The Laura Dowling Experience
Conversations about health, science, wellness, life, love, sex and everything in-between. Laura is a Pharmacist who loves to talk to interesting people about their unique life and work experiences. See @fabulouspharmacist on instagram for more information.
The Laura Dowling Experience
Perimenopause and Menopause 101: Libido, Weight Gain, Loneliness and Anxiety with Dr. Sarah Callaghan #030 (Rerelease)
This week we’re revisiting one of our most popular episodes from April 2023, with Dr. Sarah Callaghan, a GP specializing in women’s health and a true champion for women. In this episode, we dive into the big questions around perimenopause and menopause, including how to manage loneliness and anxiety, whether testosterone can boost libido, and what to do about the seemingly inevitable weight gain.
This episode is for anyone going through menopause or perimenopause, as well as their partners, friends, and colleagues who want to better understand and support them. With Dr. Callaghan’s insights, you’ll feel empowered to seek help and reassured that you’re not alone on this journey. Tune in to revisit this open and honest conversation!
Thanks for listening! You can watch the full episode on YouTube here. Don’t forget to follow The Laura Dowling Experience podcast on Instagram @lauradowlingexperience for updates and more information. You can also follow our host, Laura Dowling, @fabulouspharmacist for more insights and tips. If you enjoyed this episode, please subscribe and leave a review—it really helps us out! Stay tuned for more great conversations.
Today, I'm revisiting one of the most downloaded episodes of the Lower Down Experience my conversation with Dr Sarah Callan. Sarah is a specialist in perimenopause and menopause, and in this episode, we delved into the profound loneliness that can accompany perimenopause, along with its many other symptoms. When this episode first aired, the response was extraordinary. So many women shared that they finally felt seen, and others told me that it really helped them to understand their own mothers in a completely new light. Sarah's insights resonated deeply, highlighting the emotional and physical challenges that women face during this hormonal transition. I know that you are going to find this episode powerful and I encourage you to share it widely with women, men and anyone whose life may be touched by peri and menopause. Whether directly or indirectly, these life changes affect us all Partners, children, family, friends and colleagues, so this episode truly is for everyone. Settle in and enjoy, and don't forget to spread the word.
Speaker 1:Ladies, viva La Volva is coming back to Dublin, to the National Concert Hall, on Saturday, the 1st of March 2025, and this is your chance to experience a women's health event like no other. Myself and my esteemed panel of experts will deliver three hours of empowerment, education and laughter as we delve into important and often taboo discussions surrounding women's health and sexuality. This is a wonderful space for sharing the raw, open, honest and, most importantly, safe conversations that we will be having with you about women's health, from perimenopause and menopause, pelvic floor health, hrt sex and everything in between. This show was a sellout in 2024 and we had women from the age of 20 to the age of 88 learning all about how to love and care for their bodies and, most importantly, when to ask for help.
Speaker 1:Tickets are €75. This includes a complimentary Amazing Goodie Bag which is worth well over €100. I've become quite renowned for my Amazing Goodie Bags. Tickets are available on the National Concert Hall website, wwwnchie. So, sarah, there's a lot of confusion about perimenopause, menopause, postmenopause. Can you explain the differences and if it's necessary for us to be referring to the differences all the time, sure Well.
Speaker 2:I look on this whole stage as more like a hormone transition. So there are different terminologies used to describe the different stages within the hormone transition, but if you just zoom out, you're talking about a hormone transition here, so that hormone transition can happen any time, from, you know, your late 30s, early 40s, right through to your mid to late 50s. So we're talking about, you know, a large part of your midlife, and different women will be affected in different ways during that time. Typically, the perimenopause part refers to people who are still having periods but may be affected by symptoms, and then postmenopause. Menopause means your last period, and then postmenopause means you've stopped bleeding, and if you're affected by symptoms at that stage, we call them menopausal symptoms and we use this word in menopause, but really we just mean that your bleeding has stopped. So that's, in a way, the terminology doesn't matter to me Whether you're in perimenopause or menopause. What matters to me is whether you as a patient are affected by your symptoms, whether you're having symptoms that are affecting your quality of life, and whether you don't feel like yourself anymore. And if you're feeling, you know having any one of the 150 different symptoms that you can have in perimenopause and menopause.
Speaker 2:The bottom line is if they're causing you trouble, then typically women will say look, I just don't feel like myself. So the simplest way that I can put it for women is if you don't feel like yourself and you're anywhere between your late 30s and late 50s, it's worth talking to a doctor about a hormone assessment, and obviously there are lots of other reasons why you might not feel well. It's up to us as doctors to kind of look at it with a wide angle lens and make sure that we're not missing anything else. But hormones certainly are on the table as a possible cause. The danger is that we miss the hormones. We miss this simple, treatable cause of you know symptoms that are affecting your quality of life and, as a result, you can lose a significant portion of your midlife. You know, anywhere from months to years and not feeling well when there was something that was potentially really treatable.
Speaker 1:And we're going to get into it, but there has been so many women that weren't treated well and they couldn't find the help. There's generations of them isn't there. So we're now coming to the stage where, thankfully, there is help. This is what we're here for today. So are the symptoms mainly in perimenopause or does it just depend on the woman?
Speaker 2:No, I would really take the focus off perimenopause versus menopause and I would simply say during this time of hormone transition you may have symptoms. So I would be saying to women in their like mid thirties listen, you should. You know, arm yourself with some facts, know what to look out for and know that if you start to suddenly feel off in your 40s or 50s you know you need to be thinking hormones, particularly to the women in their 40s, because the danger is that this perimenopause you miss it. So many women miss their own perimenopause, so many doctors miss their own perimenopause. So many women miss their own perimenopause. So many doctors miss their own perimenopause. Like you know, louise Newsom, one of the menopause specialists in the UK, would candidly talk about how she missed her own perimenopause. So it is so important that we are just aware of it, and I suppose two of the biggest reasons that we miss our hormone transition are well, number one, because we're not expecting it in our 40s, but also because the symptoms do fluctuate, particularly in perimenopause. But even in menopause they can fluctuate. So, particularly in perimenopause you might have a terrible month, then you might have a better two weeks, then you might have a terrible six weeks. So you and sometimes you get cyclical changes. So every month you feel terrible before your period and then it gets a bit better. Women describe their duration of PMS symptoms extending. So it used to only be three days before my period, now it's like I'm losing two weeks every month. So there's fluctuations in symptoms. So just as you're thinking, god, this is terrible, I need to do something about it, you suddenly start to feel better. Then you start to doubt yourself and you start to think you know, maybe I just wasn't coping, maybe I was too busy, maybe I'm stressed, maybe I need to exercise more. You know all that stuff. So fluctuating symptoms kind of go against you, acting on them. The other problem is there's this insidious creep of symptoms. Now, not every woman gets this, I should add. So some women will sail through their perimenopause. Some women will even sail right up to their menopause period stop and they may not be bothered by symptoms at all. But if you are one of the group of women who are affected, then you need to know what to look out for. So if you are affected by symptoms, typically they don't come on with a bang, unless perhaps you have your ovaries removed for a surgical reason, but typically it creeps in. So women say God.
Speaker 2:In my clinic I would see women who say really I don't think I've been right for the past two or three years. You know it's come on so slowly. There was COVID, then we moved house, then my mom died. You know all different stuff going on. I was grieving Now I don't think I'm grieving Then.
Speaker 2:And another example is like the women whose kids turn five. I have a particular group of women and they're kind of 44, 45. Their kids turn 43, 44, 45. Kids turn five. They come in and they say my baby's now sleeping but I'm still exhausted. All the time I thought it was postnatal anxiety, I thought I was tired because of the baby. But to be honest, I haven't been right since my last baby.
Speaker 2:And again, they are very often in a perimenopause situation but they've mistaken it for postnatal anxiety. They've you know all the stresses and strains and challenges of managing small children. They've put it all down to that. And it's amazing how, like you're talking durations of years here where you can be, you know you're functioning, but often you would think of it as a sort of a muddling through where you're getting by but you're not living your life in the way with the greatest quality of life the way you could. Your energy levels are down, your libido's down, you're more irritable. You know you're not getting the same enjoyment out of your relationships, your children, your work. So that's why it's so important. If we have this thing going on with hormones, that is treatable, and you're one of the women who's affected to a significant degree with it. We need to be talking about it. We need to be supporting you to get you the right help, rather than wasting time not feeling good.
Speaker 1:Goodness, it's just, it is a minefield, isn't it? It's a real product fault, isn't it? Our whole reproductive system and the way our bodies are made. Like it's just. It just seems so unfair that we that this, that we go through this. So can you tell me about? Typically, I come to you, sarah. I'm 43. I was really irritable this morning with my entire family. My children are looking at me. I haven't been feeling myself and that's it, isn't it? It's the. I don't feel myself. There's no joie de vivre anymore. Like there's that. So what would you? How does a typical appointment look? How would you take me through it?
Speaker 2:Well, basically you fill out a questionnaire before you come in which just gives me an idea of your medical history and you know where you're at with your periods and all that. We do a symptom score sheet, which is useful because it gives me a sense of just an overall representative sample of how much your symptoms are affecting you. Now you have to remember with that symptom score sheet and this is important because some women will access them online and stuff that you don't have to have every symptom in the book. You don't even have to have half the symptoms. They don't have to be very severe. Some women will only get one or two symptoms, like I've had women with debilitating insomnia and maybe headaches and nothing else. You get another lady with plantar fasciitis and itchy skin. Can you explain what plantar?
Speaker 1:fasciitis is to people.
Speaker 2:Yeah, so that is pain in the sole of your foot when you get up, and so it's a quite a common menopause related symptom. Obviously, men get it, lots of women get it, you know, and it's not related to menopause, but it's the type of thing that you would never put together with menopause ever. You know, we're expecting drenching, we're expecting to be gray haired and have sweats and have our period stopped and the message to get out there is that's not what it always looks like.
Speaker 2:So that's why all this talk is so important, because we're just trying to get the message out. You might be 40 to 42 and have a three-year-old and have, you know, niggling aches and pains all over your body, be irritable and not be sleeping, and that might be what your perimenopause looks like, and that is okay. It doesn't have to be drenching night sweats. It doesn't have to be a particular collection of symptoms. And that's where I think it's so important that we keep the door wide open, that we're not saying you have to have the top five symptoms. We are saying if you don't feel like yourself, in whatever form that takes for you, please come forward for an assessment. So when the women come to the clinic, my first job when you walk in the door is to get a sense of are these symptoms due to hormones? Because we have to remember no more than the lady herself being confused whether it's due to hormones, like it is possible that it's something else. There are situations where obviously, things like thyroid iron levels so underactive thyroid, long COVID iron levels all of these things anemias can present with tiredness. There's lots of other medical conditions that can present with tiredness. A woman may just be in a profoundly stressful situation, maybe totally burnt out, and that could account possibly for feeling depleted and exhausted. Also, there is a group of women who have pre-existing medical conditions and I feel particularly, it's particularly difficult for them. You've got ladies with things like rheumatoid arthritis, ms, fibromyalgia, conditions that cause fatigue, conditions that cause joint pains, you know, and they then get worsening of these symptoms in midlife. Maybe anxiety and depression is another one. You think you've been well controlled, you've been on top of things. Suddenly it all starts to fall apart in your 40s and your disease seems to be affecting you more. We've got to be so careful that we don't miss an underlying hormone issue that could be aggravating their symptoms. And then you start pushing the treatment for the disease rather than identifying the hormone issue. So when that lady comes in I have to figure out, you know, does this look like it's a hormone issue or does it look more like something else? And it is like the balance of probabilities and obviously experience, listening to the language that people use. But it is always going to be a working diagnosis, like the proof is that somebody gets better with the treatment plan and we do always keep an open mind. So there's always a follow up appointment, you know, usually around three months later, sooner if there's issues. And so if someone comes back to me and their prominent symptom was headaches and a whole bunch of other stuff, like you know insomnia and flushes and irritability and all that and everything gets better except the headache Well, obviously we have to go back to the drawing board on those headaches and see why they're happening. So you have to remember like it is a process of elimination of, you know, of different conditions and then a trial of treatment if it's felt appropriate. So usually for me it's fairly clear.
Speaker 2:The language women use is generally very typical if they're talking perimenopause and menopause. The phrase is I just don't feel like myself, I feel lost, I just can't seem to do the things I used to do. Work used to be easy and now it's really difficult. I just feel so anxious all the time I wake up with this knot in my stomach. You know my relationships. My kids just say I'm irritable all the time. I never used to be like that. So all these words, all these patterns of language come up which you know are quite classic Most people.
Speaker 2:People say I know I'm not depressed, but I don't feel right. Now. I've never met in all my time as a GP a person who had depression saying I know I'm not depressed. But almost every person who has mood disturbance in perimenopause and menopause will say to me I know I'm not depressed, but there's just something not right. So it's so interesting how it presents like it's a different feeling.
Speaker 2:And women are so good if you let them talk and listen carefully. They're so good at articulating what they're trying to put their finger on something they're not exactly able to say I think this is perimenopause, but they're able to describe it in a way that you know points you in that direction. The other thing is the pattern of distribution. While it is true that some women get a very limited number of symptoms, most people are hit across a few different parts of their body, from head to toe. So you usually get a few pointers that way, like there's very few diseases that will cause you to feel hot and have itchy skin and be irritable and have some vaginal dryness and low libido. So it is kind of a pattern of symptoms that you often see, but you get the odd tricky person and often you get people with that, say, pre-existing fibromyalgia or long COVID, where, like I've had a few patients with long COVID, where we've had like one or two, where we've had really fantastic responses to HRT and for them it was at the start.
Speaker 2:What I said was look, we can't be sure how much gain there is here. There is no harm in a trial of treatment, because your symptoms could possibly be mimicking perimenopause. And there was one lady who had an absence, like she went back to riding her horse. She, you know, she'd had to give up everything and now she's back to herself and it was a profound, just debilitating perimenopause that she was experiencing, on top of having had COVID. So now, obviously most women aren't in that boat, but it is interesting You've got to be so careful, like the whole point here, I think, and the whole message that I'm always trying to get across is let's not miss something that potentially could drag on for months or years and cause you to not feel like yourself. And that just leads me on to one other thing, which is the idea of how bad do I have to be before I come to you?
Speaker 1:This is really important. I want you to get this across to people.
Speaker 2:So, like, the way I would say it to people is because people are often almost apologetic when they sit opposite me, like, I know I don't have everything on the list, but it's just, it's kind of bothering me. What I would say is like, if your functioning is down 20, 30 percent, it's kind of bothering me. What I would say is like, if your functioning is down 20, 30%, you know, on an ongoing basis, well, to me that is significant. Like if someone could give me an extra 20 or 30% functioning in my day, I would grab it, you know, because most of us are trying to balance a lot of things and we need, we've got used to being at a certain level of capability. If someone takes that away from you in your 40s and even drops it down two or three notches, then that is a problem, because you've built your whole life around this level of functioning. And you know, obviously some women walk in the door and it's really clear cut. They are literally falling apart. Their relationships are in trouble, they're thinking of giving up work. Everything is, like you know, very, very difficult and for them, you know, it's really clear cut where they're at. But for those ladies who are just kind of you know, somewhere between kind of tipping into the moderate, but they're almost apologetic that they're not that bad. And when you add into that fluctuating, so they get a bit better and maybe they even have a decent week where they go God, I was fine that week.
Speaker 2:Then it all came back again. I don't know what's going on here and you can see what a confusing picture it is and that's why I would say you know, I say this frequently the two common themes that I see day in, day out from almost every patient I see in the clinic are loneliness and confusion. And all the podcasts and books and programs in the world have not changed that. And I think the reason is that our individual experience of perimenopause or menopause is so unique to us, a bit maybe like grief in that you know everybody's interpretation of it is different. So for that reason it feels lonely.
Speaker 2:Also. It erodes your confidence, your sense of self, so you kind of feel like you can't rely on yourself anymore. You can't rely on your body, your brain, you can't even rely sometimes on your word finding. You know your brain fog can affect you. So everything feels like it's falling apart.
Speaker 2:And then the other thing is confusion. Most people are confused. Even people with mild symptoms are confused. Should I be on HRT? Should I not be on HRT? When should I go on it? My friends say I should be on it, and all of that leads to you feeling confused. Your partner feels confused if you have a partner as to what has gone on with you. Why have you changed? Why are you not behaving the way you used to behave? Your children are confused. So the whole thing can be quite a muddle and generally what I find when people come to see is they're just relieved that there is a sense. There is a feeling that somebody is making sense of it all. And usually when you kind of do an assessment and reflect back your findings to the patient, they're like okay, right, yeah, that all makes sense, and then they have a plan and then they can get on with it.
Speaker 1:And is HRT or they're calling it now menopausal hormonal treatment? Aren't they Rather than HRT? But is it usually always the first?
Speaker 2:port of call. So no, going back to where. So the lady comes in the door. My first job is to figure out are the symptoms due to hormones? If I say, if I decide, look, yes, I think they are due to hormones.
Speaker 1:And this is done on a purely a symptomatic assessment, so it's a chat.
Speaker 2:No, not a blood test in general. Now, unless somebody has much younger women, we will sometimes do blood tests, but in general the blood test will only be to exclude other stuff. So really it's about a conversation. It's about listening and obviously having some you know, it's the symptom score sheet. But as well it is the language that you use, it's the way you present and it's like that you know if you come in with appendicitis or with tummy pain to a doctor, we are going to kind of do it's not just how is this pain out of 10? It's a global assessment of the sense you get from the person.
Speaker 2:But obviously the symptom score sheet is, you know, is really important as well, and making sure that there's not other stuff going on in your life that could be causing you to feel like this. That's the biggest thing. Like, is there anything else causing you to feel like this, or is the balance of probability that there's nothing else that's more likely to be causing it than hormones? So therefore, let's proceed to manage it as a hormone issue for the moment and see if it gets better, and it's safe to do that. We almost use time, like it's safe for us to use time as a diagnostic tool, because this is not something that's going to markedly worsen to any kind of critical degree in, you know, three months time.
Speaker 2:So then that leads me to my next question, which is are your symptoms mild, moderate or severe, and do you in terms of their impact on your quality of life? So that's an important question, because sometimes the scoring can throw you off a little People can. So we put those two things together. And the reason that question about quality of life is really important is because, if your symptoms are, if you perceive them to be having a mild impact on your quality of life, so you know, they're a little bit irritating from time to time, but provided I get my walk in, I don't drink too much, I get to bed on time most days, I'm actually able to manage them.
Speaker 2:Well then, you're doing just fine and you can. I would say to you look, you have mild symptoms of perimenopause or menopause. You do need to think carefully about lifestyle. You're not going to get away with burning the candle at both ends the way you did in your twenties. And you know, and it's all the good lifestyle stuff the nutrition, the exercise, not too much alcohol, enough sleep, and when we say exercise, exercise for the body, but then the mind. That whole self-care for the mind piece is really important as well.
Speaker 1:Isn't alcohol. So I have found, as I've got older, I was never able to drink very much, but alcohol actually really depresses me the next day, even for a couple of days afterwards. And this is just maybe. Three glasses of wine, yeah, and this is normal, isn't it? As we age.
Speaker 2:So it's normal for some people. But then you will get other ladies who, like I remember speaking to a lady who was having like a large amount of alcohol, like 30 units a week. So the recommended units for low risk drinking have actually got really low now they're down to like 11 units a week for women. So that's a bottle and a half a week and that's the upper limit of the lower of the of the low level alcohol intake. So, but this lady was having 30 units a week and I said, look, you know, the likelihood is that is really having an impact. She gave it up for a month and she said it actually made no difference.
Speaker 2:So I think we can't generalise but in general for our health it's better to absorb the low level alcohol drinking and even at that I would say for some of us we're better off without it. Like, if you as an individual think it makes you feel worse, then you're definitely better to. You know, really cut it back, and we do know it generally makes sweats worse and we do know it generally makes you sleep less well, even though you get to sleep more easily, you have a less lower quality, a poorer quality sleep and typically it affects your mood the next day, especially if you drink to excess. So, like at this time when you're trying to figure out what's going on with you, I would say taking alcohol out of the mix just simplifies it. Even for me as a doctor, it's one less thing that I have to consider, you know, as a variant in the whole picture.
Speaker 2:So that's it. So I think that message about if your symptoms are having a mild impact on your quality of life, you don't, you know, lifestyle measures are enough. And that is an important message, because your friends may have gone on HRT, they may have been having symptoms that required treatment with HRT and they may have had an amazing response. So you go out for dinner and they go oh my God, this HRT is amazing, you should totally be on it. And I've had ladies book appointments just to kind of say should I be on it? And so it's easier to save yourself the trouble of the appointment.
Speaker 1:Women are so good at spreading news to others, aren't they?
Speaker 2:And in one way it's wonderful because, like the whole reason the menopause, like yes, there was Joe Duffy and there was Davina McCall and all that yes, there was Joe Duffy and there was Davina McCall and all that. But one of the reasons that this converse, like that the menopause awareness has so taken hold and even is such a political hot topic, like that the government are prepared to put you know, to do the menopause awareness campaign, like they realise that this is an important issue to women. But part of the reason is that women are talking about it everywhere, like a woman you know. A woman told me about how she was talking about it on the side of a GAA pitch down in Meath. Another woman you know, women out for dinner, women going for coffee, sisters, mothers, daughters now talking to their mothers. So like it's almost like this sisterhood, this network of whispers.
Speaker 2:And the whispers have become louder and are now becoming like like it's safe to say it out loud not everywhere still, but it's.
Speaker 1:It's safer than it was and there's less chance that people are going to kind of look at you, you know, uh surprised or kind of embarrassed on your behalf that you've brought up this taboo subject yeah, it is because even I've had, I've had ladies say to me I don't want to tell my partner because, like, if that means I'm getting, yeah, like your partner is also getting old and your partner can only support you if they know what's going on. But do you hear that a little bit?
Speaker 2:I hear that a lot and it's actually been helped somewhat by so pre-Joe Duffy, which I think was June 20, was it 21 or 2020?
Speaker 1:I still think it's funny that Joe Duffy is the face of menopause in Ireland.
Speaker 2:Well you know, he as a doctor working in that area, like he, I, he it was the biggest transformation Before that show. Women came in in two groups. They came in in their fifties in floods of tears, their partner generally having pushed them in and having said, like you have to do something, and they were absolutely at the end of their tethers, like they were, you know, physically and mentally really debilitated and it had got to the end of the road for them and they had to come forward, even though they were embarrassed and in general there was an atmosphere of like shame about it in the room. They were one group and the other group were the 42 year olds who came in, usually having had babies, you know, in the past two or three years. Going, I just feel tired all the time. I don't know what's wrong and as I explored it I would say, look, there is a hormone change that happens. It's called perimenopause. And they would look at me totally stunned and then start to cry because I had said something that was unspeakable, the idea that I was mentioning the word. They didn't hear peri, they didn't really know what peri meant, they just heard menopause and they were like what the hell? Yeah, what does this mean? Like how can this be? This isn't supposed to happen till I'm 55? And that was how it played out before Joe Duffy post Joe Duffy.
Speaker 2:What happened was those women in their 50s actually came to the door like there were some really beautiful stories like women, some women's husbands, particularly working like in transport or taxi drivers, or like a farmer there was a farmer in his, in his tractor, who heard a show about it and who they were saying coming back, saying to their women I think this is what might be going on, why don't you go to the doctor? So the women were then coming sooner and coming like with a different slant on it, and then the younger women have started coming in now in their droves saying I think this might be perimenopause and sorry, but suddenly perimenopause is cool. Well, you know what? I don't know if it's cool, because that speaks to the loneliness part. It's fine if you don't have it. But when you have it, it brings you into a place where you feel depleted and not coping well and your confidence is down. So, even though maybe in your head you know, you know nobody's going to judge you for it, but you still are feeling pretty rotten because of it.
Speaker 2:And then it is interesting, like the psychological piece is still there. Like I've had conversations with people who are like, yeah, I know I probably need HRT, but I don't want to start it because if I do, it's like admitting that I'm getting old. And then you have younger women who are like it is like if you're in your early 40s, because nothing makes you feel older than being severely affected by estrogen deficiency symptoms in perimenopause or menopause. They're like they're feeling old. So they think. They often say to me I think this is just getting old and I would say bluntly, like I think that's rubbish. There is no such thing as getting old in your you know. Obviously, if you're 85 or 90, your stamina is going to be lower, your energy is going to be lower, but at 45 or 55, getting old is not a thing. It's not a medical diagnosis, not a reason for anything. So love that you just said that. That's lovely.
Speaker 2:It's a fact, though, and this is where our whole engagement with like being 40 or being 50 or being 60, like we need to shake it off, the idea that I'm getting old. The only thing that's changing perhaps is your mental attitude to your actual age. So you're beginning to tell yourself a story. Your actual age, so you're beginning to tell yourself a story. Now I would agree that you know the women I see over and over like they feel ancient, they feel achy and creaky and exhausted and miserable. So they kind of equate that with feeling old. It's kind of that perception of feeling depleted. But once you sort out therogen, they go back to feeling like a 42 year old or a 46 year old. So so it's so important. This is why, like active management of your perimenopause and that brings me back to like so we talked about are your symptoms having a mild, moderate or severe impact on your quality of life? So if they're mild, you go down the lifestyle route. If they're moderate or severe, you go down, most likely, a trial of HRT, and that, generally, is really important. Now, lifestyle is never going to be forgotten about. But the challenge is, if you don't get the hormone, I think of it like the foundations of a house. If you don't get your foundations right in terms of your hormone balance and you've got significant symptom load, you're never going to be able to get the benefits of your lifestyle or really enjoy it or flourish. So that's why we have to sort out your hormones. And then the women start to say things to me like I have space in my head now to actually think about going back to that gym class. I'm thinking more about what I'm eating. I'm losing weight now because it's like I have the energy for it again. So it's like the chicken and the egg Like.
Speaker 2:On the one hand, you know, sometimes as doctors we can say like you need, you know your, you know you really need to look at your weight management. But if your alcohol intake has been driven by the fact that you feel absolutely miserable all day and the only thing that gets you through is that glass of wine at seven o'clock to take the edge off things, Well, telling you to get rid of that is not really helpful. What we need to be doing is looking and seeing. Is there, for example, a hormone issue that's making you feel so unwell during the day, in whatever form that takes for you? So, and similarly, no weight management. We need to be careful to make sure that there aren't other factors that are like making your life more difficult. If you're awake on, you know a lot with insomnia and hot flushes. You're not in a good spot when you wake up in the morning to have like make healthy food choices during the day or even have the energy to exercise or exercise. So often it's like you get those foundations right and then you're able to kind of go forth and flourish, and so that's where I would say moderate to severe symptoms.
Speaker 2:You know there's no reason not to consider a trial of HRT. And for those women who for some reason have contraindications to HRT, they're few and far between, but if they are, there are non-hormonal medications. They're few and far between, but if they are, there are non-hormonal medications which we can use as an alternative to HRT. I suppose the message is there's menopause care for everybody and perimenopause. I use the word, the kind of. We use perimenopause and menopause, I suppose somewhat interchangeably, but the bottom line is the care is there for everybody and even whether you know, you're a lady at 65 who feels she might be bothered by symptoms and you're thinking, well, I'm too old now. No, like there are lots of treatments, different treatments. It is not all about HRT, but for some women, particularly in the moderate to severe category, HRT is going to be a cornerstone of treatment. And then the lovely thing is you add in all the extra good things there. So you add in the lifestyle, you add in, you know, your exercise, nutrition and all the additional pieces that allow you to feel good.
Speaker 1:Yeah, can someone though the whole HRT debate? A woman can't be on HRT forever and ever and ever, though, so you know when do we decide to take someone off HRT if they've been getting on really well with it, like that's anxiety driven in and of itself if someone thinks that they're going to have to come off something after a certain length of time, yeah, so historically like and you would have heard that on the Joe Duffy show like there were all these really sad cases of ladies who had been doing really well and somebody decided they had to stop it, and that was based on some of the kind of guidelines and evidence that was around at the time.
Speaker 2:But increasingly the buzzword in perimenopause and menopause care now is individualized care, and that's really about talking to the person who's in front of you, counseling them appropriately about the risks and benefits of staying on treatment. Typically, the way we approach it is we deal with the lady in front of us. So whether you're 42 or 47 or 53 or 61, we're going to be dealing with where you're at right now. What is your symptom load? How is it affecting your quality of life? That is the most important question, because if it's significantly affecting, if your symptoms are significantly affecting your quality of life, we need to do something. And then the question is what do we do? And we discuss the options with you around. What are your choices? What are the best choices for you at this time, given your age and all the different factors? But in general, certainly most of the time, people's requirements for HRT will diminish over time, so your body naturally adjusts to the lower levels of oestrogen over time. When you manage someone through their menopause, you're simply getting them through that time when they're having symptoms due to the drop in oestrogen and you're giving them back some oestrogen to help to treat the symptoms they're having. But then you will gradually withdraw the HRT and, as you do, wean them down over a period of time which will be different for everybody. Their symptoms, you know. We're aiming to wean it in a way that their symptoms don't come back. Now, if a lady comes down to say you know a lower dose of her HRT say 50% of her HRT and she's 57 and she's decided she wants to try weaning off her sweats, come back with a bang. We will go back up. We might try another wean in a year's time. At that time she might be ready for the wean.
Speaker 2:There is a small chance a small proportion of women will be resistant to coming off the HRT and in those cases in general we are not going to stop something that is working for you and giving a benefit to you. But we will always talk you through the things you need to know if you're going to be on this longer term. But the big message to get out is it's never too early to start. It doesn't have to be stopped. There is not a time frame, nothing is written in stone, there is nobody who is excluded from care. All the black and whites are gone and there are shades of gray now for each individual, where we will talk you through it, you know, talk you through it as an individual.
Speaker 2:But this idea, you know, if I am I delaying my menopause if I go on it now? No, is the answer. You're simply managing it. And if I go on it too early in perimenopause, do I have to come off it? No, is the answer.
Speaker 2:Like, if you think about it, we're giving you back some oestrogen, the contraceptive pill which is now licensed up to the age of 51, your 51st birthday. That contains oestrogen and progesterone as well. If we suggested to somebody in their 40s to go on the pill, provided they didn't have any contraindications to the pill contraindications to the pill they probably wouldn't bat an eyelid at it. So HRT contains the same hormones as the pill or similar hormones. So these are kind of myths that are out there. You hear these myths about the pill as well. I'm sure you've heard them over the years like I need to take a break. I need to give my body a break from it. You know it's not good for me to start it when I'm too young. All these different things and these are just myths, and that's why it's so important that you come and talk to a doctor if you feel you're in trouble with symptoms, rather than taking your information from, you know, throwaway comments from friends or even mums.
Speaker 2:I find the mums can be amazing, and I'm speaking generally here in terms of the stories I hear from the women who come to the clinic. Some people's mothers have been really helpful to them. They have said things to them like you seem to be having problems. You should go and talk to a doctor. Other mothers have said things like oh geez, no, I wouldn't touch that Sure that can give you breast cancer. And anyway, we all got through it. You can get through it.
Speaker 2:And when these women come in to see me like you can imagine what that does to you. As you know, your mother tends to be quite an influential. You know character in your life, person in your life, and when you're already feeling like I'm not coping, I'm not managing, and then you're told by women around you that they just got on with it. That then leads women to feel like you know, you know, maybe she's right, maybe I should just get on with it. And then sometimes, hopefully, a sister or a girlfriend steps in and says no, listen, there is help now. It's different now, and pushes them in to see a doctor.
Speaker 2:But you can see how, like everything from our conversation, everything is conspiring against a lot of women getting help. So the fluctuating symptoms, the fact that it mimics loads of other stuff, the fact that it comes on so slowly that you're not even sure when you last felt normal, your friends are telling you different things, your mom's telling you different things, you're embarrassed about it, you feel like you're not coping anyway, and all these things conspire to create a total muddle in your mind. That can be, and you're stuck in a rut and it can be really hard to kind of make a concrete decision. How am I going to get out of this? Whereas if you've got a rash on your leg, you just go straight to the doctor.
Speaker 1:But with the rash on the leg and going straight to the doctor. Generally, every doctor will be able to treat that rash on the leg. What I'm hearing from women is they go to their GP, who's been their GP and an amazing GP for many, many years, you know. I've heard of 45-year-olds going and the GP says, oh no, you're far too young for menopause. So there is a lack of awareness even amongst the GP community certainly amongst the pharmacist community, about the fact that this hormonal transition that you're talking about is something that does happen in the 40s. So the access to care for many women isn't there. So do you have any comments on that?
Speaker 2:Yeah, I think it all begins with the patient and with the conversation among women. I think that's where raising awareness is the biggest issue. So I think, with any like, we all have different areas of expertise as doctors, but what is so important is that we as women like, have knowledge, education and then are empowered, like we trust our bodies, we listen to ourselves and we are prepared to seek advice. And if we don't always get the answer that sounds that makes sense to us that we seek advice, you know that we get a second opinion that we advocate for ourselves Like we've seen this over the years, I suppose, at mental health as well. You know mental health has really like in the past maybe 15 years. You know the kind of awareness within society, even you know within healthcare providers, how mental health issues can impact on you in so many different ways. We've become so much more aware of it and I think menopause and perimenopause is moving in that direction. But in the end of the day, it's as an individual. You have a right to advocate for yourself, to trust yourself, and you're not always in perimenopause like you're doubting yourself, you're overthinking everything. That's often how women who are in trouble with symptoms present. And again, some women don't have this problem at all, but some women can feel like that. But I think you have to. You know you have to listen and learn from the information resources that are around and then you have to be prepared to trust yourself, to back yourself.
Speaker 2:And you know, a bit like going to a physio and maybe you don't always get the exact. You feel like my shoulder didn't get better there, it just didn't. The exercises didn't make sense to me. You might try somebody else. You know.
Speaker 2:I think it is important to recognise like I would not necessarily be a good fit as everybody's doctor, but if somebody doesn't feel that they got the answer that made sense to them from me, I would urge them to go to somebody else. And you know, sometimes we have to make two or three attempts before things click for us in terms of, you know, finding an answer that makes sense to us. So I suppose I do think, like in an ideal world, there would be a women's health clinic on it in every community centre and you would pop, you could pop down and it would be free of charge and there will be, you know, women's health specialists there and there will be a physio in the next room and a women's and a pelvic floor physio and a pharmacist in the next to like rationalise your meds, but unfortunately we don't live in that world.
Speaker 2:So I think, because this is such an important issue, like you have to add, you may, you may have to advocate for yourself and don't be afraid to do that as the message, because if you don't, you know the danger is that you walk away and that you leave it for two years or four years or six years. And I do hear stories from women in their fifties who say, you know, we meet a woman of 54 and she says, yeah, like I really think this has been going on since I was 46. I remember it's. I started having hot flushes then and you know this and this and this, and you're like going, that was nine, whatever eight years ago, and it's just such a pity that you had to. Now, you know you survived it, but you put up with this.
Speaker 2:So that's where I think all of these conversations, like people say, is there too much talk about it, is there too much hype about it? Well, I think it's really important that the conversation is, you know, carefully balanced to reflect the fact that it's a transition which everybody will experience differently. Some people will have no bother with it, but if you're one of those women who has bother with it, you need to have access to the right help, because there's great treatments there which can, when you actively manage your perimenopause or menopause, you can effectively take it away as a problem.
Speaker 1:Yes, it's so important. So I think that the message there and I think it's really important that, if we're speaking to people who may not have had or thought that they got the care from the doctor that they're currently seeing, that they do look for that care elsewhere, the issue being, though, they're probably low in confidence anyway, and making that step can be difficult, but I suppose we're just urging you to keep an eye out, listen to what your friends are saying. Word of mouth often gets out, and there's a list of menopause specialists now as well, isn't there on the HSE website or something like that. I mean, it is growing this idea that there are GPs that are specialising in it too, which is so very important, because, you know, gps can't be all things to everyone, and that's the reality, and you all have your own special areas of interest. So, yeah, there's lots of.
Speaker 2:GPs who, would you know, have no problem at all providing menopause care, and obviously there are some doctors who may not have as much interest in it and for that reason, you know, I think a good opener question is, like you know, do you provide any care to perimenopause women in perimenopause or menopause? And if you ask that as an opening question then you know you just get a sense of whether it's going to be useful to pursue it or not.
Speaker 2:But in general like the ICGP, the College of General Practitioners, are, like you know, providing a lot of training on it and there is, you know there is a huge push towards building awareness in GP as well. But you know it is challenging, like I would see patients for 30 minutes, 45 minutes, whereas you know GP consultations are 15 minutes. So it is really challenging to, as I said at the start, is this problem due to hormones or is it due to something else? And it can be challenging. It's not like there isn't a blood test that comes up flashing menopause.
Speaker 2:So that's where I think we all have to have a really sharp radar for it and not always to be considering it just as a possibility, while not jumping on it is important as well, and I suppose there is that sense, though Is there too much hype about menopause? Are we all jumping on it? Are people sort of saying there should be HRT in the water, kind of thing, and I think it's really important like to say no, you know, and to know when you're doing just fine, you're 46 and maybe your PMS is a little bit worse than it used to be. An extra day of being slightly irritable, but overall you're fine. You don't need anything, and you might never need anything, but, on the other hand, you could be the 46 year old who's really feeling.
Speaker 2:You know that she's suddenly got yeah, she's got all these new symptoms. She doesn't know why her periods have got really heavy. And she, you know, I had a lady this morning like and actually I should just tell this anecdote because, like this lady this morning, she came to me last September. She was flooding this morning. She came to me last September. She was flooding, bleeding so heavily that she was flooding through her pants. She was having to bring spare trousers with her.
Speaker 2:And she came to see me and she had been living like this for about 10 years and her husband had actually said to her if I could just take your period away from you for one month and just suffer it myself, because she was having such heavy bleeds and was so miserable with it, she literally like had to stay in the house for two or three days. So we put in a Mirena, which is like a hormone treatment which reduces the blood flow. She was also having perimenopause symptoms. She started HRT. She came back today and she's like my life is totally different, like I no longer lose days every month, like I actually actually has no bleeding now at all with her Mirena in and her menopause symptoms, her perimenopause symptoms, are really improving. And these were just two simple interventions which, like, have transformed this 46 year old lady's life. Now her periods. I don't know when they were going to stop, but you know the average age is 50, 51. So so, and her iron had been really low.
Speaker 1:Her iron was now normal.
Speaker 2:So, like you have this lady who was potentially going to have, you know, four or six years of living like this and every month being hugely disrupted and the low iron causing her to feel profoundly're able to change the trajectory Like that's why, as a job, it can be really rewarding, because it's so nice to see someone come back and go. My God, this thing is amazing. It's changed things. So for all those women out there who might be putting up with losing days each month due to heavy bleeding, I would say you know, talk to a doctor about hormone treatments for heavy bleeding. Is the other part, like that's so important.
Speaker 1:Don't just think it's a in your forties thing, because there's no such thing. Yeah, what I do, the people that I do often think about, are the older women that I've missed out on this entire conversation. Yeah, and you and I have both seen them in both our practices. These are older ladies that were just told to put up and shut up. It was almost like there was a deafening silence around menopause for so long With the, you know, everyone was scared to prescribe HRT. Do you see those ladies now? Are they coming to you? Are they? Can they access care now too? Or?
Speaker 2:They can Like. The sad thing is, I think once you're sort of over 60, there's a cohort of about 60 to 64 year olds who are coming forward, who feel that they've missed care but are still beginning to have the conversations you know on the sea, swimmers or golf club or wherever, and are saying, you know, is there anything I can do now? But above 65, typically those women are still of a generation that don't talk about it and that's why I think, as younger women, we should be asking our moms. Like you know, vaginal dryness, itching, lack of lubricator well, typically it's more the dryness and the itching for that age group and then urinary frequency, urgency, like leaking, getting up at night four or five times a night, or recurrent urinary tract infections. So they all happen because of lack of oestrogen to the pelvic floor and the vaginal tissues and the vulval tissues.
Speaker 2:And women can like be awake at night. You know older women in their 70s and 80s literally scratching and really intense itch. That's like really really troublesome and keeps them awake at night and then obviously getting up really disturbs their sleep, which isn't good for them and all the rest. So for those women they can definitely have vaginal oestrogen and it can be a game changer, and so many women come to see me. I work with two male colleagues and they would say, oh, I didn't want to bother him, I didn't want to bother him.
Speaker 1:And it's sometimes dextrin cream. Yeah, that's the red flag.
Speaker 2:But the interesting thing is like some 65 year olds won't be bothered, some 40 year olds will be really bothered. So we're all very individual as to whether it causes us trouble. But so for the older women, definitely, you know, we should always be thinking about their bone health, about their vaginal health, about their urinary symptoms, because these are quality of life issues and obviously as well, you know, you don't want to be having recurrent courses of antibiotics for urinary tract infections and that. But it is also like there will be a handful of women who are still having flushes. It's rare but, you know, over 65. And for those women, you know, we do have non-hormonal treatments. I think it's really nice to like the. Even the conversation is useful. So looking at you as an individual, whether you're, you know, 45 or 55 or 65 or 75, and seeing what you need to manage your health. So whether it's vaginal health, whether it's maybe that you're one of the few people who've continued to have flushes we need to talk about that Whether maybe you've got some mood issues that never fully settled, we have non-hormonal treatments for that. And then for those women in the group, like the kind of over 60s, 60s, 65s, again, we're going to do an individualized, very individualized assessment. We're going to talk about whether your symptoms are having a significant impact.
Speaker 2:I often find with those women that the idea and this holds true for women of any age the idea of a jigsaw that you're putting together, a jigsaw of what you need in your life to allow you to have a good quality of life, so we'll all need, like healthy living stuff. Some of us will need, you know, vaginal oestrogen. Some of us will need HRT. Some of us will maybe need non-hormonal medication. Some of us will need counseling or, you know, to talk therapy about something that's holding us back. All these different pieces, we put them together. Maybe we need physio for something you know, a chronic ache or pain. We put together these pieces that allow us to feel good.
Speaker 2:So often for the over 60s ladies, it might well be just sorting out their vaginal and urinary symptoms, mean that they now sleep at night and they're now not afraid to go for a walk with their friend because they don't leak anymore, because we've stopped them having urinary leakage with the vaginal oestrogen, and maybe, you know, the fact that we've even explored the kind of pathway that their hormone transition took may be enough for them and they may find and we've maybe talked about alcohol and talked about bone protection and that might be enough for them and they might say you know what I'm doing my exercise now. I've started my Pilates. I'm actually really enjoying that. You know, my my vaginal symptoms are gone away and I'm actually feeling more kind of in control of my health and I'm happy with where I am.
Speaker 2:Now. You'll get some ladies at 62 who have got horrible aches and pains, sweats that never went away from, you know, their fifties, mid fifties, and for them we will talk about HRT and you know there isn't an absolute cutoff for it but it's all about individualising it to the person that's in front of you. But that's where this message of like it's never too early, it's never too late, don't be afraid to come forward and talk.
Speaker 1:You know about any symptoms you're having that are bothering you Do you see a lot of women coming into you that talk about oh my goodness, my mother had an awful time and nothing was ever said, but we just she just changed, yeah, so probably be.
Speaker 2:I would guess, like certainly 20, 30% of the women that come in to see me would reference their mothers, and it's often like it often brings tears to the women's eyes. There's kind of two things that make women typically are make women cry in the consultation when they start talking about their children and how their symptoms are impacting on their parenting, whether it's like young kids or teenagers, that generally brings up a lot of emotion for women, and the other part is their mothers. I think it's because it's such a profoundly you know, deep childhood memory. People use words like I remember my mom going off in her forties or fifties. We never knew what was wrong with her, she just changed or used the word crazy or something like that. They say she never got back to herself. Like that phrase, she never got back to herself.
Speaker 2:And that is why I think the idea of actively managing your health in midlife is so important, because how you manage yourself in your forties is going to determine the person who turns 50, the person who turns 60, the person who turns 70. So you put in place this jigsaw with all these good, healthy habits like this stuff that makes you feel good, that makes you feel like you're flourishing, like your exercise, your, you know, your connections, your friendships, your relationships, your, whatever purpose you have in life, like your work or whatever role you have. And if you keep all this stuff nicely taken along, you turn 50 feeling good. But if you gradually let it slip from 43 on, you know you start to give stuff up. People describe like, oh, I don't want to meet my friends, I just feel like I'm saying no to stuff.
Speaker 2:Well, it's our natural reaction, like, if we're feeling rubbish, we don't want to go out and meet people, we start to prefer to curl up on the couch and, you know, not eat healthy food and watch Netflix, because it's a safe place. You're retreating, you're not taking on new stuff, you're not feeling, your mojo is down. So instead, if we can actively manage someone's perimenopause and menopause, I think it's a critical life stage because instead you're like flipping things and you're moving a person to a place where they're ready to take on like they're turning 50 and they're feeling great, instead of turning like often these milestones. It's so distressing for someone If their perimenopause hits at 49 and they're coming up to their 50th birthday. They're feeling old because of their estrogen and now they're turning 50. And they're like well, that's just it, this is what 50 feels like, but it's not.
Speaker 2:It doesn't have to be like that. So I think it's kind of part of almost age proofing ourselves is. You know, there's this whole idea we're all living longer. We want to live longer, healthier. So we're putting in place the foundations in our 40s for our 50s, in our 50s, for our 60s, 60s, for our 70s and, like you know, most of us have got like they're going to live until we're like 90, you know, 80s, 90s. So we want to be in a good place as we get older and we can only do that if we look after ourselves well in midlife.
Speaker 1:Can I ask you a little bit about weight, because weight comes up time and time again. Women who may have been able to maintain a healthy body weight all throughout their lives ate well, exercised or maybe not, and then they suddenly hit middle age and, like that term, barrel around their tummy. Yeah, they can't shift. Yeah, you know the bottom goes a bit flat.
Speaker 1:There's a completely the proportion of fat on your body changes. Can women get back to their old body weight, or old body shape rather than weight? Isn't it Because you shouldn't really be focusing on the weight, yeah? Or is it something that they need to accept and learn to live with, with making some small changes? Because people do talk about the fact that you should be eating less because your metabolism is slower. Women are going around starving and they still say that they have this belly weight. So what are your thoughts on that?
Speaker 2:Well, we know that, like when your estrogen levels, if they're fluctuating or if they're lower, it does change your metabolism. So your metabolism slows down, which goes against you burning off the calories that you're taking in. And then your fat distribution patterns, we know they change. So your deposition of fat you tend to put more around your midriff. And so you know people, unfortunately they call you know women have all these different words for it. A lady this morning said my donut, people say my, you know my roll and they despairingly, like you know, grab their tummy. And the other thing then obviously that feeds into it is the fact that if you're awake at night and you're exhausted, you're not going to feel like exercising as much and your food choices are probably going to slip and your alcohol intake might increase. But you will have some ladies who are like being absolutely meticulous, they're still going to the gym, particularly, you know, some of the ladies in perimenopause. They're going to the gym, they're really working out and it's literally like the scales is going up while and then there really isn't a good. You know it is not reflected in their lifestyle. Their lifestyle is excellent. So we know that the hormones play a part, and typically so for women who have significant, like moderate to severe symptoms, who might be considering a trial of HRT.
Speaker 2:Often I do find like that when you're feeling better, hrt seems to have an impact on. It can make it easier to lose weight because your metabolism will correct somewhat. Now that obviously all depends on your lifestyle as well, but it certainly isn't the first thing to improve. But a lot of women will notice that their weight like that, they will find it easier to lose weight. They then, of course, will have more energy to exercise as well. But that they find and this is a large amount of it as well as anecdotal, but they will find that they are. They often use words like I have more headspace now so I'm actually able to think about my exercise and my food choices, and but you do, they do. Many of them do notice that they are fine, that they are, that they get more bang for their buck from their exercise, and even that they're I suppose they're losing weight. So therefore their body shape, you know, looks like it's coming back closer to where it was before. But so overall, I think it is likely, you are likely to see benefits, but it all you know it's very individual.
Speaker 2:It isn't a reason to go on HRT itself, obviously, but usually you know, lifestyle is a huge part of it, so I suppose it really depends where you're at with your symptoms. Weight in general is such a it's such a hot topic at the moment weight management and there are so many different reasons why a person can gain weight Like our genetics play such a huge role. There's all the new drugs now, medical treatments, and so you really almost need to consider like if your weight is causing you significant distress. It is worth considering an assessment in relation to your weight alone. Hormones are certainly not helping you, but they may or may not be. You know the major factor, but it's generally part of this global kind of sense of decline that you see in women, where there's a load of difference. There are a lot of different symptoms going on.
Speaker 1:Yeah, and they're just.
Speaker 2:This is just one other thing to, but I would see anecdotally, like, like women or I mean I'd see it in the clinic like lots of women lose weight when and I think it's a combination of the fact that they're, yes, their metabolism probably has increased, but also they're feeling they're exercising more and they are more careful about what they're eating and they don't even want alcohol.
Speaker 2:A lot of women will say I just feel so much better, I don't even need wine now, whereas before they were turning to the bottle of wine, like a lot of women will tend to have slipped towards, you know, two or three glasses of wine in the evening as a coping strategy, or even just one glass of wine, but one glass of wine is seven glasses of wine over a week, which you know is enough to add significantly when your metabolism is down to your calorie load. And then what you eat obviously is affected by drinking alcohol as well. So all of these things it's quite hard to separate out. It's just not one size fits all. Sure it isn't, no, but I think it's that's why you as an individual like you, really have to kind of look at your own life and what? How are you behaving? What coping strategies have you developed? Which ones are helpful, which ones are not?
Speaker 1:Yeah, and even when you say seven glasses of wine, it's probably very large measures too, like we don't necessarily pour ourselves the 125 mils that we should be.
Speaker 1:So, that seven glasses could actually be 14, if we're to be really honest with ourselves, you know, and that's the reality. I'd like to chat a little bit about the loneliness that some women can feel, that many women can feel at this time in their lives, because they almost feel like they're losing themselves. We discussed it, touched on a little bit earlier, and it's normally at a time when it's the busiest time in their lives. They could be minding either teenage kids or younger kids, because we're having babies later these days. Their parents may need a little bit of extra care. It's normally at a time when their careers are taking off too, and then suddenly they're in a meeting and they can't find the word that they were looking for when they were presenting their presentation. So there is a loneliness. There isn't there, and how can women help themselves with that?
Speaker 2:I think, like knowledge. So if you know what's going on, the confusion is probably what drives the loneliness, because if you knew for sure what was causing it like if you could do a dipstick on your urine and it came up flashing perimenopause well, you'd be like, ah right, okay, well, at least I have an answer. Now I mightn't like the answer, but I know what's going on and I don't think you'd feel as lonely then because you'd be like, right, what do I do about this? But instead you've got this model of symptoms, like and I think of you, know all the things the women that I meet, particularly COVID was such a good example because people were homeschooling, they were working from home, their whole routines, their whole like social connections were all just temporarily thrown up in the air. So a lot of women came in as COVID restrictions were lifted, they came in saying I thought it was COVID, but now things are getting back to normal and I don't, and I still feel the same. So that's just an example of how, like, you're mixing up, you're attributing your symptoms to a different cause. So I think that's where a lot of the loneliness comes from.
Speaker 2:And I think by listening to you know conversations like this by reading, you know different, you know following different blogs and Instagram posts, and that you will hopefully see something that will trigger you, that you will recognise Whether it's. You know, I heard a lady said last week to me she was in the middle of the conversation and she was a new patient and she said to me, like I don't know, I just feel like I'm too young to feel this old. And I was like that is a really interesting way to put it. And I said to her do you mind if I, you know, take that phrase, because it was just such a, it was a phrase that I thought would resonate with people, and so we all need to kind of hear something that triggers us, that we recognize that goes. Oh my God, I think that could be me. And when we have that, that moment where we go, that could be me. Then we stop feeling lonely because we now have connections. So that's why things like the Irish menopause Facebook page has gained such huge traction, because women go there and they see stories of people who, stories that they recognize in themselves and it somehow validates us.
Speaker 2:If someone else has it, then it's not just me Like. It's not just me not coping. This is actually a real thing and there's an answer to it. And then loneliness and confusion is replaced by relief. But I do have to mention the partners because, like, however confused we are as women, the partners are in some ways doubly confused, because they are still kind of in their right minds. They're not affected by all these symptoms, but all they have in front of them is, you know, their partner, who's changed and who now they don't seem to be able to do right by in any way. No matter what they try, all the old strategies don't work.
Speaker 2:Like I read a lovely there's a lovely leaflet for partners written by this lady, diane Dansebrink. She's in menopause. She raises awareness about menopause in the UK and she went through a horrible menopause and her partner was very supportive. And one day she was in a car with a taxi driver going to an awareness campaign event and he started talking about it. He said where are you going? And she explained and then he started joking me. In the beginning he was really joke, host, but the conversation got really serious. He said yeah, and he said you know what? My wife actually and they had a conversation and he was really upset about the changes that had happened. So Diane went away and thought about it and wrote a book, wrote a kind of a pamphlet for partners and it says things when you read it like you know I try to.
Speaker 2:You may try to plan nights out, you may try to cheer her up by taking her out or by taking her for a weekend away, but she keeps saying no, all she seems to want to do is sit on the couch. You know she doesn't want to have intimacy with you anymore. She's lost. You know she's always irritable. You try and be pleasant and she snaps your head off.
Speaker 2:You try and help and you know the truth is that obviously the reason these things are happening is because this person's partner is feeling unhappy, you know, has lost her confidence, doesn't feel like meeting anybody, doesn't want to go to the pub because she doesn't feel like having a chat with anyone, because her mood is low and she's anxious and she's tired and achy and she just wants to hide at home.
Speaker 2:So from her point of view it all makes sense, but from his point of view it's like what am I supposed to do here? And I often print off that leaflet, you know, when I get a sense that there has been like a lot of confusion with partners, because the lady can take it home and give it to her partner and I say just leave it beside his bedside, let him have a look at it so he can begin to understand. Because, you know, often the men won't have heard any of these podcasts or chats, so they don't know what's going on. They're doing their best, they're trying to do and all the old things that worked in the past. You know, if you think about it, we have strategies as couples to help each other, like if someone's grumpy, we try and do something nice, but if all your efforts are thrown back in your face, it gets to a point where you're like well, I don't know what am I?
Speaker 2:supposed to do with you. That then feeds into the lady feeling more isolated because he stops asking and then she doesn't want that either. So you can see how you go down this rabbit hole and it's you know. You get stuck in a rut and sometimes maybe they hear, maybe a lady talks to a friend who says something like I went to see a doctor because I was having this thing, and then she goes oh my God, that's kind of what I'm having. And you know it can open a door to a whole new way of being, not just for the lady but for her partner and then probably for if they're children in the house. It's probably going to make things a whole lot nicer for them. If she's an employee somewhere or an employer, it's going to make everything better at work as well. So you can see how, like it touches everyone.
Speaker 1:It doesn't just touch the woman.
Speaker 2:Sure, it doesn't, yeah, I always say that, like I believe it's like you know you go through perimenopause and menopause together. I don't think you do it in isolation.
Speaker 1:I wonder what it's like for same-sex female couples to go through menopause together. I'd say that's some picnic.
Speaker 2:Well, I think it probably brings its own challenges and similar challenges. In some ways, in fact, maybe worse, because if two people are affected at the same time, but the challenge is again, everyone's going to be affected differently. So you're not necessarily, and at different times, so you're not necessarily going to understand each other any better than a heterosexual couple?
Speaker 1:Do you prescribe a lot of antidepressants for women?
Speaker 2:of this age group Very rarely, and when I do, there are a handful of women who it can be helpful for very occasionally, in combination with HRT or as a non-hormonal medication to manage certain symptoms of menopause. But before I do it, I beat the drum loud and I really I start off by saying I am prescribing this. This is a drug that's used to treat anxiety and depression, but in this situation generally we're using it to treat either hormone driven anxiety, if that's what we think it is. Now, occasionally obviously sorry, I should say there are a handful of women who might have no other symptoms and may develop mental health issues in their midlife and they may have true generalized anxiety disorder or, you know, depressive disorder, and that's that. That is usually obvious because there's an absence of all the other perimenopause and menopause stuff. But generally the mood stuff is going to be rolled in with the hormone symptoms. So I, the way I describe it to women, is hormone driven mood symptoms or anxiety symptoms. So I'm saying, look, men get anxiety and depression. Women do, but in this case I believe that yours is driven by anxiety, by hormones. So for those ladies, generally the recommendations are to go for HRT, but very occasionally it can be helpful. It's literally very, very rare that we would add in sometimes a low dose of an antidepressant as well, if they're already on it when they come to me.
Speaker 2:Typically, I don't change it until we get the HRT sorted, and then we often wean it off, and they do very well without it.
Speaker 2:We don't suddenly take it away, though, and then the one problem is it is used. It's kind of unfortunate One of the non-hormonal prescribed medications for menopausal or perimenopausal symptoms. If you can't use HRT or you don't want to use HRT like, for example, a lady's had breast cancer you would prefer to stay away from HRT. So we know that there are tablets that are used to treat anxiety and depression that work really well in some women, for sweats particularly and for the mood disturbance. Now it's really unfortunate that they're also used for anxiety and depression, because you have to say to women beforehand look, I know this can be triggering for you, because I am not saying that you're anxious or depressed, that you have, true, you know, isolated anxiety or depression, but I'm giving you this for hormone driven anxiety and depression, and we know it works, and it also works for your sweats. Some women still are so resistant they're like no, I'm not anxious or depressed, is this?
Speaker 1:because there's a stigma attached to taking them.
Speaker 2:No it's usually because they feel like they've been misdiagnosed. Sometimes it's a question of was it mistaken in the past? For me, like, did somebody label me as anxious, you know, as having anxiety disorder in the past when I felt that I had menopause? And then it's really triggering, if you like. We all want to be heard and we want to be heard in a way that makes us feel hurt. So if you think you don't have anxiety and someone says I think it is anxiety, here's a tablet for it. You're not going to like it. And if you go on to have, like you read more and you listen more to perimenopause and menopause stuff and you go like, but I had the joint pain and I had the sweats, it wasn't anxiety, then you're going to be kind of hurt and you feel dismissed and you feel like you are vulnerable and you're exposed and you are mislabeled. And a lot of us don't, like many patients would prefer to be told. For some women can feel like I suppose it's just also it's that it doesn't fit with them. So some people feel it's just not the right fit, it doesn't feel like an authentic cause for their symptoms to them and they're kind of saying no, like I was always fine. Why is this just started now? And I have other stuff as well. So often it's a trigger to them, whereas you know, the funny thing, though, is if a lady comes in with true anxiety disorder, like generalized anxiety, where I think it's just purely an anxiety disorder maybe they're younger or even older, or maybe it's a man Generally these people don't have a problem with the diagnosis because, you know, it kind of makes sense to them.
Speaker 2:So we're quite good as individuals. Like this is, I believe that patients generally have the answers within them. Like you just have to listen carefully enough and they will kind of give you the information, and they will they're able to articulate. If you listen, they're able to give you all the clues, and, and then they're also able to sense whether this fits with them as an answer. Like there's no mystery generally around our when we come to diagnosis as doctors, like we're basing it on a history, sometimes in examination and sometimes in investigations, but we're generally able to explain the pathway that we went along to come to this answer in a way that should make sense to you as a patient.
Speaker 2:If it doesn't make sense to you as a patient, there's a problem because you're not going to buy into the treatment plan. So that's where I would say to people like you can trust your instincts. Now obviously you need to listen to the provider and you need to kind of find a doctor who you have faith in, who you kind of feel you can trust and rely on. But if you know, if you get, if you, if you, you need to feel like you're getting an answer that makes sense to you. Now, obviously you know, if two or three doctors all say the same thing, well maybe you need to think about whether your own health, you know, whether there's something else driving your attitudes to the particular complaint. But generally people are really good.
Speaker 1:And they're good at being, they can be an advocate for themselves. I think that's important. Well, they can.
Speaker 2:I think they shouldn't be afraid to be, because I think most patients actually aren't that good at being advocates for themselves in general. Now, there's a handful who are wonderful, but in general or maybe a bit too much Well, I think there's a fine line, I guess, but in general, particularly when it comes to sensitive subjects like you know, mood or anxiety or things that make us feel vulnerable. Well, you know, because mood and anxiety they present in feeling like I don't want to go out so much, I find it hard to speak in public, I find it hard to stand up at meetings, I feel down all the time. So these kinds of symptoms, they make you feel vulnerable. So going in and talking about them makes you feel vulnerable. And it's so important then that you know you feel like you have a good consultation and whatever outcome we come to, whatever conclusion we come to as a possible cause, that it makes sense to you as an individual too. Okay.
Speaker 1:Can I ask you a little bit about ADHD and menopause or menopausal symptoms? I'm not sure if it's an area that you are, like, overly familiar with, but there is a lot of talk and chatter about the fact that women often, you know, go through life and ADHD has become a more of a thing. Now. It's a lot of social media being talked about, particularly with younger people, but there is this cohort of people that are saying that a woman may have had ADHD all her life and may have had good coping mechanisms for it, and then she comes into menopause and it exacerbates the ADHD, or else the ADHD is mistaken for perimenopause, because it's getting worse and it's all this brain adaptation anyway, because the lower eastern levels. Have you any thoughts on that or any kind of?
Speaker 2:Well, I think it actually fits with all this idea of perimenopause and menopause. There's kind of I think of it like three balls colliding your pre-existing medical stuff, your life and then your hormones. So ADHD, I guess, will come into that pre-existing medical condition piece and really it's not to me as a doctor, trying to figure out are your hormones causing this. It's not really any different, unless of course, we're querying a new diagnosis. But then it's ADHD is going to affect your cognitive function, your attention, all that sort of stuff. But it's typically if it's perimenopause, you're going to have a more global picture of symptoms. So, yes, you know there may be subtle cognitive changes, but usually someone's going to be hitting other parts of their body as well. So there's going to be pointers towards it being something else as well or towards it being perimenopause, other than just ADHD. Similarly to like the anxiety. It's kind of like anxiety is a really common one that we see where someone was really nicely controlled. They had anxiety all their life, always prone to it, maybe were on medication for a while, came off the medication, figured out all these really nice coping strategies a bit like ADHD, where people have coping strategies and then got into midlife and suddenly their symptoms fell off a cliff and they're like why is my old coping strategies not working? I had this sorted. My old coping strategies not working, I had this sorted. Yeah, I knew I had kind of issues in this area, but I had them well under control.
Speaker 2:And the problem there is that if you don't pick up what's going on like they will attribute. So people will say oh, you know, I need to raise my, I need to go on a back of my anti-anxiety medication, I need to increase the dose if I'm already on it. But you may be going down the wrong route With ADHD. It probably makes it all the more important that we are proactively managing hormone issues. It's going to be a tricky time to get a diagnosis because of ADHD because there is a lot going on in the mix. So you know you're trying to tease things out.
Speaker 2:Sometimes it might be that by just like often, I would have a low threshold for saying let's do a trial of HRT for any of these women, whether it's women with pre-existing joint stuff like rheumatoid arthritis who are now getting worse, or whether it's the anxiety getting worse or whether it's, you know, I think I might have ADHD or a new onset and maybe there's enough to support the possibility of perimenopause.
Speaker 2:Let's go down that route, correct the hormones and see if things improve. We can do that for three or four months quite safely, and then we can see. So we've kind of fixed the foundations and then we can see where you're at in relation to your other symptoms. Are they improving, are they staying the same, are they getting worse? In which case we need to go off down another route, which might be, you know, a psychiatric evaluation, working with psychologists, all that. But it's about that idea of, I suppose, fixing if it's appropriate to consider a trial of HRT, like if there's enough in the mix to convince you that it could be possibly perimenopause or menopause. A trial of HRT is a really nice way to clarify it.
Speaker 1:Okay, Can we talk about libido? Yes, Because libido is affected. I've had women say I feel dead from the waist down. Yep, you know. And what can they do about it? And testosterone is a huge buzzword at the minute, but we all know it's not the magic bullet either.
Speaker 2:So I'd love your thoughts on it, sarah. Well, I think of libido like a tangle of threads, and when somebody comes in, you know, or when I ask the question about libido, I think we have to remember that you know, libido is made up, there's a number of different things that can influence it. So that's where my idea of the tangler threads come from. So I'm thinking there about, like physical stuff, like you know, your vaginal health. Are you dry, is it sore, are you lacking lubrication? Obviously that's going to make it miserable. What is your relationship like If you're cranky and irritable and you've been feeling down for months and you haven't had a, you know, a night out, you have.
Speaker 2:You know a night out, you have. You know everything is very kind of on eggshells at home. That is going to affect, or maybe your relationship is just in trouble for other reasons. Well, that's going to affect things. Obviously, you know all the stresses and strains of life, like women are particularly like typically women tend to have lower sex drives than men anyway. So all the stuff, like the financial stresses, kids stresses kids, you know, knocking on doors, trying to actually get privacy, all that you know. Teenagers, all that sort of stuff.
Speaker 2:And then as well, there's also this what I see a lot of is this idea that you've got stuck in a rut with your sex life, basically, where you lost interest in it for all the reasons that I'm talking about. You weren't feeling good, you weren't interested, but now you almost are not in the habit of it. You've lost the habit of having sex and you've kind of you don't even have it on your radar in your week anymore. So it's not a thing. It's because it's because it doesn't come easily and because it's not, you know, immediately fun, you're saying, well, it's no good anymore. I don't have libido full stop. So when I talk to a lady, I'm asking these questions. I'm saying, like, have you totally fallen out of the habit? How are things with your husband? Well, we only ever talk about the kids, like I don't know when the last time we were out, all that sort of stuff, and it's sore anyway when we do it. And so when you have that conversation you're like okay, so is this actually sex drive? Like, has someone turned off your sex drive tap or has a whole lot of other factors got in the way of you actually having satisfactory sex?
Speaker 2:And there's one other piece that's really important that isn't really focused on a lot, I find, which is there's the vaginal health. So if it's dry or lack of lubrication, that's going to be sore. But then there's a thing called vaginismus, which a lot of women don't seem to be aware of, and it's just basically where your brain and your vaginal muscles are like. There's a strong connection. So if you've had any kind of negative experience, then your brain remembers this. So when you go to have sex it can be painful because the vaginal muscles clamp shut. So basically it feels like too tight, it feels sore.
Speaker 1:So you're not on the drive, and could this be a bad experience just related to dry vagina?
Speaker 2:Yeah, exactly.
Speaker 1:So that's enough, you had one session where you had dry vagina and it was sore. Well, if you've been, having it.
Speaker 2:For if it's been going on for months where you've been having like very infrequent sex, often just because you feel. You know, women do describe like they feel that they should because their partner like they feel bad for their partner or they just want to. They want to try and be normal, but when they do it it hurts. So every time it hurts and it starts to hurt more and more the drier it gets. Well, then your brain is anticipating pain before you ever actually have penetrative sex, and typically you know so. Then you can get this vaginismus on top of the actual lubrication issue and the dryness issue. So all of these things are kind of coming together. And so the question then for us as doctors is, like the way I would approach it. I would say number one are you in trouble with vaginal health? And the questions are do you have dryness, itching, lack of lubrication or painful sex? And if you have any of that, we need to get in there with vaginal oestrogen, because that is, without fixing that, we're not going to. You know it's not going to, it's not going to be pleasurable, and the other thing that can happen is your sensation can really reduce, like it was amazing who, like literally you know, the vulva, the clitoris had all atrophied and she hadn't had sex for like five or six years. And it was actually one of the most rewarding encounters. I said to I was thinking about the highlights of my day, and she came back and you know, about two months later and she said I had an orgasm for the first time in six years and it seems like it's kind of swollen there again. And when I examined her, like her vulva was back to normal, had, like you know she was, she was pink and plump again, the way it should be, whereas her clitoris was like visible again, whereas before it had been like pale and quite like shriveled. And so the vaginal estrogen had done a wonderful job at restoring her vaginal, her vulval health and her vaginal health and allowed her to like actually find intimacy again with her partner, with her husband, after six years. And she had tears in her eyes as she said it. She said it's just, it was really special and like this is a big deal. So now don't want to terrify a lot of women out there, for many women it's just a bit of vaginal dryness and that's it. And maybe you think, oh, I'm getting thrushed a bit more than usual and that's all it is. But for the women who are significantly affected, you know it can be a really big deal and obviously it's really hard for partners if you no longer want to have sex. So that's the first thing, the vaginal health.
Speaker 2:Then I would urge women to kind of think about this have I just taken sex off my list for the week, like, when do I think about it? Do I bother with it? Or do I just expect it to happen, because it's not, probably not going to come back on your radar if you just are waiting for the day when you suddenly feel, you know, really like it, especially if you're running a busy house and you know all the stuff that's going on. And then the other thing then is are we going to look at oestrogen, like, do you need HRT for other reasons? And if you do, often women find that their libido really improves with oestrogen. So now is it a question that their mood and everything else is improving as well, probably multifactorial. But then if after say, 12 or 16 weeks of your HRT, you come back and you're like everything has got better my sweats are gone, I'm sleeping, I don't have any joint pain, my skin's much better, and but the only thing is I just still have no libido. Well then, that's it, and and and I say to them, like, did you kind of focus on it? Like they're like, yeah, like you know, we've been spending time together, relationship's great, everything's perfect, but I literally just don't have any urge. And then we're into a different, you know, ballpark and you can see there, like the tangle of strings kind of sourced out. There's just one thing going on here, and you know, and I kind of think of it like the tap's being turned off and you know it's literally this is just a pure libido issue then.
Speaker 2:And then we are talking about whether a trial of testosterone is warranted, and it's got a thorny, it's become a bit of a thorny subject. There's been so much media attention to it because it is a lovely idea, like you know, take some testosterone and you will suddenly, you know, be a sexual goddess. I think we would all go for that. But the problem is that it doesn't work like that. From what we've just talked about, you can see that there's lots of reasons why you might not be having, you know, a good sex life. But once you get down to distilling it down to okay, it really just seems to be a pure libido issue. Then we're into are we allowed to use testosterone or not for this indication? So have there been studies done on it?
Speaker 2:So the studies were done in post-menopausal women and the problem was the drug companies that funded the studies. There wasn't a lot of money in women's libido historically. There wasn't a lot of focus on perimenopause or menopause historically. So they did short studies up to two years and they did show an improvement in libido in post-menopausal women. We now have all these perimenopausal women. They're dying from a little testosterone Now.
Speaker 2:Many of them don't need it, like for all the reasons that I've just said, and like we're going to listen really respectfully and we're going to go through it all. But generally women come on board and are like okay, I see where this is going and it's amazing how many actually identify with the stuck in a rut and the part where sex isn't quite the same as it was before. But that doesn't mean that I have to totally say like it's no good, I just need to go back to the drawing board on it a little bit and give it some time and give it some attention. So there is that I find that is one of the most common useful things that I can say to people. But the perimenopausal women then the studies weren't done in perimenopausal women for testosterone replacement for low libido, so the studies were done in postmenopausal women. Now there is a license for testosterone use for hyposexual desire disorder, which is where you have basically low libido in younger women and it's a relatively rare diagnosis. So we sometimes do do a trial of testosterone replacement in younger women in perimenopause. But it's important that you check that they have low testosterone levels before you start, that you keep them within a normal range, and many women don't need it.
Speaker 2:As I've said, there is this whole question does testosterone help with, like brain fog, with energy, sharpness, muscle strength and all that? And the studies, most of them, didn't look at that end point. So the studies didn't actually look for those end points and they were all, a lot of them were small studies. Some of the studies that did look for it didn't find it Anecdotally. A lot of women would report it. But again, that is just anecdotally it is and we can't, you know, rely on anecdotes. So really we look at each individual case, we explore, you know, the possible causes. We certainly, you know, in certain cases we will, you know, suggest a trial, but certainly it's not a panacea for low libido and it's not for everybody and the vast majority of women won't need it.
Speaker 1:Okay.
Speaker 2:But it is. It is really important to discuss it with women, because the last thing you want is a lady feeling like something's being withheld. That is going to be the magic bullet. You need to have that conversation to help them understand how much is in the mix in terms of libido. I think we simplify it to ourselves. It's like you know, if you don't have the urge, well, therefore, there must be a tablet for it, a bit like Viagra. It's not like that.
Speaker 1:Wouldn't it be wonderful if there was a female Viagra? I'd love to. I think a lot of men would be happy. I think a lot of, I think a lot of everyone would be happy, saving relationships everywhere. Oh, my goodness, that could be your next supplement, I know, I know, sarah. Is there anything else that you'd like to say about this topic before I ask you the two burning questions that I ask everyone Because you've so much to say about it? Is there anything that we haven't? I'm trying to think. I think we've discussed it all, haven't we? I suppose one thing.
Speaker 2:I do find helpful. I do find I do think it's important to say is that a lot of women are the awareness is really is a good thing, but it brings with it fear. And when I start talking about you know, like vaginal symptoms and that people are like, oh no, and the girls that I work with at the reception, there's a couple of younger girls that are like oh my God, I can't believe this is all ahead of me and I say, you know, over tea I would sit in the tea room. I would say to them girls, don't worry about it, it's going to be absolutely fine. Like I'm not afraid of my perimenopause or menopause, I just want to. If I, if I need, if I have problems, I want it actively managed, that's all. I don't want to waste time not feeling well, but I know that it can be actively managed, so I'm totally confident about it. It's not going to cause any bother. You know there might be a couple of weeks where you go off and it takes you a short time, like it takes a bit of time to figure out what's going on, but other than that you can get on top of it.
Speaker 2:And it's the women who come to me in trouble often, I think make the most kind of useful changes to their lives ultimately, because it's an opportunity to figure out what's going on in your life, what's working well for you, what's not working for you, to throw out the stuff that is actually not positive, not healthy, not good for you and to do the things that actually make you feel good. So women who get kind of stopped in their tracks with perimenopause or menopause symptoms are actually kind of forced to go to the drawing board. There are other women who aren't, who kind of glide through it and continue, maybe, you know, drinking more than might actually be making them feel good, or, you know, not exercising or working too hard, you know burning the candle at both ends because they, you know they haven't had to try and find kind of the inner peace, kind of find the balance. So it's actually an opportunity to find your balance. So I think there's nothing to be scared of and it's actually an opportunity. So hopefully, on that slightly more uplifting, note.
Speaker 1:It is an uplifting note and I like to say that too, because even after the RTE programmes that come out, they weren't very optimistic. A couple of them, I think Some of my friends are phoning me up. They're like I want to go on HRT now. I want to prevent these symptoms even occurring. So I think that we need to let them know that everyone goes through it differently. It can be more severe for others, but the vast majority of us will be okay.
Speaker 2:Well, even if it is severe, like there's treatments there. So like yes, and it doesn't come on generally overnight. So the whole point is, if you pick it up, you know nice and quickly, then you can get on top of it. So you know, in general I find, like the vast majority of women, whether their symptoms were moderate or severe, they're going to get sorted out because they're going to get the right treatment. The problem is, if they don't get the treatment, then that's when the problems arise. So that's why I have no fear of it. I don't, you know, if I get a really severe menopause, I believe that the treatments will sort me out. Okay, so if I need them.
Speaker 1:so I'm not afraid of it. You've hoped for yourself.
Speaker 2:Like I have total confidence, I feel empowered. I feel probably particularly empowered because I work in this area. Yeah, like I feel, and I see the results day in, day out of women and it's why I do really enjoy this area of medicine, because it's an area where we can make a big difference. There are so many parts of medicine, unfortunately, where it can be difficult to make changes to people's quality of life, but this is one of those areas where, you know, with the right support and management, you can really transform somebody's experience of their perimenopause and menopause from something that's scary and debilitating to something that becomes just a background. It's just a medication that you use, end of. It's like being on your. You know I'm scared to say thyroid hormone because I know there's a whole controversy around that, but you know it's just something that you do that manages it for you.
Speaker 1:Okay, and how did you get into it in the first instance? How did you become so interested?
Speaker 2:Well, I am my background's in general practice and I was in Canada for a few years and I did a lot of women's health over there and then I came back to Ireland and I just found I was, I'm the was the female GP in our practice. So I was doing I was mainly seeing female patients and from there it just kind of grew and then, um, obviously I so I w I kind of really interested in providing women's health to like girls you know from, you know like we, we we would see girls as young as nine or 10, who might be having problems with periods or stuff like that, then right up to elderly women who you know are having vaginal issues. So it's that idea of like women's health for women of all ages and how you manage that 10 year old affects, like her perception of periods and you know how they affect her quality of life and her confidence and you know the whole thing of like shame and all that around period issues. So how you handle that 10 year old determines the type of how she will feel about her reproductive health and her women's health issues for the rest of her life. So those 10 year olds are, you know, as I think managing them appropriately is as important. Or whether it's a 13 year old or a 16 year old, you know who's like doing her leaving and afraid she's going to flood during the leaving. Or you know has painful cramps and is missing days off school. Or whether it's a 20 something who's got some vaginismus. Maybe you know with a new partner, like whatever time of the women's life, how we respond to their problems.
Speaker 2:I think is really important because it all plays into the next stage and the next stage. So you know how you're handled in pregnancy. If you do have a pregnancy, that will affect how confident you feel to come forward with any postnatal issues and that. And then obviously that leads into perimenopause, menopause and then postmenopause care. So it's like this continuous journey for women and I think it's really exciting to be, you know, to provide care throughout all the different stages. But I do believe, like the women that I talk to in, say, perimenopause, they will be the women then whose periods will stop and will go on into older life and if we've handled the consultations and given them the right support, they won't be afraid to come forward and say when they you know, maybe they do get vaginal dryness when they're 62, they'll just come in and tell you about it and ask for, you know, assistance. They won't have any embarrassment about it. They'll know it's an open door, that it's an easy conversation. So I really enjoy providing care right across the spectrum of women's health.
Speaker 2:But there has been a lot of focus obviously perimenopause, and menopause has just got very, very busy because more and more women are coming forward and like that is wonderful, like it's a sign that things are changing. And even when it's a woman who comes in and says, look, I just want to know, what should I know? Now, ideally she shouldn't really have to come as far as me for that, but it's worth it because if you think of it it's worth. You know, it's great that she's just preparing for this. And hopefully women listening to this might feel like, OK, I'm a little bit more prepared, I have a little bit more information, and that's what it's all about. Like knowledge is power and in this situation it's really important because if you don't have the, if you don't have the education around it, you don't know what to look out for. Then how are you supposed to know what's going on with your body?
Speaker 1:Exactly, and you are speaking my language when you talk about.
Speaker 2:No shame when it comes to the female body.
Speaker 1:isn't that right? As I go around the world with my vulva puppet in hand, take it out at any opportunity, sarah, where can people find you? Are you active on Instagram with your ideas? How do you you know? And obviously, talk to me a little bit about where your clinic is based.
Speaker 2:yeah, so I'm in Dunham, eaton, north Dublin Complete Women's Health and there's a website there. I am on Instagram but, to be honest, I have a kind of a difficult relationship with Instagram. Yeah, I find it really hard to get the work-life balance and I found that Instagram was intruding on my headspace outside of work and ideas kept popping into my head and then I'd write them down and then I felt like homework that I never had done. So I do intermittently pop something up on Instagram, but to be honest, I've kind of given up on regular posting because it was just too challenging. So, yeah, so they'll, but they'll get a sense of of like well, you know the kind of style of service, I guess, and what we do at the clinic, and it's Complete Women's Health in Donomage.
Speaker 1:Yes, okay, that's lovely. So, to wrap it all up, I would love to ask you my two questions, which are what advice would you give young people today, and what is the meaning of life?
Speaker 2:Well, I think the advice I would give to young people if anyone would ever listen to me my own kids don't listen to me a lot, but I think the idea of being gentle with yourself. So I think we are all our own harshest critics, no matter what age we are. If something goes wrong or if we don't achieve something or something feels embarrassing, we immediately turn on ourselves with that negative critical voice. Feels embarrassing, we immediately turn on ourselves with that like negative critical voice. And if we could all be a little bit more gentle with the voice that we use to each other. You know, maybe say like it didn't go well, but I'm going to try it differently next time. Or I did my best there. Or you know I tried hard but it wasn't my fault that it didn't work out, then you know it could make life a lot easier yeah that's
Speaker 2:lovely? Yeah, absolutely. Then you know it could make life a lot easier. Yeah, that's lovely, yeah, absolutely. And the meaning of life? Well, I was thinking about this and I think the meaning of life lies in having a purpose, having a point to get out of bed in the morning. And I think then the challenge is that if you have a purpose, you may get caught up in your goals and your ambitions, and you need to be careful not to miss the moments on the journey. So, like this phrase, letting the good stuff land every day, like noticing the moments so you know whether I'm at work or with um, you know with family or whatever, I think it's really important to kind of notice those good moments and feel them, but still to kind of have that bigger picture in mind.
Speaker 1:That's lovely, lovely Sarah. It's been an absolute pleasure.
Speaker 2:Thanks so much. Thanks, laura, thank you.