Everything you need to know about Menopause with Dr Amy Lewis

In this episode we’re joined by Dr Amy Lewis, GP & menopause specialist.

We cover everything from perimenopause, menopause, hormones, and what women actually need to know when it comes to training, health and feeling like themselves again. 

We talk about training through perimenopause, how and when to get support, managing symptoms and how the right support can make a huge difference to energy, strength and quality of life.

In today’s episode we cover:

•  Signs and symptoms of perimenopause
•  Hormones, recovery and training tolerance
•  HRT myths and facts
•  Sleep, mood and energy changes
•  Training for health, strength and longevity in midlife

A really useful listen for any woman who wants clear, evidence-based information without the noise of social media and sound advice.

Transcript

SPEAKER_01 0:04

Hello and welcome back to Ann's Bloom Unfiltered. Today we've got the lovely Amy joining us. She is a GP and menopause specialist. She is very passionate about helping women navigate the menopause. We've also got Emma here with us. How are you Emma? Hello, good. How are you? Amy, we'd love to hear a bit about your story, how you got into uh helping, specialising menopause. Um, yeah, tell us how you got started.

SPEAKER_00 0:32

Hello, and thank you for having me. Um, so I've been a doctor for 24 years and a GP for probably 15, 16, 17 of those, maybe more. Um, and I've always been really interested in women's health. And when I was um newly a GP, I did the diploma in sexual health and family planning. So I saw loads of women and had lots of consultations about contraception and periods, and I think with time I noticed that we were really well educated about that and about pregnancy. But I didn't know as much about menopause initially because we just weren't taught about it at medical school when I trained to the deaf in as much as they are these days. So I went off and did some extra training, and I really noticed that I was seeing more and more women in midlife when life is full. You might have young families, aging parents, busy at work, really struggling with a wide range of symptoms. I wanted to do some extra training to help people more as I was increasingly seeing women trying to access health to try and navigate their midlife. So I went and did the British Menopause Society in the short courses and then did the advanced diploma in menopause care and have been really fortunate. I do a private menopause clinic for menopause care and also an NHS menopause clinic, and in general practice, I'm really lucky to see loads of women and talk to them about what's going on in midlife. So I have a broad experience of women who some of whom don't have penny menopausal and perimenopausal issues, and some of whom really struggle, and actually, it's I think it's a really important phase of life that we are supporting people to navigate but also to thrive because there's hardly any species who have who live after the menopause. I think it's us, some sharks and some whales, and there's a reason why evolution keeps us on after the menopause, and it's because we're really useful, we're useful to society, we're the wise women of the villagers. So actually, being allowed to be our best selves during this stage of our life is really important. So I think that's where my interest came from.

SPEAKER_02 2:42

I love that. That's made me smile, like ear to ear, as you've said that, because I think so many women do maybe dread it or see it as a really uncomfortable time. And you're and you're right, I think you hit the nail on the head when you say most of the women that you see are people that are being pulled in every direction, and that's really what we notice is actually you get to that stage of life and you're probably trying to hold down a career as well as look after a family and a house and everyone around you, and then also you get pulled into this hormonal shift that a lot of women describe as changing part of their personality, of their capability, they end up not recognising themselves. So I really like the fact that the way that you framed that as actually we need to spit a bit of a positive around this because yeah, I think that if we're lucky enough to live long enough, we're gonna this is going to happen to all of us.

SPEAKER_00 3:34

So actually, it's a privilege, isn't it? We all have lost people way too young. It's a real privilege to get to this point, and I always go back to trying to understand what's coming. So if we think about when we had sex education at school, we all knew that we were gonna get boobs or you know, periods would start, so things are less terrifying. Whereas because this hasn't been talked about enough historically, it's really terrifying for women, and I hear a lot in clinic people feel like they just lost their sense of self. You know, women say I don't recognise myself anymore, and that's really I think that is something we just need to be empowering women to understand what's going to happen so they know how to access the help that they may or may not need, um, and then they can thrive.

SPEAKER_02 4:18

And I wonder sometimes how much of that is a build-up of things, right? You become, I think you become a mum, or you become your identity becomes your career and who you sharp as in the workplace, and then it's almost like it menopause allows you a time to stop and look around and go, actually, who who am I? And is what I'm you know, uh working towards what I want, or is this a time to and you see, you know, a lot I think most women over the age of 45 are people that are looking to get out of the workplace or become self-employed or do something for themselves. It's that time to reconnect and go, I've got another hopefully 50 years on this planet. What do I want to do with it?

SPEAKER_00 5:02

Absolutely. So a few years ago I did a talk about menopause, and my introductory slide was how things have changed, and that it's something like in 1850, where there was obviously no menopause care, the average life expectancy for women was 45, as was the average age of menopause. So obviously it wasn't very relevant. Whereas these days we're living after you know we're living decades after our menopause, and we need to feel well and optimized during that time. So, yeah, and I think a lot of women, their tolerance for the nonsense that perhaps we might have put up with with me when we're younger is less as we get older, and it becomes can become a bit of a perfect storm, can't it?

SPEAKER_01 5:42

I think that's something a lot of our members will be able to relate to. Yeah, I'm sure. But you are so prepped for puberty, we are so prepped, and we are exactly upcoming. You made a really good point that we are probably in a rush to grow up, but don't think anyone's in a rush to land force. But no, no, that's a really nice thing that we can actually look forward to, and it might be a really nice period of change.

SPEAKER_00 6:07

Yeah, and I think you know, there's a real fear, there's a societal fear around aging, isn't there? And we all go on our own little personal journeys with that. And I think really we all just need to be striving to be the healthiest versions of ourselves that we can be, and then we can be our most fruitful as well, can't we? Because if we feel good, we can exercise, we can enjoy things, make plans, thrive in the workplace. So it's understanding what these shifts are, and that you know the hormonal shifts are enormous for some women. So 90% of women will have symptoms of the perimenopause and menopause, a third of those will be debilitating, and I've heard so many women who have stopped their jobs not because they want to go and pursue something different, but because they just felt that they couldn't do it anymore. Yeah, and that's really sad, isn't that?

SPEAKER_02 6:57

So, what are the early signs um of menopause?

SPEAKER_00 7:03

So when I think about it, I think about the different stages. So the menopause is a one-day event, it's the day on which you are one year from your last ever period. If though you've gone on to um say the Myrena column, you've not had periods for years, or you've started HRT in your perimenopausal years, you'll never know when that day is. So it's like an but it is a day. All of the years before that, you were perimenopausal, and that can last 10 years, and probably then those changes are going on for a decade. Every day after that one day event of menopause, you were post-menopausal. So the early signs, I tend to think of it like a bit like that head, shoulders, knees, and toes song we used to sing as kids because there are receptors to the hormones throughout our body, so they can be anything from brain fog, anxiety, dry eyes, your skin can change, you can get bladder changes, your periods will change, your sex drive may change, you might feel achy when we present with a frozen shoulder, all the muscular schizetal things. I'm sure you guys see. Early signs are often a slight change in your menstrual cycle. So you might have always been bang on 28 days, and then little by little you might think, oh, that was a 24-day period, or has gone to 32. So there's some early subtle signs. For some women, the period changes come much later, and that's one of the things that I a misconception I hear quite a lot that I can't be my hair menopausal because my periods are still the same, but the other changes kind of can happen. So any hormonal change that has an effect is when it starts, and it can be for any of any of a million different symptoms. Hot flushes, people talk about, and another misconception is people say, Well, I don't get hot flushes, it can't be that. Loads of women won't get hot flushes, loads and loads won't. When they can, they can be really awful for women, but lots won't have them.

SPEAKER_02 8:56

And I think it's also having that realization there's symptoms all the way through. So people have said to me in the past, you know, I didn't I didn't really think that I was hit by perimenopause, and I kind of sailed through it all five, but then it got to my post-menopause years, and that's when it really hit me. But it almost took them longer to recognise because they didn't relate it to the menopause.

SPEAKER_00 9:19

Oh, yeah, yeah, yeah, yeah. I think the the big shift in menopause care is that it has to be really individualized. So, you know, for women, if women want to go onto HRT or they don't want to go onto HRT, if they want to do the lifestyle stuff, all of this stuff should be individualized, as should be how we how we you know go to treat them initially. And some women will have that awful perimenopause time. And I do wonder sometimes if the women who sort of flew through it were almost just really distracted by life, that they had a load of mild symptoms, but there was you know they'd lost a parent, so they were grieving, or there was loads of work-related stress, so they almost forgot themselves. And actually, had they taken time for themselves, they probably would have noticed sometimes something happening. But you're right, it can it the different stages can bring all sorts of little surprises.

SPEAKER_01 10:10

Um, at what point do you think women should start getting help? Is there a point when it might feel too early for some women, or some women feel like it's too early for them to see someone?

SPEAKER_00 10:20

I don't think it's ever too early to be starting to think about and talk about your options and what's going on. I always say to my patients that I think knowledge is power. So, you know, if people are frightened to get a test or something, you might be anxious, but it actually we what once we know something we can deal with it much more. So, whilst it's really hard to diagnose the perimenopause because the blood test results will fluctuate, so we have to, you know, be really mindful not to do too many blood tests. Having the conversation is really important so that when you when your symptoms get worse, or they may not, they may come, they may go, you know what your options are. So I don't think it's ever too early to be thinking about it. Um I think that, and I don't think it's ever too early to be making sure that you're in the right place with it and in the right frame of mind and physically supported.

SPEAKER_02 11:07

And some women might think, oh, it's just stress, or I'm just working too hard at the moment, or there's just too much going on. So, how do you differentiate between Yeah?

SPEAKER_00 11:18

It's really hard. I always so there's some symptoms that stress can't like it would be I've never heard of stress causing vaginal dryness or vulval symptoms. You know, so there are some things that are not going to be down to stress. You know, anxiety is a massive thing for loads of women in the perimenopause, so that can be very difficult to tease apart. Um, some women will say get to say 47 and go, I've never had anxiety before, but now I'm too scared to drive on the motorway. So those women I'm always very suspicious that that probably is hormonal because it's new and it's sort of appeared from nowhere. Other things that are tricky to be stressed, like proper hot flushes, whilst we can all get a bit hot and bothered when we're stressed, you know, that menopausal flushing is unlikely to be stress. So it's and period changes. And I know there are women who some of us are very sensitive, aren't we? And if we if we're stressed, our periods will change. But if you're having a consistently changing pattern, those are probably more likely to be hormonal shift symptoms, I'd say.

SPEAKER_02 12:15

Most people will probably get two or three of what you're talking about at once, right?

SPEAKER_00 12:20

Yeah, and and some women, if we think that it is, they think it's about 90% of women will get symptoms. It's very unusual to get one symptom. Um, and normally what happens is you're having a conversation and I list a few, and people will go, Oh, and I've got that, and I've got that as well. Oh, I forgot my eyes were dry, you know. So I think I think a lot of it is that we don't pay enough attention because we're in the busyness of life all the time.

SPEAKER_01 12:46

Yeah, very interesting because you said a couple of things that I had no idea were linked to menopause, and I want to try and say, I'm struggling with this. Okay, and I do just think it's so random, and maybe it's not so random.

SPEAKER_00 12:58

No, and I'm lucky, aren't I? You know, this is my job, so I get to chat to loads of women and hear everyone's stories, and then patterns emerge. So, you know, the frozen shoulder is a really common one. So, whenever now I see I feel like everyone in my work must be really bored of me because I'm always like, How old is she? Has she got a frozen shoulder? And then I'm like, and then you can piece it together and it makes you ask other questions, doesn't it? And inquire about other things. Um, so I think it's remembering that three female hormones, Easter junk, progesterone, and testosterone, and that there are receptors for all three of those hormones throughout our body. Therefore, the symptoms are really wide-reaching. It's fascinating.

SPEAKER_02 13:37

And I just want to highlight something that you mentioned a second ago, which was around some women go for HRT and some go down the more lifestyle route. So I would love for you to talk a little bit more around what are the options. I'm a woman, I'm I've come to you because I'm struggling with those things. They're affecting the way that I show up as a person, it's affecting how I show up at work with my family, and you know, my self-confidence as well. What would you what would you say today are my options?

SPEAKER_00 14:05

So the option, the options are pretty vast, and I always say to women that if you haven't got the foundations of your life right, so you're not sleeping, you're eating really badly, you're not making any time for yourself, all the HRT in the world won't do its job properly because those foundations have to be right. So the lifestyle is enormously important, and without that, the other stuff won't work very well. So, if we think about sort of my medical training and the guidelines we have, HRT is considered the first line treatment for symptoms of perimenopause and menopause. And we're going to assume that everyone is doing all their wonderful lifestyle stuff. We know that things like booze and sugar and eating badly massively impact how bad our perimenopausal symptoms are, as does caffeine. So lots of women who've been able to tolerate certain alcohols for years suddenly really can't. It makes their flushes worse, makes their sleep terrible, up all night with anxiety. So all of those things are really important. Then you have your hormonal drug treatments and your non-hormonal drug treatments. And there are some women, if they've had a history of breast cancer or many other things, they um they cannot have um hormonal treatments, or they you know it's a it's a it's a different sort of conversation, and there are medications that you can use that really help with the anxiety and with the hot flushes. Some of the complimentary therapies can be really good as well, and I think it's about having that open-mindedness to try things that work for you. There's just a lack of evidence because there hasn't been the research into those things. Then, in terms of the HRT, if we may want to go down that route, we as much as we possibly can would go for the estrogen through the skin, the transdermal, which can come in patches, gels, or sprays, and then you'll have a patch that's combined with progesterone as well, or you'd have a separate progesterone. Then you have to think about things like does this woman still need contraception? Um, where is where is she on her journey? How can we make all of that as easy to use as we possibly can? Because adding another complicated thing to already busy life is hard, isn't it? So we want to make it as straightforward as we can. Um, but yes, there's I think it always goes back to, doesn't it? What the symptoms are, what do I want to achieve out of this? Is it that I'm getting recurrent urine infections because I've got really bad vaginal dryness? We can treat that with vaginal estrogens very successfully. There's a huge morbidity associated with having recurrent urine infections, it's horrible. If we think about vaginal dryness, which in the UK we're really bad at saying the word vagina or vulva or talking about it, um, because we're not, you know, we're brought up to say front, bottom, and all this nonsense. Actually, it's really healthy to just be able to say it's really it hurts when I have sex, I'm getting infections, because the treatment is incredibly safe for vaginal estrogens. If you used a vaginal petary or cream every single day for a year, it's the equivalent of one oral HRT tablet, estrogen tablet, in terms of its systemic absorption. It only really acts on your vaginal involva. So very, very safe and hugely beneficial to women. So some women will go down that route because that's their main symptom. Other women are more interested in the systemic HRTs. We've got the orals as well, oral estrogens, which are not used as much as they used to be because the transdermal products are really helpful and they have a lower risk profile in terms of clots, um, and they're also easier to kind of change the doses. Does that make sense?

SPEAKER_02 17:49

Yeah, definitely. And I think you know, it is really important for women to know that there are so many different options out there, and also to be tackling these lifestyle things as well. What are some of the biggest myths around HRT?

SPEAKER_00 18:04

Um, there was a huge study in 2002, so just before I qualified, which was deeply flawed. So it had women in that study, it was a um, you know, had it was a massive study it conducted in America, but had women already in their 60s, women who had big health problems already, and it said that HRT would increase your risk of heart disease and increase your risk of breast cancer. And that whole generation of women who followed that, most of them didn't access, loads of them didn't access HRT because they were too scarce to that narrative. So we now know that it was a deeply flawed study, and that but those those that narrative has really persisted. So there's still loads of women who are terrified of HRT, it's going to give them heart disease and going to give them breast cancer. We know that actually, if you use HRT for more than five years, it probably slightly increases your risk of breast cancer, but that risk is kind of in line with the risk associated with having an extra glass of wine a night in terms of breast cancer risk. So it's about understanding our risk, and I think there's a lot of misconception around that. Um so for instance, they did the in 2015 they did a study that attracted a thousand women over five years and tried to kind of work out the rate of cancer in certain groups. So if you fall into the obese category, there were 17 more cases per thousand women. If you smoked, there was something like three or four or five more cases, alcohol was three or four more cases, estrogen only HRT, there were three fewer cases. So it's the addition of the progesterone that was increasing the cases to an extra three or four, so in line with those very modifiable risk factors. So this is why these the lifestyle stuff is so important. It also showed if you exercise more than twice a week, there was something like three or four fewer cases of breast cancer. So there's all this stuff we can be doing for ourselves that you guys are promoting so brilliantly. So that is a that's a big thing. I think it's that fear. We all have to know that nothing we ever do in medicine or life is without risk. Not you know, crossing the road, going to the supermarket, there's risk everywhere, isn't there? It's about understanding our personal risk and not being scared about it. Other myths I hear a lot, like I said earlier, about I'm still having my periods, I can't be perimenopausal, but we know that can't be true because we know we can be perimenopausal for 10 years. Um, the other one here is I've had a normal blood test, I can't be perimenopausal. Again, we know that the hormones massively fluctuate, so you can absolutely be having perimenopausal symptoms, it can be really life-affecting. Um, what else do I hear? Um, that you can only be on it for five years, and that again came from this flawed data. Um, but with the big push now is individualized care, and for most women, they should be on it for as long as the benefits still outweigh their risks. So you should always have an annual review once you're fully established, but it's an individual um approach to it.

SPEAKER_02 21:03

I have the right thing. I just wanted to understand a bit more around, and we say this a lot. So women go for a blood test and they say, Oh no, I'm not menopausal, I'm not perimenopausal. But you just highlighted the fact that we have fluctuations throughout the month. Is there a time where you wish that women would come and see you so that they can get an accurate understanding of whether the perimenopausal can't speak to perimenopausal people or not?

SPEAKER_00 21:36

I think I think we should be having this. So the NHS now offers a free health check to women once they're 45. And I think that you know, even before then, really, we should be talking about it. So when we're seeing people for their you know contraception, just contraceptive reviews, it's worth us sort of talking about it. You know, this will come, don't worry, this will come to all of us. It's uh it's you know, it means we're living longer, it's great. Um There are some apps that are amazing to track your symptoms. So some women find them really valuable where you'll put your periods into it and the symptoms that you're having at a particular time, and then it's understanding your own personal patterns. Because if we think about the menstrual cycle, we think about the fact that every month we will release an egg and your body will prepare for pregnancy, and then if you don't get pregnant, you'll shed and you'll have your period, and that will just keep repeating. When we're young, we have loads of estrogen, so we kind of just cope with the natural fluctuations. There are women who struggle forever with all of that, and they have the hardest time with that cycle anyway, but lots of us don't. As we get older, because we're born with this finite number of eggs, they just decline. So with every cycle, we're losing an egg, and then as we get older, we have much less estrogen knocking around. So we're much more aware of those fluctuations. Then you're more aware of your progesterone, and this is why there's this roller coaster symptoms. So that's why the blood test is really difficult. Because really, why I use the blood test in my younger people, so under the age of 45, to make sure I've not missed an early menopause. Because I don't want to miss some early menopause because I want to make sure that women have healthy hearts and bones. So that's why I'm doing the test. I'm not doing the test to go, your blood test's normal, you're not perimenopausal, because that's that's not how it works, because we know there's fluctuations. So most of us under the age of 45 will have a normal blood test. But most of us, once we're hitting about 45, will be perimenopausal. So there's a big old disconnect there, isn't it?

SPEAKER_02 23:40

So there's not a better time. I shouldn't show up to you when I'm ovulating and my hormones are high, for example.

SPEAKER_00 23:46

No, so if we're going to be doing a blood test, the best time to get it is at the beginning of your cycle. That's the most accurate time for us to see it. If we want to know if you're ovulating, that's different, that's more like what we do when we're looking for fertility stuff. You want to have a progesterone blood test on day 21 because that helps us work out whether or not we think you're ovulating. But in the terms of the menopause, early in your cycle is better. The difficulty comes when people's periods are all over the place, and then I'll just say just get a blood test when you can if you need it. But most of the time, once you're over 45, you don't need a blood test. We go on your symptoms, yeah. But the earlier the better, though, for the conversation, I think.

SPEAKER_02 24:24

And then you're recommending for people to be on HRT for maximum of five years?

SPEAKER_00 24:31

No, not anymore. That's for the that was the old knowledge. So, like I said earlier, not everyone wants HRT, not everyone needs it, and that's completely fine. And in this country, it's still only licensed for symptom treatment, the symptom control, but like I also said, 90% of people will have symptoms. Um, so no, the advice these days is that it should be completely individualised to the woman, and that for the vast majority of women, the benefits of HRT, HRT outweigh the risks, so therefore we often continue it until the woman really wants to stop it. Some women never want to stop it, and then it's about that risk discussion because as we get older, the risks of everything get bigger, don't they? Just naturally because we were aging. So, yeah, so there isn't this arbitrary five years you're off anymore, which is you know, which is a very difficult conversation to have with women when they felt well.

SPEAKER_02 25:20

Yeah, yeah, absolutely. When you think, oh god, well, this has kind of saved me, it's been my lifeline, and now you're telling me I've got to come off it, and we know that the symptoms last up to ten years, and all of those things I can imagine that's a really hard place to be. But I suppose we hear a lot of conversations in the gym around oh, I've upped my HRT, or I've upped my HRT, my symptoms have got worse. So, and this is the last question I'm gonna ask you about this. But what's the guidelines around that? When when do you think or what will people be feeling in order to then up it? And when do you think that's a really good idea? And then is there other any other time where you think, oh, actually, that might just be something else going on?

SPEAKER_00 26:00

Yeah, absolutely. So it and that can be really challenging. Teasing apart what's life and what's other stuff and what's perimenopause is tricky because, as we've said, perimenopause can cause loads of things. The vast, vast, vast majority of women will have their symptoms controlled within the licensed doses. So, for instance, if we're thinking about Easter gel, that's anything from one, two, three, or four pumps of Easter gel, then with the progesterone to even you know to balance it all out if you've got a uterus. Um, when the reason we increase it is because symptoms aren't controlled. So, say if somebody's got hot flushes and you've started some HRT, maybe you've started with two pumps of gel and they've got a Myrena coil and they come and see you for their three-month review and they feel loads better, but they're still getting some hot flushes, then you might say, right, let's go to three pumps of gel. So you're going very much on the symptoms. We used to do more blood tests for estrogen level, but they've gone quite out of vogue because we think those levels fluctuate so much as well. That there are obviously exceptions when a blood test is really helpful, but going on women's symptoms is that is generally the best thing. There's a there is a very unusual thing where people keep going up and up on other doses and they don't feel any better, and it's not safe to do that without a seeing your doctor because some women can become resistant to it, and actually they can have really high levels which you wouldn't want them to have for a long time, you know, for a period of time. So just going up woody-nilly is never the right thing to do. It should be based on symptoms in quite a controlled way.

SPEAKER_01 27:32

And if people are listening to this thinking this is something I might need help with, what is the best way for them to access that?

SPEAKER_00 27:39

I think your GP, um, I think GPs are in, you know, we're increasingly educated about it, and those are where those initial conversations are really helpful. There's loads of really good information out there to do some stuff yourself first. So the British Menopause Society has some really exceptional um information on there, and it's really and it's very it's all very evidence-based, so that's really helpful. There's a load of noise on Instagram, isn't there? Um, and it's hard to know what to listen to and what not to listen to, but there's some excellent menopause doctors on there. I work for menopause care, and um Dr. Naomi Potter has loads of really excellent um Instagram lives, really and hers is all evidence-based and safe stuff and really informative. There's something called menopause matters, so there's loads of stuff you can do yourself. Keeping going to your GP kind of forewarned, so have your symptom diary, think about when your last periods, what's going on with your periods, do we need contraception? Think about your family history because these are all things that the GP will need information on. You know, have you got a couple of aunts you've had breast cancer? That's really important information. So if you think things are changing and you think I really need this conversation, I I think your GP is your first port of call once you've got some information yourself.

SPEAKER_02 28:57

I love the fact that you recommend keeping a diary because I think it's so difficult. And you know, we talk about the fact that us women have to relearn our bodies so many times um across our lifestyle, and menopause being one of them. But you'll know whenever you go and you know, whenever you've gone to see a doctor in the past and you go, they go, Have you got any other symptoms and you have to really think about it? It's so important that you're turning up like completely transparently and openly with that doctor so they can help you in the best way.

SPEAKER_00 29:26

Yeah, because you know, nobody becomes a doctor because they don't want to help everyone, you know, everyone wants to help. So actually, once you've got if you've got the correct information, then you're much easier to help as well.

SPEAKER_02 29:36

Yeah, definitely. And again, we touched on the the lifestyle bits, but is that anything? So if I was someone that didn't want to go on HRT or maybe couldn't go on HRT, is there anything that you would recommend looking at lifestyle-wise?

SPEAKER_00 29:51

Yeah, um absolutely. So all the stuff you guys do is really, really important. We know that in I think it's the five years after the menopause, we can lose up to 10% of our um bone density. And if somebody fractures the hip, the mortality rate is really high when you fractured it and then afterwards, and I think that's a combination, isn't it, of not moving so much and you know, natural you age much more once you can't move. So everything you guys do with all the strength training is unbelievably important. We also then think, don't we, about how that sort of middle-aged spread that we can get, and so much of that is our formal falling metabolism and our falling muscle mass, and if we can counter that with exercise, eating enough protein and lifting weights, it really really helps. Keeps us strong, it's also really empowering, isn't it? But keeping us physically strong is really important. Diet cannot be underestimated, so as we get older, we cannot cope so well with the peaks and troughs of you know glucose control. We just can't. So making sure that it's nutrient-rich, protein-rich, you know, still enjoying life and making sure you're eating what you want, you're not obsessing over it, but really trying to make sure. I always say try and eat 80% really well. Um, and then actually there's room for treats, aren't there? And sleep, sleep seems to be a massive issue for loads of women in the perimenopause. And I think it's because the area of the brain that deals with sleep is very rich in estrogen receptors, and progesterone is very important for sleep as well. So as these hormones fluctuate, sleep's often disrupted. Trying to have you know not be on your phone lasting at night. It's really hard, isn't it? Because most of us have got our alarms on our phones, so not checking that email, really watching your caffeine intake and alcohol in the perimenopause seems to be a real problem for lots of women with sleep. So all those things can help. The data, the you know, there's loads of questions around creatine, collagen. You know, you can hemorrhage cash on vitamins, can't you? And I'm asked about them a lot. There isn't a huge evidence base for any of it. I think that there's a lot, there's stuff coming out on creatine actually, and how it's really good for brain fog and cognitive function as well as all the muscle recovery stuff that you guys know about. Um, magnesium's incredibly helpful for people, magnesium glycinate with people having difficulty going to sleep. Vitamin D is really important, and then I do like the omegas for your brain health. But I wouldn't, you know, you've got to be careful, you can you can spend so much money on vitamins.

SPEAKER_02 32:26

And that's where, again, it's really important to have that personal service, right? And in treating everyone as in as an individual, I completely agree. And I I would say all of those supplements that you've just mentioned are probably worthwhile for most women over the age of 30 to take, probably over the age of 20 to take anyway. Um, but I think with anything like that, it's really important to actually look at look at the whole picture and look at, like you said, look at the symptoms and look at what other medication you're on as well, because we know that it can then have an effect on absorption and gut microbiome and and things like that. I did have one question actually around menopause, and and this might be a little bit off topic, but is there any new research around around how it does affect our gut microbiome?

SPEAKER_00 33:11

I would imagine so. There must be because there's so much talk. There's nothing conclusive. Um, but at they were talking, I was at the Bush Menopause Society conference not last year, the year before, and there was a chap over from America talking about it then, how we think that all of it is linked. So if you think about how our hormones are used and excreted and metabolized, if our gut health's not great, nothing can work very well. And ultimately, I think that your gut health is essential to everything, therefore, it must they must affect each other with the hormonal fluctuations. I think I would have to look into that further. There must be ongoing research on it.

SPEAKER_02 33:51

There must be, but from a kind of the fact that you said about the receptors, we have so many receptors in our gut, right? And it's it's important then to then just be aware of that because I think sometimes people's people can notice it in just their gut health, or they can notice it in their mood, or and you know some symptoms are gonna be coming from that as well.

SPEAKER_00 34:12

Absolutely, and I think that without we know, don't we, that so much of our immune system, everything lives in our gut, that actually if we can't if we got that if we haven't got that right, then everything is less likely to work well. But I will actually I will go and remind myself of that lecture I went to because it was really fascinating, and I will let you know. I reckon I would have loved it. Yeah, it was fascinating, it was absolutely fascinating because it makes perfect sense, doesn't it? That if your gut doesn't work very well, then nothing's gonna work very well. And but that all comes back to these basic foundations of life, doesn't it? That we've complicated the way in which we live, haven't we, by eating too much processed food. You know, if we think about if I think about my grandmother, um, she ate food that she'd grown in the garden, or you know, an animal that she knew where it had come from. And she lived a very simple life, and she was really fit and really slim and really well her entire life. And I just think that there's so much complexity to life now. We don't really understand what stress and that complete busy the addiction to busyness has done to us all. Um, but it all all of those things are essential to us thriving, really.

SPEAKER_02 35:26

Yeah, so I've loved this conversation and and thank you so much for coming on. So, is there anything that you would say to anyone who feels like they want to go into menopause and come out and and just feel like they're thriving and not just surviving it?

SPEAKER_00 35:41

I guess to embrace it and to go like I'm one of the few species that that this is allowed to happen to. It's really easy for me to say that sitting here, feeling quite well, um, because there are women who really, really struggle. And I think don't be afraid to reach for help if you are struggling, because it's really hard for lots of women, and people can feel very on their own with it because we've all everyone will have a friend who put on the first HRT she was ever given and she's been fine ever since. The vast majority she's that's that's an unusual woman. I would say most women need some tweaks because if we think it takes us 45 years to get to this point, it's gonna take us a number of years, isn't it, for everything to settle down again. So my take-homes are to not to be scared of it, educate yourself, and don't be afraid to reach out. And I guess if you don't get an answer that makes sense to you, ask again. Because, you know, just keep asking.

SPEAKER_02 36:37

Yeah, yeah, absolutely. Thank you so much for your time today, Amy. I know that as a GP and everything else that you do, you're so busy, but we're really grateful for you to come on and actually share some of that wisdom. And I think you know, the the mindset of we're really lucky to be here is a really nice mindset to start that journey off on.

SPEAKER_00 36:58

Yeah, and to embrace it because it's it's it's cool to get older and it's it's we're wiser as we get older. And I think that I prefer my life in my 40s than I did in my early 20s, probably when I worried about things all the time. But it's just then trying to make sure that those other bits are okay as well and supported. And I guess the big it's my other big take-home, sorry, I'll really, really, really think about bone health for women because it's so significant not having strong bones. And if you've got any concerns about that, it's always worth flagging that. If there's a family history or if you've had a history of lots of steroid use for whatever reason, or you know, you've been underweight or malabsorbing for years, it's it's really important to have these conversations.

SPEAKER_02 37:41

Yeah, and I and I think that conversation again, because when people are in a big calorie deficit, whether that's through like medication or through um like natural choices, um, people, you know, that that does speed up. And I think that's a really important conversation to be having here and now is actually you can build but build back that bone density through strength training. We didn't know that a few years ago, but we do now, and so it's really important to maintain not just your muscle mass but also your bone density, which we just know is vital as we get older for an independent and a long, happy life.

SPEAKER_00 38:16

Absolutely, and we can't see it, so we have to just have that awareness of it. Um, yeah, lovely.

SPEAKER_02 38:22

Yeah, thank you so much. So insightful, and I think we're gonna have lots of questions and we're gonna have to probably get you back at some point. But I think for you know, a quick 40 minute listen that should arm our ladies with enough information to get started with.

SPEAKER_00 38:39

Brilliant, brilliant. With pleasure, lovely to see you both.