#73: Perimenopause Unpacked - Lifestyle Tips, Weight, and Hormone Health Explained with Dr Gill Shields

Are you wondering if your mood swings, sleepless nights, or sudden changes in your body might be more than just “life stress”? 

This week, I'm joined by Dr. Gill Shields, an experienced NHS GP and British Menopause Society specialist. 

Gill sheds light on what perimenopause really is, busting myths about hot sweats being the defining symptom and revealing that there are over 70 recognised symptoms - many of which are overlooked or misunderstood. We discuss why you don’t need a blood test to validate how you’re feeling, the misleading legacy of past HRT research, and the importance of individualised care. Gill also sheds light on what happens to our weight in perimenopause, and the lifestyle changes that can help support your body and your mind during this time of life.

By the end of the episode you'll know when it’s time to visit the doctor, how to advocate for yourself in healthcare settings, and why being well-informed is key to getting the support you deserve.

Highlights include:
2:01 Understanding perimenopause symptoms
06:20 When to see your doctor
10:17 Lifestyle changes and supplement efficacy
17:16 Weight gain and body changes
23:56 The truth about HRT
30:56 Common misconceptions and final advice

This week's guest:
Dr Gill Shields completed her medical training at Imperial College London in 2006 and went onto work in several London hospitals before completing her GP training in 2011.

Along with her MBBS/BSc/MRCGP she has Diplomas in Obstetrics and Gynaecology, Sexual and Reproductive health and has FSRH letters of competence in IUDs (coils) SDI (contraceptive implants). She holds the Faculty of Sexual Reproductive Health Advanced Menopause Certificate and is a British Menopause Society specialist.

Dr Gill Shields is a GP partner within the NHS and PCN Women’s Health Lead. She runs regular specialist menopause clinics, group menopause consultations and general women’s health clinics. She enjoys listening to her patients and helping them make the best decisions around their health with support of the most up to date evidence based medicine.

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Transcript

Dr Liz White 0:02

If you're looking to improve your mental health and well-being, then keep listening. I'm Dr Liz White, a consultant clinical psychologist with over 20 years of experience. Whether you're a frazzled parent, a stressed out professional or finding your way through the challenges of midlife, you're in the right place. Or finding your way through the challenges of midlife, you're in the right place. Through a mix of solo episodes and insightful conversations with expert psychologists and therapists, I'm bringing you evidence-based tools and strategies to help you navigate life's ups and downs with confidence, clarity and compassion. With confidence, clarity and compassion. This is your space to feel seen, supported and empowered. Welcome to Hello Therapy.

Dr Liz White 0:57

It's September, so that means it's Perimenopause Awareness Month, and to mark this, I am talking with Dr Jill Shields, an experienced NHSGP and British Menopause Society specialist. I ask Jill the questions that you might be wondering about if you're a woman in your 40s or maybe even 30s, including when should you go and see your doctor if you're experiencing symptoms or you just don't feel like yourself? Why does weight gain feel so inevitable in this time of life, and what works and what doesn't when it comes to supplements and lifestyle changes? We also tackle some of the most persistent myths about HRT, and Jill shares her practical, evidence-based advice for navigating this often really difficult time of life. So let's dive in. So, dr Jill, thank you so much for coming. Do you want to tell our listeners who you are and what you do?

Dr Gill Shields 2:01

So my name is Jill Shields. I am a bread and butter NHS GP. That's what I've been doing for the last 20 years. I've always been the women's health GP. That's an area I've always found particularly interesting and over the last five years or so I've been doing a lot of extra training, working at Addenbrookes the local hospital in Cambridge, particularly specializing in menopause, and I'm now a British Menopause Society specialist. So I do do the the bread and butter menopause. I love that stuff. That's that's what I love doing. But I often see much more complex menopause. So people with histories of cancer when the usual stuff hasn't worked, nuances in in medical health, things like that. And I also run one day a week a private clinic in Bishop Stortford.

Dr Liz White 2:48

Yes, you rent our rooms, don't you? So that's how I know you. No, I'm really excited about today because we are going to hone in on perimenopause, which is a really hot topic amongst my friends and my peers who are my age. Same, a really hot topic amongst my friends and my peers who are my age. Um, so I'm gonna essentially fire a load of questions at you. I was saying before, like the questions that I want answered and I think my friends might want answered, but let's sort of set the scene for people. What is perimenopause first of all like? What are the common symptoms of perimenopause?

Dr Gill Shields 3:21

so people, they have a journey to take, so so you don't just stop your periods. So the average age to stop your periods is 51. There's a run up to that and, interestingly, the perimenopause that run up to actually finally stopping your periods can actually be the worst bit, and what's happening is your ovaries are starting to slow down, but it doesn't want to slow down, so they start doing this with your hormones up and down.

Dr Gill Shields 3:46

Yeah, up and down, up and down and that up and down is the feeder for those horrible hot sweats. You get the feeling you want to kill your husband with all your might. You know that lack of resilience, that anxiety, happy, anxiety, happy that is the reflection of your, your um, your moving hormones. What the symptoms are?

Dr Gill Shields 4:10

I mean, I think there's 70 recognized symptoms, but I've been in this job a long time now and there's way more than 70 like I talked to a professional singer the other day and one of her symptoms was she'd lost the dexterity in her voice and that was obviously huge because that was her profession vertigo, itchy ears, palpitations. It's not just hot sweats. Only 80 percent of women get hot sweats um 20 percent don't. So hot sweats is not a condition defining symptom. And I think I have women coming to me going well, I don't think it is the perimenopause, because I haven't had the sweats yet and I'm like that's just one small part, um you not feeling like yourself, your more jaws gone, your, your mental agility is going. Those are much more indications to women that actually things are starting to change.

Dr Liz White 4:58

I I remember it was COVID for me. So those COVID years when we were at home, kids are homeschooling, I'm trying to work, etc. And it was a couple of years where I just didn't feel right and I was just sort of carrying on loads of migraine.

Dr Gill Shields 5:15

As women do. We just blood it off as we do. Yeah.

Dr Liz White 5:18

But I just assumed it was like the extreme stress of the COVID situation. Extreme stress of the COVID situation, um, but then, sort of, as the years rolled on, I realized actually, well, covid's finished now, yeah, and we're allowed out of our houses and I still feel like this, or it's kind of getting worse. Yeah, so and I and this that is a very similar story to what I hear from the clients that I see as well, who sort of say I'm really anxious, I, yeah, my moon's all over the place. I have that kind of rage and the anger and I'm not I'm not normally an angry person. Yeah, and when we start talking about hormones and things, the sort of penny starts to drop a little bit. And I would always suggest to someone you know go and get that checked out, go to a GP, because it might not be a purely psychological issue that you're experiencing?

When to See Your Doctor

Dr Liz White 6:08

yeah, and I guess one of the questions that comes up for people is well, when do I see my doctor? Like, when is a good time? How do I know when I should be going to the doctor?

Dr Gill Shields 6:21

do you know what it's so individual? So I have women coming to me in their late 30s going I'm not sleeping anymore because often sleep is one of the first things to go, not necessarily related to hot sweats. The oestrogen is involved in the circadian rhythm and they are their personality is, they are type of personalities, so they are organized, they are on it. They often have high-flying careers, you know. They organize the family to an nth degree. I wish I could be like that, you know. And then as soon as their sleep goes off, that there's a domino effect and then the whole day then gets affected. So I have some women that will come into me. Often they're very educated, wanting to sort this out and often very quickly go on HRT.

Dr Gill Shields 7:07

I have some women who are more relaxed, who are rolling with it, who maybe, you know, are trying to work out is their feelings due to life stresses. We all have busy life, itis as women. Is it that that's making them feel like this? Or is it hormones? So maybe they start looking at nutrition, which can be hugely beneficial. Hormones. So maybe they start looking at nutrition, which can be hugely beneficial. Looking at, you know, exercise, helping with your mental health with your exercise, looking at wellness. You know, I think, as women we don't have it all now. We just do it all, don't we?

Dr Gill Shields 7:35

you know, back in my mum's generation. She didn't work. My dad went out and you know, and the the food on the table and what have you. We're now in our family dynamic. I pretty much work full time. My husband does as well. My husband has stepped up. He's a great dad. He does the school run and all that kind of stuff.

Dr Gill Shields 7:53

But there's no way I would ever let him organize a birthday party, buy birthday party presents, sort out Christmas, sort out Christmas dinner. You know we do everything and actually I'm finding you, finding you know, me myself and my girlfriends, we are starting to go. Do you know what? We do need some time just to look after ourselves. So, yeah, there's some people that might be yoga pilates, it might be a day out shopping, you know, just just trying to look after yourselves and those women. Often they try all that and they then might get to a point where they say, look, I've done, I've, I've, I've listened to, I've read Davina's book, I'm doing this, I've seen a nutrition, I've got a PT, but I'm still not feeling right. And then they might come to see me more in their their late 40s, you know, sometimes early 50s. I sometimes have 80 year olds coming to see me saying I feel I've missed out. I would like to try HRT. So it's hugely variable.

Dr Liz White 8:48

I think it's when you feel the time's right and and everyone's going to be different about that yeah, and I know also I've heard many, many stories of, unfortunately, women going to their GPs and being told or being fobbed off essentially or being, you know, prescribed antidepressants and sort of sometimes there are GPs out there who are just unwilling to even sort of think with the person about perimenopause and that can be quite devastating for people, can't it, because you can feel very dismissed and not understood and not knowing what to do. I don't know, is that, is that something that you've heard, or yeah?

Dr Gill Shields 9:31

so you do not need my. My take-home message from today is you do not need a blood test to validate how you are feeling yeah especially.

Lifestyle Changes and Supplement Efficacy

Dr Gill Shields 9:41

You know you can be, have the most awful perimenopausal symptoms but still have a 28 day cycle. I do not base where you are in your perimenopause journey based on your periods. The problem is some GPs and and specialist nurses who do menopause do, and so I encourage, so I do a lot of teaching in Cambridge and Peterborough, which is my, my ICB, with new doctors or even established doctors saying, if there's, if so a woman is still having periods or has had a period in the last four months, there is really no point doing their girly hormones, yes, check their thyroid, their iron, their anemia, their vitamin, you know, b12, all that kind of thing. But a normal blood test does not mean you're not going through hell and I think it's allowing women to feel confident enough to say to their clinician I, you, blood tests don't mean actually anything. I've told you I'm, I'm not sleeping, I'm hot sweats, I want to kill everyone. You know I'm depressed, I'm anxious, I'm, whatever those symptoms are. If you have been, you know, feel as though you've been fobbed off, and it does happen. I'm. I'm honestly not saying it. Doesn't, talk to your GP receptionist. They know their team better than anyone and although they can sometimes be dragons and it is the hardest job in the NHS being a GP receptionist. So sometimes that's a little bit of self-preservation because they can become like that. But if you ask nicely and say, look, who's your women's health GP? Usually there will be one in surgery who will be much more on board, engaged and willing to listen. And that's what women want is to feel listened to and that actually someone understands and empathizes and is happy to work with them to try and get the best decision to them.

Dr Gill Shields 11:28

Antidepressants aren't wrong HRT. If you're going through clear menopausal symptoms, hrt is gold standards. That's what we should be offering to everyone. But I'm sure you see it in your job. Do you know what Antidepressants sometimes for some people is absolutely the right thing? So let's not be scared of anti-depressants. I sometimes use HRT and anti-depressants in conjunction. Sometimes I we have to use anti-depressants by themselves, particularly those women that have had an estrogen receptor positive breast cancer. So there are women who it is appropriate with.

Dr Gill Shields 11:59

But if you are struggling, see someone else because usually you'll get a very different conversation and I would say you know, I had a teaching session with the first fives, the new GPs that are five years from qualification. Their level of knowledge was exceptional. I was so impressed with them. Menopause and women's health has become a real hot topic in training of new GPs and gynecologists as well. It's not all gynecologists know about HRT, so it is changing.

Dr Liz White 12:29

But there are still people setting their ways and if you get one of those, you just go and see someone else Because one of the things that does get talked about now is the lack of education that women of sort of our generation have had. As I say, our mums may have gone through perimenopause, menopause. Education that women of sort of our generation have had, you know, as they sort of had our, our mums may have gone through perimenopause, menopause, gone on HRT, but it wasn't. It wasn't talked about like we're not educated in schools, about with you know, we talk, we talk about periods, but we don't talk about menopause or perimenopause. I certainly didn't get any education around that. I really hope that's changing. I don't know if it is.

Dr Gill Shields 13:42

Well, I talked to a patient the other day and she was talking about her daughter that had had some education at her secondary school and I was really excited about that. That's excellent because, you know, I keep telling my girls about, you know, menopause and the different phases of your hormone journey, and I want them to be really well informed. Unfortunately, that teaching then, she told me, was that HRT causes cancer and you shouldn't use it.

Dr Gill Shields 14:04

Oh no, so it was you give and you take away, you know. So I think you know things definitely, definitely need to change, unfortunately, um, but you know we're mothers, so it's our job to teach our children and to change that and to make sure women are feeling much more empowered about their hormone health. I think for women, me included it can feel a bit overwhelming. You know, if you look on social media, even if you google, there's just sometimes there's just too much information and trying to work out what is quackery and just some influence made up because they want to sell a product versus evidence-based medicine can be really difficult to navigate, I think, for our generation a hundred percent, and it's.

Dr Liz White 14:48

It's very difficult, isn't it, to know who to listen to yeah isn't it as, as you say, like there's so, and there's a lot of talk these days also about supplements and like you should take this, you should creatine and collagen and magnesium and all the rest of it. So I was going to ask you about like lifestyle changes, um, that that a woman can, can make. So talk me through. Supplements like what? What is it that actually helps?

Dr Gill Shields 15:16

so, yeah, I think collagen is the one I get. I get asked about collagen pretty much every day in my working life. Collagen we do have collagen all over our bodies. It's a very important protein. The reality is evidence around its benefit is very small. Often that evidence comes from people manufacturing collagen.

Weight Gain and Body Changes

Dr Gill Shields 15:37

Scientists have looked at collagen for use in hair skin really have not come to any solid conclusions around it. It's very expensive or it can be. To get any benefit from collagen, rather than just pooing it out, you need to take high-dose you know, not high-dose high-quality collagen consistently for months to start seeing the benefit. And I have women come and see me spending £100, £200 a month on on collagen and I'm like you know what for your overall as a GP that's my job, you know overall health. I think you should be spending that money on looking at your nutrition, you know, and making sure that you're you're getting all the colors of the rainbow with your, your foods, avoiding all processed foods. Looking at your protein, I would look at your exercise, you know. Gyms are expensive, pts are expensive, you know. But if you're spending 200 pounds on collagen, why don't you spend that on someone who knows what they're talking about? Look at strength training. Let's build up your muscle, especially in the perimenopause. You lose 10% of your muscle mass as you go through the menopause. Your muscle is really important, not just for kind of strength and agility, it's, it's, it's part of your metabolism. It's a big burner of calories. I have lots of women really struggling with their weight as they go through the menopause, which you know, which happens to most women going through the menopause. But building up your muscle mass can be hugely beneficial, not just for your wellbeing but also for managing your weight and things as well. So collagen yeah, I'm probably going to get messages now from the collagen manufacturers being very angry with me. I don't recommend it. I don't recommend it.

Dr Gill Shields 17:07

Vitamin d I do a big fan of vitamin d. It's not just good for bones. We have a lot of evidence around it reducing the risk of dementia, people with ms, multiple sclerosis, um, a lot of data around its benefits. Uh, to keep that brain healthy. Magnesium I I quite like magnesium, you know, at night the calming, you know, just don't take too much of it. You're going to get the runs.

Dr Gill Shields 17:28

Creatine there's a bit of evidence around creatine with strength training. I wouldn't use just creatine on its own. So if you're doing no, no exercise, no strength training, and you're just putting it in your smoothie, it's probably pointless. Yeah, you can. You know the red clovers, black gorge, lion's mim, herbal side of things, mm-hmm. The problem with herbs is you're never going to get Pfizer to invest 10 billion pounds on a trial into red clover because they're never going to get the money back. So we will never have the robust data like we do with Estrodot and all the oestrogens and all that kind of thing. But there is a bit of evidence and that can be helpful and I know on the ground when I see women they often try it. They definitely say you know, often it helps, but it's not a substitute for HRT. So it helps and for some women who are keen to avoid HRT for whatever reason, that might just be enough to keep them leaving a happy life. So you know.

Dr Gill Shields 18:28

I'm not against those, but just don't spend a fortune.

Dr Liz White 18:33

Well, yeah, and it's easy. It's easy, isn't it, when you are so fed up with all of the different symptoms that you're experiencing and life and the life stresses, that you just want a solution. You just want to feel better. Yeah, don't you?

Dr Gill Shields 18:48

and you know, yeah, and I've done that as well. So you know, you know, whenever I'm filling under the weather, there's my barocca. That'll make me feel better, when actually I just need to rest and not working all the time and have a weekend off. But Barocca will sort it out.

Dr Gill Shields 19:01

You know, we all do it, we all do it um, but it's just, it's trying to be rational about it and you know, it's a small, small part of the puzzle. There's lots of other things that I think would be more beneficial to you than lots of supplements.

Dr Liz White 19:19

But you're saying there, so you're bringing quite a few things in terms of the lifestyle changes Because, as you say, you know, up to perimenopause we're just sort of running around working and doing lots of things and organizing stuff. Working and doing lots of things and organizing stuff, um, and I think perimenopause forces you to look at how am I actually living my life and where can I slow down, where can I rest and what changes do I need to make? Like the exercise, you know, if you're someone who runs, you know every day, you know maybe you need to bring in some strength training trainings. What you're saying, isn't it like that muscle mass is important. So, in terms of the lifestyle stuff, nutrition wise, yeah, weight gain is a is a big thing, isn't it? And your body change like your, your body mass changes like, or your shape changes, doesn't it?

Dr Gill Shields 20:10

yeah, tell me a bit about what's going on there, what, what's happening around the whole kind of weight thing and so when you go through the perimenopause, your body is recognizing that your oestrogen is going down, um, and it doesn't like that, because oestrogen is involved in so many bodily functions. Your cells love oestrogen, um, so it tries to find oestrogen from other ways and your adipose tissue, posh way of saying fat cells. They produce a form of estrogen and it's not a great estrogen, but it is a form of estrogen and there's a high concentration of those around your tum breast tissue. So that's the reason, even if women have not put on weight on the scales, often they'll say to me my dresses don't fit anymore, or my jeans it's tighter around the tummy.

Dr Gill Shields 20:55

You know the shape and the composition of your body changes. Your basal metabolic rate is slowing down. Your muscle mass is going down. Remember that muscle is a big burner of calories. You're not feeling great in yourself. No, maybe you haven't slept. And instead of taking the dog for a one-hour stomp along the field, you just take it around the block because you're too tired.

Dr Gill Shields 21:15

You know you've had a busy day at work. If you are, you're feeling like yourself. You might then make that quinoa salad. And you know, no, you're just stick chicken kievs in the oven because that's quicker and you're knackered you're not sleeping.

Dr Gill Shields 21:26

Maybe you're starting to drink a glass of wine in the evening to help you sleep. You know there's lots of things other than just what your body's doing going through the menopause, so it's quite multifactorial where that weight comes from. People often ask me does HRT help you lose weight? Not that I have shares in HRT, but I never sell it as a weight loss aid because it's not. And some women actually they hold a lot of fluid when they're on HRT and actually sometimes their weight goes up. But a lot of women do lose weight when they start HRT, but that, and actually sometimes their weight goes up. But a lot of women do lose weight when they start HRT. But that's not because the HRT is somehow changing your metabolic rate. That's happening. It's because if you're feeling better in yourself, you're sleeping better.

Dr Gill Shields 22:04

You're then going to take the dog for the walk You're going to make that clean mouth salad, you're not going to turn to a glass of wine in the evening to help you sleep.

Dr Liz White 22:11

So sometimes, just by nature of feeling better, you subconsciously are making better lifestyle choices, which, then, is going to help you with your, your weight and things like that because I think a massive part of perimenopause like with all of those things, but particularly weight gain or your body is changing shape and you're not used to that that's really tough emotionally. Um, particularly women, I think of a certain age. We were brought up in a culture of you know.

Dr Gill Shields 22:41

Skinny is best, yeah.

The Truth About HRT

Dr Liz White 22:42

Skinny is best. Yeah, all of that kind of diet, culture, beauty, standard stuff, so you know, when you enter into midlife and suddenly you're not the size that you were or like, like it can really really impact someone's self-esteem so I'm the type of person my weight has gone up and down like a yo-yo for years, so I'm used to being different sizes.

Dr Gill Shields 23:04

I have a wardrobe of multiple sizes, um, where I mean I've got some girlfriends. You know one of one of my best friends. She's, she's always been, size eight, always been, you know, tiny, tiny, and she can eat what she likes, and that was just who she was. And actually she's put on weight through the perimenopause. She's, she's embracing it. She still looks fabulous. You know, she's rolling with it. But patients that I see who've never had to deal with weight are the ones that, from an emotional confidence point of view, really struggle, really struggle yeah, and if you're someone who's experienced an eating disorder previously, like the premenopause is going to maybe trigger that a lot of women in premenopause going on the um incretin injections.

Dr Gill Shields 23:42

So the weight loss injections actually right um what do you think about that?

Dr Liz White 23:46

because I've. What I'm seeing out there is, especially on social media, is like videos from women who are microdosing and in perimenopause and how it's like this amazing thing that's making them feel amazing. So what's your take on that?

Dr Gill Shields 24:01

So I mean I do diabetes clinics in my NHS work so I've been using them for a few years now. They can be revolutionary. So I'm being hugely generalized here. You know my 20 stone lorry drivers that eat their dinners off the side of the road. You know who was the best will in the world. My diabetic nurses have tried to work with them. They've been on the Desmond course. They really were, you know, really had a lot of education on nutrition and we've never been able to get their weight down and their diabetes is just getting worse and worse. It can be revolutionary for those kind of patients. The problem is we had a stocking of smeglutide, so zempic um a year, two years ago. You couldn't get it for love, no money on the nhs and those patients their weight very freakishly quickly went straight back on.

Dr Gill Shields 24:48

So when people are going on that you know journey of using the GLP ones which no judgment here that's totally fine with me. I mean, I think when people, skinny people, say to you eat less and exercise more, you want to throttle them, because weight and obesity is much more than just exercise and diet. It's got genetics, it's got psychology. You know it's much more complex than that. But people who do decide to go on it. You need to see this as an opportunity to change your ways. So learning to change your palate. So you know, if you're you know I know I do it when I get home from work sometimes I haven't eaten all day I'm moorish, I'm like my body takes over and I'm just like, right, I need cheese, I need sweets, I need something because you know I'm slightly hypoglycemic here Because you don't have those. You know that food noise is turned off. You'll then take the five, 10 minutes to maybe make a fruit salad or, you know, make that salad. You know it will.

Dr Gill Shields 25:44

It changes your behaviors and in doing so, hopefully it changes your palate so that when you come off them and you know this whole microdosing, going down on low doses, being on them forever, the evidence and the research and that is still awaited, um, it's, you know, it's not you need to use it as an opportunity to change so that, if you do, when you do come off them, you've actually can move into your new groove with change behaviors. Right, if you just use it as a I'm going to eat, you know, instead of a whole big mac meal, I'm going to have half a big mac meal and then you come off it. You're just going to eat the whole big mac meal again. So it's not. It's not going to change you long term, so it's just doing it sensibly, okay yeah, but it's.

Dr Liz White 26:28

It's interesting, isn't it how there's, you know, with the introduction of the GLP ones, like it's, it feels like a whole new world, right in terms of like it's an, it's another option for people. But I guess the fact is we don't know the long-term benefits, or or.

Dr Gill Shields 26:43

I mean they mean they have been around quite a long time in the diabetic realm, so they are new they're just new in the weight loss realm. So yeah, when people are worried about that, you know that they aren't new drugs. They've been in trials for 20, 30 years. You know they aren't this brand new thing. They're just suddenly accessible when they weren't before there's quite a lot of judgment, I see.

Dr Gill Shields 27:04

You know, if you look on the Facebook site, someone said where's where I want to start Manjaro, where do I buy it? And I feel for those women. So I'm like you don't know that woman, you don't know the journey she's been on, you don't know if she's had an abusive relationship. You know she's, you know, in poverty and can't afford fresh fruit and veg or going to the gym. I was like there is women should look after women. You know women supporting women. And sometimes you read that and my heart breaks. I'm like don't judge that lady. She's asking a question, just answer the question, don't judge her. I don't judge women.

Dr Gill Shields 27:37

You know, I talk to a lot of women who are on GLP ones and I'm like you know what? What can I do to help? You know, yeah, what kind of information can I give you to help you along the way? You know? You know, let's talk about the benefits of it. You know, if you look at breast cancer, one of the biggest risks for breast cancer is obesity, cardiovascular disease, diabetes, you know. So we need to think about the long term health of people and if their BMI comes into a normal range, they're cutting their cancer risk, their heart attack and stroke risks. You know it can be revolutionary for people's well-being.

Dr Liz White 28:08

And I think, at a time in your life where, as we've said, your body composition is changing and and you're, you're getting, maybe you're gaining weight, yeah, and you're knackered and you're, and you're not sleeping, it's really hard, isn't it to then, you know, sort of launch into uh, uh, losing weight or exercising loads, yeah, and even I, you know, what I hear from people is that even when they're doing that, it doesn't work in the same way as it did. You know. Yeah, I saw a lady yesterday.

Dr Gill Shields 28:37

Actually, she, um, she was a staff student, she was with a PT. That she was. She was cycling, she was really on it with her diet, um, but she had some thyroid problems. She had actually started Manjaro and she hadn't lost as much weight as she was hoping to, okay, and she was a bit despondent and I was like, actually, do you know what? You've still lost nine kilograms. That's amazing. You know, if you hadn't been on this, I have women who are doing all those perfect things and still gaining weight. So don't see, it's just nine kilograms from baseline. Your baseline could have been another 10 kilograms higher by now. So try and stay positive. It's still in the right direction. This is really good for your mental health, your well-being, that you're doing all those lifestyle changes along with it. So, yeah, it can be quite an emotional journey for women to go through.

Dr Liz White 29:22

Yeah, no, absolutely. You've mentioned HRT, but obviously it's a big part of menopause, perimenopause journey. I guess the thing about HRT is that there's a bit of a distortion, isn't there, in terms of how HRT is viewed? I think there was. Was that, um, what was that 2002 trial? Was it where it's a women's? Health initiative, yeah which um really shifted the perspective on HRT. Can you talk us through what that was and why is it that there is that people are quite worried about starting HRT?

Dr Gill Shields 29:53

I think so that trial it. You know it changed the treatment of menopause for at least a generation, if not two.

Dr Gill Shields 30:02

It was an American, british trial. It was involved a million women. It looked at the risks of HRT. It came to the conclusion that HRT significantly increased your risk of breast cancer and overnight 90% of women stopped using HRT and that lasted for at least two decades. I would say Right Clever people not I, but have looked at that trial data and it was just not a trial that we run today. Interpretations that they made wouldn't be made today. You know the women on that trial were 63. That's not the average age of women that I start HRT on.

Dr Gill Shields 30:40

It was using, I guess the more old fashioned HRTs so they're much more synthetic oestrogens and progestogens which we know have a higher breast cancer risk. It was, dare I say, sorry to anyone who is American, it was done. There was a lot of Americans in that trial so they already had baseline obesity, smoking booze which are big feeders for the breast cancer risks. It wasn't representative of the average British woman in the UK it didn't mention the benefits. So even in that trial 20 years ago, which was slightly biased against HRT cardiovascular disease you know the biggest killer of women worldwide is cardiovascular disease. It's not breast cancer and HRT reduces your chance of having a heart attack or stroke by 24%. So there were lots of benefits to HRT which were never publicized. It was just against breast cancer. Times have changed. People are much more informed about HRT. We have lots more trial data which is much more robust and kind of accurate trial data, and we know actually, if you choose the right combination of HRT, at least for the first five years, your breast cancer is risk neutral with the best kind of HRTs. Even longer term, you know we're using much more body similar hormones and things. And I say to women sometimes you know they might be overweight, smoking, high blood pressure, diabetics, and they come in going oh I'm worried about HRT. I'm like well, even on the older fashioned HRTs, if you've got your BMI into a better range, if you stop smoking, if you did some exercise and you stopped your booze, that's your risk for breast cancer? Yeah, not going to be HRT. Time is changing.

Dr Gill Shields 32:22

You know, louise Newsom, the Davina effect. I don't agree with everything they say. I'm not going to lie, but they've been big advocates for women's health. They've got people talking about women's health. You know, they've been on the telly, they're in the magazines, they're on Instagram. It's starting a conversation with women and it's sometimes getting women in my door because they said, oh well, davina said you know, and I'm like, ok, well, let's talk about it, how are you feeling? And it starts a conversation which I think is fabulous. Yeah, what don't you agree with?

Dr Gill Shields 32:51

Well, with Davina and Louise, oh, I mean, sometimes, I think every woman has a right to make an informed decision about what they're doing. I think that's our right and that's my job is I'm. My job isn't to make a decision about you. My job is to give you the information for you to make the best decision about yourself. And I think you know the, the news and clinic. They have done huge things. They've made, you know, menopause care much more accessible. You know I'm I'm not naive enough to say you can get an appointment with me on the NHS tomorrow. I know women have to fight for appointments for me on the NHS, which isn't good enough.

Dr Gill Shields 33:27

Sometimes they're told that the dorsing regimes are safe. There's no evidence of safety. They they say, well, there's no evidence of safety. They say, well, there's no evidence of risk and that incurs safety. No, no, no. If you want to say something's safe, you need to prove that it's safe. You can't just say, well, there's no data to say it's risky. Therefore it must be safe. So we have a different view on how we prescribe and things. And I think you know I'm a working GP, so I'm much, probably much more holistic than a menopause specialist who just does menopause. I can talk to you about your rheumatoid arthritis, your migraines, your rash on your leg, you know. I can talk about your ADHD and if you should take your ADHD meds, you know, rather than increasing your HRT, Because I think it's the ADHD that's the problem here, because I'm a generalist, you know.

Dr Liz White 34:14

So I think that you need to look at women holistically and not just always about hormones so if someone's listening to this and knows that she's paramenopausal and and they're sort of wondering whether she should go on HRT or try it, yeah, would you sort of always say let's you know, try it and see. Or is it more of a, because I guess once you're it's difficult.

Dr Gill Shields 34:41

Once you're on it, do you come off it?

Dr Liz White 34:43

Yeah, it's difficult. Is it difficult to come off when you're?

Dr Gill Shields 34:46

on it? Not really, no, so especially in younger women, often we give a three-month trial and you'll know. You know, if you feel no different at all, then it's probably busy life-itis. You know no self-care because you're running around like a blue-ass fly. You know all that kind of stuff. No, we don't always start HRT, so you know, sometimes it's very clear to us that actually the problem isn't your hormones here, it's you're getting three hours sleep a night here it's you're getting three hours sleep a night.

Dr Gill Shields 35:17

You're living off takeaways because you're actually a high-flying solicitor in london and you've got you know.

Dr Gill Shields 35:20

You know you're not looking after yourself and hormones is not going to fix that. You know hormones is only part of the picture in your well-being and if something very clearly is off, that's really off and that's a big part of your well-being. You need to sort that out. That's going to have the biggest effect on how you're feeling, not the HRT. So not everyone starts HRT, but I do believe in choice. I just believe women. Women, you know they're not daft. They should be able to make the choice for themselves. Um, and it it's one of my pet peeves when people have gone to their GP and said I'd like to try hrt and they've been told no. I think our job is to work with women to get the safest form of hrt, the right doses for them. You know, work with them to try and help, maybe suggest alternatives if it might be more appropriate, but allow a woman to make that choice rather than point blank refuse.

Dr Liz White 36:13

Yeah, absolutely. What would you say are some of the common misconceptions around perimenopause that you've come across?

Dr Gill Shields 36:23

I mean hot sweats is not. Like I said before, hot sweats is not a condition-defining symptom. You can still have regular periods and feel really bad. Periods is not a gauge on how you're feeling, so don't base it on that. If you try HRT and you get side effects or you're not quite sure it's actually helping, go back and talk to someone. Don't just stop, because you know that's what I do all day is I see those women who need a plan b, c, d and D and E, you know. So go and talk to someone again.

Dr Gill Shields 36:58

Sometimes there is, there's always other options available to you that might work better for you. We're all individual and what we need is very different. So the fact that your girlfriend's getting on with the gel and the you know tablet might not be right for you. Maybe you might need the combined patch, you might need a marina call. You know there's always different options available to you. Um, and it's not bad. You know going on HRT isn't bad. I've had some women say to me oh, you know, I've tried and tried but I finally decided I'll just have to give up and go on HRT. It's like it's some sort of failure, right, I'm like it's not. It's not, it's not bad. You know it's great for bones. It's great for cardiovascular health. It's not bad. You know it's great for bones. It's great for cardiovascular health. If you start it in time it's great for bone health. It generally makes you feel a lot better. It can be good for libido.

Dr Liz White 37:44

You know it has lots of benefits, so you're not a failure if you end up going on HRT and I think one of the things that I've come across and sort of from my own experience is that I guess I was I had the, the misconception that you go on HRT and then that's it and you feel great. But actually what I learned was that you, you have to sort of there's a bit of waiting, so it takes a while, but also getting the dose right and the, you know, whatever you're on like, just getting it right, like tailored to you, that can take some time, can't it? Yeah?

Dr Gill Shields 38:20

lots of tweaking, so I very rarely see a lady and then that's it. Usually you know, and sometimes you know that first HIPAA prescription works brilliantly for six months or maybe a year. But we know younger women tend to need more oestrogen than older women, so sometimes there's a time of increasing how much oestrogen you're using. Sometimes there's looking at the progesterone because there's bleeding or problems with bleeding, and then, as you go through your journey, maybe that bleeding isn't so much of an issue, maybe the amount of oestrogen you're having isn't, you know, is too high and you need to reduce it. It's absolutely a journey. Absolutely a journey and it's trying to find someone that you you trust to listen to you, to how you're feeling, to work with you, rather than tell you what to do. That, I think, is key.

Dr Liz White 39:08

Yeah, but as you said earlier, that's tricky, isn't it? Because you know a lot of people can't afford private yeah, the private side of things, and if they're at a GP practice that doesn't have someone who specializes in women's health. I mean, you said earlier that hopefully there are practices. Most practices do.

Dr Gill Shields 39:27

Usually. I mean, I work in a. We've got about 35 doctors at this point, so we're a big six practice. You know GP surgery, so I have lots of people coming from the other practices to come and see me. So you know there's pros and cons of big gp practices versus small. You know there's always debates about which one's better. But one of the benefits of being big is that you know it's pretty unheard of to have two british menopause society specialists in one gp surgery. That's just unheard of. So you know, I think our patients they still have to fight to get an appointment on the NHS and I, you know we do group menopause consultations in the evening.

Dr Gill Shields 40:03

We have specific online kind of women's health that our receptionists can book into. We do women's health only clinics. So we're trying to do as much as we can. But the reality is there will never be enough. You know demand is always going to outstrip supply. So I do sympathize for those women.

Dr Gill Shields 40:20

If you're on a smaller practice and you don't have a women's health GP there, the reality is you're welcome to move GP surgeries. You know you're not within reason, you can't. Usually you will have a choice of a few GP surgeries. Sometimes another GP surgery has that woman's health GP that might be more supportive Advocate for yourself. So I have lots of women.

Dr Gill Shields 40:42

Not so much these days, but I used to have women coming in who've read Davina's book and they've read Louise Newsome and they've done all their research. And they come in for a fight because they've done all their research, you know, and it takes a wee while to unpick to go look, hey, I'm not. Uh, you know, I'm not the enemy here. Tell me what's happening. I totally respect, you've done your research. Let's talk. But sometimes going in educated can help as well. Um, if you are feeling like you're being brushed back, the nice guidance, say the gold standard for treatment of the menopause is hrt. Would you like to see the niceICE guidance? You know in a polite way because let's not get into a battle, but sometimes being educated and informed can help in those consultations as well.

Dr Liz White 41:23

Yeah, absolutely so. Last question with this what would you want a woman to know? Like, what's the top takeaway from our chat today? That you want someone who's really struggling with symptoms of perimenopause. What's your takeaway?

Dr Gill Shields 41:39

probably keep fighting until you get the support you need, because there is a happy life at the end of it. So many women I see they can be at rock bottom. You know I had one lady who really high-flying lady she was, I think she worked for the police as an armed you know the ones that shoot people Really high flying person and never had mental health problems before and just in front of her eyes just deteriorated and really struggled and she, she was her own advocate. She, she was talking to me. We were working together. We were trying conventional stuff wasn't working so we were getting you know, the kind of the back of the box kind of medications for her. She was working on her lifestyle and her well-being as well and we worked together and she's doing brilliantly now. So there is an end that is happy. You just have to work through it to get there.

Dr Liz White 42:34

Well, jill, thank you so much for your time today. Thank you for tuning in to this episode of Hello Therapy. We'd love for you to join our growing community over on Substack. You can sign up for free or become a paid subscriber for access to exclusive perks like never before seen video interviews and downloadable guides designed to support your mental health. If you enjoyed this episode, make sure to subscribe so you never miss a new release. And if you got value from this episode, it would mean the world if you left a five star review. As always, check the show notes for my full disclaimer. Thanks again for listening.