The Dr Louise Newson Podcast - 236 - Menopause in overlooked communities

Episode Date: December 26, 2023

This week Dr Louise is joined by Dr Ruth Beesley, a GP who works in central Peterborough and who specialises in working with the homeless, those with alcohol or drug addictions and vulnerable women who engage in sex work. Dr Ruth talks about the challenges vulnerable groups of women face ­and how their trauma can act as a barrier to accessing the healthcare they need, both in general and for the menopause. Passionate about reducing health inequalities, Dr Ruth tells us about her outreach clinic and a new mobile bus clinic, both of which allow her to reach more women. Finally, Dr Ruth shares her learnings on working with hard-to-reach groups and reflects on the three things that have made her job so rewarding: Giving women the confidence to believe that they and their health really matters. Listening and seeing people's story – people are more than just a set of symptoms, they are a whole person. Being part of someone's life at some of their most vulnerable times, and they share some of that vulnerability with you, is a huge privilege as a doctor. Click here to find out more about Newson Health Group

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 in this week's podcast, I've got someone called Dr Ruth Beazey with me, who I spoke to a few weeks ago now. She's a fellow GP and has a really, really fascinating and interesting

and I think very rewarding job as well. So she's kindly agreed to come and talk about everything today. So welcome, Ruth. Thanks for joining me in the podcast. Hello, Louise. Nice to be here. So I spend a lot of my time thinking about how to help people that will never come to my clinic, that they'll never probably go anywhere and get the right help, treatment, advice that they really need and deserve.

And many years ago, some people might know, I worked in a prison for a week. And I've still got my notes, actually, from that week. It was one of the most harrowing, hardest weeks that I've done. done as a doctor listening to these stories and thinking about women. And as a GP, it was a real privilege. I worked in quite a deprived area, going into people's homes that I'd never meet socially, you know, seeing how people live, listening to stories and realizing how lucky I've been in my life that I've never been abused. I've had warmth. I've had love. I've had attention by not just my family, but my friends. And I've had a good education as well. I've got a lot to be grateful for. But

people aren't as fortunate, but they all deserve to have the same advice, support, treatment for whatever condition. And so you've spent a lot of your time and you still do reaching a lot more people than I've ever reached. And so I'm really keen to hear more about your work if that's okay, Ruth. Yeah, so I work in a busy city centre general practice. And a few years ago, we realised that actually there was a lot of people out there that just weren't coming into the doctor surgery. And they were living with... awful symptoms and illnesses, but for so many reasons, there was just barriers to them accessing the service. And we kind of, you know, I came to realize that actually often the services we

design, we develop, they work for us and they don't necessarily work for some of our patients, particularly, you know, thinking of people who are very busy, who work long hours, who don't have access to smartphones, who maybe don't speak English, can't read and write, have literacy issues, women who are in abusive relationships, dealing with addictions, mental health problems, all these huge numbers of factors that can make actually trying to get an appointment with your doctor even more difficult than it already can be for some people. And so they just don't prioritize it. They don't prioritize their health.

They live with symptoms that are gradually getting worse and worse. And we know that often they get sicker, they end up in hospital more, and they die younger. So the practice I work at and myself, we decided to try and do something about that. So we initially started doing an outreach clinic, particularly for the homeless population, those in temporary accommodation. And from that grew at a specialist women's clinic, which we called Wildflowers Clinic. And that is particularly aimed at women who are struggling with mental health problems, with addictions, particularly drug and alcohol addictions,

who are facing homelessness or living in bed and breakfast accommodation. who are often victims of domestic violence or sexual exploitation, and they are just extremely vulnerable women. So we set up a specialist clinic to try and meet them where they're at to meet their needs, and particularly looking at things like their sexual health, psychosmear testing, and issues such as menopause, which they know very little about and are very unaware of often. It's so interesting because so much of this is actually, interwoven and it's all together and in medicine we can be very compartmentalised really and think about mental health or physical health or think about like you say drug addiction or people have been abused and

you often don't always think together and even when I did psychiatry actually I did a project about abuse and eating disorders and a lot of it can be really linked and it was only actually when somebody spoke to me and because as a medical student I had an hour with somebody and you know you really get to know them don't you want to have a long long period of time and it was this lady who'd had an eating disorder and she had bulimia and then actually she said well of course it's because I've been abused right at the end like 57 minutes into my and I was so young and naive and I was like what and she said well yes there is evidence that people here and she was telling me you know that there's a lot of people that I've been abused at actually having eating disorder and that's this cycle.

And I was thinking, oh my goodness, there's more. I was just concentrating on, you know, how many meals do you eat and how many times do you make yourself sick and, you know, what's your body image? Because they were the questions I had been taught to learn. Suddenly, I'm asking about her mother's ex-partner and the things that he used to do to her and how it would be. And then it's then that you think, goodness me, actually, no wonder this poor lady has developed and all these things.

And it can often have such a big, impact, like you say, not just on her immediate family, but the community around her and how then she tries to develop and lead her life and then her knowledge as well. And actually, the project that I wrote ended up being a lot longer. And it made me realise the power of time, actually, with people. And I was there as a very young medical student. She knew I had no power to treat her in any way. But she'd never spoken to anybody at any length who she could trust. And I thought, wow, actually, what an incredible job I'm going into where you can have that time where, and I'm sure you hear it's a lot, people will tell you things that they probably

haven't told others. Yeah, definitely. I think one of the things that I've certainly learned when I'm talking with patients, particularly when they're in these kind of situations, is rather than the kind of very traditional doctor approach of, you know, what's the matter with you, what's wrong with you, to try and think actually what's happened to you. Yes. And we're. And we're not. And what's your story? And then you get, like you say, you get so much more and so much then starts to make sense. And you can understand then where some of their fears come from, some of their anxieties around authority, around filling in forms, around giving details, all these kind of things that can be really quite traumatic for some people.

Yes, and it's very revealing, isn't it? And I was reading a really interesting book, actually, from the 70s last weekend. And it was actually about PMS, premenstrual syndrome. And there was a lot of debate about whether it should be a disease, whether it should be an illness, the ethical and the moral side behind it as well. And they were saying about labelling of all these different areas for the same condition and how it can really change patients and people's perceptions. And then they were comparing things like drug addiction, which fits lots of almost criteria that is drug addiction and illness, is it a disease? Is it illegal? Because a lot of people are taking illegal drugs and then some people obviously do end up in prison. And how did society

define those people? Do they feel sorry for people who are drug addicts, for example, or do they blame them? Or do they, are they cross because they're committing a crime? And what about the psychological and the mental health issues of these people? Or what about, and it's like you say, it's so interesting. But for that person, they don't give a flying monkeys, whether they've got a disease, or illness, whether they're committing a crime, whatever. And so much of it is situational as well, isn't it? They didn't choose to have that life. But so many people, it's sort of almost repetitive behaviour,

their parents, their grandparents, their aunties, or whatever. And it's not being able to escape and move away, isn't it? There's a lot of people that don't want to have the life that they have. And they really, really want to be healthier, don't they? or maybe change, but how do they start when there's so much going on? I think a lot of people I've dealt with have been so much stronger and have the most amazing personalities that have just been undervalued. Yeah, absolutely.

That's definitely my experience is that actually the women I work with who struggle with addictions, there is nearly always significant childhood trauma, significant mental health, significant abuse, and they are such incredibly strong women. to actually get through every day and try and fight and try and get help is really, you know, they're really strong, incredible women who are just having to deal with this chaos and this, you know, trauma. And, you know, they do sometimes feel judged when they go into various environments and settings, you know, and I think, you know, when I speak to them and spend

time with them, what they tell me is they already feel bad enough themselves. they're already angry and frustrated with themselves and, you know, desperate for help, but actually help is pretty hard to come by. So, you know, it's really good when they do come to the clinic. Yes. And we run the clinic in a really relaxed way. So it's a bit like a kind of a coffee afternoon, really. We do tea, coffee, cake. We kind of have like a, you know, silenatory products that are kind of donated and things and create that environment where there is some peer support. They can support each other. They can talk to each other. We have. drugs and alcohol workers there who can chat to them and try and support them to get the help

they need and then we kind of get them into the room and get the medical bits done but actually those bits are actually quite a small bit sometimes of what a positive experience that can be particularly around building trust and building relationships and hearing their story and then understanding them better absolutely yeah and I think a lot of people don't realize as doctors I certainly feel very strongly that I'm not here to judge anybody You know, we've all dealt as healthcare professionals with people with, with addictions, with all sorts of lifestyle behaviours that we would never want ourselves, but I never will judge someone or undermine them or not value them or not treat them in the same way as I would somebody else because there's always a reason. And I think also as healthcare professionals, we're not shy at asking questions. And also people know that what they tell us is confidential.

And I think that's really pivotal, isn't it, as well? that we do have this sort of art skill of being able to tease out information that maybe others haven't asked before and certainly even in the clinic. Just something as basic really asking about libido and sex. All sorts of things come out actually and people have not even, often say, no one's ever asked me before. And it's quite straightforward if someone's in a heterosexual relationship with one partner, then it's really just talking in that way. But then I've asked other people and it's

unasked all sorts of abuse stories or all sorts of things that you just think, goodness me, if I hadn't asked a simple question, you know, things don't develop, do they? And my experience with these women is they like to be asked. They like to tell their story. They like to feel that somebody is actually interested. And I think people often feel quite anxious or nervous about talking to people who've experienced trauma, talking to people who are going through very difficult situations with, you know, domestic violence or addiction problems. But actually, these women, they like to feel heard. It's important. They feel heard and valued. Yes. Absolutely. I think being valued and not being judged, really important. I spoke to someone on Sunday,

actually, who actually had messaged me with some awful thoughts that she was having in her head. And she had all sorts of things that had happened in the past, but she'd been sexually, used by her father, even after she was married, and he only died two years ago, and she's 53, and the sexual abuse had carried on, but she was very matter-of-fact about it, because that's what she knew it was wrong, and it was a real relief when he died. But obviously, on the Menopause podcast, we need to talk about female hormones, and I do feel the impact of our hormones on our brains for a lot of women can be really huge and very common symptoms that I hear in our clinic are this low self-esteem, this feeling of reduced self-worth. You know, I deserve to feel like

this. I really am just a shell of myself and I have no confidence anymore. And for some women who, you know, a CEO's of a massive organisation, obviously that really can affect them at work. But for women who have been subject to abuse or do have a alcohol or a drug addiction, they're going to feel even more worse, aren't they? And how do you diagnose that and how do you recognise it and how do they recognise that there may be a hormonal element? And also a lot of these women, if they do abuse drugs or alcohol, often their periods will stop or they'll have an eating disorder and their periods will stop. Or they're on drugs, some of the antipsychotic or antidepressants or contraceptives will block hormones.

is working. And it's this whole chicken and egg, how do we as healthcare professionals pick up those ones? And I'm not just talking about menopause. It was easy. This lady in her 50s, she was clearly menopausal. But what about women in their 20s and 30s who may have PMS or PMDD or be perimenopausal or have an early menopause or P-O-I? How do you think, Ruth, we should be picking these women up? Because I really worry about them. Yeah. I think it is difficult. I had a lady in my clinic recently and kind of she was using the sort of early 40s now and kind of reviewing her notes, chatting to her. She had actually had, you know, gone through her menopause in her 20s and had never had any treatment. And actually her life had become actually increasingly more broken from that point

on in that she had developed more mental health problems, ended up sleeping in a tent. Her husband had passed away, so life had got extremely difficult. But actually, she'd never been really spoken to about her. early menopause about the effect of hormones on her mental health and how she was feeling and also obviously the sort of the physical risks of not having had any any hormones for that period of time so we know it's out there we know it goes on but as you say there's a whole group of women I work with who don't experience the classical menopause symptoms because of other factors affecting them in terms of mental health side effects of drugs side effects of medication

side effects of poverty, of malnutrition, of all these other things that they're dealing with. So I think as healthcare professionals, we need to be much, much more alert to acknowledge you that, recognising it. Also, I think from the point of view of education, these are women who, you know, don't know very much about menopause. And I think it's absolutely brilliant that we have a society now where menopause is much more spoken about. There's a lot more media coverage, there's a lot more information available or all sorts of different formats. but actually for these women, there's still very little knowledge. And I kind of, I think when COVID first happened, we were kind of, you know, you couldn't not know about COVID, except my homeless patients didn't know about COVID

because they weren't watching the news every day. They didn't have a smartphone. So we were having to educate them. And I think it's similar with menopause, actually. We assume that basic knowledge that it's actually sometimes not there. Because they had no relationship with their mother. They don't have siblings, they have relationships with. Yeah.

I was doing some training a few years ago now. There were some doctors there who work in a city of Manchester in areas of deprivation. I said, well, what about the menopause? Louise, it's not a priority for us, the menopause. We are dealing with chronic mental health. We're dealing with hypertension, obesity, diabetes. We cannot deal with the menopause. And I just thought, oh, really, actually, we need to be thinking more of how it is associated

with these chronic diseases. And we know the longer the woman is without her hormones, the greater the risk of all those chronic diseases and the diseases of deprivation are the chronic diseases. They're the inflammatory diseases, aren't they? They're the heart disease, you know, diabetes, even osteoporosis, but certainly mental health issues. And we know that for so many women, their mental health is worse when the hormones dip. And, you know, I'm not just interested in the menopause and perimenopause, this PMS, this change that occurs. And, you know, I was reading some papers even as earlier as in the 50s, showing that women are more likely to undertake a crime or be admitted

to a prison and be arrested in the days before their periods. And Catherine Adelton did some amazing work looking at this. But why aren't we looking at it? Why aren't we addressing it? And I'm really obviously not saying that everybody's issues will be solved by hormones. That would be completely naive and wrong of me. But in the same way, if these women were hypertensive, we would give the medication to lower their blood pressure, can we not consider giving them estrogen, but also testosterone, our audit data of more than 1,000 women, show that their mental health improvements are more statistically significant

than their libido improvements. My clinical practice every day sees women who are mentally, and also physically, they're sharper, they're more active, you know, on testosterone. And how many women are not having, you know, we don't know because no one's done any studies, but I would much prefer as a woman to take hormones than I would to take a psychiatric medication. I think the women that I'm working with, particularly,

the effect on their mental health has a magnified impact on their ability to cope with what's already a really difficult life, you know, already trying to sort out finances, trying to sort out food, trying to sort out housing, dealing with all those constant hurdles, when you haven't got access to a phone, you maybe have poor literacy, all those things I mentioned. And then you get another whammy of your hormones. Yes.

You know, very low, feeling even less motivated, feeling even more anxious, feeling even more that you want to just bury your head and shut the door and not engage with the world that was already scary. It just magnifies all those problems, yeah, because people get distracted. And absolutely. And also, we know things that memory can be affected and cognition. If you're having to fill out a form or go and speak to someone about your housing and you can't string a sentence together, you can't remember words, you can't remember your date of birth, you know, that actually has a really big impact as well.

But I remember a lady many years ago who'd become housebound with her crippling anxiety because of her menopause. And she had access to the internet, but she ordered lots of things over the internet. So when I said, what medication you want? She said, well, are you any supplements? Anything you buy? She was, oh yes. And she brought two carrier bags with her.

to the clinic. And she tipped them out. I've never seen so many supplements. Some of them were labelled menopause, but a lot of them were just all sorts of other things. And she was just desperate for help. And then when we put all those in the bin, she took her own hormones vac. She came back and she said, I want to thank you because I've left my husband. I said, I'm sorry. I don't know why you're thanking me for. She said, I have been in an abusive relationship for 25 years. And she said, I've just been so submissive, I've just done everything that he wanted and more, I'm basically, all I am is a paid cleaner and prostitute for him. And it's been horrendous, but I've not been able to do anything. But she said, now I've got the confidence, I've got the knowledge that I can live on my own,

and I've got the independence now. And I've just stood up to him for the first time and confronted him with all this abuse, physical and sexual that I've had for so long. I just want to thank you because now, and now she actually lives a bit in Spain. She's been doing all sorts. And it's been so rewarding watching her, seeing how she's changed and improved. But it's also been so incredibly frustrating for me, thinking about how many other women are in those situations and don't realize and how easy it was for me to just give her some hormones.

So she can do it from within. And obviously, so much in medicine is multifactorial. It's not just a treatment or not. but actually I was able to listen to her, to be able to support her, and everything just pieced together. And her whole life has really changed over the last seven years, and it could have been very different. And I spend a lot of my time worrying, but I think it's necessary worrying because there are so many neglected people out there, aren't there? Yeah, there are. And their lives just get increasingly difficult and they feel more and more disempowered to change things.

And I think recognising the hormonal component in that is hugely important. But it means thinking about it, asking the questions, continuing with that kind of health promotion and understanding and education around menopause, which are different groups, like, you know, I was talking at the beginning, you know, about going out to these populations that we know don't come in. Yes. And actually recognising there are, you know, pockets of women out there that really don't know anything about menopause at all. Absolutely.

And so before we started recording, you were telling me about a new project. So I'm really keen to talk to you about it on a podcast. And I'm actually very jealous, Ruth, because when I started the clinic five years ago, my poor finance director who struggles because we give so much as an organisation away to the free balance app, to our education, to our research. And I said, I've got this idea, Katrina. She said, oh, what now? I said, I really want to have a menopause bus. I want to have a news and health bus that can go into areas of deprivation. It might not be a clinic, but we can catch it out for a clinic so we can do blood tests, we can examine people if we need to,

but it can be an awareness and we can rock up outside Asdae into areas of deprivation. She said, Louise, you've only just opened the clinic, I really just think we need to put this on a back burner. And you've just told me that you've got a bus, and I'm now very jealous. I'm not a jealous person, but I am jealous of this bus. So tell me a bit about it. We've got a fabulous new bus that arrived last week. It's a mobile clinic. It's a clinic room on the back of a bus that can go out to,

where populations are. And it's primarily aimed at outreaching to the homeless population, to those that are living in hostels, bed and breakfast accommodations. And we know there's lots of people out there. There's lots of families out there. There's lots of women out there that aren't accessing services, don't come into doctor surgeries, don't come into day centres, things like that. So this is about actually taking a clinical room and a doctor or a nurse. We're also going to look at having things like podiatrists and physiotherapists on the bus and going out to where people are. One of the things that I said when the bus was being designed that we absolutely had to have was an examination couch that I could do smear tests on.

So we can do smear tests on the bus, which I think is really important. Yeah. No, I've still got pictures of mine. It's all been branded and we can see because, so it's done as a clinic. And, you know, I really, with our education program, we're putting it under a not-for-profit, which will soon be a charity. So all our money will be recirculated. And for me, this is an area that if we've got some money,

I would love to do it because it's reaching people. People won't always come to the clinic. They won't always come to see the GP. They won't go to see a healthcare professional. But if they're there and they're stumbling over them, then they will. And they'll go with others. And people learn from their own a lot more, don't they as well? And I think that's really important.

Yeah, absolutely. And I found that with a couple of women who have, you know, sprained up menopause and who've actually started on, you know, on hormones. They're very keen to, you know, talk to other women, women who are, you know, in the hostels out on the street and show them the patch that they've got. And talk about it and talk about how accessible it is and how, you know, easy it is for them to use, even with quite chaotic lives. We can tailor their hormone treatment to meet the needs and to meet how their lives are, you know, to make it as easy as possible for them to manage their treatment. But yeah, women talking to other women about their experiences, particularly women who share their experiences, share their background stories.

understand where they're coming from. I think it's really powerful. Absolutely. I think we do have an edge on men in lots of ways. One of it is we're very good at talking and sharing and allowing people to learn from each other and a lot of in my bus that I eventually will get. It doesn't all have to be healthcare professionals there as well. So, you know, sharing knowledge with those that have first-hand experience is often, like you say, really, really powerful. And I know the work you're doing is incredible. And wouldn't it be great if we can maximize and do we, more because obviously you're only working in a small geographical area. But I'm very grateful for your time, Ruth, because just in this half, and now I'm hoping people have listened will be

thinking in a different way about people, absolutely not judging people, but thinking in even small ways how we can all help in society to really help because there's a huge amount we can do. And hopefully people have just maybe thought about things in a slightly different way. And we can take this conversation further. So I'm really. interested in going forward and seeing how things are in the future. So, but before we end, I'm very keen, obviously, for three take-home tips. So three things that you think have made the biggest difference to the largest group of people with the effort that you've done and the work that you've done, the most rewarding things, really, that you've done reaching these women.

Oh, it's tricky. It is definitely the most rewarding part of my career, without a doubt. And I think that certainly giving women the confidence to believe that they matter, to believe that their health matters is really important. I think listening and seeing people's story, not just a set of symptoms that are in front of you or a drug addiction or, you know, another issue, but actually seeing that as part of a whole person and a whole person that has come from childhood. And I think Oh, a third one. I think, I guess personally, it's just really exciting to do a job where you get the privilege of being part of someone's life at some of their most vulnerable times and they share some of that vulnerability with you. And that's just a huge privilege as a doctor. Absolutely. I totally agree. And I think it's so interesting. Someone said to me a while ago, which is so true, that medicine is a science and an art and the art is individualizing. care and care means a lot, but it's also about listening.

And it's really looking after that person, thinking of them as a person, not a patient for a lot of the time, which sometimes gets lost in medicine, actually. So I think stripping it back to the basics and remembering, which I do every day, what a privilege it is to be a healthcare professional is really good. So don't lose the work that you're doing. Keep going and we'll look forward to talking to you again. But thanks over so much for today, Ruth. It's been really interesting.

It's been great and I'll let you know how the bus goes. Oh, yes, thank you. Thank you. You can find out more about Newsome Health Group by visiting www.org and you can download the free balance app on the App Store or Google Play.