It wasn't like me at all. Really heavy periods that would bleed through my trousers really quickly and jaw-raise. And jawrache, but I would get terrible jawrache for like two weeks of the month, which was a sort of really odd symptom.

Gosh, yeah. And then night sweats that were just disgusting and I would wake up absolutely dripping, you know, all down by cleavage. And so I initially, I just thought there's something wrong with me. What's wrong with me? I must be allergic to something is what I kept thinking. So I went to a nutritionist and they tried all sorts. They did like, maybe do a big poo sample.

and then they, you know, made me change my diet and did all sorts of stuff. None of it worked and it cost me a fortune. So I went to the doctor and I said, I've got all these symptoms and I don't know what's wrong with me. And they said, okay, well, it's obviously related to your menstrual cycle. Let's do a blood test. So they did blood test. Two or three weeks later, called back and said, oh, no, nothing wrong with you. So I said, great.

Okay, thanks very much. What do you say when someone says, nothing wrong with you? You're making it up is what you feel like they're saying. And she suggested that I go in the mini pill to calm my periods down, which I did. And I went completely crackers. And I had a non-stop period. My period just didn't stop when I was on it really heavy. And I was crying all the time and felt just really bonkers.

And it took me a while to realize that it was the mini pill that was causing it. And when I realized I threw that in the bin, stopped it. registered again at the doctors for another call. 30 days it takes each time you register at the doctors to get a call back. So they called me back and then I said, well, that's not worked. I don't really know what else to do. And, you know, again, there was just no real conversation about menopause or perimenopause. And it wasn't until actually I met a woman who's written a book about the menopause who also worked on the Davina McCall documentary, Kate, I've totally forgotten a surname. But I met her at an event. Kate Muir, probably. Kate Muir. That's

That's right, yeah. And I told her, you know, poor woman, I sort of collared her and cornered her and told her my symptoms. And she was like, well, you are very clearly, very menopausal. So I thought, oh, okay, well, I really need to push this with the doctor. I went back to the doctor. Another blood test, absolutely fine, no problem with you. And then I met a GP who told me the blood test do not identify whether you're menopausal or not. So this was a revelation to me. So all this time, they've been giving me these blood tests and not telling me, but you're hormones jump around like cricket, all over the place, and it depends when you have the blood test as to what they identify. So by this point, you know, where we're sort of over a year in of me trying to get some help, and by this point I am absolutely convinced it's perimenopause. And so I registered with a new sign, which somebody recommended. So I had the appointment, was told I was ticking pretty much every box, you know, yes, you are perimenopausal. And I remember saying to the doctor, how do you know if perimenopause and not depression? And she said, I don't. But what I do know is you tick every box and I am really

confident that I'm going to give you this medication and you were going to feel better after it. I said, okay, that's good enough for me. So she put me on. the gel and progesterone and it was going great but I am the most forgetful human you have ever met in your entire life like I can literally I will have lost these glasses before the end of this podcast recording like I just lose things and I forget things so I thought I'm not going to remember to take the progesterone when I should do I was diarizing it but I thought something I'll go wrong so I thought right well I'll get the coil fitted because I've heard the coil's quite good the marina coil so that i don't have to think about it so finally got the coil fitted and i felt

dreadful absolutely awful and i called one-one-one because i was panicking because i couldn't at first i thought i was burnt out so i messaged my staff and i said i am really burnt out i need to just stop working now and then i thought hold on this isn't this isn't burnout i know what burnout feels like. And I couldn't get up as I was in bed. I was crying all the time. I just felt horrendous. And I ended up getting a call with the doctor. The doctor told me there's no reason why the coil would be making me feel unwell. And if I wanted it out, it would be 12 days time before I could get it out. And she said, but I think there's something else wrong with you. I don't think it's anything to do with the coil. So I think by the time we get to those 12 days, you will not be.

want it out because it's good you need to have it in it seems like it's the right thing for you so um I kept it in and then I did start to feel a bit better and I thought oh maybe it is me maybe I've you know maybe I wasn't well I did start to feel a bit better and then I crashed again so I started feeling a bit better and then I crashed again yeah for a minute and I was about to go to the labor party conference to do a talk at the labor party conference and I thought I can't go feeling like this because I feel crackers. And so I tried to coil out myself. I thought I've got no option.

So I googled how to do it. And I spent all morning before I went to Liverpool desperately trying to get this coil out of me. And my friend Kat was meeting me at the Labour Party conference and she turned up with a pair of rubber gloves. And she said, and she had her coil in a plastic bag to show me what it looked like. And she said, right, let's get back to the hotel room. I'll get this coil out of you.

And I was like, Kat, I love you. But no, this is too much. You are a friend. I'm not sure I want you fishing around in my vaginal canal. That's just probably crossing a line. So we decided not to do that and I kept the coil in. And then finally the appointment came. And the woman that was taking it out said to me,

there's no way this is causing you problems. And I think this is a mistake that you are going to have it out. Anyway, I said, I don't care you get this thing out. out of me. So she did and immediately I felt better. And then I did googling around and discovered that the progesterone that your clinic had put me on is body identical progesterome. And the progesterone in the coil is. It's synthetic. Yeah. And it's really important to know that there's a difference. And there's so much this story, obviously, that should be thought about and unpicked even. but you know you've made the diagnosis yourself because you're telling me even if I wasn't a menopause

specialist or even a doctor that you have changes that are fitting in with your periods. So it's got to be some hormonal change. And what's really difficult sometimes with women is knowing is it PMS, is it PMDD, is it perimenopause? Actually, all of these are just labels. It is a hormonal changes that are occurring in the body. And often our hormones change for many years before our period stop. So there's a lot of these. lots of women in their 30s and 40s and even younger are having some hormonal changes. And I'm hearing more and more from various groups that I go to to say it's outrageous that women in their 20s and 30s think that they might be perimenopausal. And I sort of think, well, it's not actually outrageous because one in 100 women under the age of 40

have an early menopause. That means there's one in 100 women in their 30s who are likely to be perimenopausal. But we know that PMS is really common. Most women will have some symptoms that change through their periods, through their menstrual cycle, rather. And they can just get exaggerated as we get older. So some women are very responsive to changes in estrogen levels. Some people are very responses to drop in testosterone levels. And some people, it's the progesterone. And there are many women who have PMS or psychological symptoms related to the perimenopause

as well, who are progesterone intolerant. But progesterone, as you say, there are different types. So the natural progesterone, often people tolerate better. But the synthetic progestergens that are in the contraceptive pills, all the contraceptive pills have synthetic progestogens. There are different types, though. And then the mini pill, the implants, the injection for contraception. And like you say, the marina coil, they all have different types of progestogens.

So progestogen just means it's a synthetic progesterone. So it's been biochemically changed. So it doesn't lock on to. the receptors in the cells quite as easily as the natural progesterone, the body identical progesterone does. Many women find it doesn't make any difference. They benefit and it doesn't cause problems. But certainly there are women and some studies say it's at around one in 10 women. So not insignificant who have some psychological changes and, you know, what you're describing is very common for someone who's got progestogen intolerance. With the marina coil, the dose is very, very

low and lots of people say well you don't get any systemic absorption as in it doesn't go in the bloodstream and doesn't affect the rest of the body well there are women who are very sensitive that it even a little bit in the bloodstream as in what probably happened to you is still going to cause problems and for a lot of women they do feel a bit low or a bit flat for the first three to six months and then they feel fine and the marina coil as you know is licensed for five years so if women don't feel too bad sticking with it can be a good thing because when it settles down, you can imagine the concentration is highest when it's new and fresh and then it sort of stables and reduces. But there are a lot of women I spoke to a psychiatrist recently who actually did pull out her own marina because she was

suicidal and it was at the weekend and she knew it was her marina coil and she just, she was really scared but she had insight and she pulled it out herself and she said within literally minutes she started to feel better. And, you know, it can happen. And I think what's really sad is that when you're not believed or understood, it makes it even more difficult, especially when you've got a mental, psychological symptoms, then you think, well, maybe I am sensationalising it, or maybe I am going mad, or maybe, like you say, maybe I'm having a breakdown. And that's really, really scary, actually and I always feel with women who I speak to, like I have no idea whether their hormones are related, which hormones they are, or whether it is that they're having a breakdown. How do I know?

Because there's no diagnostic test. I can't do a blood test. As you know, your hormone levels were fine. But at three in the morning when you're having a night's sweat, they probably aren't fine, but no one's going to come and do a blood test then. So then we go on symptoms and a lot of uncertainty, but I often say to women, well, let's just balance your hormones and then see what's left. And some women even actually still have side effects with the body identical hormones. They're very, very sensitive to them. And I personally have progesterone intolerance. And when I was starting to take progesterone as part of my HRT when I was perimenopausal,

I had three or four days a month where I could have just shut the doors, shut my clinic, walked away from everything. And I just thought it was at the same time as I was setting up my clinic. So I thought, well, I'm just like you, a bit burnt out. And then my husband said, but Louise, when you're coming towards the end of those two weeks of those pills. Look at you, you're lying on the bed, you're not even moving, you're not interesting to talk to you. It's only 8 o'clock and you're telling me you want to go to bed.

Something else is going on and then you sort of think, oh, right, I'll maybe try not taking the pills or you can insert them vaginally to reduce the absorption. And some women that helps, but even I found that I could have still walked away from life with that. And so it's very hard sometimes to work out the right dose of the, because you have to balance estrogen and progesterone and testosterone to protect the lining of the womb. And occasionally women actually have a hysterectomy because they need estrogen and testosterone if they take testosterone as well,

but they can't tolerate any progesterone at all. I was going to say, what do you do if you have complete intolerance to progesterone? Yeah, and, you know, I have got some women who do have a hysterectomy because of progesterone intolerance. And that sounds really quite dramatic. But I've had a patient recently who was diagnosed with premature ovarian insufficiency when she was 34.

And she'd given up her job as a police officer. She'd tried some bioidentical hormones, which were just horrendous. And she'd had managed to have a donor egg, actually. So she'd had one pregnancy, and then she adopted a child and was really high up in the police. And then her life fell apart with her hormones.

And then she started, to feel a lot better, but every time she took progesterone, she felt dreadful again. And then we tried to reduce the amount of progesterone, but then she was getting bleeding. So the gynecologist said, well, we'll do an ultrasound, a hystroscope and a biopsy every six months, as long as you're on HRT. Well, at this time, she was 42, and she said, well, I'm going to take it forever. I can't be subjected to a hystroscope and biopsy, because I'm sure you've heard, or women listening might realize they can be very uncomfortable and painful. and intrusive as well.

Yeah. And cost money to the NHS. So she said, well, I don't want that. They said, well, you're going to have to increase your progesterone. And she said, but I can't because every time I do, I feel suicidal. And without HRT, I'm suicidal. So I can't be without it. And I'm young and I need it for my bones, heart and brain and future health.

So then she had a hysterectomy. And I reviewed her recently. And she's just so happy. And it seems like a big thing to have a hysterectomy. And of course, it is not an operation you would do first line. But if you think when I was doing obstetrics training in the 1999 and when I was training as a doctor in the 80s, lots of women would come in with very heavy periods,

thinking about they were all perimenopausal because they were often in their late 40s. And people would do hysterectomies for heavy bleeding. If these women didn't have a hysterectomy, they would have had to wait probably two, three, four, five years until they were menopausal. So you're doing an operation to get them through the next three or four years because marina coils weren't around then,

so it was a lot harder to manage heavy periods. Now, moving forwards, we've got the marina coils, great, so there's less hysterectomies for heavy bleeding. But if someone, like this lady, has had a hysterectomy for her menopause, you're not just helping her for three or four years. It'd probably be helping her for 30 or 40 years. So it's actually even more cost effective.

But I think the important thing is knowing there's always choice. And I think, you know, reading your comments from this, this post is just makes me so sad because women are not being listened to. There's no one to say. And I think as a doctor, I always say to people, whatever treatment, whether it's a blood pressure treatment or a HRT treatment, if this doesn't work, we can go to this. And I think sometimes just knowing that there are options is really, really useful, isn't it? Because if you know you're at the end of the road, then what do you do? Yeah, and then you just feel completely helpless. The thing that I found

really shocking was this arbitrary, age 44. So when I finally did get the doctor to talk to me properly about perimenopause and admit that the blood tests weren't necessarily the right indicators to whether I was menopausal, she said, but you're 43, so I can't prescribe you with HRT. And I was, you know, 43 and a half. And I said to her that, but that's ridiculous. Like that is absolutely, can you not see that that's madness? Because of course, everybody's body is different. And I'm very close to... And I heard that so often in the comments as well. Yes. And I think, you know, I work out of the nice guidance, which are now seven years old, and we've got the International Menopause Society guidance that are six years old, but it doesn't matter.

They're still the most current guidance for the menopause. And they're very clear that there isn't an lower age limit. They talk quite a lot about premature ovarian insufficiency. And also, they do mention perimenopause as well. So there's no one's too young to be considered for hormones. I think it's really crucial. And this is one of the reasons that I've worked so hard on the information that I've written and given out freely to people is that women can then become advocates and really, like you're doing with pregnant then screwed, allowing people to have the information, then they can go back.

You know, obviously for you, it's the employers, but for me, it's going back to a different maybe, or even the same healthcare professional and say, look, actually that's not true. Or could you show me where you're getting your evidence from? And I'm happy to be challenged. but what I have read from the NUndt's is that there is no age or there is no reason why I can't try. But it's very hard and it just shouldn't be this exhausting for women to be listened to. No, it really shouldn't.

And that's the hardest bit when you really are fighting your corner against a medical professional and you feel different to them, of course, because they, and so you should, you know, in many regards because they're the trained people. But certainly for me and certainly for many of the people that commented, the information they're getting is just not accurate. And so you have to go off and find your own information and then go back and have these conversations with them.

And of course, some people are not receptive to that at all as well. Medical professionals sometimes don't like you to, you know, challenge them on those issues. Yeah, but I think, you know, I love being challenged. And I'm very happy. and I think it's really important that we learn from our patients all the time and what's concerning them and what they want. And it's not for us to say what people can and can't do. And I think often when we feel threatened,

it's because we're in an area of uncertainty or an area without the right knowledge. And so I think positioning it in the right way, you know, making sure that you're respectful to healthcare professionals, but say I'm finding it very frustrating, actually, and this is contrary to other information that I've read and is there someone else in the practice that might be able to help me because I don't want to fall out with you over this,

then keeps that respect going because some people have actually helped by writing a letter to say to the consultation I'm going to leave now because I'm not getting anywhere and then write a letter to that doctor or nurse or pharmacist or whoever it is you're having difficulty with and then saying, is it possible for you to ring me when you've considered this information that I've read from the nice guidance or whatever is relevant. and that can help because it's like, you know, for those of you've got teenage children, there's no point arguing if everyone's worked up. It's better to diffuse and go back.

But it's essential that women do get listened to because we're talking about lifelong improvement if you get the right treatment. And that's really important. How can we change the system? What do you think needs to happen for menopausal symptoms to firstly be better understood but also for women to be listened to when they go to the system? the GP and get the right treatment. I think a lot of it is about training and education. Yeah, and big question. Sorry. Yeah, no, no, no, it's fine. A lot of it's about training and education

of all healthcare professionals. And I think, you know, allowing women to understand what's going on is number one because I think medicine has really changed where it's so much more patient-centered. So allowing women to be in the centre of the consultation is huge, whether it's about their pregnancy, their PMS, their endometriosis, their migraines, whatever, or their perimenopause or menopause. And then it's the education for healthcare professionals and it is happening with younger healthcare professionals. They're a lot more aware, but it's also making sure that the right colleges are involved and the government and NHS England. And it's, it's a huge amount of work because it's a big culture shift and it's changing people's perceptions

of what the perimenopause and menopause is. And so many people just see it as something that causes a few hot flushes and stops periods. They don't see the bigger picture. So there's a huge amount of work that needs to be done. But I think in the meantime, the most important thing is allowing women to know what's going on and give them tools to try and get help. So for you mentioning or even talking about the topic was overwhelming. But again, it's showing that women need a platform.

They need a voice and they need to be listened to. So I'm very grateful for you spending some time on a Sunday morning, But before we finish, three take-home tips. So three things that you've learned from, you know, your experience of the perimenopause that maybe you could impart for others. So they're a bit more in control and hopefully don't suffer like you have. Probably the first thing I would say is talk to as many people as you can about it because I found out the majority of my information from just having conversations

with a variety of different people. I got so obsessed with it that I, it was the first thing I was not talking about. It's a pretty much woman I met who I thought could potentially be of perimenopausal age. But that's where I got most of my useful information from. And that's essentially how I ended up diagnosing myself because of all these different conversations I was having with different women. I think it used to be such a taboo subject and people never used to talk about it. And it's not now. And people want to have the conversation.

And I found people really relish talking about it. And we learn from each other. And that can be really powerful. probably second tip would be, you know, keep going, don't give up, you will in the face doctors or other health professionals who will tell you things that aren't necessarily accurate and you know yourself or how you're feeling and if you're not getting the help that you need, keep reading and keep pushing for what it is that you actually need. And thirdly, if you have the marina coil and you feel absolutely. mental, then it's the marina coil. Get the thing out. Probably not by your friend then. Go and see a healthcare professional. Don't get cat to come out with rubber gloves. Go back to your house professional. Yeah, absolutely. And I think the most important thing is just if you feel something, whether it's the coil or the

tablets or just the way you're feeling isn't right or if you think it might be related to your hormones, then just be persistent and eventually hopefully you'll find someone that will help. So I'm very grateful for your time today and I'm looking forward to seeing how the response to what you're doing but also how you're just changing the face for women going forwards because it's so important to start young and keep the conversation going. So I feel that what you're doing, all these women who have been pregnant are guaranteed to become very menopausal or menopausal after. So it's doing this sort of joined up thinking I think is really.

exciting so thank you again thank you well thank you i mean literally your clinic saved my sanity so i am enormously great for you thank you oh thanks dearie for more information about the perimenopause and menopause please visit my website balance hyphen menopause dot com or you can download the free balance app which is available to download from the app store or from google play