Episode #15 - Women's Cycling Health: From Endometriosis to Ageing, Nutrition & Beyond, with Dr Jess Preshaw

Loved my chat with Dr Jess Preshaw, consultant gynaecologist at North Bristol NHS Trust about some of the issues that women face when cycling.

We explore key health topics every woman cyclist should know, from endometriosis and UTIs to vaginal infections, saddle sores, and the impact of ageing.

We also discuss the vital role of nutrition in maintaining overall well-being and vaginal health, and the difference between your on the bike nutrition and everyday fueling.

Whether you're dealing with specific health concerns or simply want to stay informed about your body as you ride, this episode offers expert advice and practical tips to help you navigate common challenges in women's cycling.

Tune in to empower your journey on the bike and prioritise your long-term health!

You can find Jess on X  and Instagram

Link to a short video on Endometriosis

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Smack the Pony Sketch

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Transcript

0:03

[Music] hi I'm tiia boothman founder of LTR coaching and I'd like to welcome you to the inspired triathletes podcast where I'll be bringing you stories from female triathletes and taking on topics that are important to women in the sport okay hello and welcome to today's episode today I'm going be talking to Jess praw a consultant G gynecologist in I don't know where you work actually where where you it h I work at South me hospitals so that is North Bristol okay oh it's not too far away then brist there you go so yeah the we've got Jess on to talk about all things women related to do with cycling because Jess is a keing cyclist herself and we're going to start off just to talk about how you got into cycling you know the kind of riding that you do personally you know what you love about it and we just take it from there so well firstly thank you Celia for inviting me on to do this it's a really lovely opportunity um so it was probably about 10 years ago when I moved to South Africa for a year and I it was to do some to work over there and do Obstetrics and Gynecology as part of my training but I arrived and was invited on this mountain bike ride on a game reserve so I found myself on this really uncomfortable bike doing um about 70 kilometers each day of mountain biking through the most fabulous scenery with zeborah and giraffe there was even a rhino um and I absolutely loved it I was last by a really long way because I hadn't done any training and didn't really cycle and um bought an mountain bike there and did quite a lot of mountain biking would do these mountain bike events and then when I came back here morphed into Road cycling so now I do have a mountain bike which I transported back from South Africa which sits in the garage and now I just Road and I commute I just love I mean that's the beauty of living in Bristol can just I live in the city center but I just you know five minutes when you're out into beautiful countryside and I just love the freedom that it gives you and yeah it's a nice area for for cycling actually that because that you haven't got that like I've got to cycle for half an hour to get out into something that's a bit more rural less busy with traffic and that kind of thing oh it's just fabulous and you can finish work and suddenly find yourself you know out near clevedon and by the Sea and then you're just cycling back into Bristol at the end oh it's just I love it and the other Bo said um oh so I mean I just do this for my own sort of enjoyment but I joined a charity bike ride this year to raise money for endometriosis UK um and so a group of us it was primarily a group of gynecologists cycled from Manchester to Belfast um and we covered 250 miles in 3 days with a ferry Crossing from Conway in is of angala to and I'd never cycled that distance in my entire life before um so that was quite a shock to my own system um and um but yeah that was a really incredible experience and we all sort of bonded and we raised all the money for Charities so that was really great and now I'm organized you train a bit more for that one then I did train a bit more for that it wasn't just yeah my normal commute I was like no I actually have to do a bit of distance so that I'm not going to slide down and but it was fine because we broke it up into sort of 20 mile Alo quats uh and each stop there'd be snacks yeah snacks you need snacks when you're riding that kind of distance exactly and there was so much energy with the ride and group cycling and it was just the most positive experience um so yeah next year we're going to do another ride but a different I think we're doing stran ra down leads so wow another 250 miles but that's going to be like a cross a bit of Scotland I really hope that's nice yeah yeah it could be really amazing and it could be kind of wet dismal as well and great I think I was listening to like Radio One um a little while ago and there was someone doing some charity bike ride and it was all the way down through the country and I think it was just raining and raining and raining and I don't think they did much you know training to be able to do you know they're just kind of like DJs on the radio doing it and you think my God it's quite a big thing you know because if you train for something it's it makes it a lot easier to to deal with but people that don't necessarily have trained properly or they've done a bit and you know not it's just I it blows my mind when I hear people doing that because it's like riding a bike for that amount of time you don't realize how uncomfortable and painful it can actually be until you there you absolutely and then I arrived at this conference because we were cycling to a conference the following day I was like having to walk around being very professional in my sort of work outfit with my heels I was like God this is just this is a bit tiring and a bit of a struggle yeah but um yeah yeah no it's it is it's it's a long you know long way and and different things that you would normally do so yeah and so you're with a group of gynecologists what is it that kind of in I know you've been on the gcn show um they've been a little segment with you which is great and that's how I heard about you so I wanted to get you on to have a chat with you as well but what was it really that inspired you to start talking about this because you do on X it's called now isn't it not not Twitter but um you talk about women's cycling all you know issues to do with Women's Health yeah do um I mean the gcn video came out of the fact that a male colleague of mine who is a urologist did a very popular video for them on men's issues and cycling and that was about three years ago and I think they've just been sort of seeking for somebody to cover women's issues because there's just no very very little information out there about it and so um they were wanting that to be covered and yeah I then got approached to do it and it was something that I was already really interested in because you know it's this is stuff that I talk to patients about all the time um and whether that be pelvic floor issues vulval issues I mean my interest is par particularly endometriosis um but yeah having an opportunity to just create some really sort of vibrant educational content was just a really lovely opportunity really I could yeah and down yeah know it's good it's it does need talking about and we do need to be you know have those conversations because it sort of goes on behind closed doors doesn't it it's kind of like you I remember going to a time trial one time like her 100 mile time trial and um there was it was the first time they'd been like I'd been in with a fairly large group of women because it was a championship of some sort and it was my first time going there but they obviously like you know regular cyclist they do a long lot of distance cycling and we were in the toilets kind of like trying to get changed because that's the only place we had to get change and they're sort of slapping suda crem on themselves going yeah this is great and kind of talking about all the things that they did to sort of deal with sad or sore and all that kind of thing and it was like a w sort of wide open it opened my eyes to the fact that oh it's not just me that's like dealing with this stuff this is common kind of issues that we we have to deal with and they obviously had their Solutions not sure if they were the best but you're right kind of about it people are really embarrassed about it people are really embarrassed about it when they come to see me and I recognize that people don't wake up in the morning and go oh I really want to go and see a gynecologist but at the same time this is something that I think about and talk about all the time so shouldn't be embarrassed about it and the fact is if they're experiencing a problem somebody else probably in there very near vicinity is probably experiencing a very similar problem and maybe by talking it a solution can be found yeah definitely and it's like you know we we sort of you hear it like through the grape vine or whatever it's like not always you know the best way of of hearing about something that isn't you know it's just a solution that someone's found it might not work for you either like everyone was kind of going oh I do this I do that it quite interesting actually can't remember all the ins and outs of it but I thought this I I quite enjoyed the the kind like down to earth of it that no one was really worried at that at that place about talking about that so it was cool but yeah it comes up so much when you're talking to female cyclists and like oh my saddle I'm so uncomfortable and yeah it can be a real problem for people so you said people come to you all the time is it do you tend to get a lot of women that have cycling related issues um or is it I think it's more than I see a lot of women who have vulval issues and so that that's what they're referred to see me with and then you start sort of delving into that or it might be sort of pelvic floor issues and you delve into that and you know something that you ask about is well what's the impact what does this what does this mean for you and I suppose I'm quite chatty and I'm quite open about sort of exploring some of these things um but I suppose I'm always interested about what's motivated Somebody To You know go and see somebody is it pain is it um and and I do a lot of stuff with pain a lot of stuff with pelvic pain so a lot of that is about you know what's the impact what is the goal what is the goal of treatment what do you want to achieve from this and out of that will often come you know people saying oh actually I find this is a real issue when I'm cycling and so I'll be like right okay well actually there's this little video you could watch and let's just Target a few things that I think might might be really useful for you um so it's either they developed some sort of problem or discomfort because maybe they've been cycling a lot or they've come to me with another vulval skin condition maybe that's they've got something called lyan planus or lyan sclerosis it's sort of an autoimmune condition in the skin and it causes really sore itchy skin but you can imagine that if you've already got a skin problem and then you want to cycle it's going to make a 100 times worse it's also managing it from that aspect and I um sometimes also it's just Clues like people come into clinic and they've got a cycle helmet and a big bike bag and sat there and you're you talking about this soreness and I'm like how does it affect you when you when you get on your bike this morning and they actually s of the eyes widen and they're like oh my God it's just it's awful or um I've had to do this or you know what would you recommend and so that sort of Segways neatly into a conversation about some different things that you can do and you know to make it make difference really um I think that's really such a great question to ask I love that you ask that to people because a lot of a lot of times when you go and see a GP or a DOT they don't necessarily think about your life in like what you want from your life they just see you as another patient that is like okay you're going to be like everyone else and I'm just going to treat you the same as everyone else so that is such an amazing question to ask and I really appreciate that you do that um and I'm sure everyone that comes to see you does as well you know actually saying what is it that you want and what do you want to get from this because I mean that's a fundamental question we should always ask isn't it whatever whatever we're looking at it's what's that person's agenda that's what I need and sometimes yes I might have a bit of a gender as well ultimately I want that patient the most positive experience but you know maybe it's I have to rule out something sinister and but that's when our agendas normally align um but yeah I mean why did they why did they bother to come to see me like yeah they had a they had a reason there was something it's causing a problem somewhere and you need to find out what it is that's yeah that's causing that that's cool okay um so yeah you specialize in endometriosis often I know people sometimes ask me about it and I really don't know that much about it um so yeah if you can kind of give us a bit of information about endometriosis and what kind of impact it could have on you if you are training for endurance events or I will I could talk for a long time on this topic um yes so this is sort of what I specialize in that and it's sort of sister condition adenomiosis and pelvic pain and I co-lead our endometriosis service at southmeade um so we're an endometriosis Center but endometriosis is where you have endometrial like tissue so tissue that normally lines the womb and it's outside of the uterus and it is most commonly found in the pelvis so it might be on the fallopian tube on an ovary it could affect the bladder it could affect the bowel and depending upon where it is depends on the effect it might have on you and some women have it in sites that are distant from the pelvis so for example you could have a lump of endometriosis in your cesarian SCAR or you could have it in your Naval or some people I see have it in their chest so it's it can affect lots lots of bits of your body um I mentioned adenomiosis this is where you get endometrial like tissue it's also misplaced endometrial like tissue but it's in the muscle wall of the uterus but what it um I mean endometriosis is common so it affects one in well it is present in about one in 10 women wow and so I mean hugely common that's like diabetes but yet so could you have it without realizing it like if yeah absolutely and about 50% of people who have it don't have symptoms from it but that is massive cohort of women who have it and are affected by it and it's an whole body systemic chronic condition you know you can't there's no cure for it um and it might be it causes different symptoms in different people so it primarily causes problems with pain so that might be painful periods pain with sex some people have chronic you know chronic pain daily pain might be pain with your bowels your bladder you might have an overactive bladder you might get lots of bloating um and then people are often really fatigued with it that's a really big symptom with it you know you're living in chronic pain chronic inflammation and it can interfere with your sleep so and then some people have really heavy periods you know bleeding that means that they're flooding they can't leave the house so and I suppose if we move that into how it might affect you know Triathlon or training yeah um I think it's like what would what would triathon effect on endometriosis I was thinking about that and I was I suppose one know if you are if you're experiencing pain and then you have a stressful event pain experienced is often often it's often more severe so um you know it might make make pain flares more frequent or more intense and so if your body's in stress that can happen and that might happen with you know excessive training and also I was thinking that if you're really you if you're training a lot and you are calorie deplete then some people find that they just their whole menstrual cycle is just switched off and I suppose that might be a bit of a benefit you know if all your pain is coming with your period and suddenly you don't have a cycle because you're training so hard and you're not really supporting it with enough calories but I would say that's that's really not a good long-term solu because absolutely like quashing your menstrual cycle is not a it's not a healthy way to be because you know you always no well that's like the old sort of oh well if you don't have your period will put you on the pill to start your you know to get you get your periods which isn't starting your period it's just masking the symptom of you not having a period it's kind of similar to that isn't it it's like oh I guess I don't know you're right in that um because then I was also thinking what how would endometriosis affect your training and you know I think if you are struggling with a chronic condition chronic pain poor sleep fatigue I mean it's obvious ly going to affect the way that you train the way you perform your um you know if you're housebound with your periods how are you going to keep up the training what happens if that falls on events that you've just you know you've been training really hard to complete I mean that's devastating and the other bit is that some of the treatments that you might need for your endometriosis can also have their effect so people having to take loads of painkillers that can make you feel really sluggish make your bowels really sluggish make you feel fatigued it can um you know some people with endometriosis find themselves having multiple surgeries well it's not ideal if you've got multiple bits of time out to to need to have an operation and recover from an operation that's also going to be really impactful um and then yeah you mentioned hormonal treatments so yeah so that's that can help with endometriosis concer I'm aware of that but yeah so talk us through so well it's just that you know endometriosis is a hormon dependent condition so we often use hormones to help suppress it because it can be a really effective treatment for endometriosis I mean it's it's not for everyone because some people you know might be trying for a pregnancy and so taking hormonal therapy is Contra is going to be contraceptive so you couldn't take it in that that you know that situation but there are loads of different types it doesn't matter necessarily which one it's about trial and area to find one that works for you so whether that be an or contraceptive pill or the Implanon or the Depo injection or a hormone-based coil if you're wanting to avoid systemic hormones or there are injections and tablets that place you into sort of a temporary medical menopause so that's like next level medical treatment for endometriosis but they you know they we do normally advise triing some sort of hormonal treatment to try and press it um we do end up having conversations about that yeah because I mean the thing that sort of jumps out for me as well it sounds like a really difficult situation to manage um but like you know when you're in a big training cycle there's a lot of inflammation in your body anyway and having that on top of it must be very hard to manage I guess you know good nutrition getting enough sleep you know what other ways are there to to manage that information and do you have any success stories because it sounds kind of grim at the moment it's like oh my God sounds really nice answer is yes um so you're completely right self-care is really important so yes adequate sleep that I mean there is randomized control trial evidence for yoga with managing endometriosis endometriosis Associated pelvic pain so there's loads of different components whether that be mindfulness some people find benefits and CBD oil but what I would say is that I really preach about having this preach is maybe a wrong word but or encourage someone to really take a sort of a multimodal we call it a multimodal approach basically just really looking at the whole person and tackling it every angle um and yes and by doing that we get success it's not just reling on hormonal treatment alone or not just relying on operation it's about really taking a much broader approach to it um and yes with that we can manage it and manage it well and I've got a fabulous and demetrios's nurse in my team and so she also offers support for people because it's really you know unpicking what's going to work for people what's going to suit them it's really personalized so yeah it's not all doom and glue I can I promise actually you mentioned about nutrition like nutrition is and for hormonal Health it's also really important I really I'm very keen on the microbiome and about diet that supports the microbiome so Prebiotic so I basically I'm always encouraging people to have a lot of prebiotics in their diets so lots of fiber I ferment lots of things so I make my ke Crut kombucha so you know having you know introducing healthy bacteria I talked to people about um lots of plant-based lots of different PL plant B based foods in their diet colorful foods to have all those polyphenols um avoiding ultrapress food trying to avoid a bit of alcohol um well hydrated um all of those types of things so they're really endometriosis and inflammation in life really yeah because it's I was going to say I mean that is leads us back to inflammation because all that nutritional component is so important with that and the processed foods that you know if you eat a lot of processed foods then it definitely increases your inflammation so we do need to work on that um it's probably one of the things if you you know if you've not been eating well your whole life it's one of the hardest things to change because you're in a habit of it and you need to get out of that habit so it's it's not an easy fix as it were but it's so important and not just for that you know condition but everybody I think needs to be looking at that definitely and it's also where if people are struggling there are loads of great resources out there or seek some help you know yeah maybe touch base with a nutritionist to see if they can give you some tips or or just make small changes it's like build on a tone yeah just yeah you that's what I say to people just a little do a little thing like swap one thing because people want to change everything at once because it's like no just it because it won't stick then it doesn't stick if you try and change everything at the same time you need to have like gradual things that are achievable and that you're not going to fail on so that you can celebrate and then go y I did that and then move on and and then and you can you've got time to integrate it then as a habit haven't you if you do it gradually so yeah I think people need quite a lot of support with that but it can be done definitely yeah it can be exactly so yeah just go back to my question we've talked about endometriosis and um yeah we've talked about oral contraceptives and I so some one of the things that is kind of important all one of the things that I talk about quite a bit is having a natural cycle and this can be this can follow on from in metriosis because obviously you're not going to have a natural cycle with endometriosis if you're on a neural contraception but if you are healthy and you've got a natural cycle it can be a really good performance enhancer so we were talking earlier about how you know when you get into a state of nutritional deficiency you can go into that red s syndrome where you don't have a period having a a natural nor normal period because they're not normal um do you see that as a a really good health indicator for people and oh yeah 100% Celia so your menstrual cycle is just a really lovely barometer of well-being if you do have a really reg but that is then difficult for people who are and I have that conversation with people because they're like no I want to know what my my body natural sort of position is and I'm like I get that but at the same time you do have a medical condition that does respond well to a hormonal treatment and stop that condition progressing coming back I I would recommend a some hormonal treatment and and that's okay and I and I that is a difficult conversation to unpick because that's a difficult thing to UNP you know to to balance in your head I have a lot of people I want to I don't want to be on a hormonal treatment and I'm like I I hear that and I get that but you know you've just told me that the worst time is when you have your period what if you didn't have your period and they're like oh but maybe I want it but I don't really want to be housebound and in that much pain and I'm like yeah maybe we have to balance it and you know you would take an aspirin if you had a heart condition so maybe we need to reframe this and be like well this is the tablet that we currently have available for this condition because is a non hormonal treatment yet and yes I know it' be nice if so what because I I can understand how I'd probably be exactly the same I wouldn't want I don't like to take medication really it's like I just kind of want want to manage things myself and and kind of with the tools that I've got but obviously sometimes you do need it and if if you've got a condition like that then it is something that is going to help you and make your life your quality of life better but yeah getting your head around that must be quite challenging for some people I often will then you know potentially talk to people about a coil as in a hormone based coil because then at least it's locally more locally acting hormone yeah so that can be so that can be a solution that can be a solution yes some people are very hormone sensitive and still respond to the the small amount of systemic hormone that you get from that but it the dose is really quite low so that can often work well for people if they've been on some form of hormonal treatment that's you know maybe it's messed with their mental health or they've just not like the sort of overall sluggish bloating feeling they that's not some people take stuff and they absolutely fine it's really individual but that can sometimes having some sort of locally placed hormone can potent be a solution for some yeah that's that's good to know because I know it's it's kind of like the alternative you know if you're looking at hormonal contraception it's one of the ones that Dr Stacy Sims recommends because she says it's more like a natural cycle in in that you still you know as you say it's low level so you still kind of go through a bit of a cycle but it's not as it's not the same as being on an contraception yeah exactly so um we'll move on to a little bit more cycling specific stuff y if you so if you're cycling regularly do you have like more of the risk of having a urinary tract infection or getting issues in your genital area or what kind of what's going on down there absolutely no you yes is the answer so you are at increased risk of infection so from a bladder perspective you might be dehydrated if you've gone out for a long ride or I mean if you've done any form of intense exercise so it's really important to stay really well hydrated drink through your ride drink afterwards but also all that friction moisture heat um pressure in that area it can change the well one it creates a a warm happy environment for bacteria to flourish and that can increase your risk of infection so whether that's a urinary tract infection or some sort of vaginal infection that might be a yeast infection so thrush or something like bacterial vaginosis so that's where you get like a change in the balance in the bacteria in the vagina and you get an overgrowth of certain types of bacteria and it can lead to quite a lot of discharge it can be really quite unpleasant and quite smelly and just really offputting for people that could be really yeah really upsetting to deal with um and also you can all of that just you you have a natural sort of bacterial environment in that area and all that pressure heat moisture sweat time in the saddle can just change that natural environment and then lead you into risk of infection so you know it's important to have you know well-fitting well-fitting sh and to not linger in your clothes after a ride and to wash you know wash your under wash your cycling gear on a high heat and everyone goes oh but I don't want to wash my expensive padded cycling shorts and I'm like I know it's that balanced but maybe just like occasionally you should do or if you've had a problem more maybe you are going to have to accept you're going to have to put it on a higher heat for just that you know that cycle to try and nuke anything to interrupt but can you so I used to get quite a lot of yeast infections when I was train and I think it was when I was training hard like towards the end of my training blocks every night it would happen and it also happened when I was pregnant as well it was like a recurring thing so I think it's related to sort of stress and and fatigue with me um but I read somewhere like if you don't want to like put them shorts in the wash you can pour boiling water over the Shamy but I don't know whether that would make a difference or not what's your thoughts on because I have done that I did do that for a bit because I was like did you find it help helped did you find it help I don't know because I was doing other stuff as well so you never know do you whether it was I would that be enough to kill stuff in the sh it mean it should do might just soak it for a bit rather than because it's if it's in um I mean it do if you're putting boiling water on something that should sterilize it so I don't think that's an unreasonable thing try exactly um and I mean some people they might want to wear underwear well if you I mean I would say avoid underwear to avoid some chafing in area but if you are going to wear underwear I mean just got to wear some really boring sensible neckers Sensible cotton underwear to try and and then wash those ones on a you won want to be in some fancy underwear with cycling short just in case it wants to look nice exactly it's not very glamorous is it cycling yeah yeah I think I mean the recommendation usually is like no do not wear underwear with cycling short because of the chaping it's just like you're adding another like that other you talking about the friction you're adding another layer aren you there to to rub against St um yeah so to try and avoid the friction it's about I don't know getting a good having a slightly wider saddle getting good bite fit um your pubic hair is really important G to bring hair into this like reason it's like a cushion it's a wick so it will take moisture away from the skin and then if people are shaving or waxing they're often going to get like tiny little Nicks and skin which are just like these beautiful little entry points or doors for infection so you might then get boils and so thinking about pubic hair maintenance you've just got a trim it's really difficult though isn't it because like so for me I swim you know when I was doing a lot of training swimming regularly and you're like oh God that's a really good point it's like good point and then balancing that I suppose you could really desperate and you you really were like no I've got to I've just got to potentially doing some form of like laser so that you're then not and then leaving a bit of time so you're not constantly traumatizing the skin through like Waxing or shaving I that would be the only other way just do the sides and then just keep my legs I that's very wise I did sh I did used to shave like in between my legs just up to you know the edge just you know to keep things neat but it did C when I was on the bike it was causing issues in fact I was waxing at one point like and and that yeah it wasn't good because I think I damaged I I probably did damage and there was one area that it just got really swollen up and it was just it's painful every time I went out on the bike and I just kind of had to suffer with this painful lump for ages um and then I I read that you shouldn't shave I stopped it sounds TR but I mean I didn't do any related maintenance in that area up until that big 250 mile ride like I just I cannot imagine being really sore and it's not nice on the bike the following day I was just like it's just not worth it so no it's not it really isn't and yeah I think you can sort of no one's looking really there's a funny um sketch I don't you you might be I don't know if you would have seen this but do you there was some female comedians that were called drop drop the dead donkey or something like that I just wanted to quickly interrupt here and say that it wasn't drop the dead donkey and my mind is uh going a bit awall at the moment because it's second time I've misquoted a reference but the program that I was talking about is called smack the Pony and I'll put the link in the description below anyway back to the show no I've not too young but anyway but yeah if anyone wants to laugh it's a sketch and there's a woman going to um going in for a swim and she's like oh I was get a shave I be bothered and her friend's like oh it's all right and she turns around and she's just got loads of hair in it like oh it's a really funny sketch and if look it up on YouTube I think it's on YouTube after this after I think it's called drop the dead donkey and yeah they did it was I really used to enjoy that it was quite funny they were female comedians and they used to do quite good sketches but there's one about pubic hair and it's quite good okay so yeah we talked a little about bit about the yeast infections and and UTI and what we can do about it so do you so talked a little bit about I thoughts that stress could affect that as well but so when you're in a high training load and you're under more stress then you could get a flare up are there any kind of preventative things the other thing I thought as well was like maybe sports drinks you know when you're out on the bike consuming a lot of sugary sports drinks gels that kind of thing does that mess with your mut gut microbiome which then or is it probably more to do with the I would so I mean you're completely right that stress and Mal malnutrition are going to increase your risk of infection and mean that your system is less able to fight infection if you do get an infection so it's going to take you longer to get over it it's going to take you longer to recover um I mean having loads of sugary drinks is not going to be great for your microbiome but at the same time you know occasional you know if you are exercising you kind of need it you need it you also that's it so I think it's that balance I think you know it's okay to use have boosts of sort of sugar energy on a ride because you also need that to sustain you and if you don't you're going to be really fatigued and really deplete and that's going to put you in a in a cycle where you're going to be more prone to infection so you know I think I would say you know you've got it on those types of rides whatever got do what you got do you've got to have that boost but you know o overall you want to have sort of sensible nutrition just to give you a good Baseline I would have thought yeah that's yeah that's kind of what I would say to people if they were asking it's like your normal normal diet like outside of training should be introducing those prebiotics and probiotics that you talked about earlier but then when you're on those long bike rides you need the sugar and a lot of people they don't want you know they're trying to find Alternatives and there are some ways around it but there's not yeah you you kind of have to just go okay this is exceptional circumstances and it's not like my normal diet and yeah then so like in your normal life you wouldn't want to be consuming a load of sugary drinks you would not have that you know not be drinking can a coke with your lunch or whatever you'd be but I think you need that on a ride otherwise you're just G calorie the calorie deficit will be huge and you'll just be destroyed so think your advice is completely right yeah yeah it's just I think sometimes it's hard for people to get because they're like this is unhealthy you know doing having this and you know it's like everything isn't it it's it can be unhealthy if it's taken to an extreme and sometimes it will be like when you're training for an endurance event it can put you into that unhealthy zone for a short amount of time and then you can come back out of it and kind of build yourself up again because you're kind of pushing your body to its limit so it's got to like it's it it then adapts you've got to go there and so sometimes you have to do things that you think are not very healthy which is difficult when you want to train you know you're used to exercising for health and that's sort of what you've got in your mind it's it's like a different turning through thousands of calories you've got to put that back into your system somehow and that that's what you've got to do you've got to match that because otherwise yeah well you're not going to train successfully and no and then I guess you will be more you will be more susceptible to those things as well if you're coming back and you you're not fueling or you're not fueling on the ride you're getting exhausted and other stuff as well people get you know upper respiratory tracts infections and you know that kind of thing as well and they're under that amount of stress yeah cool so yes saddle SCE we' sort of talked about pubic hair is there anything else I yeah why is it happening why are we so at risk well you've got your saddle on that area you're going to be squashing the blood supply to that area so you potentially are going to restrict the blood supply to that area if you're on a saddle for a long time you are you have like this lymph system it basically sort of drains lymph which out of that area and so if you're compressing that sort of drainage that can lead to swelling and you're also sat on the nerves so you've got the pudendal nerve that comes in and you're sat on it so this area is really at risk of you know damage through pressure prolonged episodes of pressure and it can lead to numbness tingling pain pain with sex pain when you urinate um and you can also damage the skin so it can ulcer it can fisser so I was thinking about this like what would I what do I say to people who have got those problems like getting a you'll know more than me like getting a a proper bike fit yeah really important like getting those handlebars up just a fract so that it's trying to transfer a bit of your weight back onto the sit bones rather than directly onto the vulvo and the Paran is really important having a slightly wider saddle which I know goes against all the nice sort of sleek snazzy thin sort of saddles but having a little bit of a wider saddle just to transfer that weight over a wider area um and then there's the whole thing about volval skin care which I was recommended pudm by the the time trial ladies I don't know if that's so I I normally have to I really go into like unpicking what is it that you wash the area with and and so it's like don't just use water avoid soaps bubble baths perfume products some people use those feminine wipes I'm like I think my eyes then widen as a bit of like don't do that this is really delicate skin so really look after it so I advise people get an emolient so like a medical moisturizer and they use that as a soap substitute and there are loads of different varieties some are prescribed some you can buy from the pharmacist um it's about finding one that works for you but they have different water content or oil content in them and you can get creams you can get ointments um and essentially I advise using one as a soap substitute and then getting one that is a little bit more oily like an ointment as a moisturizer afterwards and that can be really protective really moisturizing nourishing just to sort of give make the skin a bit more robust so that it can stand up to this and it can also be really soothing on the skin um and the other thing that I really would recommend to people is estrogen cream so it's stal cream and it's on prescription in this country you can get it over the counter in other countries and I think that just represents how safe it is and I think people are worried about it because they think oh my God it's estrogen in a cream it's a hormone it's hormone replacement therapy but this is locally acting hormone you barely absorb it like you basically don't it is so safe super safe and you can put it on the skin and if you've got fishes or an ulcer from cycling you can rub it on and it will speed up healing it's really effective um and also if you are at that stage of life where you're getting a bit older and maybe you're very menopausal or postmenopausal then actually the lack of estrogen in that tissue can lead make those tissues more fragile more Frable more prone to trauma it can bleed it can be dry it can be sore so actually it's really treatable with some EAS Easter cream yeah nice I'd really recommend that stuff yeah no that's that's really helpful so that's kind of led me on to my next question of how things change as we get older you know as we age and we're we're starting to cycle we're carrying on cycling wanting to carry on doing the the same as we did even though we probably should be thinking about changing things at that point in time um what you know what issues could we face as female cyclists as we age in the sport or TR athletes I think it's fascinating that there there are over 30 symptoms of the menopause you know everyone thinks about heart flushes and maybe poor sleep and but there's actually the range of symptoms that can happen are vast and so you know if we just go a bit deeper into some that I think might be problematic for some people so one would be vulval or vaginal dryness and with that comes skin that is more fragile it can be more uncomfortable so more uncomfortable with your saddle so doing all those things that we've been sort of talking about are really important thinking about some topical estrogen also how having a lack of estrogen in that area can affect your bladder so it can lead to sort of urgency getting up in the middle of the night to go bit of leakage from urgency again all of this is really treatable with some topical estrogen so either that can be a pesy that you put inside the vagina or estrogen cream so that's something that I see a lot um and yeah something can be done about it so that might does become an issue um the other thing that I thought about was joint aching so that's something that I hear a lot from people just all over body aching and with that fatigue so it's important to you know stretching I'm not going to tell you about that but I mean it's having you know good mobility within your workouts and stretching is really important and it's not for everyone but I see a a lot of people and talked to a lot of people about HRT and systemic HRT so hormone replacement therapy I think there's a lot of fear out there about HRT but actually there are safe combinations now uh many different combinations that can be explored so you know if someone's thinking about it I would be I'd be like you know don't don't be scared of it explore it go and see your GP about it get a bit more information and you could just try it you know it doesn't need to be I'm G to start it I'm GNA start it for life you know have it for to go and just see if it makes a difference um and then also like sleep a lot of people re like fatigue and sleep um I mean you could put anxiety I see a lot of people who come to me and they're really really anxious all of these things are going to impact and that affects your cycling with fear of descending you know cars on the road and all that sort of stuff yeah so some people again for some people HRT will really help that there's also really strong evidence for CBT so that can be really helpful for people um and then the other B is your your metabolism changes as you as change so you know your weight distribution changes you get a bit more in the middle so you know making sure you've got a lot of protein in your diet uh doing those strength training so having a really balanced training schedule that could be helpful and I suppose with this I would say to people if they're if they're not sure of where to go you know seek some help you know either it will be seeing your GP or or maybe it's seeing a physio if it's more of a joint related thing or a nutritionist or um you know or some sort of therapist if you're looking to deal with anxiety from a more sort of holistic aspect you know don't Silence with this and actually the other thing sorry I will stop talking I talk too much no no go ahead like there's really good apps that can help you track some of this so there's like the balance app that's the one I normally recommend to people see it's free and you can just track your symptoms so that can help you sort of work out what's going on but it can also be quite good evidence to then you know if you're going to your GP you know it might be a short consultation and you're trying to really transmit that problem and you could bring up that app and be like look actually look I've been tracking it and this is the problem that I'm having and that can help them see what you're going through so that they can help you help help you both address it well yeah yeah definitely i' so I'm 48 now so I'm kind of like you don't look it CIA going thank you but I am um so I I like a few years ago I had sort of weird palpitations and stuff and I was getting really emotional and I just went through this really weird blip and it happened to me like about the same time every year and I was like is this something going on and I went to see my GP and she said well we could I think it was she suggested maybe anti-depressants and I was like no I don't I don't know why I even went to the GP CU I kind of didn't really want any treatment but I think maybe just wanted to talk to someone about it and go is this could it be perimenopause or that I'm starting to go through and um yeah I came away not have they did my Bloods I think and actually I had really low iron I was anemic so I ended up taking like high dose iron tablets and that's something that happened again like later on with the high training load um and I I think that might have been causing the palpitations I'm not sure it's was just I would go like weak and not be able to trade um so yeah but I think there was also symptoms of you know I do some I noticed my cycle has changed now it's like I used to get um be fine as soon as my period started I'd be like yeah feel great I'm much more positive but I feel like that and then I get about of anxiety and then I sort of go in back into I'm okay again I have this kind kind of like weird glitch in the middle of it of being like I'm a bit anxious now and I'm like no it's cuz You' feeling like you know your your hormones doing weird stuff yeah they are like in very menopausal phase that can last you know for 10 years your hor are just playing it's just chaos with your hormon don't know what's going on and it and I think that's also you sort hit the nail on the head with the fact that it's some s really AR difficult to it's very muddy because there's so many different symptoms of it people are like is it that or is it that I had a really big glass or maybe I had one too many glasses of wine last night and I didn't sleep particularly well and I had an argument with somebody and then I lost something or whatever it is what life factors are also playing into this and that's that's why it's really helpful to to track some of it because then no this not going crazy here this is yeah it's like a regular occurrence and it's happening at this point time something I want to address or or at least get some reassurance you know you did the right thing by going to see someone being like actually do I need to do anything else about this is this is this is this normal should I you know is this okay can I keep managing it as I'm managing because I'm sort of doing okay or do I need to do something different or if I miss something yeah you did the right thing by yeah no I don't well the iron definitely improved good but also I think there was it wasn't just that there was other stuff going on as well and you know like you say it is very difficult because there's so much going on like like in my life at the moment I've got my mom was in hospital for like three weeks not that long ago my son's leaving for University soon um my my uh father-in-law died like this year I had a friend you know there's all this other stuff that goes on in your life isn't there when you're that age I think you've got like quite a bit or some not everybody but I feel like I've got lots of other stress areas in my life that would impact that anyway so it's like okay it could be that but it's also to do with this and I I'm you know I wouldn't ever rule anything out but I try and manage everything with my exercise habits and my nutrition and my sleep and I always thought I slept really well but I wor what you know one of the tracking watches one night and I was like God I'm hardly sleeping at all God I sleeping but it's like I wake up quite early in the morning and then I'm obviously not quite sleeping but sort of am and sort of aren't and I think that's quite common for women of my agees they wake up super early and then mind starts destru sleep is yeah is a really common thing in this pH but it sounds like you're doing a lot of the right things like exercise the nutrition sleep thinking about sleep hygiene they're all really important things that yeah I like wind down for ages before I go to bed it takes me you know I'm I've never been like up all night anyway I'm kind of an early bird but you know and for people that aren't I think they find that really hard to implement that then because they've been used to I don't know burning the candle at both ends and suddenly it's like I can't do this anymore how do I how do I cope and you know you're used to doing a volume of training and then suddenly you're tired because you didn't get enough sleep or your joints are aching and you Sip and you saw and you've got to just change things up quite a lot and it can be very hard for people to let go of that part of themselves it is like a part of yourself you're kind of like well I'm not going to be that you know I'm I'm changing everything's changing your body's changing it's a quite a major thing and maybe we don't think about it enough or sort of give it as much I don't know I feel like I try and minimize it anyway and probably a lot people do because they don't want to admit that they're getting older and it's okay to do that to get older it's GNA happen to everyone there is the potential for for grief in that in that like oh that's what I was yeah that's what I was doing that's what I was achieving at that point but actually that it needs to just stay as a celebration of check out all this incredible stuff that I did and yes I changing but I can still do all this incredible stuff I just I'm gonna do it in a different way yeah and also I find like it's that wisdom as well that comes with it it's like well I did this and I've learned that and I can implement it this way now rather than you know I've got a 14y old son and he's like kind of just bull at a china shop you know kind of like throwing himself around and doing this the other which is great it's so cool to see like so much energy and things but the experience that I have I can kind of like go okay well why don't we think about it you know and so we have to celebrate that we have that experience in our lives and that kind of sort of groundedness I suppose and and that's a good thing to be able to bring to anyone really um so yeah it should we celebrate that and celebrate being being older and having the we have to get back to the wise woman don't we EXA the wise elders but yeah wisdom lived experience yeah yeah it's it's cool to to to acknowledge it and appreciate it rather than fearing I'm going to get older and everything's going to be gone I won't be who I was no you're going to be a better version of yourself a better version that's what you should exactly Ely yeah CU I think people think it's all downhill don't they and it's not all it's a I'm not accepting that because yeah I don't want that having a downhill my future so that's fine no it won't be it won't be it definitely won't be not if you've got I think it's it's a it's a mindset you know you might I'm always talking about mindset and and mental attitude but it's so important and I think with aging especially because we've all got fixed ideas of what it's going to look like and it doesn't have to be how you have been told it's going to be or what you imagine I'm rambling now I agree so yeah I've written that balance app down I'm going to put that I'm going to find that and put it in the show notes but yes that's a really good tip for tracking stuff is there anything else that you want to add or that you'd like to like people to know about I'm sure there is stuff oh I suppose my biggest message would be just that I I want people to talk about it more like and not be fearful of it I don't want you know if you're thinking oh my God I'm really not very comfortable I'm not feeling confident about cycling or about any issues gynecological related don't sit in silence don't fear going to see a g um yeah I'm not everyone's guy the colleges is like you I'm sure they' be I'm not very scary person maybe a bit too oh well never mind it's nice a as well and and someone that understands your sport you know that's a big thing for a lot of people and I was just talking to a client the other day and she said this person didn't ask me anything about my lifestyle and they said I'm going to have to have this ation it's you know and it will stop me running and so yeah it was kind of like if I mean I'm not even a you know I don't do any any substantial running or you know I'm not a remotely Pro you know I'm not professional athlete and if somebody told me that I was going to have an operation that was going to stop all the activity that I do I'd be absolutely like devastated I struggled breaking a finger and they told me I couldn't cycle for six weeks I mean yeah yeah it's massive yeah I know I think sometimes the the messages can be delivered like a little bit more like considering you know people's circumstances and and their lifestyle and yeah I mean that's and actually the other thing I I want to add is that if people do develop issues in that area maybe they've got a lump so one I'd really recommend that people take a look at their volval area people might not want to but get a mirror look at it familiarize yourself with what normal is for you because if it is you know if you notice skin changes an ulcer a lump um you know you're having bleeding lots of itching you know don't just assume it's because you got on your bike and spent too much time on your bike because some of those symptoms can be a sign I don't want to scare people but sometimes those symptoms can be a sign of something else and so you know if that's the case and you're not sure it's much better to just get it looked at and checked out and reassured because you wouldn't want to miss anything so that other sort of thing to people is that it's far better have a look note it down you want to take a photo take a photo like and just yeah go don't be afraid to just go and ask someone about it because it's really important and you wouldn't want to miss anything yeah definitely I think I've quite often I've been to a GP or someone and got gone in with something just to get it checked out and then come away not doing anything about it necessarily but just for that reassurance and I think sometimes that's all you need is some reassurance that everything's okay and sometimes it might not be but that's it most of the time go and it's like yeah it's fine and that's great and if it's fine then fabulous but also at the same time it's not yeah any whatever then at least that can be done and done timy fashion rather than someone sort of ignoring it for ages that wouldn't be wise okay very awesome that's great confident the area it can be comfortable yeah yeah don't AF to talk about it there's lots that you can do to make it more comfortable take a minut yeah yeah okay brilliant well thank you very much for your time it's been amazing chatting with you thank you so much and yeah if I had any issues I'd definitely come to see you oh and you're welcome to be absolutely fine just reach out if you've got any question than any of it and yeah and thank you for this opportunity it's been asking and if people want to follow you you're on X aren't you and Instagram not very good at posting stuff I probably should post post more more educational things but do but can only do so much can't you that's so I'll post I'll post links to those to X and your Instagram thank you and people can kind of connect with you there and thank you so much for your time it's been amazing my pleasure thanks for listening today have a great day take care bye for now[Music]