The Dr Louise Newson Podcast - 221 - Emma Kennedy: the menopause, the speculum and me

Episode Date: September 12, 2023

Bestselling author, screenwriter and TV presenter Emma Kennedy joins Dr Louise Newson in this episode to talk candidly about her menopause experience. Emma describes how she thought she had got through her menopause when terrifying heart palpitations and anxiety struck. After always being fearful of HRT due to a strong family history of breast cancer, a careful and detailed discussion with a GP around the risks and benefits led to her starting a low dose of hormones. ‘It's the first time I've ever cried in front of a doctor,’ she says. ‘Ever, ever. I felt that terrible. [But] Just that tiny amount of estrogen and the heart palpitations stopped in 48 hours and they haven't come back. It's like a miracle.’ Dr Louise and Emma talk about the importance of a personalised discussion between a doctor and a patient to assess whether and what type of HRT may be the right choice. Emma also talks about the lifestyle changes she has made to reduce breast cancer risk and help control menopausal symptoms. Emma, who wrote the bestselling The Tent, The Bucket and Me, also talks about her frustration with the pain and discomfort women are often expected to put up with during routine procedures. She gives a stirring call to action for the speculum – the device used in many intimate procedures – to be, at the very least, radically improved. For more about Emma visit her website and you can follow her on Instagram @emma67 or Threads @emmak67.  

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. and always inspirational personal stories. This podcast is brought to you by the Newsom 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've got someone with me who, again, I haven't met in real life, but I've been stalking from afar and watching what she's done for many years, actually.

And more recently, she's popped into the menopause space. So someone called Emma Kennedy, who met her. many of you might have heard of, very inspirational, the work that she's done. And now she's here talking about the menopause. So welcome, Emma. Thanks for joining me today. Hello, hello. Hello. Thank you for asking me on. Oh, no, it's great. So for those people that don't know you, can you just give a bit of a push-it history about who you are and some of the incredible things that you've done? I'm an author and screenwriter. I was an actress back in the day and also a TV presenter. and I used to be a lawyer, but I gave up the law in order to be a writer.

And I got sidetracked into acting and presenting and all those things. And then I sort of jacked that in in order to become a proper writer again. The book I wrote that was a bestseller, was called Tent the Bucket of Me, which lots of people have read, about my family's disastrous holidays, disastrous attempts to go on holiday, I should say, in the 1970s. And I've written for lots of. lots of children's animation series at Paddington and Danger Mouse and Waffle the Wonder Dog,

etc, etc. Great. So lots of skills. And so, yes, I mean, I grew up in the 70s, great time. And things in the 17th, when thinking about the menopause, people didn't really talk about it. They didn't talk about any conditions, really. If they did talk about the menopause, it was the change. I don't think anyone would ever use the actual word menopause, a bit like cancer was the

big sea, no one would actually say the word cancer and depression or mental health just wasn't on anyone's radar at all. So thankfully things have improved. There's a lot of people though who keep saying, will Dr. Louise Newsom stop talking about the menopause because people have had it for years. So why do we need to talk about it now? But actually, you know, the life expectancy of women is longer. But in the 70s, my mother was quite unusual. She did work and she still works now if she's considerably older than me. But a lot of people didn't work. So they could hide behind their aprons. They could sort of withdraw from society a bit. They were still menopausal. They still experienced symptoms. They were probably similar to now being misdiagnosed with things. And I see and

speak to a lot of women who are misdiagnosed with depression when it's their menopause, but there's lots of physical symptoms. And one of the things that call my eye on your Twitter was when you were talking about palpitations. And we see so many women who have palpitations. So this is a, when you're more aware of your heart beating. And it can be very scary when you're aware of it in your ears, in your whole body. And then so many women I speak to go and see a cardiologist, a heart specialist, they have various tests and told her, it's all normal. So therefore, what does a woman do? Is it, you know, it's not in her head. She's not making it up. But there's no treatment. And often and cardiologists aren't trained in the menopause,

they're not putting the two and two together. Women don't know, but it's a very, very common symptom. And we know the importance of our hormones, estrogen, but also testosterone actually on our cardiovascular system and our conducting system, so the bit that sorts out our heart rhythm and rate and everything else as well. So it's no surprise when levels are low

or levels are changing, it can trigger these palpitations. But you spoke about them on your Twitter account, didn't you? Yeah, I was having crazy. heart palpitations. I actually thought I was through the menopause. I thought I was out the other side. I'd gone through the hot flushes. These are the things that everyone expects. The hot flushes, the night sweats, not being able to sleep. Those things were sort of done, ish, ish. I still sort of had the waking up at four o'clock every single morning with sort of a thumping heart. But other than that, that was the last lingering thing. So I thought I was.

through and I was very smug about it, to be honest. And I thought, well, I've done this without any HRT, I'm a genius. I have broken the back of this and I've done it without having to take any drugs. And then the heart palpitation started and also interestingly coupled with anxiety, which I had never, ever, ever had in my life before. I've always been, if anything, a disgustingly confident person, disgustingly confident. But I was suddenly like, oh, I've just got random anxiety about this and that. It may well be that that had been exacerbated by the pandemic, but it was there.

It was definitely sort of a palpable and very different experience for me. But the heart palpitations was something that were beyond anything I could comprehend or understand, and I thought I was dying to the point that at one point I was carted off in the back of an ambulance because they thought I was having a heart attack. And I wasn't. So after I was carted off in an ambulance, I was referred to a cardiologist. And I had every single test under the sun that's possible to do. So I had the ECG. I had an ultrasound. I wore a heart monitor for a fortnight. I did an exercise test. They literally wanted to do every single test that they could do on me to make sure that I didn't have a problem with my heart. And guess what?

absolutely nothing wrong with my heart. And when I went back to see the cardiologist for my results, there was that moment where I just sat there and just thought, well, what's going on then? Because this is happening. These palpitations aren't imagined. They are actually happening. And they're horrible and they're scary and I don't know what to do about it. And luckily, my cardiologist said, I have a colleague and I'm going to refer you to her. And she was a GP that worked in a practice and they had a menopause clinic. And I went to see her and I have a very strong familial link to breast cancer. My mum died of it. My grandmother died of it. My Aunt had it. Thankfully, she's still with us. But on that side of the family, it's just breast

cancer, breast cancer, breast cancer, breast cancer. And I'm of that age that's been sort of brought up thinking, well, you can't go on HRT if you have a familial link to breast cancer. So I'd always been very, very wary of it. So I went to see the GP and we discussed this and she at first, she thought, well, you know, I don't know whether I am going to put you on HRT because of the breast cancer link with your family. But she said, but let's actually look at the risks. And I don't drink anymore. I've lost a lot of weight. I've lost three stone in weight, which I think is the single best thing you can do for yourself. Yeah. When you are post-mone. So I did classic just stuck a load of weight on after I became menoborzel. So I've lost three stone. I gave up alcohol, as I said. I

eat really well. But being overweight increases the risk of getting breast cancer way more than being on HRT. Being on HRT is about the same as drinking alcohol and I don't drink alcohol anymore. So I just thought, do you know what? I feel rubbish. I feel awful and it's got to the point where I feel like I need help because this isn't a way to live. And so I said that to my GP and it's the first time I've ever cried in front of a doctor ever, ever. I felt that terrible. And so she put me on the most minuscule amount of estrogen that you can have. I think I'm on 25.

I don't know what the measurement is. Micrograms it will be. Yeah, 25 micrograms. I'm on 25 and I do, I have the spray. So I just have that. and then I have the progesterone in the evening. And just that tiny amount of estrogen and the heart palpitation stopped in 48 hours.

Wow. And they haven't come back. It's like a miracle. Yeah, it is. And, you know, when I run my clinic and I see patients, it's the most transformational medicine that I've done because people often feel better and I know I'm investing in their future health.

And it's really interesting your comment before about thinking that you've done really well and you've avoided drugs. And I don't mean to be disrespectful, but there is this perception that if we take HRT, we're giving in, it's like a failure. But actually, we wouldn't do that with other conditions that needed treatment. You know, we wouldn't do it if we had an underactive thyroid gland. And we've sort of grown up thinking that hormones are so dangerous, they're so awful, there's so many risks that we really, really should do everything to avoid it.

And then there's this whole narrative like you say, oh, I thought I'd got through it. Well, no one gets through it because you've always got low hormones. And symptoms can often change. You know, the classical phaser motor symptoms, flashes and sweats are fairly common. They're not the commonest symptoms, but they often do go. But sometimes it can be many years. But then other symptoms can creep in. And it's the mental health symptoms that affect people.

The most commonly is what we see when people monitor their symptoms through the balance sap in my clinic, the anxiety can be crippling. It really can be very catastrophic for people. But palpitations are also a very, very common symptom. And they're often worse in the perimenopause, when hormone levels are changing. They can often be worse in the early hours of the morning. And they can be really scary. And I had palpitations about 10 years ago. And they probably were my hormones. I obviously didn't think about it then. But I got them to the stage where I was getting chest pain and shortness of breath. And quite often I'd wake up in bed.

It was always two, three in the morning. And I'd say to my husband, I think you're going to have to call an ambulance because this is now really scary because it's really affecting me. Can you take my pulse then? He's a doctor as well. And I'd already had, like you, I'd had investigations and I'd been reassured. And then you think, well, am I making it up? But I don't drink alcohol.

I don't drink coffee. I don't eat chocolate. My lifestyle is good. I've given up coffee. I only do decaf coffee now. And so you think, well, I've done all that, but I'm still getting it. What do I do? What do I do? And I just, I tried to think really positively.

Last time I went to a cardiologist, they said, look, it's fine. There's nothing wrong with you. Well, there's something wrong because I can feel it in my chest. And, you know, we've only got one heart. We need to look after it. And so actually then the symptoms did improve for me with time. But it was really starting HRT that has made a difference. And I've not had any palpitations for many years now, but it's that thing that we don't think about.

And I said to a cardiologist once, how many women do you see? He said, well, most people who come to my arrhythmia clinic, so with palpitations are women between the ages of 45 and 55. And I said, but why don't you screen those women, you know, while they're waiting for all their tests or say to them, download the app, do you think it could be your hormones? How about a trial of HRT? He said, oh, no, I don't know how to prescribe HRT. I'd be too concerned. I wouldn't know how to. Well, he's prescribing really quite toxic drugs.

You know, a lot of the anti-ohythmia drugs do have side effects. They're special heart drugs, whereas hormones are just natural hormones. And as you say, even low doses can be very transformational. And we know they have positive effects throughout the whole heart system and everything else. And in fact, the types of HRT, you're on with the natural body identical hormones. They've never been shown to be associated with the risk of breast cancer anyway. So it's sort of win-win, but it's frustrating. that women are suffering without people joining the dots, isn't it?

Yeah, it is. It is. I've also got HRT to thank for the fact that I discovered I had a polyp in my uterus. So I had some spotting, some blood spotting, but it was after I had started on the HRT and that's quite normal for the first three months. So I wasn't really concerned at all. But my GP who wanted to cross the teas and dot the eye said, We'll just send you off for a little address out.

But this is the other good thing about being on H2 is that they sort of suddenly think, well, let's go and get you seen doing sorted out and just make sure that everything's working. And I had some slight thickening of my womb lining. But then, of course, I had the thing that also I'm discovering is very, very, very common, is that I was sent to my gynecologist and she wanted to do a smear and a hystere in a hystereapy, routine hystereoscopy, and could not do it because I could not tolerate the speculum. I just couldn't do it. It was absolute agony.

And I have a really high pain tolerance level. And it was just absolutely impossible. And I talked about this on Twitter as well. And I was astonished by how many women were replying, just saying, oh thank God it's not just me every time I go and have try and have a smear it's absolute agony I've ended up sort of staring screaming at the ceiling crying in pain and you think why on earth hasn't the medical profession worked out a way of doing smears where it isn't this painful why don't people use a numbing spray for instance why is there nothing done so I have

had to go back to be knocked out. I had to have a general anaesthetic to have a smear. It's absolutely ridiculous. And then this is my second beef about, you know, if this was something that applied to men, this would have been sorted out decades ago. The next problem, when I was under, and my gynaecologist was trying to get in, she discovered I had a polyp and she needed to remove it. I have a pinhole cervix and I always operate on the basis that if the medical profession has given it a name, then you're probably not the only woman in the world who has got a pinhole cervix. So that's what I had and she did not have instruments small enough to get through a pinhole cervix in order to remove the polyp and so she had to use a nasal

polyp instrument. That was the smallest they could get. And she had to go in blind because there is no instrument that can go through a pinhole cervix. And she perforated my womb. Oh, dear. And, you know, you're warned in advance

that that could happen. But that probably wouldn't have happened if there was an instrument available to gynecologists which they can use for pinhole cervixes. It's absolutely nuts. They can go in with cameras down the smallest, tiniest veins to fix things in lungs. They can do all these things, but they haven't even thought to make instruments small enough

to either make smears comfortable or to operate through pinhole cervixes. It's unbelievable. And the situation now is that my gynaecologist has basically said to me, if you get another polyp or we have to go back in there, actually it will be easier to just have a hysterectomy. And you think, really? Really, I have to have a whole hysterectomy just because there isn't an instrument available

that is small enough to go through a pinhole cervix in order to remove a polyp. It's madness. It is madness that, you know, in 2023, women are suffering. And I did a little survey just on my Instagram a few months ago asking how many people found smears painful and it was a really high percentage and then would people not go and have a smear because of the pain and it was over 50% said they would not go again and

we know that symptoms related to sort of vaginal dryness, soreness, affect around 80% of women who are menopausal yet some studies have shown only about 8% received treatment and so there are a lot of women who are just giving a few weeks of vaginal hormone preparations before their smear can actually be really transformational because then it's not uncomfortable, it's not painful, the tissues are softer, they're more lax, they're easier. And, you know, there's very few indications where you have to rush and do an emergency smear. You can wait a few weeks for this treatment and then usually people carry on with it. I'm on what I like to call vaginal training now, using dilators to try and sort of turn

my delightfully tight vagina into a windsock. But I don't like the peceries, the vaginal peccaries, because they give me discharge. And so I'm just going to stick to the dilators now rather than using the pezzaries because every single time I use the peceries, I just get discharge. Yeah. And some people do get discharged too. I mean, there are pezzaries, there are vaginal tablets. There's creams or gels, which some people find messy.

really good ring called esterine, which literally just stays in the vagina, usually for three months. And it's just a little silicon ring with some hormone in. It's just a very slow release. So a lot of people find that really useful as well. But also having systemic HRT, changing the dose, sometimes adding in testosterone, because we've got testosterone receptors in our vaginas, our vulva, all around as well. So sometimes having testosterone can really make a difference. So there's lots of choices and what I spend a lot of time my patients making the consultations very individualised. So what suits you and what suits your best friend or your sister or your cousin or whoever are going to be different. We're all made differently. We all look different. So of course our anatomy is going

to be different. Our response to hormones, the way we absorb them is going to be different as well. So it's really important that people are given individualised consultations but also reviewed regularly because sometimes what suits someone now isn't going to be the same in three or six months time as symptoms might change or develop or, you know, requirements for different doses of hormones might change as well. So what was your, the response to you tweeting about your palpitations, but also about problems with smears? You know, it looks like you had a lot of engagement from people.

Were you expecting it to be quite so big? No, no, not really. I mean, I get quite high engagement, but it was massive. and I was really shocked by it because it's that interesting thing, isn't it? I thought I was experiencing something that was a bit unusual and it turned out it's not unusual at all. There were hundreds, hundreds, if not thousands of people, replying

and just saying, I absolutely hate having smears done, never offered pain relief. There were lots of people worryingly saying, you know, I haven't been in 20 years because it was so bad. and I won't go back. And you think about the ramifications of that for women, especially sort of as we enter menopause and beyond. You know, I'm afraid, if you're listening to this,

that you reach a certain age and you are going to be constantly, or if not constantly, but on a regular basis, you're going to have to have someone, you know, staring up the red carpet. And there's got to be a way of doing it that's not agony. Absolutely. So I'm hoping that regular use of the dilators is going to make a big difference, but we'll have to wait and see. It's very sad, isn't it?

I expose myself to a lot of women through my social media platforms, and I'm really shocked with the stories that I hear. And when I started my Instagram about seven years ago now, I just did it really just to try and use another platform for people to be educated. And I would have thought seven years later, things would be easier and people, they'd be left suffering. But the stories that I hear, I haven't got any better. In fact, a lot of them have got a lot worse because women now seem to understand more about

the menopause. So they're asking for more help, but they've been pushed back more. Can I ask a question? Yeah, of course. Is there a reason why numbing sprays aren't used when you go in for a gynecological exam? Is there any good reason why they're not used? Yeah. One of, there's a couple of things.

We do sometimes use numbing spray or gel to numb the area of people who are in, have discomfort, which is really important. What we wouldn't want to do is numb an area that would cause any trauma that you wouldn't know about. So say, for example, I've seen patients who have been comforted, menopausal or perimenopausal, they've got a lot of atrophy sort of changes. So the tissue of the vulva and the vagina is very thin, very friable. it would be incredibly painful, of course, to insert speculum.

But even if they were completely numbed, it actually might cause some damage to the tissue. So those people, I would say, I'm not even going to examine you, let alone put a speculum in. I'm going to give you treatment to improve the tissues, everything else, and then I will review and then have a look and see. So what I wouldn't want to do is to cause trauma or damage, even if it wasn't causing pain, if that makes sense. but for those people where it's uncomfortable, then absolutely, then they should be able to.

And it's the same when you put coils in, so like the marina coil, some people need to have more numbing than others. And people are different. It's a bit like when we go to the dentist, isn't it? Sometimes, you know, we need lots of injections to dumb, and other times it can be a bit of that gel, and you're fine. And it depends on the procedure that's being done. And that's where it's really important that women are assessed properly. And also, we know when people are more anxious they're more worried, their pain is going to change as well. So a lot of women tell me that they feel completely traumatised by the way that they were examined. You know, they had to strip off without a screen or they didn't have a chaperone or they just

weren't explained what was going to happen. And so, you know, to have any invasive procedure or even just being examined is a very intimate examination. It's a very intimate thing. So you've got to feel at ease. And I think for my job as a doctor who's going to examine something, someone is make sure that the patient understand exactly what's going to happen, they feel comfortable before they're taking down their pants and getting onto a horrible pouch.

But it's also important to know as a patient that if an examination begins and you can't tolerate it, you can just say, no, I can't do this and we're going to have to come up with something else before we can do this again. Yeah. And that's really important. But I think a lot of people, when they go into a doctor, they just do what the doctor tells them. You're absolutely right.

And there'll be women who just lie back and stare up at the ceiling and are clenching their fists in absolute agony. But no, you can stop it and say, no, we're going to have to reassess. And that's so important. And it's really important for us as doctors to not just look at the bits that we're examining, but also look at the patient's face, look at their body language and make sure that they are allowed to, like you say,

be in complete control and stop. And I feel really sad when women feel that they don't have this voice or they're not allowed to say. And it's really, really important that patients are in control of everything that they do, actually, any examination. So not just an internal examination. Really, really important. And also knowing the reasons for why they're having something done as well. And this is where consent is really important, but knowledge as well. So people feel completely in control.

And it was interesting. I mean, I see quite a few people who have had cancers before, especially of their vulva, their vagina, their cervix. So they've had radiotherapy, they've had chemotherapy, they've sometimes had surgery as well. And they get a lot of scarring and you can imagine really uncomfortable. And the lady I saw recently, I said to her, would you like me to examine you? And she said, oh, are you allowed to? Is that all right? She said, I've been going to the clinic for the last two years and no one has ever examined me. And I don't know what it should look like down there.

I've got a mirror, but I don't know whether it's normal. And for me, just literally, I didn't insert anything. I didn't use a speculum. I didn't examine him internally myself. All I did was look and talk through. And I could just see her shoulders come down about six foot. And she was just calm because somebody could just talk through something with her. And you forget sometimes as a doctor how important speaking and reassuring

and just going with the patient's expectations. and then, you know, the next time I saw her, she knew me better, I knew her better, I could do an intimate examination and it was a lot easier. But going at the patient's pace, I think, is really important. And it's one of the first things that I certainly learned as a doctor to listen to your patient. And I think that's so crucial because otherwise you're not in control, are you as a patient? No. And again, I'm going back to why on earth are we still using medieval instruments that hurt like,

Heck, speculums, I mean, surely, surely there is something better than a speculum or way smaller than a speculum in order to do smears and anything else that needs to go up there. I mean, you know, come on. We've got fibre optics now, lads. They can get things up on things as thin as a thread. Yes. I mean, can you imagine if men had to have speculums shoved down their penises, you know,

it just wouldn't happen. would it? If men were experiencing the pain that women have to go through when they're having a basic medical examination, there would be pharmaceutical companies falling over themselves to invent and create the patent for whatever it was, wouldn't they? Absolutely. You're totally right. There's a lot we need to do. And I'm hoping this conversation will just get people to think and reassess and hopefully think about how we can change and improve things for future generations of women, because that's what a lot of my work is about, is improving the health of women, not just now, but for the future as well. So I'm really

grateful for your time today, Emma, and for being so revealing, actually, about your various symptoms, which hopefully are improving and will continue to improve. Before we end, I always ask for three take-home tips. You've given people lots of tips already, but three things that if people are either suffering from palpitations or pain or discomfort when they have a spectrum examination or just have symptoms in general, what three things would you recommend that women should do? Give up caffeinated coffee and go decaf, give up alcohol. And you might think that that sounds absolutely terrible. But trust me, I used to love wine. I loved it. And I now don't miss it at all. And a really good trick.

about giving up alcohol is there are loads and loads and loads of really good non-alcoholic alternatives now. There's really good non-alcoholic beers. There's really good non-alcoholic like gin and tonic. There's a really excellent fin and tonic you can get. And what I've discovered now, because I wasn't an alcoholic by any stretch of the imagination, but I was a habitual middle class drinker. But what I have discovered is that if you find yourself a not unalcoholic drink that you only allowed to drink after six o'clock, then you can trick the reward centre of your brain that that is your treat in the evening in the same way that a glass of wine was a treat in the evening. So that's my second tip. And number third, it's lose weight.

Very good. So lifestyle is so important. And those are the three things that you are in control of and you can make proper really healthy, sensible change. and your menopal symptoms will improve. Very good. So thank you very much. It was sometimes easier said than done, but certainly worth trying because it can make a huge difference

for so many people. So thank you ever so much again. It's been really lovely talking to you today. So thank you. Thank you. You can find out more about Newsome Health Group by visiting www. com.com.

And you can download the free balance app on the App Store or Google. play.