In this latest fascinating podcast, Dr Saadia Meyer from the Meyer Menopause clinic - discusses Menopause with a look at the science, the impact on general wellbeing and how best to deal with the life change that many women experience.
The Meyer Menopause clinic is led by Dr Saadia Meyer who is a practicing GP, Obstetrician, Gynaecologist and a BMS Menopause Specialist. She is a Fellow of Royal College of Obstetricians & Gynaecologists, a Member of Royal College of General Practitioners and earned a Diploma of Faculty of Family Planning and Sexual Health at The Royal College, London.
In this latest fascinating podcast, Dr Saadia Meyer from the Meyer Menopause clinic - discusses Menopause with a look at the science, the impact on general wellbeing and how best to deal with the life change that many women experience.
The Meyer Menopause clinic is led by Dr Saadia Meyer who is a practicing GP, Obstetrician, Gynaecologist and a BMS Menopause Specialist. She is a Fellow of Royal College of Obstetricians & Gynaecologists, a Member of Royal College of General Practitioners and earned a Diploma of Faculty of Family Planning and Sexual Health at The Royal College, London.
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Speaker 2:Yes and hello. Welcome along to another of the Vita Health Group podcast. Thanks so much for joining us. I'm Glenn Thompson and it's my job to host this series. Along with a variety of guests and experts from Vita, we tackle a whole range of subjects which we hope you find beneficial. Vita Health Group works by providing integrated physical and mental health services to employers, insurers, the NHS and private patients as well. Today's podcast is all about the menopause and I'm pleased to say I'm joined by Dr Sardia Meyer. Dr Meyer is a menopause expert and highly qualified. She's a practicing clinician gynecologist and BMS menopause expert over 25 years experience and she joins us from her Waybridge Insury Clinic. Dr Meyer, welcome to the podcast. How are you?
Speaker 3:Thank you. Thank you for having me.
Speaker 2:Great to talk to you. So 25 years practicing in the menopause a long time, I mean. What did you do before?
Speaker 3:that Right. So I've been a clinician over 25 years and I think the question that I ask myself is having been a clinician that long, how did I end up thinking about menopause and female hormonal balance and how did I get here? And I think it's interesting when I look back at my journey. I was born and raised in Pakistan. I qualified as a doctor there and as a female doctor in a conservative society. For me, women's health was something that was a natural choice for me. I started my specialist career after having my first born, my son, and it was then that I realized that the top gynecologists, even in conservative Muslim society, happened to be men, and I asked myself the question that how can they do it so well and how come we don't have as many women as they should be at the peak of the career doing this? And once I entered obstetrics and gynecology, the thing that fascinated me was hormones, and obviously I was young at that point in time, so I was fascinated by hormones from puberty to the reproductive phase. How do we beat it start it's all controlled by hormones. How do we get pregnant or don't get pregnant? Then it's all about hormones. Having birth all about hormones. Breastfeeding starts stops, all about hormones. And it wasn't until when my mother was put on hormone replacement therapy, not by gynecologist but by an orthopedic surgeon people who deal with bones and ligaments and this was well after she had been through her menopause and his advice was that, look, this is all wear and tear and this is going to happen, but it would be useful for her to have some years of it and it will put her in good stead for later. So that happens and that kind of happens and she's on it and obviously the benefits in her case are long term. She doesn't have any short term symptoms that will hot flushes and all the rest. What she may have had is all passed off.
Speaker 3:And then I arrive in the UK for my post graduate, for my membership, through our College of Phops and Gynecology and then I start working here. We are very different. Whereas in Pakistan my whole focus was on maternal mortality and obstetrics and saving lives and helping with fertility issues and puberty issues, because things will take your focus whatever journey you are on in your life as a woman. But what I found here was that, because of the better healthcare, women were living longer, which means that all the issues of a hormone-deprived state, ie the osteoporosis, your bone staining, your mental health being affected, the fact that the society is such that we could be aging on our own and therefore the independence factor is even more important. It's even more important to prevent falls, so that we don't end up in hospital.
Speaker 3:And then all the research that was coming out about hormone replacement therapy in terms of reducing heart disease risk, in terms of reducing Alzheimer's risk, in terms of colon cancer risk. And then you think to yourself that, right, you know, these are the things which are not as common in men as there are in women, especially when we get to menopause, because that's when our graph is going down, whereas the male physiological graph in terms of testosterone, which is their protective hormone, carries on. And that is just nature's way of doing things, because, you know, we would have ordered X number of X cells whilst you were still in our mother's womb and then, every month, after reaching puberty, nature is giving us a chance to procreate, but it's a very short window, and whereas for men, their reproductive physiology carries on, so their testosterone keeps going and they're getting a new set of you know eggs every three months, whereas we will start to drop that graph from the age of 30. So therefore, they will not suffer with all the problems that we will suddenly start building up on from the age of 50. Their hormones will still go pretty strong to the age of 70 and so on. And because we are living longer, then it means that you know this is going to impact on the health services, this is going to impact on the quality of life.
Speaker 3:And the whole thing about preventive medicine became my next interest that how can we prevent things from happening. It's great that we're able to do hip replacements in, you know, very elderly patients. It's great that we can, you know, do our stents and, you know, help with heart disease when those things do happen. But how can we prevent it? And hence, yeah, I got more and more interested in it.
Speaker 2:Oh, that's excellent. I mean, you know, it makes you realise that the body male and female is an incredibly complex machine, isn't it? And you know, years ago, I guess, before we knew about the menopause and what women go through today, years and years ago, it must have been quite a mystery to a lot of people thinking well, what's happening to my body? I don't really understand it. I mean, it must have been a puzzle for many people years ago.
Speaker 3:I'm sure it was. But you see again, like I say to my women, that back in the day half of us probably would have died in childbirth. So the ones who would get too menopause, nature has a bit of a backup plan, which is generally relies on the adrenal gland. But then if you're too busy stressing out and what life is throwing at us, then those are not functioning as they should and then you probably would have, you know, on the basis of that, lived on for a few more years till some other disease would have caught us.
Speaker 3:But I think the whole business now of the awareness is ever so important because we are living longer. So when we are saying that the average age of menopause is around 51, so there'll be people who, you know, stop having periods, you know, some years before that, others some years after that. Having said that, it's not a cessation of periods, which is what we're looking for, because the changes will start to happen long before everything comes to a halt. That's the tumultuous time for women, the perimenopause, when these women are a lost tribe, because the general feeling is a consensus in mainstream is if you're having your periods, you are okay. There are some hormones still going. Yes, they are, but they may be a bit out of whack and somebody needs to understand and listen to them and see where lies the problem and do that detective work.
Speaker 2:Is there an integrated approach to menopause care now, Dr Mayer?
Speaker 3:There is, and I think it's. We see we take the lead from the US. They've been ahead of in this game for a long time and we are getting more of it in this country and hopefully we will follow suit. And we have to look at the whole person. And this is where, coming into a general practice, which I did because of my personal circumstances I have this on my own with my two boys and it meant that hospital practice was not going to fit in, especially, you know, considering for me it was important that I was around for them, because childhood is finite and you can't turn that time back. So I needed more flexibility and for everybody around me and my peers, they were like how can you have done this for so long and achieved everything and now you're gonna go into general practice? And I was like I need the flexibility, I need to do it. And it's only when I came into general practice that I realized that you always had to look at the whole person. They don't come in again telling you I've got a gynecological problem. You have to do that detective work and I quite enjoyed that and I'm so privileged to have done that because that meant that as a specialist, I could still look at the whole person, and that's where integration becomes important.
Speaker 3:Where you are looking, we are trained as conventional doctors. We are experienced in our robust methods of diagnosis and treatment, but we also integrate into it selective, evidence-based practice that may be coming from alternative medicine, that may be coming from functional medicine, that may be coming from complementary medicine, and it's only then that you're looking at the mind, body and spirit. You're looking at that whole entity functioning as a unit. It's not about treating symptoms, because for me, hormonal balance is about preventive medicine. It's about giving people the choice and for them, that when they're going to that time of their lives, we never have that conversation that, look, this is what's gonna happen now. So where's your lifestyle sitting? What changes can you make there? What are your choices? And if you don't choose, what does it mean? Because some people may choose not to do anything, and that's a choice.
Speaker 2:Well, what does that integrated approach then, dr May, what does that integrated approach mean to the patient? What does that actually mean for them?
Speaker 3:What it means for them is that we will be giving them a comprehensive treatment plan where we will be using elements from conventional medicine, ie, if you need to prescribe hormones, then we do that. If you need any testing, if I need to have any screening done, then we use all those evidence-based elements. But we also then bring in things which may mean that changes to the lifestyle, to their diet, to their work-life balance, to any supplements that will help with metabolism of any prescription hormones or whatever else may be needed. And then if we need something to have more attention, then we can find another colleague who can take a deeper dive into it, Because my practice is more towards metaphors and hormones. But if somebody has gut issues that need looking into, then you can refer them to an integrated gut specialist. But it is essentially what we're saying is that the body has an innate ability to heal itself and we should not be ignoring that side of things and we use conventional medicine to our advantage and we will not ignore any evidence that comes from outside of conventional medicine.
Speaker 2:Let's talk about hormone replacement therapy then I mean, can anyone take that, Dr Maher?
Speaker 3:Simply answer the question. It will be pretty much, but there will always be exceptions to the rule, and I think the biggest one being women who may have suffered estrogen, who suffered breast cancer tumors which are estrogen receptor positive or progesterone receptor positive. But again, it's important to have that conversation to see what else can we help them with. It is a joint conversation, a joint decision, where they have to be informed about the risks and benefits and, at the end of the day, it is the patient's choice and it is my job to say what's the risk of this and what's the benefit of it. And if she's like, well, I do want to do this or some part of it, we'll say this might be safer for you. You might not get the whole range of stuff to help you, but if we can solve one problem, what would that be? And it's about quality of life for most of them, and I think for all of us. For me, quality of life would stay way above length of life, and in an ideal world, we want both, don't we?
Speaker 2:I'm guessing a lot of women suffer the menopause in silence, don't they? What would you say to those people who do suffer in silence and are going through absolute hell really?
Speaker 3:Right. So there are two categories there of women going through menopause and what I always say is that you know there'll be those who'll be the smooth sailors. You know they will not have any overt symptoms, so they're not getting the hot flashes and the night sweats which tend to be the most traumatic of all symptoms, and therefore a lot of us will get help when we're getting those symptoms, because they're completely unbearable. But then there are other symptoms, like anxiety or mood changes or energy levels depleting or sleeping disturb, and those symptoms can happen for a whole lot of reasons and it is so difficult to tease out whether it's life that's doing it to you. Is it your young adult children, or is it long standing relationships hitting New Rocks? Or is it parents or not? Well, is it all of that body that's making you more worried, or is it few to five, being added by the hormone changes that are happening? And I think, when you're not sure, just go and have a conversation, because having a conversation will allow you to see where the problem might be. And so suffering in silence no, like I say, there are no prizes for martyrs and also a lot of us will not have symptoms. So this is the important bit here and again it's about having the information and being able to make that informed choice, because we may not be having any symptoms.
Speaker 3:A word leave are totally fine. You know, we don't sort of memory is OK, energy is OK, so it goes. But silently, behind the scenes, things are happening. In the first year of our period stopping, we lose 5% of our bone mass and 1% every year after that. And this is when the grandmother, who's been fit as a fiddle, just trips, you know a little trip, and the hip is gone because it has thinned over this time. But if we had prevented that from happening, then it is about prevention. It is about understanding the fact that the benefits in terms of, again, heart disease reduction, so we're not going to wait for that heart attack to happen. We know that. You know things are changing the elasticity of the blood vessels. Changing the blood vessels will the surface of the blood vessels is going to get roughened up and therefore, you know, more likely to form clots and occlude.
Speaker 2:It's amazing, isn't it, how it affects many different parts of the body. I mean, are you saying as well that it affects bone density?
Speaker 3:Absolutely so. Nothing. Nothing works of bone density as well as estrogen does in women and, of course, testosterone does the same job in men, because what estrogen is doing is it's allowing for what we refer to as a healthy bone cycle. So if you were to imagine, like a Pac-Man situation, where all bone has to be taken away by Pac-Man and the other guy is coming in putting in new bone, so then this bone is healthy, it is not just hard and bone, it is flexible, it has, you know, the tensile strength, but it is flexible at the same time.
Speaker 3:What ends up happening is that we haven't given women the hormone replacement therapy or the choice of when we end up fracturing or breaking a bone. We get put on to, you know, substances like what we refer to as bisphosphonates, and what bisphosphonates do is that they harden the bone, they marbleize it, they make it hard, it is not flexible anymore, and then that leads to other situations with dental problems, where the bone then starts to undergo necrosis, meaning that it's losing its blood supply because it's just getting, you know, more and more and more to put on it, to make it hard and marbleize it. But it's not healthy bone and those drugs are very hard to take. They take a big toll on your stomach. They have to be taken 30 minutes before eating or drinking anything. You have to remain upright for 30 minutes and you know the amount of water you have to take with it and you know half the time the patient is not able to tolerate it.
Speaker 3:At the age when we start, we put them on it.
Speaker 2:Dr Mayor, what if a patient or somebody who's going through the menopause has had cancer? What are the choices then?
Speaker 3:So, again, like I said, depends what cancer. So, say, if somebody's had cancer that's related to blood or it's not related to hormones at all, they can have hormone replacement therapy. Obviously we will go through the history and, you know, look at all the factors which are involved. If somebody's had breast cancer, which is the biggest issue, that needs some research is going on. But we need that research to become practice. And the trouble is that for any research to become practice or any good evidence to become practice, you know it can take up to 20 years.
Speaker 3:So in those women, again, it's good to have that conversation because they may be part of the integrative approach that we can use to help. They might be on a localized hormone or they may be able to take, you know, supplements that come with evidence or with any other alternative therapies that will help to improve their quality of life. But yes, you know, we would like to have hormones that will not stimulate the breast tissue but will give them the benefit for the bone and the heart. So we need hormones which are selective, which will selectively target tissues that we can help to improve but not stimulate tissue that we don't want to stimulate, ie the breast cancer. So that's the direction where things are going in.
Speaker 2:You say on your websites which is a great website, it tells you all about your particular clinic that no two individuals are the same and you say it automatically results in a bespoke treatment plan. Tell us more about that.
Speaker 3:Because you know to me the most. And you absolutely right no, two people are no. Two women are the same. We all share the same hormones, but every women's journey to puberty is different. Every women's periods although they're all having them, even if they're all having them months a month is different. Their journey through pregnancy is different. How they have gone through trauma is going to be different, and how.
Speaker 3:I always refer to it as an orchestra. You know it's all these different endocrine systems, ie your adrenals, your ovarian hormones, your thyroid hormone, which all interact and if one piece is out of sync, it is my job to understand as to what that can be. And you can only do that by listening to their story and because the answers are in the story. But if you do not listen to their story, as in the story of their life and what they've been through and what's gone on and what impact trauma could have had, and we don't take that into the equation of proposing the treatment plan, then we will miss a trick. So you have to look at the hormones.
Speaker 3:Yes, you know we are guided by tests. We are not dictated by them. They're very complex. You know there are snapshots in time and therefore you need to have the experience of A having done them, b having worked with them, and C having understood them and also looking into more research-oriented tests that can sometimes give us information. But at the end of the day, you know it is a clinician's job to work with the patient and you work as a team, so that relationship is very important. I have to listen to them. I'm like no, you've got this, this has got to work. No, if it's giving her a headache, it's giving her a headache, so I need to think of how I'm going to improve that or what can I do to change that.
Speaker 2:Sure, I'm going to ask you a very, very layman-type question now, dr Mayer, and that is how long does the menopause last? And again, I guess it's an open-ended question, isn't it An open-ended answer? Everybody's different.
Speaker 3:Right. So here's the thing which I think that we haven't done any service to women in terms of the definition of menopause, because menopause just simply refers to no periods for the last 12 months. Now, that's no news to the woman. It doesn't help her in managing her life, it doesn't help her taking any decisions. It only helps us clinicians, because for us, if the periods have stopped, ie the ovaries have stopped working for 12 months, and then if they go on to have a bleed or a period, then we're like well, where did that come from? Is there another source of hormones that's kicking off in the body? Could there be cancer of the lining of the foam? Could there be something going on with the ovaries? That's pretty much about it really.
Speaker 3:So, to answer the question, really we are essentially going to be in a hormone-deficient state till we die and hormones have left us, and then everything that will result subsequently due to the loss of that hormone, all those disease processes will slowly start working. Then again, that's where it's important, as if people who are not on hormones or can't take hormones, or do not choose to take hormones, what else can they do to help themselves? And the hormones will start changing from our mid-30s, 40s and again, everybody's starting point will be different. Some will settle very quickly in terms of hot flushes or night sweats, because those are the apparent ones, but it's not like your brain fog is suddenly going to clear one day. If those symptoms are happening, it's unlikely that they will recover. So, yes, you're right in saying how long is a piece of string, in terms of symptoms only, but menopause is here to stay.
Speaker 2:This is where we are.
Speaker 3:This is where we are, this is what I call the base cap menopause, and this is where you need to decide. What are you going to put in your backpack to take on your hike for the rest of your life? So it's important to put the right things into that backpack, things that will work for you.
Speaker 2:And I'm guessing the first port of call to talk about the menopause is what With your GP, and then maybe come to somebody like yourself.
Speaker 3:Absolutely. And I think here's another thing that we need to restore the confidence with regards to hormone replacement therapy in clinicians and doctors, because when the flawed studies came out in 2003, it meant that it took the confidence away from the doctors. We lost a whole generation of clinicians who were confident in prescribing hormone replacement therapy. It, of course, took away the confidence from the patients. So for us to restore that confidence first of all is very important, by making sure that we are getting the education and knowledge and we are spreading that information amongst colleagues. So we are trying, but it's something that we all have to make an effort to. And what really does help that, if you go and knock on your GP's door, you don't know what you'll find. If somebody is really interested and will be able to help you, and if they're not able to help you, then it will highlight to them that they need to know more about it. So it's a complete win-win situation and my position is if your GP is not able to help you, then come to me. Or they have tried something. It hasn't worked, then come to me, or if you just choose to come to me, then come to me.
Speaker 3:But I feel that the buffet has to be available to everybody. Everybody should have a choice, and then if you want to have something different, then yes, that's up to you. But the basics have to be available and we have to move towards good practice, because we are still prescribing hormone replacement therapies that are archaic. That we, as clinicians, is not good science. We moved away from it, but because it is still being manufactured, we are still prescribing it. Long gone are the days when the prototype of hormone replacement therapy was hormones which were derived from the pregnant male's urine, and then they were the conjugated equine hormones, but they are still being prescribed. So it's like, well, no, it doesn't look like a human's estrogen, it looks like the male's estrogen. We need to change that rhetoric.
Speaker 2:Fascinating, absolutely fascinating conversation. There's lots of great advice and detail on your website as well.
Speaker 3:So my Instagram is menopauseexpert and my website is menopause-treatmentcouk.
Speaker 2:And you work closely, obviously, with Vita as well, don't you, Vita Health?
Speaker 3:Yes, again, I am totally open to all evidence and what preparations are coming in and if it is scientifically vetted, I include that in my treatment plans. Integration is so important. That's the way forward.
Speaker 2:Thank you so much, Dr Sadi Amir. Dr Sadi Amir runs the Mayor Clinic in Weybridge in Surrey. You can find out more at menopause-treatmentcouk. Dr Sadi Amir, thanks for joining us on today's Vita Health podcast series. Thank you.
Speaker 3:Thank you for having me and all you women go out and inform yourselves.
Speaker 1:Thank you for listening to this Making People Better podcast, part of the wellbeing series from Vita Health Group. Improving your lives, physically and mentally, drives everything we do, and getting you back to doing what you love is our priority. Vita Health Group Making People Better wwwvitahealthgroupcouk.