The Dr Louise Newson Podcast - 203 - Nursing and the menopause: International Nurses Day special episode

Episode Date: May 9, 2023

In a special episode on the eve of International Nurses Day, this week’s guest is Sue Thomas, an advanced nurse practitioner with an interest in menopause who works alongside Dr Louise at Newson Health Menopause and Wellbeing Centre. They discuss Sue’s 30-year nursing career, including her work in cardiovascular disease prevention, and talk about the vital role nurses play in raising awareness and treating women during the perimenopause and menopause. And with figures showing nine out of ten UK nurses are women, and more than half aged over 41, Sue and Dr Louise discuss the impact of the perimenopause and menopause on the nursing profession, with Sue sharing her own menopause experience and the barriers she faced when trying to access HRT. Sue’s three take home tips for fellow nurses and healthcare professionals are: Look for more education about the menopause, such as the free Confidence in the Menopause course If you are struggling with menopause yourself, be open with colleagues and line managers – we need to look after each other Let’s make the menopause a positive thing. Click here to read an advice article by Sue for healthcare professionals on coping with menopause in the workplace.

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. On this week's podcast, I've got with me a nurse who I've known for quite a few years now and ensnared her into the News and Health community more recently. So someone called Sue Thomas,

who I met quite a few years ago, Sue, didn't I? Was it, I think, did you come and set my clinic first? Or was it a conference that you came to? Yeah, no, I sat in on your clinic. You very kindly let me do that. because, of course, when I'd been through the British Menopause Society course for nurses, there's no mentorship, unfortunately, there's a shortage. So in order to get the experience, the clinical experience, I ask, could I come and sit in, you very kindly like me, and I sat in with Rebecca, actually. And I think that was after we'd done a little presentation on group consultations many moons ago. Yeah, that's exactly right.

And I think like me, you were sort of quite standard with the stories and the need for women. And I know when I did some theory training, many years ago, I read lots of articles, went on a few courses, but I just thought, when a patient's sitting in front of me, I don't quite know what to say or what to do. And you want to see people do it in action. And it's like anything in medicine, isn't it? You learn on the job. You obviously need to have theory. Of course you do, whether you're a doctor, nurse, pharmacist or whatever. But you actually, you learn so much more from your patients and the way that we did.

with patients, obviously every consultation is different, isn't it? And every menopause and perimenopausal story is different. So how we approach is quite different as well. And I think, you know, there's a lot of people who come and sit in my clinic or our clinic and really quite surprised, actually, with the amount of suffering often that women have, which I don't really think there are many other areas of medicine where people are left to suffer and be ignored for so long. I don't know what you think? Well, I remember the first patient actually that I saw with Rebecca. And I've been nursing a long time and I've seen a lot in my time. And I always remember that patient, she'll stay with me, actually. And it had been a 15 year journey for this lady to finally get the care that she needed.

And I think at that point, she'd actually given up a job and she was quite high up, she's quite senior. But she'd been to see, I think, several doctors along the way and just was struggling really badly and of course her work mustn't have been so supportive and she ended up leaving her job and coming into clinic and I heard a story and I sat at the back of the room listening to this and I just couldn't believe it and I remember Rebecca saying so there are a lot of ladies that you're going to be dealing with as a nurse in the menopause clinics that have similar stories I'll never forget that lady you know and I've seen and heard you know quite a few sad stories along the way as well I mean it it's getting better isn't it louise but with a fair

way to go, I think. Yeah, I think it is and it isn't. I think some of the problem is that there's more awareness, which is not a problem. Of course, that's really good. There's more knowledge, which again is really good. But actually, there still seems to be this imbalance between the amount of knowledge that women have and the amounts of knowledge that some, not all healthcare professionals, have. And I spoke to a lady this morning actually who's had symptoms for about seven years now and She's on phragabalin, a type of medication because she gets really bad pins and needles. And she's also on some drug. It's codeine and paracetamol and something else in it.

And I said, what do you use that for? And she said, I'm really embarrassed to tell you. And I said, well, tell me. I said, is it for pain? She said, no, not really. It's actually to help me sleep. Without it, I can't sleep. But she said, I know I'm a bit addicted to it now.

So she's been given this medication. I said, what about your menopause? Do you think any of your symptoms are due to your menopoles? Oh yeah, she said, but I was just told I just need to get through it. It's just one of those things. It's just part of being a woman. And I think this is where it's sad that women are not offered evidence-based treatment for many reasons, and it's been medicalised in the wrong way.

And I know your background is obviously very evidence-based and your sort of specialty, really, before you came into menopause was cardiovascular medicine, wasn't it? Yeah. Cardiovascular disease prevention primarily. So within practice, I did a lot of work with a national education charity called Education for Health. And we went around the country training doctors and nurses to look after patients who were at high risk of cardiovascular disease and those who had cardiovascular disease. And of course, you know, I didn't realize actually until fairly recently, I have to admit, we have to remember that a lot of ladies are very frightened of breast cancer, particularly. in relation to hormone replacement therapy.

But we have to remember, Louise, that, you know, it's not breast cancer that kills women. It's heart disease. It's cardiovascular disease. And we've got really good evidence that hormone replacement therapy reduces that risk. And so, you know, to my mind, and I'm hoping that in the not too distant future that actually hormone replacement therapy is, you know, a big part of the cardiovascular disease prevention strategy, really. I don't see why it shouldn't be. I know it's not for primary prevention at the moment, but I can see that happening because we've got really good evidence.

It's coming through thick and fast know, isn't it? That it does protect. Well, it is there, and isn't it interesting? Because the USA preventative task force have just announced there's not enough evidence for primary prevention. And as you know, some of us wrote a letter to the journal, and others did as well to say, well, there is evidence. And sometimes I think about it and think,

because HRT is so cheap, and there's not big, farmer involved. Actually, there's a lot of big farmer that want statins to be prescribed. They want blood pressure lowering treatment to be prescribed. And there may be antidepressants as well and painkillers and, and, and, and, especially in America, actually, but also, I think there is that in the UK as well. And just for transparency, those who are listening, none of us who work with Newsome Health do any paid work with farmers. So we're not talking about this from a vested interest. But I think because pharma for HRT is not really there, there are

pharmaceutical companies, but they haven't got the same presence and money behind them, I wonder whether that has a difference because there's more evidence that HRT can reduce future risk of a heart attack than there is for statins in women. Yet we've prescribed statins and a lot of people are encouraged to prescribe statins for primary prevention of heart disease for women, aren't they? Yeah, absolutely. And I think if you look

at framing them, the big study that's ongoing. We didn't have a lot of women in that study as well. But we know that heart attacks go up as women go through the menopause and we know that estrogen replace, we know that that is an anti-inflammatory effect, isn't it, on big vessels? Yeah. So I'm just hoping at some point, alongside, of course, lifestyle management that we start looking a little bit more seriously really at how we can incorporate good menopause care as part for primary prevention for cardiovascular disease. Well, absolutely, because like you say, it's the biggest killer. Killer, yeah.

And increasingly, we know that women who have a heart attack actually often present with different symptoms to men, and they have a worse prognosis actually after a heart attack. And it can be harder to diagnose because of their atypical symptoms. Right. So even having heart disease as a woman puts you on a wrong foot almost compared to men. But also, we want to prevent disease. You know, we've come into medicine, me as a doctor, you as a nurse, obviously to treat disease, but also to prevent diseases as well.

And, you know, there's been an amazing work with prevention of cardiovascular disease and everything else as well. You know, I often think in my mind about hypertension, raise blood pressure, because that doesn't usually cause symptoms. And I think, is it a disease or not? Well, it doesn't actually matter whether it's a disease or not. the reason that we treat raised blood pressure is to reduce risk of cardiovascular disease, isn't it? And absolutely there is good evidence that lowering blood pressure can reduce incidence of heart attacks and strokes. Absolutely.

And modifiable risks are the biggest area, really. So it's a lot is lifestyle, Louise, you know. Totally. You've got your family history and your genetics and all the rest of it. But actually the biggest risk factors are in that modifiable category. So if we can educate, which we do. do as part of our management of women going through the menopause, certainly lifestyles are really big. And that's the same with hypertension management.

You know, prevention of cardiovascular disease, the majority of it is lifestyle. So exercising, I don't like to use the word exercise, actually. I like to use the word activity. Yes, yes, activity or movement. Or movement, yeah. Because we know that reduces blood pressure. We know that has a really good benefit for mental health, as well as reducing cardiovascular disease risk. Absolutely.

So anything for prevention is really, really key. But we know, actually, that to try and ask many menopoles of women to exercise more, to eat better, to reduce alcohol, to stop smoking, can be really difficult, can't it? And often that's... Yeah, especially when you're not feeling very well. Well, this is the thing, isn't it? You know, I had someone, a doctor sat at my clinic a few years ago, and she said, oh, Louise, you seem to be prescribing HRT in the first consultation. what I do is I encourage women to change their lifestyle first. And I won't give them HRT unless they've shown me that they're committed with losing weight,

doing exercise and sleeping better and everything else. And I said to her, I understand you saying that. But actually, as a perimenopause of woman myself, it was impossible for me to improve my exercise, to sleep better, to eat better, because actually I had so many symptoms, I couldn't be bothered to do anything. And I didn't feel like exercising. much muscle and joint pain and headaches and reduced motivation. And I was putting on weight despite eating relatively healthily. So actually I'm setting myself up to fail. And the last thing I

wanted when I saw a doctor was for them to tell me to improve my lifestyle. For some women, absolutely, it might be the right thing to consider first line. But usually we do it in conjunction, don't we? Right. And I think that's the same, you know, when I used to run diabetes clinics and the recommendations are lifestyle first, before starting a diabetes drug. And that's probably where your colleague was coming from. Yeah, probably. But actually, when I was in general practice,

I knew a lot of my patients really well. And I knew that I could sit there until I was blue in the face, telling them that it needed to change their lifestyle. I knew they wouldn't. But actually, if they started a drug that then helped them to feel better and help their sugars to come down, then often the rest would fall into place. And so I often didn't adhere to the guidelines in such a strict way.

I'd give them the choice and say, look, the guidelines say three months before, but actually I know what you're like and I know you've sort of tried with lifestyle before. So how about having some medication and then we can review. And then sometimes, and I had quite a few patients who then their lifestyle became so much better that they would lose their weight and everything else. So then they would reduce some of their medication afterwards. Yeah, which is good. That's not unusual.

No, it's not, is it? And I think that's the same with heart drugs as well, actually. If we can optimise our diet and exercise and sleep and everything else, a lot of people come off anti-hypertensive, don't they? Yes, yeah, definitely. And I think in medicine, we sometimes forget, don't we? Everything we prescribe can be stopped as well. And a lot of women we see in the clinic, they come on all these medications,

like this lady I said today on with her progabalin and her painkillers, But I know in three months time she'll be able to come off those. Oh, I'm pretty sure. And we do that a lot. And I think it's really important, isn't it, to remember that any medicine is not, you don't sign up for life, do you, for a medication? It has to be reviewed and the dose might need changing. The type might need changing. And that's the same with HRT. Although most people take it for life, the dose often does need changing, doesn't it? Yeah, absolutely. And it's that holistic assessment, isn't it? And that shared decision making. And I think it's terrible. things to the individual as well, what one person can do or wants to do, the next person doesn't. And I think exposure to different activities, because as I say, I don't like to use the word exercise. Because the minute you say exercise, you know, people have, all they can see is a leatherclad lady on some sort of treadmill in a sweaty gym or whatever, but it doesn't

have to be. It could be ballroom dancing, Latin American dancing, if you fancy dancing. That's exercise, yoga, golf, tennis, anything that gets you moving, gets, you know, warm. They've got really good evidence for walking groups now, isn't it? Where you can improve mental health, you're getting out with other people. You're having a conversation. And there's some good evidence that it improves brain function as well, as well as getting the weight down. So once the weight comes down, then the blood pressure starts to come down. Then everything's like, you know, it's like a domino.

But you've got to feel well in the first place. Yes. I mean, Louise, to be able to do all those things like you say. I do remember that when I had my hysterectomy back in 20, 2020. And I remember post-operatively walking down the stairs. It was about six or eight weeks later and thinking, I don't have to walk down the stairs. After I'd recovered, of course, one step at a time. And the only difference was, Louise, I was on HRT, I was on estrogen. So the wound was, you know, tender where the incision was and so on. But the actual joint pains, and I had never, I'd just been

suffering with joint pains for years and brain fog and a bit of anxiety. I never thought I was going through the menopause. I didn't assimilate those symptoms to the menom. But I've been suffering with perimenopause must have been for years. And the only thing that changed after my hysterectomy was estrogen replacement. And I was able to come down the stairs. And it

was only then I twigna thought, oh my goodness. I've not been able to do it for years. Yeah. And actually we're just presenting some results of a questionnaire that we did recently about surprising symptoms of the menopause. And muscle and joint pains was one of the

things that affected over 15% of women, but they were surprised about it. And often people say how hard it, especially in the morning when you are levels, usually at their lowest, when people are perimenopausal, coming down the stairs, holding the banister, taking time. And sometimes people say even their souls of their feet feel very uncomfortable, you know, like walking on pebbles, very uncomfortable. And it's one of those things that you, because all we talk about is flushes and sweats, you know, for many years. That's all it's been done. But, those physical symptoms, but also the psychological symptoms that are affecting people in the workplace. And, you know, I've said it before and I'll say to again that about 40% of NHS employees are

menopausal. But when we look at nurses, it's probably even more than that, isn't it? Yeah. I mean, I think we're all in very difficult jobs and we're care for others and we're less likely to care for ourselves, aren't we? And our teams around us as well. I don't think we're the best at doing that because we're just so busy and demanding jobs as doctors and nurses. But I think we do need to look after ourselves because there's not that many of us, let's face it. I mean, we're in a crisis at the minute, got our colleagues on strike with no doctors, nurses coming into certainly primary care. I'm working general practice.

And a third of our workforce is going to be retiring anytime soon. And there's no one really to refill those places. So we have to look after ourselves. And sometimes we have to work differently with patients. And we have to think about different ways of caring for patients because the demand is ever increasing. And we don't always have the staff and the resources to deal with that demand. We're doing the best that we can, but we do need to look after ourselves.

And I think, as you know, Louise, it's a huge amount of perimenopausal and menopausal age that are in more senior jobs often within the NHS. We've got to keep hold of them. We can't afford to lose any here. And it's very hard. In fact, my husband was sent something through from his NHS trust about menopause support, menopause group. And he said, oh, Louise, do you want to have a look at this?

And I said, no, because I think I'll just get too upset because it's about support. It's not about treatment. It's about support. It's like we need our hands held when we're menopausal. I didn't need my hands held at all. I just needed some hormones and I didn't know how to get hold of them. And this is a problem I hear time and time again. I see so many women who are nurses and they're unable to carry on work.

They're unable to get treatment that they want that's, you know, based on nice guidance. So they're reducing their hours or leaving. They're not leaving because they want to. You know, a lot of them have had some amazing careers and they're made of steel. Nurses are really hard workers. I think, you know, a lot of nurses I speak to when they do 13-hour shifts, it's full on, you know, really hard. They're really committed to the organisation. yet put menopoles or perimenopals into the mix, it's just too hard for them.

And it makes me really sad actually and actually very angry to think that we have something that's very cheap, that's cost effective, that's evidence-based, that's mentioned in nice guidance, yet we're refusing our own profession so that we're letting them down to the extent that they have to leave in a time when every single nurse counts. Absolutely. And from personal experience, I mean, it was only, as I say, three years ago, I had my hystretched me, I was in a women's hospital leaving and having already talked to, you know, the surgeon prior to having known a bit more knowledge about the menopause and all the rest of it, I was going

to be plunged into this surgical menopause. So I wanted to be prepared. And actually, I'd spoken about HRT and I asked, could I have it on my discharge? And when I was being discharged, Louise, there was no HRT. There was no mention of HRT. And I was to, and I was to told to go away, recover, and if I got symptoms in six months to go and speak to my GP, that's what I was told. This is a women's specialist hospital. And so, of course, I didn't do that, Louise. I asked, oh, please, may I have some estrogen? And at that point, the titoes have been done. So I was an add-on, so they had to go back and get the following. And I was offered an oral estrogen. There was no choice. But of course, having that bit more knowledge, I said, no, please, may I have some gel?

And it was, do you remember the scene in Oliver when he asked for more porridge? Yes. That's how I felt, really. That's how I felt. And then after that, it was then, you know, there's no follow-up particularly. You get your six-week remote check and all that. But then there was going back to the GP and saying, can I please have some more help? You know, and it's never on a repeat.

You know, and it's a continual, you know, you're having to bother people. And it needs to be, it could be so much more efficient. We've got increased demand because sometimes systems aren't that good. Why couldn't I have had it on repeat? So I don't have to keep ringing in. And I don't have to keep bothering. No, and it could be so easy. And I know there's a lot of people out there who are very rude about the work that I do.

And someone I know met somebody quite senior in the NHS recently. And she said that she knew me. And the person rolled their eyes and said, oh, not Dr. Louise Newsome. And she said, oh, can I just ask? Why are you saying that? What is it about her? Do you not agree with what she's doing? Or what is it?

She said, no. she's just creating so much work for us because every other patient we see is a woman who's peri venipausal or menopausal and once HRT and then this person I know said to this other person do you think that's Louise's fault and then she went no I suppose you're right it's not and I it's this deception isn't it that it's a short-term problem for longer-term gains and of course it's demanding and having more women but actually the number of women we see in the clinic who have been going back and forth for investigations for palpitations. They've gone back and forth for investigations for their urinary symptoms.

They've had brain scans for their memory problems. They've been seen by psychiatrists. They've been back and forth to their GPs with all these weird and wonderful symptoms. So actually they are creating a lot of work, but they're going under the radar. And, you know, I think back as a GPI, most of the people I saw were women. and most of the people I saw were in their 40s and 50s. Yeah. And never, well, unless they said to me, I'm menopausal or like you, I've had a hysterectomy

that when it's so obvious they're menopausal, I didn't think about it. And I would be one of those doctors that would send people off for tests. And, you know, we can nip it in the bud. And I think that's what we need to do, really. Like we've done with cardiovascular disease prevention. Yeah. You know, I used to see quite a few people, mainly men, who actually were having a heart attack. they'd come into the surgery and we'd have aspirin already, we'd have the GTN and we'd call

the ambulance. That doesn't happen anymore because awareness is huge about what is a heart attack. If you have this chest pain, you've dull 999, you know, and then you go in and you have a primary oangiplasty, it's incredible what happens. You know, over the last 30 years of me being a doctor, it's been transformational for heart disease, hasn't it? Oh, absolutely. It's been credible. And even for stroke as well, it's now seen as an emergency, whereas in my day or bed four in the corner and had a stroke just put them to bed and we'll do a scan and see whether they need aspirin or not

it's so different and absolutely isn't that right but menopause or women is just still being at oh no we don't want to manage them yeah I think there's possibly a lack of confidence and I know that the knowledge base hasn't been that great I know as a nurse going through all my career and I've been in nursing for 30 years I mean we were never offered menopause training certainly not with my training and not as a nurse

practitioner, I can't remember being off of menopause training. It was only when, you know, I remember seeing ladies and thinking, oh gosh, something, and signposting these ladies to GPs for more help. And certainly, like, smears are a great opportunity for nurses to identify. And it's asking the right questions at the right time, isn't it? And getting patients who, for example, having some GSM symptoms to get them on vaginal estrogen. Because precious few ladies can't have vagina. And it makes the cervical cytology so much more comfortable. But it's identifying them. And there's certain practices and certainly we've done this. And it was only through your 14 fish training. It's fabulous. You know, it's free training for everybody to access. I mean, I did the

British Menopause Society course, which was great. And your training as well with the case studies. And like you say, the case studies, for me, I think and for a lot of nurses, we like case studies, because that's what you learn real life. It brings it to life. It brings it to life. Yeah. Absolutely. Yeah. And so I remember coming out of that and thinking, we've got to identify these patients better. And so what we've done is in reception, because I work in a general practice, we've put a little poster up for the reception team.

We did a little educational thing and just said, if you get ladies between the ages, say, of 45 and 55, with these symptoms, hot flushes, a low mood, palpitations, about six or seven symptoms, we know there's a lot more than that, but the key ones, then please signpost them through. to the doctors and nurses who have more of a specialist interest in the menopause. So we're hopefully going to identify them a bit better doing that as well. And that's easily done, isn't that? Yeah, but it's so important. The number of people who avoid going for smears because they're uncomfortable or painful,

or a lot of people have said to me, my last one was so unpleasant, I'm never going again. So did anyone talk to you about vaginal hormones not at all. And vaginal hormones, as you know, are very different to systemic hormones. and about a fifth of people who take HRT still need to use vaginal hormones as well. And a lot don't realise that. They don't appreciate that. No, I was at an event talking recently and a woman in the audience said, I'm not allowed to have vaginal hormones because I'm on HRT,

but I'm really having a lot of discomfort. And, you know, the dose is very low. They're very safe. And even for women who've had breast cancer, they can usually very safely use vaginal estrogen. So there's a huge amount that we need to do. and I know you're doing a large amount educating fellow nurses as well, which is wonderful. And I think nurses are understanding.

You know, whenever I lecture and teach nurses, it's overwhelming the response I get. And they have a bit of a personal interest because if they're menopause it as well. But nurses are great at giving information in very easy to understand chunks of information. They sometimes have longer consultations. and doctors as well actually. And I certainly feel going forwards in menopause care, more nurses and pharmacists should be involved actually because they really do it very well. I'm not saying that doctors don't. I can't say that because I'm a doctor, can I? No, but I think you're right, Louise. Patients do often open up to nurses more.

They do. Absolutely do. They'll tell you more than they often tell us. And I think that's really, really important. But I think, you know, joined up way using all clinicians working together for the common goal of improving health and reducing diseases, it's got to be the way forward. So the work you're doing is amazing. I'm very grateful for you coming and talking about it today, Sue and opening off a bit about your personal experience. Before we end, I've got to ask you three take-home tips, of course. But I would like to ask you three things that you think, nurses could do now to make a difference. So I know there's quite a few healthcare professionals that listen to the podcast. So if there are nurses or any healthcare professionals listening

and they feel that they need a bit more education about the menopause or they're not really sure, what are three things that you would recommend for them? Well, I would definitely recommend getting some more education. And of course now, we've got access to 14 fish, which is free. And it's fabulous menopause training, so I definitely do that. I would also, say to nurses to talk more to each other and to line managers and to say if you are struggling a little bit on the wards or in practice then you know you need to let people know and you know I'm sure in larger organisations there are protocols and policies for menopause unfortunately I don't think it's that common in general practice to have those policies but I think by talking and asking

for support and don't be frightened of doing that as I say we do need to look after it each other so that we can provide the best care for our patients as well. And the third day, I want to say, let's make it positive. Let's let's make the menopause positive because I hear so many times it's negative terms that we use. I mean, recently we've set up a local support group because there really isn't anything in my kind of area, Warwickshire, NHS-wise. So I've set up a little support group. And we did a focus group and asked the ladies what one word that summed up to them, their menipause, there were 22 ladies there and we had something like 136 years of menopause between us so some were six months in somewhere at the other side there wasn't one positive word there were isolation loneliness struggle everything was negative and it shouldn't be like that we have to make it more positive don't we and i think if we stand together we support each other we talk more we can make it more positive get on the right treatment speak to people who know what they're doing and they're specialising in the menopause. And if you don't see somebody in the practice that perhaps as a GP practice

is normally the first port to call, then go and see somebody else. And if not, if you need to go privately, then do go privately because there's fabulous clinics like News and Health that's scattered throughout the country. But we shouldn't be battling for good, standardized basic menopause care. It should be free at point of access, Louise, shouldn't it? Absolutely. Totally agree. So great tips. And hopefully that's been useful for many people to listen to. And feel more empowered with more knowledge so then everybody can hopefully receive the right care attention treatment that they deserve. So thanks again for your time today, Sue. It's been really good. Oh, thanks Louise. Thank you.

For more information about the perimenopause and menopause, please visit my website, balance, balance, or you can download the free balance app, which is available to download from the app store or from Google Play. Thank you.