The Dr Louise Newson Podcast - 219 - Mental health and the perimenopause

Episode Date: August 29, 2023

Content advisory: this podcast contains themes of mental health and suicide.   Joining Dr Louise on the podcast this week are Lynsey and her husband Kieran. In this episode, Lynsey movingly describes a rapid deterioration in her mental health during the perimenopause which saw her sectioned under the Mental Health Act. ‘I just felt desperate that this was a new version of me and I couldn't work out why,’ she recalls. Lynsey and Kieran, who is a GP, speak to Dr Louise about the need for greater understanding of how hormonal changes during the perimenopause and menopause can impact on mental health, coupled with improved access to HRT. Contact the Samaritans for 24-hour, confidential support by calling 116 123 or email [e-mail]  

Hello, I'm Dr Louise Newsom. I'm a GP and menopause specialist and I'm also the founder of the Newsom Health Menopause and Wellbeing Centre here in Stratford-Pon-Avon. I'm also the founder of the free Balance app. Each week on my podcast, join me and my special guests where we discuss all things perimenopause and menopause. We talk about the latest research,

bust myths on menopause symptoms and treatments and often share moving and always inspirational personal stories. This podcast is brought to you by the Newsome Health Group, which has clinics across the UK dedicated to providing individualised perimenopause and menopause care for all women. So today on the podcast I'm actually interviewing two guests together, a husband and wife, who I've only met a few seconds ago, actually. I was introduced to Lindsay through someone else on social media.

social media has many pitfalls, but it also has many benefits. And there is a bit of a warning before the podcast starts because it is a difficult story. But Lindsay's very determined to share it. And I'm very determined to talk about it because, as many of you know, the mental health aspect of the menopause and perimenopause is actually very neglected and not thought about enough. And when we look at the definition of the menopause, it's always about periods and it's about fertility. And it's as if our hormones don't travel anywhere else other than in our pelvic organs. And of course they do. Our female hormones, estrogen, progesterone and testosterone, are neurotransmitters. They work in many, many areas of our brains as well as elsewhere on our

body. So welcome Lindsay and Kieran to the podcast today. Thank you very much. So thank you to be here. Thank you. So let's introduce you both and then we'll start talking about things. So Kieran, you're a GP. It's always very nice to have a fellow medic on the podcast. So do you specialise in anything? Or I would never say you're just a GP, but are you a general GP? Yeah, so obviously, yeah, a GP, so as you say, a generalist. But I also am a GP trainer. I also do minor ops. I'm also a clinical director as well for our primary care network where I work in the fair and area. So I do a few things. So that makes you very busy? Just a bit, yeah. It's certainly been the busiest three years of my

career so far. I used to be in the military before that. Gosh, okay. Yeah. So some of you might know I pivoted into general practice after doing hospital medicine and I still look back with my year of training with great fondness actually, but also frustration because actually in that year I was never taught about the menopause and before that I'd done a nobs and guiney job and I wasn't taught about the menopause then and then medicine I clearly wasn't. So I don't know about you whether it's been on your radar until recently so much? I think it has because we've quite a big practice and we've got seven female GPs. So, you know, they are all very sort of up on current HRT guidance.

But again, it's where that guidance comes from. I think some of the issues in the direction of it. And I'm sure, you know, you get that all the time. Yeah, indeed. And Lindsay, you're not medical, are you? No, I used to be in the Navy and I was a medical assistant. and for a short period I did work in operating theatres. Okay.

But certainly it was more technical and specialised in surgery. So when it came to hormones and female health, that wasn't particularly on my radar. No, okay. And do you mind me asking how old are, Lindsay? I'm 45, nearly 46. Nearly 46, okay. So do you mind just giving us a little bit about your street? Because you've otherwise been very fit and well, haven't you?

Not had any medical problems or psychiatric illnesses or anything. Not at all. I had two children, didn't really have any issues following my two children. Did have a very small problem after having a moraineer coil fitted, where I suffered some low mood. But it was very concentrated into that time and there was no follow-ups afterwards it sorted itself out. And I was about 35 back then. But then May of 2022, out of nowhere, I suddenly started suffering. with anxiety. And I'm not normally an anxious person at all, but this anxiety was around the most simple things. Like, what am I going to wear in the morning? What am I going to cook for dinner? What's going on the online shop? Just things that shouldn't be things that I would worry about

became really big hurdles. And that seemed to be the catalyst that then started all of this journey off. So did you go and talk to anyone about it when you were starting to feel this anxiety? Yeah, I did. I spoke to my GP practice and I was phoned by their mental health nurse. A load of antidepressants were started. Again, it was very much, was looking like an anxiety disorder. It appeared that way and I myself wasn't looking at anything other than, okay, that this must be something going on. However, in the following weeks, it was literally we are talking from the May of starting feeling like this going into the June I was getting so anxious and palpitations had started and by July I was in a depression and beginning with really really strong

suicidal thoughts and then by the end well Keown I think it was mid-July to end of July I was in crisis and needed to have crisis mental health involved and following that I was sectioned under the mental health act Gosh, so that must have been very scary for you, Kieran, with some medical knowledge and watching your wife go from being very fit and well to mentally, very disabled. Yeah, extremely. You know, obviously with my background and with the head on, but at the same time trying to be a husband and a father and trying to access the services was, let's just say, difficult and interesting. And I know the system inside out because it's my local system. and it did seem like what Lindsay just said.

It seemed, you know, it's like mild anxiety, very simple symptoms to start with, but it was the speed in which it deteriorated. And it literally was over a matter of 10 to 14 days from start to finish, of going from just some suicidal thoughts to attempts, you know, and that's where it got to the point where she had to then go into hospital as an emergency that we had to get admitted as an inpatient and that was the last thing that I wanted to do as a husband but even as a doctor I don't like doing that because I don't feel it's the best place for most people anyway but that's where we were sort of at because of the level of risk

she was having at that point in time yeah and that's the thing just to be clear of people listening people are sectioned usually because they're at risk of harm either to themselves or or others and it's a decision that's not made lightly it's done in a very professional way and I've done it several times when I was doing psychiatry, but also as a GP, you get involved. And I actually found it harder as a GP because they were patients that I knew. It was easier almost when you're a psychiatrist because you come in cold. But when you see this person who isn't the person that you've known maybe for many years

and in your case for a long time, it's really difficult, but you've got to be really clear that you're doing it with the best interest of that person to keep them safe, isn't it? Yeah, definitely. So then what happened when you were admitted, Lindsay, when you were in hospital? Can you remember? I can. And this is it.

I have such clear insight and memory about everything that went on, even though I was like a completely different version of myself. My thought processes, I felt the scariest symptom for me was I couldn't feel any love for anyone, not my children, my husband, my parents. I'm such an big animal lover. I couldn't bear my pets near me. It was such the complete opposite of who I am. So that's the person who got admitted. And I just felt just desperate that this was a new version of me and I couldn't work out why.

And I did say over and over, this feels so biochemically. It doesn't feel, you know, there's nothing that's happened in my life. My life is in such a good place that I knew that there was no trigger event, no trauma. And I did have professionals trying to unpick my life a little bit to almost. almost see, you know, maybe this has happened, maybe that had happened. And I 100% knew nothing had happened. But I almost then started thinking, I need to look within myself. It's something to cause in this. Because it was such a different transformation, but such a negative one. And whilst I wasn't inpatient, they were obviously treating me with several medications

and also electroshock therapy. Gosh, so you had ECT. And how many rounds of that did you have? I ended up having nine, and after nine sessions you would hope to see some form of change, and there wasn't any change. I mean, I was happy to go along with this, even though I kept saying nothing is changing. I feel exactly the same. And I know Kieran had a lot of frustration on the outside, because obviously he was coming to visit me and could see nothing was changing. But it was at some points it had been discussed, oh, maybe it's her hormones, or could it be?

And this is more from maybe some of the nurses, but there was never a, oh, it could be your hormones, therefore maybe there's a different treatment route. It was purely, it was just said in a back, as a background conversation and that's as far as it ever went. And can I ask, did your periods change at all over this time? This is a thing. They'd been slightly erratic, but not much over the last,

when I look back with hindsight, years previously they had started to get less regular. However, during this time, they just stopped, just completely went. But my weight had dropped so much. And I did mention the periods have stopped. And I was told they stopped because you've lost so much weight and you're depressed. So that was the only conversation I had about my periods. Okay, which obviously it is important, even if this hadn't been causing your symptoms,

because when people lose weight, obviously the brain can stop producing those hormones and the sort of feedback happens. So it would be very common when people lose weight because the body actually is very clever. It protects itself. You don't want to be pregnant if you're very underweight because you haven't got the same reserves. But also some of the psychiatric drugs, obviously I'm not sure what you were on, but there's quite a few psychiatric drugs that affect another hormone called prolactin in the brain. And when you have raised prolactin, it switches off your FSAH and LH,

your follicular stimulating hormone and your luteinizing hormone. So when they're low, it switches off your estrogen and testosterone from your ovaries as well. You know, all our hormones work in these big loops. And a lot of times when I was doing psychiatry and it still happens now when people are on certain drugs, they check prolactin levels. But they don't actually think about the sex hormones. And, you know, it makes sense really. Often a lot of people in psychiatric hospitals are on heavy-duty drugs, which will be giving people a chemical menopause. So if they didn't go in being perimenopausal or menopausal, they would

certainly go out. And often it's temporary while the drugs are on. But actually, if you're switching off important hormones that have effects in the brain and the body, then it's really important to consider replacing them if appropriate. So it was probably a double whammy for you, really, that you, in your early mid-40s, with some change in periods, that is the definition of the perimenopause. and then having some, you know, a big insult to your body with what was going on. Certainly, you were having some hormonal changes that sadly weren't picked up, were they? No, not at all. I think, you know, my bloods were taken whilst in there and looking at my, you know, FSA-levels.

Again, I was just told they were normal. But again, we were looking for anything because it didn't fear. It was definitely presenting as a mental health disorder. At one point, they suggested I could possibly be bipolar, even though I'd not had a mental health issue prior to this. And in the state of mind I was in, I started thinking, okay, well, maybe that's it. You know, maybe something is, you know, going on like that

because I just wasn't, I just didn't feel that, well, we weren't getting an answer. I think that's the main thing here. So you're in hospital for how many weeks? I was in for six weeks, and I could see nothing was changing, and I felt that this was going to be me forever. So again, my mindset was so clear, I thought I'm going to have to get out of here. So I went home on weekend leave and I felt as I got in the house, no connection with the children,

no connection with Kieran. And I just, that was it to me. All I could think that's my life forever. I'm never, ever going to be the person I was. Gosh. And then you're still here. So that's good. Yeah.

Yes. Yeah. Absolutely. The plan, thankfully, didn't go quite to plan. And I sustained some nasty injuries. I broke my spine, my pelvis in a few places, shattered my heel and several bones in my foot. So I was very unlucky in what's happened, but very lucky that my plan didn't go as it should have done. And obviously, Kieran is the one who's then got to deal with the fallout of that. And my children and my family. and thankfully they, you know, got me to a trauma hospital and everything was fine. Well, they stabilised me and I then spent the next month on a trauma ward receiving zero mental health support. There were mental health workers in the hospital, but they visited very sporadically and I was just, I felt like I've been given an even worse of punishment because I couldn't

walk, I couldn't move, I was completely then bed bound in the same. same state of mind because nothing had changed. So you were trapped in your body really? Yeah, absolutely. Gosh. So what happened after that? It was more, I say that I'll pass it on to Kearing then because I guess he's the one who was then in the background thinking this is just not what's supposed to be happening. She's not getting any treatment now. We're treating her injuries, but nothing's happening for her mental health. And yeah, so it was over to Kearing now, thankfully for what happened next. So go on then, Kieran, what happened?

So the day it happened, I had to get her admitted and obviously found her. And then once we'd got her stabilised physically, it was just, you know, I started to rethink things and try and analyse and use my brain as a GP to think, what are we missing here? You know, it hasn't played the way it should have gone with everything we've done so far.

for the sort of diagnosis we were thinking it was. And it just didn't sit right with me because her insight throughout, considering how severely, mentally and well she was, just didn't add up to me. And I've been doing this 20 years. And it was something that just didn't sit right with me. And the fact she was completely herself 12 weeks of it. And this had just happened so rapidly, you know.

And for her to do what she did and knowing who she is as a person and how much her kids, you know, our kids mean, you know, her love of animals, her life was great. And it was like, well, there's no trigger, there's nothing. This is not normal mental health reaction. It was completely out of character. And I could see it in her eyes. And that was the thing throughout the entire time she was an inpatient in the mental health hospital. And I kind of had an argument with what the psychiatrist, basically, because he came around four weeks in.

And had said, oh, you know, she's improving. And I went, sorry, what? and I went, no, she's not. I said she's still having the same thoughts. And he went, oh, is she? And Lindsay at the time, when he left the room, went absolutely ballistic at me, which is not her as a character, but because I'd betrayed her trust. Obviously, she can see that now and look back with hindsight and reality. But she was livid. And we'd never argue, and it's just who we are as a couple. But she was, you know, the most angrier I've ever seen anyone in my life. And when we were in the trauma hospital, all, it was just the same. It was just she was in absolute pain with all the injury. She was on high levels of morphine to keep the pain and the control. But she actually got better care from the normal nurses, the NHS nurses on an orthopedic ward than she did when she was in a mental health hospital, which is a bit of an irony in itself,

considering they're there to look after a physical well-being. And they got to the point where I just said, we need to try something different. And I finally got hold of another consultant, psychiatrist who was part of the liaison team within the hospital. Again, only because I know people and I know the system and it's my area. You know, I work across his entire area and being a clinical director has given me avenues into people in more senior positions, but it shouldn't be that way. And the initial consultant who saw her was a male psychiatrist and I'm a man. I've got nothing against men, but I have got an issue with the way the perception is and their lack of thought into other

options. But maybe that's my GP head on of thinking of every single option is always on the table. And so I just said, we need to try something different. I said she has had umpteen medications in a short space of time. She's had ECT. None of it has made one IA2 difference. She just tried to kill herself with an extremely serious attempt. You know, this was not a cry for help. But I then said, let's just give it a go. And then it was the logistical shenanigans between an orthopedic team going, well, we can't prescribe HRT because obviously they're orthopedics. I deal with bones. forget that and then they then contacted obsingani the gynaecology team they went i'll speak to the

GP so you've got the specialist supposedly because and i know i get letters back from the all the time they don't start HR to hardly ever nowadays the gynaecologist and to be honest there's no point in them being involved in the conversation you know why they're on the national panels is bonkers because you probably i'm sure you get the same frustration but this is me seeing it on the ground every single day both inpatients and general practice, my own patience, we see the entire pathway. We see them from start to finish. And this was me seeing it personally on the inside as a husband, but with my other head, they're going, we need to try this, this is not working, they're not listening.

And this was me from a reasonably educated standpoint, you know, knowing quite a lot about what's going on. And in the end, this lovely American S.H.O. who was working with orthopedics, went to see Lindsay and went, your husband's a GP, isn't he? And Lindsay was like, yes. Would you mind if I ring him about HRT? So in the end, they rang me to speak to me about it. I tell them what to prescribe.

They then couldn't get hold of it, the hospital pharmacy, obviously because they don't really start it that often. So it was going to be three, four, five days. So in the end, I ended up prescribing it, which goes against what I would normally do. I'm allowed to under GMC guidance, but it wasn't something I preferred to do. So I ended up prescribing it and took it into the hospital to give to the junior doctor, who then took another five hours to then put it on the drug charge because they weren't really sure what they were doing.

And so it's only because I took it in. And this was three, four days before she was about to be discharged. And she was still having the same thoughts and everything else. And it was like, I want this started so that we can at least see if it makes a difference. I said it's not going to harm. and they were so worried because of a lack of mobility and blood clot risk and all of that. But at least we got it on. And so at least just before she was discharged, she actually had a patch of HRT on.

And it was like, well, let's just see. And as you know, the patches don't increase clock risk anyway. So they're actually really no risks and potential benefits. And so did it make any difference? Initially, when it was put on, I couldn't see anything, any difference. I was still getting those intrusive thoughts. but I had some psychology sessions provided by crisis mental health and I was keeping a diary as a result of that

and I worked out in the first 21 days I'd actually only had the intrusive thoughts 10 out of 21 days now prior to that it had been 21 out of 21 days it'd been every day for as long as I could remember so I could see things were starting to change I mean Kieran said that you could see something had changed in my eyes very, very early on, but I was still in a bad place. But literally on day, I had 28 days, on day 29, I woke up and said, I'm going to phone

my friends. And it was like, ping. It was like a 28 day cycle. It can't be a coincidence. Gosh. I was me again. And it really was like waking up from a nightmare, but it had all happened. And it was just terrifying.

But at the same time, I was just. just so thankful that I wasn't in that place. It's very powerful, isn't it? And, you know, I mean, I'm, obviously, was a female GP for many years, and I didn't understand the biochemical effects of hormones on our brains because, like I said, no one had taught me, and I'd always prescribed HRT to those women who wanted it,

who actively came and asked, but I never would sort of go any deeper. And then I started to see people in my, I started my dedicated menopause clinic, who had come from psychiatrists with not as extreme stories as you, but very similar. I've seen a lot that have had ECT, but I've seen a lot. Most people that we see are already on antidepressants, and they say, I know I'm not depressed. But quite a few are on drugs such as quitoapine, lithium, progaboline. I've seen few patients now that are on ketamine. They give ketamine infusions for treatment-resistant

depression. I've been talking to the Royal Mars in Hospital because they have nothing in their big handbook about hormonal changes and postnatal depression, PMS and depression that occurs during the perimenopause and menopause. But a lot of the women I see, they come to my clinic because they're also menopausal. They've sought the clinic out themselves. And I remember the first time I saw a lady who was really in crisis and was awful and she'd had a similar story, but actually she'd been housebound for eight years. And I hadn't known at the time she'd written her suicide note, and I was her last sort of port of call, really.

But I said, well, you're 56. You know, it was almost easier than for you. You were definitely menopausal. You're getting some other symptoms. And I know that for your future brain and heart and bone health, HR2 is likely to be helpful as well. So I'm going to give it to you, but I'm not going to give you false hope because her story was so extreme and it had gone on for so long.

I thought, well, comments probably won't help. and about two and a half weeks later she emailed me to say, I just want to thank you. It's the first time I've managed to sleep, and I feel this cloud is lifting. And I thought, my goodness, me, but it makes sense. You know, you can put all the sticking plasters you like on, but if you're not treating the underlying cause,

and there's something about medicine. And I think it's because it's women's house that people don't want to believe women, they don't want to listen, they don't want to understand the basic pathophysiology. We're writing up a paper with a preclinical scientist from America looking at the role of testosterone in female brains and he's been working on animal models for many, many years

and the behaviour of the animals have, the mice, is exactly the same as women, but we can believe the animals and he's had amazing papers written in nature and everything else. I try and write anything about the role of testosterone in women and it just gets shot down and it's very frustrating in medicine when we can't move forwards

And, you know, there's lots of, like you say, Kieran, there's pattern recognition in medicine. You learn and you learn from your patients all the time. And the first time something happens, you think maybe it's a coincidence. And then when it's the hundredth time or the thousandth time or the 10,000th time, it's not just a coincidence at all. People don't make things up. People don't try and be ill. You know, there's no psychological advantage of being in a mental hospital or having these thoughts.

And, you know, it's one of the reasons that we're funding a. PhD student looking at suicide risk in perimenopause and a menopause or women. And one of the things that I've learned quite quickly from patients is this insight that's quite hard to describe, unless maybe you've done psychiatry before, but a lot of people who are that severely depressed, who are really thinking about suicide, they actually don't care. They have no insight or very low insight. And often the drugs sort of blunt affect a bit as well. But the women that I see who tell me about the thoughts that they're having, although, you know, they've even planned what they're going to do

and they're telling me in a very sort of clear way, you know, and they often have very good eye contact, they've got their makeup on, they look very presentable. It's a very different to the way that we see people who are properly clinically depressed. I don't know if that resonates with either of you at all. Yeah, absolutely with me, because it felt almost like a compulsion,

an intrusive thought that I needed to act. on, not as a result of something else that had happened externally. It was just some internal battle. But at the same time, I was very honest with Kieran and with professionals to say, this is how I feel. I don't understand why I want to kill myself. But something is driving me to kill myself. It wasn't that I felt everyone would be better off without me. I didn't even have that going on. it was as if it was something driving me. That's all I can describe it as. And it felt I needed to make a plan.

It was just completely took over my whole thought process, like all day long. And the other thing that I find incredibly sad and frustrating is the, like you say, the lack of joined up care, but the inability for people to be able to prescribe HRT. Now, HRT is one of the safest things I've ever prescribed as a doctor, especially the body identical hormones. They really don't have risk. This whole breast cancer risk has been overstated and with the body identical hormones. Then there isn't thought to be a risk of breast cancer. As we've said, there's no risk of clot. And they're fully reversible as well. You know, if I take my patch off, then tomorrow I won't have any hormones in my body. So they're not long lasting either. But when we've

done a lot of training with psychiatrists and speak to psychiatrists, but also people and other specialties like cardiologists or neurologists when they see people with memory problems and headaches, they all say, well, I can't prescribe HRT. And I understand you're absolutely right care and secondary care. Often they can't start medication. It goes back to the GP. Now this is to me noncical because actually it's using the GPs as puppets and you're not puppets. You're highly trained individuals who are busy enough anyway. I get a lot of pushback from very high up people because they're saying that the work I'm doing is creating work for them in general practice and now there's so many women asking for HRT and yes I feel bad that I'm creating work but actually in the longer

term it will be better and also if we can give people hormones which means they're not taking psychiatric drugs they're not being sectioned they're not having you know I don't really understand the harm and I've have said to psychiatrists when I've spoken to them if you had someone who was an inpatient or outpatient who had hypothympathesion who had hypothythum hypothyroidism, because that can lower mood and make people feel depressed if you have an underactive thyroid, would you not prescribe thyroxin? Well, of course we would, they say. Or if you had somebody who had a headache, would you give them paracetamol. Well, yes, of course I would. But I'm too scared to prescribe HRT. And this is the hangover of the WHOE from 20 years ago. And I just feel

it's really sad, but it's not just a psychiatrist, you're just describing in a hospital where, you know, you can access morphine. You can have all sorts of drugs. But a little patch of HRT is too complicated. I just don't know. I don't know what you think as a clinical directorate. I mean, how can we change this system? Because it's just doing women such a disservice.

And it's actually having a ripple effect on other healthcare professionals as well unnecessarily, I think. Completely agree. And I think there are ways to change it. It requires those at the top who are part of the problem to move out the way. And I find that a lot with not just this, but with lots of issues during COVID. There were so many issues just alone in that period that highlighted how poor NHS England are and how lack of knowledge of reality of what's on the ground. And that's what's important is the patients that they don't seem to grasp that we see every single day. Yeah. And, you know,

general practice saw 360 million patients last year in some format or other. So the idea that were never really truly at the table. And I agree with you when it comes to the RCGP at times, I don't know, I just struggle with the people on those panels at times and their thought processes rather than the reality of what's required. And as you say, a simple aid memoir, a medical student, if they had the ability to prescribe with an aid memoir,

could do HRD. So the idea that we have consultants who struggle to issue a medication that is very simple if you make it simple for yourself, and get just a bit of online learning, if they're really that struggling, is the easy way. Yeah, I totally agree. And, you know, as you said before, lots of the time it's gynecologists as well that are sort of, I've always owned the menopause. And I suppose I've sort of breaking the mould a bit because I'm not a gynaecologist.

I'm a physician with a pathology degree who's interested in basic science. But actually, I don't feel that it should be, if I was a gynecologist, I'm interested in diseases of the pelvic organs, and menopause is usually not a disease of organs. It's something, you know, it's a hormone deficiency. It should be endocrinologist if you're going to go to a specialty, but some endocrinologists are very good, but quite a few we see in the clinic have already been seen by endocrinologists,

and they haven't thought about sex hormones. And I find it's really frustrating as well because a lot of the pushback I get is because my clinic's private. And they're saying, well, you're forcing women to go on HRT because you're making money out of these patients. And, you know, there's not many private clinics that see 4,000 women a month and are swamped. And, you know, even the free balance app that I created has nearly got a million users. Well, I'm not making any financial gain out of that. In fact, it's cost me nearly a million pounds to do the app.

But actually, where else in medicine are people scrambling so hard to get help? And, you know, when I look at our patients, we've got people from all socioeconomic classes. You come to the clinic, people that really can't afford, they don't want to pay. But where else do they go? And it's not that they're waiting a referral for a specialist. They've just been told, no, they can't have it. They can't have HRT. And so this sort of inequality also between sort of private and NHS is actually not helpful either

because, you know, we do a lot. We try and encourage people to go and see their. GP. Most weeks I get complaints from GPs to say, how dare you ask this lady to come to us? You know, I've even had MPs that have been involved or senior clinical directors and hospitals complaining about me. But these women haven't got a job. Their partners are really struggling. And HRT is free for them because they have free prescriptions. So there's, I just feel it's women are just being blocked wherever they go. And there's a lot, obviously, of women that are getting help and it's brilliant and it's wonderful but we still know it's a minority and you know even when

we increase prescribing there's shortages which then doesn't help because then that puts more work on people but but i think i think the most important take-home lesson from this amazing very emotional podcast is that you know hormones do get everywhere and they are safe and whether it's a mental health aspect or a physical aspect or there's something else and there's certain no harm trying and you know a lot of time even in psychiatric medicine is a trial of drugs this is just a trial of something else which is actually a lot safer than a lot of the drugs so I'm very grateful for your time just to put you on the spot though I always do three take home tips and it's a bit hard to ask for one and a half each so I'm going to ask you for two tips each so I'm

going to ask you Lindsay first just for two tips for people who have listened and hopefully won't be in as extreme as you were, but people who have this anxiety or low mood or intrusive thoughts that have come on without any obvious trigger and think it might be related to hormones, what two things would you recommend for them to do? For me, I would definitely say, listen to your body. Try to investigate what's gone on. With hindsight, it's a great thing. I can look back and actually, I can see I had joint pain, I had some night sweats. But again, these are things that had been missed completely.

So I guess listening to your body, something has changed. So maybe look at has anything else changed? Have you been logging your periods? Just getting to know your body. And then my second one would be in this situation, knowledge is purely power. Because perimenopause wasn't even on my vocabulary at the time. You know, it wasn't something I was looking for either. frankly Kieran knew about it a lot more than me as a woman.

So to be to be arming ourselves as women to actually find out about these things. And the information is definitely getting out there, but only if you're then looking for it. Yes, absolutely. So education is key and also education to share with others as well, isn't it? So sometimes when you're in a state, it's too hard to find information. But if others are or you'll recognise it in your friends or your work, colleagues, don't just say, oh, that will be the menopause. Think about what can be done to help, because that will often make a difference. So, Kieran, I'd really like to ask you two things.

As a healthcare professional, as a GP, what two things do you now look out for that perhaps you hadn't before? I think it's the low-level anxiety. That's the big one. And it's really simple stuff as what Lindsay highlighted during this podcast. They're struggling with their job. They're struggling with day-to-day life, things that any woman wouldn't give a second thought about. You know, they're used to multitasking and looking after their kids and their family and working. You know, and I've had a couple recently in the last three, four months where early 40s, periods are still there, you know, but just things aren't right. They've been doing their job 10, 15 years, and they're just struggling. So I think if you're starting to get those low-level symptoms and the rest

of your life seems normal, then it's really important to think about that. And the second, one I would say is, you know, if you're getting angry more than you used to, you know, and again, you know, that's the one that I see a lot where they're saying, you know, I like my husband, but he's really annoying me, he's really irritating me. And it's like normally wouldn't. And I had a really good colleague who's also a GP and they told me so when Lindsay was ill, I was talking to them. And they gave us a really good story about they'd come home after a really busy day as a GP. And they'd gone home, the husband was cooking dinner. and their teenage children were there helping.

And she just went, sobbed this and walked out and went to the pub. You know, and then she thought, I think there's a problem. And, you know, it's just something that you would think that's really weird. But it certainly makes people think. But the fact it takes that for a woman to think, I've got a problem that I need to go and think maybe HRT might be the answer to this. I think it's getting people to understand, speak out, say your piece, and get someone to listen.

Absolutely. Gosh, brilliant advice from both of you. And thank you so much for being so open and sharing this because I know it will help many people and make people really think differently about the perimenopause and menopause. So thanks ever so much for your time today. No, thank you.

Thank you. You can find out more about Newsome Health Group by visiting www.newsonhealth.com. And you can download the free balance app on the app store or Google Play.