The Dr Louise Newson Podcast - 246 - Postnatal depression, PMDD and menopause: Wendy’s hormone journey

Episode Date: March 5, 2024

Content advisory: this episode contains themes of suicide and self-harm Joining Dr Louise on this week’s podcast is Wendy Barker. Wendy experienced postnatal depression after the birth of her first child in the late 80s and was later diagnosed with premenstrual dysphoric disorder (PMDD), a very severe form of premenstrual syndrome. ‘For probably three weeks of the month, I was like a coiled spring,’ Wendy recalls. ‘And the only way that I would get anything sort of relief from that would be to either rage, scream, shout, and then there'd be the tears. And then I would think that's it until it starts all over again.’ Wendy movingly describes the impact of PMDD on her physical and mental health and her relationship with her family, her fight for a diagnosis and ongoing access to treatment, plus her advice for others in similar situations. You can find more information about PMDD in Dr Louise’s book, the Definitive Guide to the Perimenopause and Menopause. And you can listen back to episode 216 of the podcast with Dr Hannah Ward on progesterone, PMDD, postnatal depression and menopause. Click here for more information on Newson Health. 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 my podcast, I've got someone with me who I've only recently met actually called Wendy, who very kindly has agreed to record this on a Sunday morning and talk about her experience so we can.

really help others think about hormones, not just due to perimenopause, menopause, but actually for younger people as well, thinking about PMS and PMDD, which will explain what they are in a bit. So welcome, Wendy, today. I'm really grateful that you're here. Thank you for having me. Well, we just started talking last week. And the words that you said resonated so strongly with me. And the more work I do in hormones, the more I'm seeing women and listening to women who have been experiencing symptoms for many, many years. So women who I see in my clinic who are menopausal or perimenopausal tell me how they've been struggling for years, but the symptoms were only a few days before their periods and then it became more than a few days,

and then it became longer and longer. And then often when I give them the right dose and type of hormones, they come back and go, yeah, that's great, but actually it's so sad because I could have been treated years ago. My life has been blighted by these days that have haunted my life. And I've sat there thinking, oh my goodness, no one taught me about PMS and PMD. And there's this still debate with premenstrual syndrome and premenstrual dysphoric disorder, which is a more, as you know, extreme form of PMS. No one taught me. And as a GP, I was actually taught, just give women antidepressants for those few days that they feel bad. And it wasn't, and I saw someone, I was sitting in the clinic of Professor John Studd many years ago, and he had treated a lady who

came back in a review, was feeling absolutely wonderful, really young, and she wasn't menopausal, but he had given her HRT. And after she left, I said, John, why are you giving her hormones? And he said, because she's got PMS. Can't you see? Her life's transformed. She's just using those hormones on those few days where she's been feeling awful. And I sat there, and I was really, wow, it's like this light bulb moment. It was so obvious. that you're just treating the underlying cause, but no one had taught me or given me the confidence to do it. And from then on, it just made me realize more and more

how in medicine we can be hoodwinked, and I felt I had been hoodwinked and cheated of this information. So now, obviously, I'm on a mission to help people understand more about hormones. But so, and I know you're nodding, because you've had many years, haven't you? Do you mind saying how old you are now? I'm 54 now. So you must be menopause that I presume or nearly menopausal age 54. No disrespect.

Yes. Pretty much I started bang on 51, I think, probably before that. But because I was already on estrogen, I didn't know. And I thought stupidly I would sail through menopause without an issue. Sadly, that's not been the case at all. No. So you've had hormonal issues through many years. And it's interesting, isn't it?

Because when we talk about hormones, we're only talking about three. hormones, estrogen, progesterone, testosterone, and they're labeled as sex hormones, but they're not really related to sex, and they're not even gender because men have the same hormones as women. But anyway, these three hormones vary throughout the menstrual cycle, and many of us know that when we ovulate, produce, an aid, we have a surge in estrogen and progesterone, and the second half of the cycle, if we don't become pregnant, of course, the body then reduces estrogen and progesterone, and just before the periods, those levels of the cycle. of those hormones are really, really low. Some women don't notice at all. They just go through,

no change at all. But there are many women who do, especially their brain, changes when they've got different hormone levels. So those symptoms actually of low mood, anxiety, less energy, sometimes sugar cravings, sometimes feeling just overwhelming with everything is a taster of what it's like to be perimenopausal because it's a hormonal issue. So when did you start? experiencing symptoms then Wendy? After the birth of my daughter really which is in 1988 I had severe postnatal depression. I just thought you know I had baby blues we were living away from my family and I thought that's probably what it was but it just got worse and worse and I ended up seeing a GP this is where we

were living down in Portsmouth at the time I saw a GP there and I was put on antidepressants and they were the old style tricycly antidepressants Yes. So I sort of managed with that for a little while. Then we moved back home with family and things just got worse and worse. And it was about four months after I'd had my daughter. And I was extremely anxious about everything, even like going on public transport, anything like that, was really frightening to me, which was bizarre. I was extremely depressed. I was sort of withdrawn. I sort of went into myself most of the time. But my moods were, starting to be erratic, but at that stage it was still more depression that was my main

problem and anxiety. So I just thought that, you know, a bit of postnatal depression and it would ease up, but it didn't. And that's what sort of put me on the trail to problem with hormones, really. Yeah. So how many pregnancies have you had then? I've had two. Now what happened is after I had my daughter, my husband and I was sat indoors one day and saw an advert for Kilroy Silk, who was the chat show host. You might remember. remember. And they was doing a program on post-natal depression. And my husband said, why don't we go? Okay, then. So we went up to London and went on to this show because back then we didn't have the internet. So there was no way of looking up post-nated depression. You

couldn't order a book on Amazon. No, very different. You had a medical book from the library if that was it. When I went on to this program, I found it really interesting. So did my husband. There was a lady called Dr. Katerina Dalton there. And we got talking to her and explained about my post-natal depression. And with her knowledge, she actually gave me a phone number and said, when you have another baby, which obviously we wanted to, then we can start you on a treatment called progestogen. Cyclogest suppository is basically ongoing.

So when I found out I was pregnant in 1990, I contacted Dr. Dalton. And I had to have injections for the first 10 days. one of progestogen. The first one was within an hour of delivering the placenta. So I had that in the hospital, came out, nurse gave me injections for the next nine days. And I had no postnatal depression. That's amazing. In fact, during my pregnancies, I felt amazing. I mean, it's really interesting because we know that levels of hormones are, you know, between 100 and a thousand times greater than they are normally when people are pregnant and they go up. And then obviously when the baby's born, you have a massive decline in hormones. That's just what happens. That's a

physiological process. And postnatal depression is really common actually. And it's one of the commonest reasons for suicide actually in young women as well. And we've known this hormonal change for many years. But again, most people do not give hormones for postnatal depression. And you're talking about, you know, many years ago, like 30-odd years ago, aren't you, that this has happened. And Katria and Adolton has written some amazing books. She actually went to my old school. So she came and spoke at my old school years ago, and I'd already decided I wanted to become a doctor. And her talking made me want to become a doctor anymore, but it, even more. But what I really realized when I was listening to her when she was talking on the stage in

the school hall was how hard it was to be a woman and how hard it was to be listened to. and taken seriously. And you can get that through her book. She did amazing research. She wrote some great papers. She talked about basic physiology of these hormones, yet people didn't want to listen. They didn't want to understand. And she got reported for prescribing to many hormone treatment. She got told off for prescribing higher doses of progesterone. Yet she could see in her clinical practice that women were being transformed. And we haven't really moved the needle on. You know, it's impossible to say, of course, and you know this, that the progesterone definitely reduced your incidence of post-natal depression because you don't know what you would have

been like otherwise. But common sense will tell you that it did because of your story going forwards, but it's really interesting. When you look at evidence-based medicine, everyone wants the studies, they want randomised controlled studies, but we can't always do randomised control studies. We can't have two Wendy's who are pregnant with the same baby, having the baby at the same time, and one have treatment and one not. But actually, we don't always have to do studies. We have to be putting everything together and put it in context. So it was amazing, actually that not only you met her, but that she also reached out to help you, and you were allowed to have that treatment as well. So anyway, so that was amazing that you didn't have postnatal depression. And by the way, a lot of people who have PMS and PMDD are more prone to postnatal depression.

John Studs sort of used, and others have used this phrase called reproductive depression, which basically means any sort of changes in our reproductive cycle can trigger symptoms of depression, which makes sense actually because it's about these hormonal changes. So then what about going forward then when your periods came back? Okay. It was about three months afterwards. I was carrying on with the cyclogest depositories. But I noticed that these weren't working as well as they had been. And I went to see the doctor and I said, I'm starting to feel really dark places again.

And I could feel my mood had shifted. And after five months, I stopped the progestergen because the doctor didn't really know what to do. We'll put you on more antidepressants. So I was put back on antidepressants. So I stopped a cyclogest. I think it's about four or five months afterwards. Then I noticed a massive shift in my monthly cycle. I would become somebody different for a certain part of the month, like a jekyll and hide.

One time, you know, I can remember my husband came. in and I was just sat crying. I was extremely anxious about everything, particularly with my health, convinced I was dying, you know, really bizarre things, which I was not like that. I mean, I had two children that were good kids, you know, I didn't have any issues with them. They were both good sleepers. And everyone caught, it, came to me, you know, why are you so depressed? You've got two beautiful children, you know, you don't need to be depressed. You've got husband. It doesn't work like that. This was inside. It was something in here. And the only thing I kept saying to the doctor is, I'm not depressed. There's something else. And they looked at me as if I was an alien. I'm not

depressed. There's something else here. It was like a black cloud that would descend on me. I was really anxious all the time, wasn't sleeping. And my periods were extremely heavy and very painful. So that one week I would spend literally not able to leave the house because I had extremely heavy painful periods and then I'd have maybe two days this is how bad it got maybe two days I felt normal whatever normal is and then the whole roller coaster would start again I would feel my moods shifting I was literally emotional over the slightest thing they tried me on several different hormones I was on I think it was defast on they put me on the mini pill they put me on I think it was danazole or something else just to try and help so these are all synthetic hormones so

So people listening to know, yeah, which you might not have known at the time. So cyclogest is a pezzary. It can be used vaginally or rectally, and it's got pure progesterone. So that's the body identical progesterone, exactly the same as the progesterone. We produce, not just in our ovaries, but in our brains as well. Whereas every other type of pill, including contraceptive, is synthetic. So it will help with contraception, of course, but it won't have the same biological effects. and a lot of women with PMS or PMDD

actually find they have more side effects with the synthetic progestogens as well, which I don't know whether that happened with you. I did, yeah. Definitely, my body is very sensitive. It seems to be very sensitive I've found out over the years to any fluctuation whatsoever. Yes, yeah.

And synthetic progestogens. And the funny thing is, now I've reached menopause, I've become allergic to them all things as well, antibiotics and things, which is a bit strange, but we'll go back to PMDD. Yeah. So anyway, I was on about 18 different antidepressants over the years, anti-anxiety medication.

Then they put me on to SSRIs, SNRIs. I had a GP who was fantastic, but he was really interested in mental health and hormones, which was, you know, I was very lucky. But to him, SSRIs and SNRI were the answer. So then I started on these. and these were a real turning point for me. I became suicidal. I started self-harming, which I had never done before.

Everything was a dark place. I couldn't sleep. I was literally crawling the walls. The only way I can explain it is I was looking down on myself. I couldn't control my anger. I couldn't control my emotions. I was like a coiled spring. And for probably three weeks of the month,

I would like a coiled spring and the only way that I would get anything sort of relief from that would be to either rage, scream, shout and then there'd be the tears. And then I think, that's it until it starts all over again. And at my worst, I was probably three and a half weeks where I went through that cycle. And that's, it was awful. I mean, I had two children, and the one thing that I really regret, they witnessed a lot of these rages. They witnessed a lot of the tears. They know about the self-harm.

And I wish I could have kept that from them. But I couldn't control that. I was like a different person, like a Jekyll and Hyde. Yeah, and lots of people explain that. And, I mean, some of you, if you read my book, I just talk a swall about how irritable and irritated I was when I was perimenopause. and I'm quite a calm. I can get a bit feisty, but I'm not a shouty, slammy door type of person. And I only had a small glimmer of what it was like,

but I felt like I had this demon in my head, giving me permission to shout. Like it was almost like, it's fine. You can shout, you can get as cross as you like, it doesn't matter. And we all know a good scream or a good cry can help us at some stages. But it was like all the time, and it was irrational. Like I was shouting at my husband for no reason. Yeah.

Or maybe a bit of a reason. enough reason to get so cross, but I also didn't just have a little flare. I would just go on and on and on and go, be relentless about it and couldn't stop. And then when I was feeling fine, usually after I'd had my period, I was like, what was all that fuss about? Why did I bother with that? Why did I get so cross because he hadn't entered the dishwasher or he was just hadn't put the washing way or something? I was just like, it was really weird, but do you mind? And this is funny but awful as well. You told me the story about your garage. door.

Yeah. Now, this is when I was really poorly, obviously. I had two children. I'd learnt to drive and we'd come back in. I'd started working a sort of part-time. I'd always worked part-time or full-time. So I'd come back home and I didn't have my door key. So with the children in the car, we had an integral garage.

The only thing I could see is I had to get in the house. So I just rammed the car against the carriage. door until there was enough room for my daughter to get underneath and open the front door for me. And I wasn't even in control of that. When I look back now, I'm like, what were you doing? But to me, that was, I had to get in the house. I had things to do. This was really making me angry.

I had to get in. And it was a shame that the children didn't think anything of, things like that. Mum's mad, you know, that's what we do. But she got in the house, opened the door. My husband came home. and he was like, what happened with the door? And I went, well, I had left my keys in the house. I couldn't get in any other way.

So I just rammed the car. And he just looked at me. And I went, well, I had to get in. And then that started another argument. Cool. And it would be things like that that would just go on and on. I mean, my husband, we laugh now. But I have, you know, in the past, I said to him,

we've been married 36 years now. And I said to him, why did you stay? Because I was held to him. live with for 13 years. It must have been awful. And obviously for my children as well. And he said, because I knew you were still in there. I knew you were ill. He also saw me fighting constantly for an answer. I would say to the doctors, he'd come with me. I'd say, I'm not depressed. Stop giving me antidepressants. There is something else wrong. And I think at that point, they were looking at possibly bipolar. And I knew myself, it was cyclical. And I kept saying that. I showed them

charts, because I kept charts, monthly charts, symptoms, have to have the evidence. I knew this was not bipolar because it was so cyclical. But it was near enough continual, apart from two days, and then obviously the period as well. But yeah, I mean, there were many things like that. I came out of my mum's house in the car, his car was there, I reversed straight into it and just drove away. and he came in and like, you just bashed into my car. I'm like, well, it shouldn't have been in the way then. But, I mean, that anyone else would be like, I'm so sorry, but, you know,

and if he'd said anything, it would have been a red ragged her ball. Yeah. So it was easier just to leave it. But the screaming, the rages, I can't even explain how much the rages were. I felt like I was a complete lunatic. I mean, I worked at a special hospital. to I told you. And many a time I actually said to myself, I could be a patient here because I actually thought I was going mad. I really did. And all the doctors kept doing was giving me

antidepressants. But the SSRIs and the SNRIs, I know they work for some people. But for me, I made several attempts with my life. I was self-harming the whole time. And it wasn't until my husband took me to the doctor and said no more no more antidepressants that's it you know there has to be another answer and I think that's that's where I got to with that yeah and you know what you're doing also by sharing such a difficult time is showing how hard it is for others as well you know I talk about only wanting to help 51% of the population directly but everybody can be affected as well and what's been incredible for you is that your husband stood by you because because he knew that it wasn't you.

But actually, we can see. And, you know, there's many relationships that break down quite understandably, actually. Definitely. Yeah. And actually, the children are affected, relatives are affected. And so there's this massive ripple effect. But so, just to go into a more positive note, you did manage to find someone else to help you, didn't you? I did.

Well, I'd gone through, I was in touch with NAPS, National Association of Pre-Meture Syndrome. And I was informed about a trial that was starting. at the Chelsea and Westminster for PMDD. So again, we had no internet, so it was all phone calls. I was relentless. I was phoning constantly, please let me go on this, please let me go on it. So I went on the trial and literally within six weeks of being on estrogen patches, I was a different person.

At the time, I was on three weeks of estrogen patches and a progestogen pill. The seven days I was on the progestogen pill, my mood dropped. So when I went back and told them this, they said, right, we'll just fit a marina coil. That's probably the best way forwards because some people do react, as you say, to the synthetic predestogen. And I certainly did. I was fine for the three weeks. I mean, my husband couldn't believe it. The difference in me. I was like a different person.

I felt like I got my life back after 13 years of fighting. That's incredible, isn't it? Yeah, it is. And then I had another blow that the primary care trust, when it went past, the trial to continue, they refused to fund it because to them it was a syndrome. It wasn't an illness. Even though I used to be at the doctors three or four times a week, I'd gone from that to once every four months. They refused to fund it. My GP tried. He fought for me. No, they wouldn't cover the cost at all. So my husband came home, found me sat and I remember the day for the rest of my

life. I was sat in a cold bath. I had severe stomach pain and bleeding and I was just crying and I said, I don't want to live anymore. I can't live like this. They've taken away the one thing that's made me feel normal, sorry, I ain't an emotional enough, in 13 years. And he said, right, we'll go private. And luckily, we didn't realize at the time my husband had private medical insurance. And that's what put me in touch with Professor John Studd. And I say, you know, he saved my life and the fact that I was able to get the money to go there, you know, through the insurance. Otherwise, I wouldn't be here today. I know I wouldn't. My children would have grown up without a mother and there's no doubt in my mind. Yeah. And it's sad and it really upsets me. Many people know that we're funding a PhD student in

suicide prevention. We see a lot of women who are suicidal, as well, I'll have suicidal thoughts. And I hadn't realized how common it was until I exposed myself to this work. And it's not just in my clinic. externally, I see and speak to a lot of people as well. And menopause and PMDD are aren't covered by insurance anymore. So it's a massive problem. And not everybody is going to respond to hormones, but a lot of people do when you've got the right dose and type. And that's what's really crucial. For some people it's more the natural progesterone. For some people it's more the estrogen. And actually for some people it can be adding testosterone as well. So those three hormones are really important but it's often different doses at different times of the cycle as well. Because obviously

you're producing hormones too. So that's where working closely with each person as an individual and working out what's best. So some people like yourself have a marina coil. which is a low-dose synthetic progestergen, some people can't tolerate a marina. Some people still have a natural progesterone as well as a marina coil. So there's lots of options. And what's really sad for me is that, you know, people are just denied something for no reason. And actually we give all sorts of drugs where we don't have evidence, or we don't have all the evidence, but it's still given because we know it can help.

And often in medicine, there's pattern recognition. cognition and of course medicine is a science but it's also an art and the art form is individualising it for that individual person definitely and so what's really sad for me is that you found a treatment that helped and then you were taken it was taken away and it's not like just giving you a sweet to make you feel happy no it was actually a treatment that was treating the underlying cause yeah and this is sometimes in medicine we forget the basics we do it in all sorts of things as well it's not just medicine, but sometimes we're so caught up that we don't have time to sit down and think, right, so this lady has got this cyclical variation, what happens throughout the cycle,

or periods change. She also had really bad postnatal depression when the hormone levels went really down. Second pregnancy, she had some hormones. So there must be some hormonal association, even though we don't know what the hormones are or what the dose and type are. And then obviously as you become older and perimenopause or your hormones shift and lower even more. But it's like you've said before, it's not just the absolute level, it's the change. And that's often what triggers some of these symptoms is these shifts of up and down rather than the absolute levels. Yes. And that's very interesting because sometimes when we give hormones back, people can feel worse before they feel better.

Because if you increase a dose too quickly or give them the wrong dose, either too low or too high or you increase or decrease, it can trigger things as well. And as you know, that's where it's really important that we work very closely with patients and allow them some control as well, because on days where you're feeling worse, you might need slightly more hormones than days where you feel differently. And it sounds like you hadn't really been allowed to have that sort of combination approach with a doctor. No.

I mean, I think, as you say, that that was a word. thing for me is that I had my life back after 13 years and they took it away. To me, that was, as you say, they should have looked at that. Somebody should have listened, but nobody listens. And unfortunately, the fight continues because I was seeing John Studd every six months for implants at the time. Easton implants and he added in testosterone, which did help lift. It was more for thought what I was thinking. I was getting confused still and I explained that and my skin was really dry and also libido you know that just it changed and whether obviously that clearly was due to hormones and the testosterone did help with that and then we moved up to Scotland and I had to start the fight all

over again because in Scotland there is nothing up here compared to what there is down in London and even when I went to see my new GP, I said that I have this condition. He didn't know what it was. And I had to explain, I was lucky he was fantastic and I have a really, really supportive GP now. She's wonderful. But he actually took a note of the condition, went home and read up on it because he wanted to help me. I've been very lucky. Yeah, which is fantastic.

And in medicine, we're learning all the time. You know, how I practice medicine now compared to 10 years ago, 20 years ago, 30 years, years ago is very, very different. But having this professional curiosity is really key to advanced medicine and learning not just by the evidence, but also learning by patient stories and experiences and responses to treatment as well. So the variation between regions as well, there's still a postcode lottery of prescribing in many medications, but especially hormones. And it shouldn't be, actually. We've obviously got the menopause nice guidance, but

PMDD and PMS, there's this big debate about is it a syndrome, is it a disease, is it a disorder? Yeah. Actually, it's something that's affecting people that's causing symptoms. So actually, academically, it doesn't matter what the label is.

And sometimes I say to patients, I don't know whether it's perimenopause or PMS or PMDD. Still the same treatment. But does it really matter? It's a hormonal, imbalance. And so we should be talking more about this imbalance of hormones rather than a label, because whether you were labelled with depression, bipolar, whatever, that's actually not helping treat you. So it's about what's causing the problem. And this is where I think we need to change our language as well often. And just to add before we finish the implants were used a lot,

people like John Studd use them a lot, but that was often, before we had all the transdermal preparations, the patches and gels weren't quite so readily available. And so lots of places don't provide the implants, but we're lucky that we have got the patches and the gels. And as I've mentioned on previous podcasts, especially this one with Dr. Andrew Weber, the dosing is really important. And having the right dose is really, really crucial because if people don't have the right dose or don't absorb the patch or gel adequately, then symptoms may occur. And then they think, oh, it's not a hormonal problem because the hormones aren't working. Well, they're not working because they're not the right dose or they haven't got the right balance. So you can have all the estrogen you like. But

if you need some testosterone and progesterone, and sometimes it's not just necessarily having the progesterone orally. It might be rectally or vaginally as a pure progesterone. So it's quite a skill getting the right dose and type. Yes. But you are so much better, Wendy, aren't you? Which is wonderful. So much better. I mean, I found, again, I was very lucky. You had to fight. I had to go to the newspaper, get the MSP involved, but I got my implants. And I had a fantastic doctor up here, a consultant who was actually a clinical director. And he fought for me. So I continued to get those. However, over the last year and a half, thinking I'd sail through menopause, that wasn't the case. because I started getting a lot of problems.

During COVID, I had several UTIs, was given antibiotics. Nobody examined me, and by the time I was examined, I was found to have severe vaginal atrophy. And that's, you know, that I thought, why? You know, and I really thought stupidly now, when I look at it logically,

that I would sail through the menopause because I was already on hormones, but in fact, that's why I ended up contacting you because I felt extremely vulnerable. I had a lot of symptoms coming back. And I was frightened, really frightened. Understandably. Yeah.

Absolutely understandably. And that's really important that people realize that whether people have got PMS, PMDD, perimenopausal, or menopausal, our hormones can change not just internally the amount we produce, but also the way we metabolize hormones and the way other hormones can interact. So it's quite a dynamic process and knowing that is really, really important. So I'm so grateful to you, Wendy, because I know it's been an emotional time and I know you were quite nervous the thought of coming onto the podcast, but actually having, just collecting all your thoughts and thinking about it.

It's been really powerful, actually, very sad, but also very powerful that you're sharing your story so eloquently. And I know that many people listening, sadly, will probably. probably have either experienced some of the difficulties that you've had or know people and just the words that it's a fight to get listened to, a fight to have treatment. It shouldn't be a battle. We're only talking about natural hormones. So there's a lot we need to do.

You're very determined. I'm very determined. Lots of our listeners are incredibly determined. So we're not going to give up in this mission to allow women to have their hormones back when they want them. So before we end, Wendy, I always ask for three take-home tips, I'm afraid. So three things that you've learnt now that you wish you'd known before that might help people when they're at your stage 30 years ago. So what are the three things that you would tell your former South that might help?

Okay. I would definitely say keep a symptom diary. There's lots of apps about including the balance app. That's fantastic. So you need to keep three months. of symptoms because you all need that. You need that to show the doctors. And then I would say when you go to see the doctor, ask to see if there's somebody who specialises in hormones. Because that, I think, is another thing. Because some doctors do, some don't. So I would definitely say

ask for that. And keep asking for a referral to a menopause and PMS clinic. There are clinics around now. And they have a right to treat you. You know, if you're simply, and needing treatment. And the last thing, which I think is something that I look back on now, and I know that we did do right, talk. You need to talk to your family. You need to talk to your children and your partner. If you're having these rages, if you're behaving erratically, you need to sit them down and talk to them. My children were very young and they saw me extremely poorly. To see their mum, you know, with cuts and things, it's not pleasant.

I used to hide them as much as they could, but they knew I wasn't well. But as young as they were, we sat them down if there'd been an outburst. And we explained that mummy's poorly. Mommy doesn't mean these things. Mommy needs to, mommy's trying to get help and we were. And we've kept them informed. I've got a son and a daughter. And both of them are in their 30s and know more about hormones.

and any of their friends. So I know my son would be there for his wife. My daughter knows all about hormones, you know. And it's something we talk about all the time in our family, is how they affect you. And I think that's really important. You need to talk to people because if they don't understand why you're behaving erratically,

they're not going to be able to help you or be able to support you. And I think that's the main thing. Absolutely. So great advice. And there is information about PMS and PMD in my book, the definitive guide to the perimenopause and menopause. Also a podcast with Dr. Hannah Ward.

And there's information on, like you say, the balance app, but also balance hyphen menopals.com website. So lots of resources for not just individuals who are suffering, but for others to read as well. So I'm very grateful, Wendy. Thank you so much. You've been brilliant today. Thank you for having me.

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