The Dr Louise Newson Podcast - 222 - Empowering women unheard during menopause

Episode Date: September 19, 2023

In this week’s podcast, food writer, author and award-winning entrepreneur Freda Shafi talks about her work raising awareness of menopause, and recording the experiences in the Pakistani community in West Yorkshire. Freda shares her own menopause story, and she and Dr Louise discuss key barriers women face accessing care, and ways to improve knowledge to empower women to advocate for themselves. ‘I'm a South Asian woman, I'm a Pakistani, I'm a British Pakistani woman, and I know I represent a certain demographic,’ says Freda. ‘I feel as though I can reach many women through the fact that I am from the community. That may be platforms for women like myself who are able to cascade that information and let that reverberate across those communities.’ Freda’s top three tips:  Help represent your community to spread awareness of menopause symptoms, treatments and services and help tackle the stigma that still surrounds this area. Get a second opinion if you don’t feel your healthcare professional has given you the right diagnosis. Explore the materials that are out there, including the balance app, so that you’re informed when you see your doctor.  Boost training in the menopause for community leaders so that they can signpost women to local services that can help support them. Follow Freda on Instagram @fredishafi_spiceitup  

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 I'm very excited for today's podcast. I've got with me in the studio, someone called Frida, who approached me like lots of people do

and told me about the incredible work that she's doing. And for those of you that might know, I spend a lot of my time trying to work out how to reach people who have really been unheard, have been sort of vanished from society with their perimenopause and menopause. And the more work I do, the more I realise, sadly, there's lots of those women. And it's actually, I think, the majority of women who are not able to access really good quality, care, advice and treatment. So Frida's been doing some really great work.

So I'm very privileged to have you here today at my studio. So welcome today. Thank you, Louise. It's a privilege to be here actually. Oh, thank you. So just tell me a bit about you first and your background and why you're doing what you're doing, if that's okay. As you may have gathered from some of my background information, I am a creative person who works across the cultural sector. And at the moment, I'm working in the culinary world. So everything to do with food, health, well-being and being equipped to understanding our bodies. and how we can make really the best of our health through food, through nutrition, through lifestyle.

And in the current world that we're living in, we need to be fully aware of how our longevity impacts our family and our communities. So just making sure that we are, I suppose, making the best choices when it comes to food, nutrition, and even lifestyle, and that extends to, as I say, the creative sector, the creative industry. I came across the work that you were doing, obviously, through my own journey and wanting to know more. And I equipped myself with a lot of knowledge, a lot of background. And being in a perimenopausal state myself, I felt I needed to reach out and talk to you about some of the, I suppose there are inequities that still exist. Even though there are some brilliant services out there and some great research and work, sadly, there are still.

pockets of communities that are not accessing the right care and the right treatment, especially when women of my age bracket approach menopause and are in perimenopause. Absolutely. It's interesting. When I trained in Manchester many years ago now, it was a huge ethnic minority population. And when I was working in casualty, lots of women would come in with total body pain. and they would be almost dismissed to say, well, they're on antidepressants. There's nothing wrong with them.

We've checked their thyroid. There's probably other issues at home. It's very difficult to get a history because they're not speaking English. They haven't got an interpreter with them. You know, what can we do? And I look back in horror because I know a lot of these women were either menopausal or perimenopausal because they were the right age. And I don't know how much of their symptoms were related to their hormones,

but no one even gave them opportunity to have any educational. or even to talk about it. I think that's very sad. And I think that pertains to a lot of the cultural taboos and stigmas associated with perimenopause and menopause, especially when you think that a woman's currency in many communities, not just Pakistani and Asian community or ethnic communities, but across the whole spectrum, I would imagine, a woman's currency is linked to fertility, to youth, to abundance. And sadly, it is overlooked.

not actually talked about, not even overlooked, that's probably the wrong word. It's not even addressed because it is considered almost like a failure on the part of a matriarch, on the part of a woman, and part of a family, which is very, very sad. Yeah, it's the same with so many people because when we've looked at the menopause for so many years, it's been about periods which is associated with fertility, like you quite rightly say. And because we know a lot of women are younger when they're menopausal as well at an age where perhaps they would be expected to conceive, it's a double whammy for those people that are young when they're menopausal. But actually, even when people are older, you want to cling on to your youth, if you see what I mean. But our youth should not be defined as whether we're fertile or not. But there is this identity for women. And like you say, in some cultures, it's more than others. But actually, the menopause isn't about losing. fertility and there are some women actually who have an early menopause who are still fertile. Their fertility isn't as good but they are still fertile yet they've got this shame that they

don't want to talk and we see a lot of women in fertility who've gone into fertility clinics and they have reduced fertility and everyone's been blaming their anxiety, their mental health issues, their poor sleep on their worry about whether they can get pregnant or not but actually it's because they've got a hormonal deficiency due to their perimenopause or early menopause. So there's been this misinterpretation of what the menopause actually means. And some people refer to the time after our menopause as post-reproductive health. Well, it's not actually. And that's really confusing for a lot of people. But like you say, when you've got this added burden actually of being a woman who has to be fertile, it adds a whole new dimension,

doesn't it? Absolutely. And as I said before, I'm not dismissing some brilliant work that's going on in terms of outreach and engaging more representation. There are some brilliant doctors out there like Nigat Ashraf reaching out to the ethnic minority communities through her social media platforms. But what worries me is that there are still pockets of ignorance within communities. And again, ignorance is not used as a derogatory word here. It's ignorance because a lot of the women I have been exposed to sadly have been misdiagnosed and many of them are on antidepressants. As a result of that, they are being labeled as mentally ill. And that's what probably perturbs me more than anything is the fact that they are not being,

first of all, diagnosed properly or even aware of the local amenities and resources. Even in West York, there are some brilliant resources that exist like Live UK, run by Melissa Sukia, and she's doing some great work. I spoke to her and she said, if they approach me, that's the only way I can help them. Frida and she absolutely would go in and do some voluntary work but the fact is they are not even in a position to access those services because they are not aware and just looking at the actual statistics 78% of women with from ethnic minority communities are actually still very much unaware of their menopausal symptoms and given that there isn't a definitive word for it there is a very broad

spectrum word which is very similar to the menopause you know the greek word meno pausos, which is literally everything shuts down, which isn't a very glamorous word either, but it pertains to shut down, which again is not a word that makes women feel good about their bodies and their health and their sexual health, which again should not be a taboo subject, but sadly it is and it has a cascading effect onto their families, onto their husbands and across the community and it resonates. And that's one of the reasons why I feel it needs to be addressed, even though there are some great resources out there, there are still women not accessing them. Yeah, it's very interesting and it's so frustrating, actually, isn't it? When this is

something that happens to 100% of women at different ages, of course, yet we still don't understand what's happening. And in fact, seven years ago, I used to work with West Midlands Police and we did a survey then to try and understand what women understood by the menopause and about their symptoms. And it was a very similar figure. It was about 75% of women didn't realize that their symptoms that they were having were related to their menopause. And the commonest symptoms affecting them at work were anxiety, mood problems, fatigue, memory problems.

And they'd been signed off work with depression, with headaches, with migraines. And a lot of them were just telling me that they were retiring early because they could can carry on. And this was seven years ago, so hardly anyone was talking about the menopause then. And I remember sitting in this room with these lovely officers and police staff and just saying, but you're only 50. You can't give up your job now. And we can't even go to the playground and lift our grandchildren to put them on the swing because we've got such bad muscle and joint pains. We're on antidepressants and they're not helping. And I was like, sorry, you don't seem depressed. Why are you on anti-depress? Oh, well, because that's all I could be given. And it was then that I really had

this sort of almost light bulb moment thinking, goodness me, this is to me very obvious, but people aren't accessing it. And obviously developing then the website and then the app, isn't it great? It's got a wonderful reach. And everyone says, oh, isn't it amazing Louise, you've had over a million downloads of balance app. And I think, no, it's not. There's 1.2 billion women worldwide. How do we access them and how do we enable them to find out information? Because I think women are very good, lots of communities of women are very close, but they've got to know how to start the conversation, how to open up the conversation, isn't it? And I know you've been working really hard in some areas, haven't you, to really start that going?

I feel really passionate about it because I feel if you fail one woman, you are failing a whole entire community. And within the South Asian community, there are a lot of different demographics. you have a Bangladeshi community, you have an Indian community, you have a Pakistani community. So it's a whole demographic there. And it can take one person's mindset changing for that to cascade and reverberate

through an entire community. And it can be as simple as that, Louise. And I'm on a mission, actually. I'm on a mission because I've seen generations before me. I actually have an older family. I'm the youngest of quite an older family. So I have sisters in their 60s. And I know I've actually interviewed women of different age groups and I've interviewed

women in their 60s and asked them if they would have done anything differently. And it's very sad to hear them saying, had I known about this, I would have done things very differently. And now they are on a whole spectrum of medications ranging from thyroid, right through to blood pressure and antidepressants. I was offered antidepressants when I approached my GP, but thankfully, Louise, I'd already found you. I'd already found you and I knew exactly what the protocol would be. And as an articulate Pakistani woman, British Pakistani woman, I was capable of knocking on the GP's door three times. And in fact, that's how we met because it took me three knock from the door to get my HRT. And can you imagine a woman whose language is not English, who's not very confident,

who trusts completely and implicitly what the GP is saying, which we should actually. I'm not undermining that. But sadly, even somebody like myself who is articulate and adept at getting through to my GP and armed with a whole arsenal of research and statistics, even then I was refused three times. So I think therein also lies a problem because it's still happening. And I think if we enable and empower one woman,

to knock on that door however many times it takes and if it means me going in and making sure this is happening at a pedestrian level. I'm not a clinician and I don't profess to be anybody from a medical background, but as a person who can give women a voice and enable them and maybe empower them to just, you know, keep pushing and not accept the first port of call, which sadly is always antidepressants from what I've learned from the communities and working with. And like I said, the system is still failing many women. It is.

And I don't quite know why. One day maybe I'll find out, but I really don't understand why. And I am a fellow of the Royal College of GPs, and I did speak to some of people quite high up. I won't mention any names recently and ask them where the antagonism is for my work and for menopause and why is it the women are being underserved. and one of the responses was, well, Louise, your media attention to the menopause is quite difficult

because it means so many women now are coming, asking for hormones to the detriment of other patients. And I feel really sad about that because I think if we can invest time-wise, but also economically in women in their first or second consultation, sometimes it can take more than one consultation to go through everything, but then these women will then often be liberated and not come back into the general practice or to other healthcare systems because many women, and we know that from just doing some research in our clinic, once they are better and have the right treatment and looking at treatment, when I say holistic treatment, looking at changing, improving their nutrition, exercise, sleep, well-being and hormones if they want them, then actually they don't then go back to their GP in their short term because they don't have symptoms.

but in the longer term, we know they're less likely to have cardiovascular disease, diabetes, osteoporosis and so forth. And we know that women from certain ethnic minorities have a higher risk of obesity, type two diabetes, cardiovascular disease. Many of these women have a younger menopause. We know women who are younger when they're menopausal have a higher risk of these diseases as well. We wouldn't allow women to be walking the streets with raised untreated blood pressure. or raised untreated type 2 diabetes, yet we're allowing them to have very low hormone levels with risks and symptoms affecting the quality of their life and almost being annoyed that they're coming to ask for treatment. I don't really understand that. And the more work we do empowering people,

the sad of the stories are that I hear of people being turned away. And I can't quite understand. I wish someone could tell me in a very reasonable way why it's so. awful, but I haven't heard a reason yet. Well, therein for me lies the injustice, Louise, and I think you hit the nail on the head. If a woman is misdiagnosed, then it does sadly lead to many other conditions, which you have shown to be linked to menopause, dementia, osteoporosis. All of these conditions could quite easily have been, I'm not saying remedied, but, you know, HRT isn't always the answer, but an awareness of just something as simple as diet and, you know, changes to a woman's diet when certain hormones go out of kilter.

I specialize in food whilst I'm not a nutritionist, I understand what foods work. And it's pretty common sense for me. You know, I've been cooking for many, many years where things were cooked from scratch in most instances. and I know that fresh and processed food help certain menopause conditions and it's as simple as just awareness and information in many instances which that in itself doesn't necessarily involve medical intervention. That isn't something that a woman necessarily needs to reach for, you know, the antidepressants. It's just on the first port of call it should be, have you accessed this service that is

available to you in your community. That's something I really want to do. If that's a bridge that I represent, then I would be happy to do that to signpost women from my community. And I suppose I have a special interest in my own community. I can't speak for the wider community. But having worked and being from that community myself, I understand the cultural sensitivities, the taboos and everything else I've mentioned.

But I certainly can support women. and signpost them to accessing the right health care before they go down, a slippery slope of once they're on something, sadly there are side effects, and those side effects can lead to more and more medication. I've seen it happen. I've seen it happen in the older generations of, say, for example, of my mother's generation when a lot of the women in her generation were bedridden at the age of 50 plus.

thankfully my mum's very, very well in her 80s. But she had a very different approach to it and it was more about mindset, health, well-being and food actually, which is probably where I took my inspiration from food and do what I do. But there are a lot of women who did, even at that time, and we're talking about the 80s and 90s well before you came on the scene, Louise, even less knowledge and understanding of menopause. Many women became bedridden. And I often used to wonder why. And I often used to wonder why. know now and I know lots of it, you know, a certain percentage of that would have been definitively linked to menopause. So tell us about some of the work that you've been doing,

some of the research you're doing. I know you've been speaking to a lot of people and I'm really keen to hear a bit more about that if that's possible for you. Definitely. Well, I've interviewed over 20 women. I have case studies of 20 women written down, the ones that I've found quite interesting and as I said before, quite definitive in terms of some of the really interesting points that came out. And it's a very broad demographic from very highly adept and articulate educated women right through to. And again, I'm not using this as a way to undermine women who have come from South Asia who are housewives and just as adept, but in a different way. So women who are articulate enough to access services, I interviewed them and I interviewed

housewives from certain communities who are not necessarily medically literate enough to access services. My findings are very interesting reviews because even within the more capable as in able to approach their GP confidently, even those women are not necessarily accessing the right treatment and the women in the community centres, they have been offered certain treatments but are refusing. also interviewed daughters of some of the women I interviewed to see what effect it was having in a more family environment and men as well and looking at the way men approach or don't approach or even want to engage in the conversation. So my findings are interesting. Some of the

older participants sadly said that they were felt that they've been let down by the system. Had they known about it, they would have access treatment because now they're on a spectrum of medications, which they are certain in themselves that they probably wouldn't have had to because of some of the joint pains that they're suffering, some of

the cardiovascular symptoms that some of them have suffered. Had they accessed treatment maybe 10 or 15 years ago, they wouldn't have done that. So it's almost like it's a little bit too late for them. They think, even though I'm trying to push them to, you know, have a

look and see if there are still options available to them. I'm not pushing for HRT. I'm not pushing them to go down any road other than to be more aware. But like I said, my findings are a lot of stories and anecdotes about the effect it had on their lifestyle, their marriages, their family life, right through to, as you've mentioned, some of them stopping work and feeling as they're they couldn't carry on in the workplace. The brains weren't functioning. There was the classic symptoms, brain fog, anxiety, and the husband's sadly not being very amenable or supportive to that. And the words like psychosis were being used to describe how they were being labeled by the community, by close family members. And that resulted in many of these women taking alternative

treatments, which again, I'm not a clinician, but I know that it just didn't seem to fit very well with what I was hearing. So it's quite alarming that the system has failed a generation before us. But looking at some of the younger women, thankfully, they are more aware of what's going on, even though they're not in a perimenopause or menopausal age bracket, they know from their mothers, they know from the experiences of what their mothers are going through and are more adept and probably will be more adept at accessing the services. But even then, many of them, because they're not in that age bracket or even thinking about paramedopause,

they're still very, very much unaware of what's to come. Some of them even use the word frightened, scared. You know, the idea of the menopause fills them with dread. And again, one of my roles, I feel. feel is to advocate, but it shouldn't have to be like that for a woman who is perimenopausal. And I feel it's a game changer. And I feel that there are so many things and opportunities available. If all I can do is reassure a lot of the younger women, then I feel as though, you know, there is an awful lot of value in that. I also interviewed some of the people who were running

some of the community centres. They too recognise there is a problem. Their hands are tied. It's a very political situation, as I'm sure you're aware of, Louise, when it comes to medicine. But my job is to make them aware of services outside of the GPs that exist, which I've already mentioned in West Yorkshire. We have some great resources like Live and other things, and high-profile doctors like Nigat Ashraf, who are doing brilliant things. And just seeing if they can be woven into some of the sessions, some of the workshops, some of the coffee mornings. But these gatherings usually are about lifestyle and accessing healthcare and make it a point of menopause being a very targeted thing that they talk about once a month.

I've gone in and spoken about it. And some of the perceptions that came out were very, very interesting. You know, we did post as we did some notes. And some of the quotes that came from that, I wrote them down. And some of them were quite discouraging, but some of them were very positive in the sense of that women felt empowered enough to feel like there was an opportunity for them to come back. And one of the quotes was, I'm going to start driving again. I can't believe I've stopped driving. You know, that in itself right now, it's sad because it means that a lifestyle, something that's so.

relevant somebody's lifestyle driving somewhere, somebody stopped because of the debilitating anxiety. If there is an opportunity to reverse that or address that and, you know, get that woman back, there's a bit of work to be done. So that's what my findings have revealed across a range of demographic, as I've mentioned. Which is no surprise for me because I hear stories all the time from people from all backgrounds saying similar things, but it is absolutely shocking that we're talking like this in 2023. You know, I speak to a lot of women who are too scared to go out the house. They're too scared to use public transport.

They've stopped driving, like you say. They've given up their jobs, but also their role in society. And, you know, older women often have a really pivotal place and role in society, even within families and communities to really educate and learn, and be part of something. And if they can't do it, they're losing out, but other generations are losing out. So there's so much that we need to do because there's the older generation that you say have been lost out and they're on all these other medications.

They're not too old to consider the right treatment that's individualized for them. But really crudely, and I clearly think about this a lot, having three daughters, the new generation coming in need to be educated really early. so they can make choices when they haven't become this shadow of a person that has withdrawn from society because it's too hard when you're riddled with anxiety and you're a shell of yourself and you've knocked on that door too many times to try and get help or you've received the wrong help. So it's empowering women and the work you're doing is incredible that's really making a dent and a start and we're making lots of dents in the work we do.

every day I feel inadequate about the work I do, but actually it can be amplified by us all working together. And I think that's where it's absolutely crucial that we all work together to help as many people as possible, because each of us, just helping a few, if there's enough of us, then it really gets amplified and resonates. And that seems to be what's happening, but we certainly have to do so much more work to get to certain communities. So I think your work is incredible and any of you that follow you on Instagram will see how amazingly talented you are not just, you know, with the work that you're doing beyond home and everything else, but the way that you design and cook the food, I just feel incredibly inadequate looking at some of the

you, in a while it's wonderful and it's actually a very, very calming Instagram page just to look at actually with all the craziness for everything that's going on. So there's so much you're contributing to So before we finish, are you able to give three take-home tips for those women who may have listened to this and are struggling? Or those women who think, yes, I might be able to help people in my community just by talking and how do I start or what do I do? Are you able to help at all with three tips? I think my three tips would definitely start with representation in terms of possibly seeing something that's culturally relevant. And I don't want to duplicate what's already going on because I know. that, you know, there are some materials that have been transcribed into South Asian languages.

But just to reinforce that, you know, through marketing videos, posters, I'm a South Asian woman, I'm a Pakistani, I'm a British Pakistani woman, and I know I represent a certain demographic. I feel as though I can reach many women through the fact that I am from the community, that may be platforms for women like myself who are able to cascade that information and let that, I said reverberate across those communities because if you're amenable and you're relatable, I think you will get through. If there is something that is accessible about a woman of color, speaking sense and taking away the taboo and the fear and a lot of the flawed research that as a clinician you'll know,

just dispelling all of that. But representation I think is really important that Pakistani women of all demographics can relate to somebody from their community. that is in the same space as them. I think the other very important thing is diagnosis being more considered. So when that first port of call may be getting a second opinion. So if the first port of call to the GP based on symptoms and that first diagnosis is sadly always antidepressants,

I would urge many women to get a second opinion and explore the materials I've recommended. the balance app. I'm trying to introduce the balance app into various community centres so women can chart their experiences and go to their GPs, like myself, fully armed with an arsenal of research stats, even charting their day-to-day symptoms. So the doctors and the GPs, who are much more aware now, are more capable of proper diagnosis. And then maybe finally, training, not necessarily for clinicians, but training for gatekeepers, such as leaders within the community, and they often are the community centres who look after the well-being and the lifestyle of these women who are approaching, are in the menopause or even post-menopausal.

Those women displaying classic symptoms of menopause, those community leaders should be more aware of what they are. and able to signpost them to resources outside of GP services. So to summarise representation, diagnosis and more training, I would say. Very good. And keep going with the work that you're doing and look forward to doing more together in some way as well. So I'm very grateful for your time, Frida. Thanks ever so much for coming today. You're very welcome, Louise.

Thank you for your time. You can find out more about Newsome Health Group by visiting www. www.newsonhealth.co.uk. And you can download the free balance app on the App Store or Google Play.