• Symptoms of premenstrual syndrome (PMS) include feeling overwhelmed, tearful, anxious or angry in the run up to your period
• Some women experience a very severe form of PMS known as premenstrual dysphoric disorder (PMDD)
• Hormone fluctuations during perimenopause can worsen symptoms of PMS and PMDD

What is PMS?

PMS covers a wide range of physical and emotional symptoms that you may experience before your periods. The most common of these are mood swings, feeling low in your mood, anxious or irritable, tiredness or trouble sleeping, bloating or tummy pain, breast tenderness, headaches, skin breakouts, greasier hair and changes in appetite and sex drive. The symptoms are the same as symptoms of perimenopause and menopause.

These symptoms are usually due to changes in hormone levels – especially progesterone and oestradiol – during the second half (luteal phase) of your cycle.

The timing of symptoms is important to make a diagnosis of PMS and PMDD, says Newson Health GP and Menopause Specialist Dr Hannah Ward. ‘About 90% of women will experience some PMS symptoms,’ she says. ‘They can vary a lot, and for about a third of women, they will interfere with their daily activities. To be PMS, the symptoms must occur in the luteal phase and resolve within a few days of your period starting.’

RELATED: All about progesterone: PMS, PMDD, postnatal depression and menopause

What is premenstrual dysphoric disorder (PMDD)?

PMDD is a severe form of PMS, which is thought to affect around 5% of women [1]. The symptoms are similar to PMS but much more intense and have a much greater negative impact on the life of those affected.

Definitions vary slightly, but the most commonly used is the Diagnostic and Statistical Manual of Mental Disorders, which says a woman must experience at least five out of 11 distinct psychological premenstrual symptoms, one of which must include mood [2]. Other symptoms on the list include marked anxiety, lethargy and decreased interest in usual activities.

These five symptoms should be present in the two weeks before your periods and start to improve within a couple of days of your periods starting, and be minimal in the week after your period.

One of the symptoms can be suicide ideation: an international study found that a third (34%) of 2,689 women affected by PMDD who completed a questionnaire said they had attempted suicide [3].

‘PMDD can be very severe but it is often not acknowledged,’ says Dr Hannah. ‘Often women will discuss it with their doctor who may dismiss the symptoms as they are not aware of PMDD and don’t realise how bad it can be.’

RELATED: What is reproductive depression factsheet

How will perimenopause affect my PMS or PMDD?

Unfortunately, perimenopause – when your hormone levels start to decline ahead of your periods stopping – can make your PMS or PMDD worse.

‘Symptoms are often more severe around times of hormonal change – so puberty, after having a baby and perimenopause are key times for this,’ Dr Hannah says. ‘Women who have not had PMS before can develop it, and if a woman had PMS before, they tend to get similar symptoms they have always had, but they are more severe, particularly the emotional and psychological ones.’

The amount of time that you experience the symptoms can also increase as your cycle becomes more erratic and starts to change. As you may not be regularly releasing an egg (ovulating), the symptoms can spread throughout your cycle as the changes in hormones start to fluctuate.

RELATED: All about progesterone: PMS, PMDD, postnatal depression and menopause

What can I do to help manage my symptoms?

It is worthwhile keeping a diary of your symptoms and menstrual cycle for a month or even a few months, if possible. The free period tracker on the balance app is a good option for this, and the National Association of Premenstrual Syndrome (NAPS) also has an online menstrual diary.

Guidance for healthcare professionals says women with PMS should be advised on ways to improve diet and sleep, increase exercise, stop smoking, reduce alcohol intake and reduce stress. These lifestyle changes, particularly increasing movement, can have a beneficial impact, Dr Hannah says.

You can read more about creating long lasting food habits for better health and exercising during the perimenopause and menopause.

However, these lifestyle measures should not be regarded as a substitution for treatment – which is often with hormones.

RELATED: Premenstrual syndrome and the menopause booklet

What about treatment options?

As PMS and PMDD are usually caused by changes in hormones, replacing the missing hormones with the right dose and type can really improve symptoms. Sometimes hormones are given in a way to suppress your changing hormone levels, so you have a constant level of hormones in your body each day.

RELATED: Managing menopause beyond HRT

Many women with PMS and PMDD are prescribed the contraceptive pill. However, although the contraception stops ovulation, it contains synthetic types of oestrogen and progestogen, which have different effects in your body than natural (body identical) hormones.

This means that synthetic hormones can lead to side effects occurring, such as low mood, anxiety, reduced libido and low energy, and also are associated with risks including blood clots and increased breast cancer risk over time.

‘For women who are perimenopausal, HRT will often bring other useful benefits and help with other menopausal symptoms that the pill won’t,’ says Dr Ward. ‘It will also help protect your future risk of osteoporosis and cardiovascular disease.

If you have severe PMS or PMDD leading to depression, you may also be prescribed a type of antidepressant called a selective serotonin reuptake inhibitor (SSRI). SSRIs are useful for some women, and they work better with HRT. ‘You can take both, and often antidepressants work better when someone takes HRT as well,’ she says.

The RCOG and NAPS guidance agree that HRT, through an oestrogen skin patch combined with cyclical progestogen, is a good way to manage the physical and psychological symptoms of severe PMS.

And it’s worth pointing out that often women will be prescribed oestrogen or progesterone separately, and some women’s symptoms will improve with (body identical) progesterone alone.

Progesterone is produced following ovulation and for most women it has calming, anti-anxiety (anxiolytic) properties when it acts on the GABA receptors in the brain. But some women are particularly sensitive to progesterone, known as progesterone intolerance, and the hormone can have a paradoxical effect of worsening mood and anxiety.

RELATED: Progesterone intolerance

In the last week of your cycle, known as the late luteal phase, progesterone levels drop off rapidly and this fall in progesterone may well be one of the underlying causes of PMS and PMDD. This theory was originally suggested by Dr Katharina Dalton, author of a number of books on PMS including the PMS Bible and Once a Month.

Using high doses of body identical progesterone in the form of Cyclogest 400mg vaginal pessaries twice (or sometimes more) daily may improve symptoms more than oral progesterone for some women.

RELATED: Cyclogest: what you need to know

‘It can be a journey to find exactly the right combination of medication that will work for you,’ says Dr Hannah. ‘Expect to have to be persistent, as sadly many doctors don’t know enough about this. If the first treatment doesn’t work, go back and tell the GP that you need something else. Ask to be referred to a PMS specialist if you’re not getting the help you need.’

Some women also benefit from testosterone if they have symptoms of testosterone deficiency and their blood test shows low testosterone.  

RELATED: The importance of testosterone for women

What if my PMDD still can’t be controlled well?

For the most severe cases, the surgical removal of your womb and your ovaries is an option, but this should only be considered after all other options have been unsuccessful. Removal of your womb and ovaries will trigger what is known as a surgical menopause.

As the hormones, oestradiol, progesterone and testosterone are made in your brain as well as your ovaries, some women find they still experience symptoms after this operation.

Most women are under the age of 51 years when they have surgery to remove their ovaries; their body’s requirements for hormones is greater compared to that of older women going through menopause naturally, so it is important to consider taking hormones until at least the usual age of menopause for the long-term health benefits. Most women take HRT for ever as the benefits usually outweigh any risks.

RELATED: Surgical menopause: Dr Rebecca Lewis & Dr Louise Newson

It’s important that treatment is individualised, and your healthcare team work with you to take into account your medical history, symptoms and preferences.

What about when I reach menopause?

The good news is when you reach menopause – officially 12 months after your last period – your PMS symptoms will likely resolve. This is often as your hormone levels are not fluctuating.

However, you may find that you experience menopause symptoms, which can include low mood, hot flushes, night sweats, joint aches and pains and vaginal dryness. HRT will replace your hormones, ease symptoms and provide long-term health benefits.

RELATED: Perimenopause, menopause and HRT: everything you need to know

Resources

Premenstrual Disorders, Timing of Menopause, and Severity of Vasomotor Symptoms

References

1. Gudipally P.R., Sharma G.K. (2022), ‘Premenstrual Syndrome’ [Updated 2023 Jul 17]. In: StatPearls. Treasure Island (FL): StatPearls Publishing

2. Reid R.L. (2017), ‘Premenstrual dysphoric disorder (formerly premenstrual syndrome)’. In: Feingold K.R, Anawalt B., Blackman M.R., et al., eds. Endotext. South Dartmouth (MA): MDText.com, Inc

3. Eisenlohr-Moul T., Divine M., Schmalenberger K., et al. (2022), ‘Prevalence of lifetime self-injurious thoughts and behaviors in a global sample of 599 patients reporting prospectively confirmed diagnosis with premenstrual dysphoric disorder’, BMC Psychiatry, 22(1):199, doi:10.1186/s12888-022-03851-0

The post PMS, PMDD and menopause appeared first on Balance Menopause & Hormones.

Midlife can be a time of great change – and that’s even before you think about hormones. Many of you will be affected by the loss of a loved one, changes in relationships with parents or children who are growing up or leaving home, or a career transition. Leading psychotherapist Julia Samuel MBE, author of This Too Shall Pass, calls these experiences Living Losses – changes that happen to us that are not in our control. They can feel like death and the experience of them is a type of grief.

RELATED: How do I cope with grief during menopause?

Perimenopause and menopause is another time of significant change, not just because of the symptoms, but because it can be a time where you may start questioning your sense of self, your purpose and your identity. This doesn’t signal an end – instead it’s an opportunity to discover a new version of yourself. As Julia explains: ‘When life events hit us, as human beings we are wired to adapt, but we want control. To manage that tension, you need to examine it, and to feel supported.  The quality of your relationships will help predict the quality of your life.’

Of course, your partner may not be as well versed in all things perimenopause and menopause. Even if they’re aware of your symptoms, they might not realise the impact on you and could be hoping it’s something that will blow over soon. Confusion, resentment, fear and tension can increase, and lead to relationship breakdown. According to a survey of 1,000 women by The Family Law Menopause Project and Newson Health Research and Education, 7 in 10 women (73%) who responded blamed the menopause for the breakdown of their marriage, while 67% claimed it increased domestic abuse and arguments.

RELATED: Menopause puts final nail in marriage coffin

Why can couples grow apart during perimenopause and menopause?

Perimenopause and menopause can have a big impact on a woman’s quality of life, and this has a ripple effect on those around her. A lack of awareness of perimenopause and menopause can cause issues that then plant seeds of doubt in even the healthiest of partnerships.

Arguments can occur when our partners don’t offer enough support or understanding, but also because we can let our fears spiral. Julia says: ‘Surges of hormones can act like the threat system in our brain – we go into fight or flight or freeze mode. It’s as if there’s an alarm going off in our heads, which affects all of our actions and the ways that we think. So someone doing something as simple as waving at us can be misinterpreted as an attack and we may respond inappropriately.

‘In some ways it’s a design fault – as human beings, when we’re suffering, we become difficult and intractable and not that easy to have relationship with. Yet when we’re suffering, having a relationship is the thing we need most. It’s paradoxical that when you’re happy, well and calm, people are drawn towards you. The reverse is also true. The communication then shuts down and people blame each other. Misguided beliefs then inform their relationship. “She doesn’t love me anymore.” “She can’t be bothered.” “I’m bad, I’m ugly, I’m fat now. He’s not going to love me.”’

RELATED: Loneliness and the menopause

Julia continues: ‘Menopause can break your relationship – I’ve seen couples who haven’t been able to communicate and work it through together. But actually, the thing that will help couples most is love. Love is not a soft skill. It’s talked about as this easy thing, but love is hard because where you love most, you hate most, hurt most and make our deepest mistakes.’

It’s easy to regard any pain you are feeling about your partner or relationship as purely negative but consider it as a signal or wake-up call that something’s not right and now is the time to adapt and resolve it. It’s perfectly possible to re-establish an emotional connection with your partner during the perimenopause or menopause, but it will require a multi-faced approach.

RELATED: Menopause and relationships: a guide for partners

Consider how you think about yourself

Connecting with your partner will require you both to consider how you feel about yourselves, and how that may be affecting your relationship. ‘Be aware of your own inner critical voices – what I call our Shitty Committee – and turn down the volume on those. Turn up the volume of self-compassionate voices and practice being kinder to yourself. We are wired evolutionarily with a negative bias, and if you have a compound of, say, a difficult childhood or a lot of bad things have happened to you, then you get menopausal and your relationship suffers, it feeds into the story you tell yourself about yourself and your life. You might be thinking, “Well, it just shows I’m a failure, I’m useless”. But the story you tell yourself is the person you become. If you can have a kinder view of yourself, you’ll have more capacity to manage events, including menopause, and find a way to adapt and grow through what is happening to you.’

RELATED: Low self esteem and menopause: why it happens and what to do about it

Learn to work through feelings

It’s unrealistic to expect to be positive all the time but a capacity to be flexible and adapt when going through difficult times will help you weather the storm. Julia says: ‘You can develop a toolbox of mechanisms and behaviours that help you rebalance. Consider the fact that emotions only last 90 seconds. It’s the story you tell yourself that gets you locked in the rumination of them. So if you can acknowledge the feeling, slow down and breathe, then let it pass, you’ll be able to think more objectively about a problem.

RELATED: The importance of breathing efficiently with Dr Louise Oliver

‘When a particular set of thoughts get locked in your head, it can be helpful to get outside, move your body, breathe deep, it can shift your thinking. There is also a technique called the Television Screen – put the negative on the TV screen, take a breath, switch the channel and put a positive image on the screen – then take a breath and move your attention to something else. Every time you have the thought, you go back and switch the channel again.’

Calming tips

Work out your calming toolbox – the things you can do that calm you down. ‘It might be exercise, meditation, a breathing regime or yoga. And consider things that give you joy in your life,’ says Julia. ‘Having pillars of regulation – what you eat, how you sleep – will also help build stability in you so you can weather the storms as they come through your body.’

RELATED: How walking can ease your mind

Improve communication

If you’re not used to talking about your feelings or menopause, consider where that comes from – for many of us, there can be a fear of being seen for who you really are. Are you a family that can talk about these things or do you always have to be fine? Be aware of how you’re communicating in your relationship and look at how that might have changed.

‘One way to open up communications is to take 10 minutes each day to say what’s happening. Say, “I am feeling this” and the other person just listens,’ suggests Julia. ‘The power of just being heard and the person isn’t rehearsing what they’re going to say to prove you are wrong is amazingly potent.

‘When you understand fully what’s going on in the other person, you ignite your feelings for them because you have empathy. Your partner might realise, “Oh, it’s not because she can’t stand me or whatever. There’s all this going on.” And then you can slowly build the bridges of connection and understanding and kindness, which can reinvigorate the relationship.’

RELATED: The juggling act: how to navigate menopause and midlife

Have shared rituals

Building in little moments in every day can help forge an emotional connection. Small gestures – such as a cup of tea in bed each morning – can help make the other person feel valued so each agree one little thing you could do for each other every day.

Bring back the memories of the good times you have shared, perhaps by playing songs you used to dance to or looking at holidays or times you were happy together – sharing the memories will evoke those joyful feelings.

Regularly check in with each other. Julia suggests: ‘Walking and talking is really good therapy – being outside, moving your body, not eyeballing each other as you talk. Share how the week has been, what’s been difficult, any symptoms that you’re struggling with. Let you partner share his experiences and just listen.’

Build in regular treats, such as going out for a meal or to the cinema. You might want to do it after your walk and talk so that you have space to process how you both feel.

Rediscover touch

A loss of libido is a common menopause symptom and even if this isn’t one of yours, a strained relationship certainly can cause it! Sexual desire is “use it or lose it” but, as Julia says, ‘you can’t get hot from cold’. In order to build on your emotional connection and create an erotic energy, focus on giving each other more attention and touch in your daily lives – hold hands, snuggle up on the sofa together, etc.

RELATED: How does menopause affect my sex drive?

Be kind!

It’s quite normal in a relationship to put each other last, especially when you are juggling children, elderly parents, jobs, etc, and your partner can be relegated to the bottom of your to-do list. That can often mean you take each other for granted. A small way to help validate them is to give each other genuine compliments or positive feedback. For instance, if you notice your partner tries to be supportive about your symptoms, even if it doesn’t quite hit the spot, thank them – knowing your efforts have been noticed can really help. Good relationships are built on hundreds of small moments of kindness rather than grand gestures every now and again.

Seek help

Remember, perimenopause and menopause symptoms can usually improve with treatment, including the right dose and type of HRT with testosterone. Seek advice and treatment from a clinician who is experienced in hormones, and encourage your partner to learn more about perimenopause and menopause – our website has plenty of resources for partners.

Finally, remember that you both have agency about how you manage your feelings and your relationship – by taking some steps you can restore your emotional connection and restore that loving feeling.

Julia Samuel MBE is a psychotherapist, bestselling author and podcaster of Therapy Works. juliasamuel.co.uk

The post Emotionally supporting each other when you are perimenopausal or menopausal appeared first on Balance Menopause & Hormones.

Relationships can be put under immense strain during this time and can be made more difficult by the fact that many couples don’t openly discuss menopause. It can be challenging, but it doesn’t have to be – armed with knowledge and advice, you can support each other through this time and towards a new chapter in your lives.

What is menopause?

Menopause is actually one year after a woman’s periods stop. It occurs when the ovaries stop producing eggs and as a result, levels of hormones oestrogen (oestradiol), progesterone and testosterone decline. During perimenopause, these hormones fluctuate so can be both high and low.

The low hormone levels last for ever. These hormones are also made in the brain and other tissues – the have important effects on every cell and organ in the body. 

There are four key stages:

Pre-menopause: the time before any menopausal symptoms occur.

Perimenopause: when menopausal symptoms begin due to hormone changes, but periods still happen (even if irregularly).

Menopause: when there has not been a period for 12 consecutive months.

Postmenopause: the time after there has not been a period for 12 consecutive months.

When do perimenopause and menopause happen?

The average age of menopause in the UK is 51 [1]. However, it can occur earlier or later than this – health conditions, medical treatment, genetics, ethnicity and social economic background can influence the age.

Menopause is described as early if it occurs before the age of 45. If it occurs before the age of 40, it’s called Premature Ovarian Insufficiency (POI).

Some medical treatments – such as having ovaries removed, breast cancer treatment, chemotherapy or radiotherapy – can lead to an early menopause.

Perimenopause, which starts when the first menopausal symptom occurs, can vary in length from a few months to around 10 years. Some women start to have these symptoms when they are in their early 40s, others can be younger.

Some women do not realise their symptoms are due to perimenopause – they may put them down to stress or their busy life. There is also not as much awareness of perimenopause as menopause so women can be surprised to learn their symptoms are due to perimenopause.

What symptoms might my partner experience?

During perimenopause and menopause, hormones – oestrogen (oestradiol), progesterone and testosterone – fluctuate and then decline. This change can result in a whole range of symptoms.

Some women have very few or even no symptoms and their periods simply stop happening. However, around 80% of all women experience several symptoms [2]. Around 25% of these women have severe symptoms [2].

Symptoms can include:

Changes to periods: they might become heavier than usual, although for some, they may get much lighter. Periods usually occur more irregularly before stopping altogether.

Hot flushes: these can come on suddenly at any time of day, spreading throughout the face, chest and body.

Night sweats: women can wake up drenched in sweat and need to change their pyjamas and bedding.

Mood changes: they might be irritable one minute and tearful the next. Mood changes may be more common if your partner suffered from premenstrual syndrome (PMS) or postnatal depression in the past.

Fatigue and poor sleep: your partner may be more tired during the day.

Joint pains and muscle aches: all three hormones are important in providing lubrication in the joints and preventing inflammation, so low levels can leave joints sore and muscles aching.

Brain fog: this is a collective term for symptoms such as memory lapses and poor concentration.

Lack of libido: Declining levels of the hormone testosterone can lead to a lack of interest in sex and lack of pleasure from it.

Vaginal symptoms: The tissues around the vagina can become thinner, drier and inflamed. The vagina also expands less easily during sex, which can make intercourse uncomfortable or painful.

Urinary symptoms: The lining of the bladder can thin, and some women have the urge to go to the toilet more often or have recurrent urinary tract infections.

Hair and skin changes: Skin may have reduced elasticity, fine lines and dryness. Some women find their skin becomes itchier, or they develop acne. Hair may become thinner and less glossy.

There can be other, often surprising, symptoms of perimenopause and menopause, including dry eyes, dizziness, altered sense of taste and smell, bleeding gums, and tinnitus.

How are perimenopause and menopause treated?

There are a range of treatments available to help manage symptoms, and in many cases, vastly improve your loved one’s quality of life. Nobody should wait until symptoms are unbearable before they seek help.

The most effective treatment is hormone replacement therapy (HRT), which works by replacing the hormones a woman’s body has stopped producing during the menopause. There are different doses and types – the three hormones oestrogen (oestradiol), progesterone and testosterone can all be prescribed.

In addition, lower levels of hormones are associated with an increased risk of developing other health conditions including osteoporosis (bone weakening disease) [3], cardiovascular disease (conditions affecting the heart and blood vessels) [4], type 2 diabetes [5], dementia and cognitive decline [6], auto-immune diseases [7] and some cancers [8], so speaking to a health professional is really important. They will be able to talk through available treatments to help your partner make an informed decision, based on their individual circumstances and preferences.

If you’d like to read more about the treatment of perimenopause and menopause, NICE (the National Institute for Health and Care Excellence) has released updated guidance. This emphasises the importance of an individualised approach and shared decision making when considering treatment options and choice for menopause care. Find it at nice.org.uk/guidance/ng23

How might menopause affect our relationship?

No man (or woman) is an island so if your partner experiences menopausal symptoms, they’re bound to have an impact on you too. This might be directly – if your partner’s night sweats wake you, for instance – or indirectly, say if your partner seems lower in their mood than usual.

Although most people associate menopause with flushes and hot sweats, these aren’t necessarily the symptoms that have the biggest impact on women. In a Newson Health survey of almost 6,000 women, an overwhelming 95% of respondents said they’d experienced a negative change in their mood and emotions, so you may notice your partner is more irritable, tearful or angry than usual [9].

Menopause also tends to coincide with a time of life where women are going through other transitions – children are growing up and may be leaving home, elderly parents may require care, and work may present new opportunities or even retirement. It can be a time for reflection and even reinvention – your partner might take on new hobbies or be thinking more about her future.

You might feel discombobulated by any changes your partner makes, especially if they come out of the blue, so it helps to understand that she might be embracing a new stage of her life.

How can I support my partner?

1. Learn about the menopause

Read up on the perimenopause and menopause so that you can have a greater understanding of what your partner may be going through. Offer to accompany her to any medical appointments – she might appreciate having someone to take notes or to just be there for her. Don’t be offended if she’d rather go alone though – just offering your support will be appreciated. You can find evidence-based information on everything perimenopause and menopause related at balance-menopause.com.

2. Be patient

If your partner does take HRT or receives alternative treatments, don’t expect it to be an instant magic “cure”. Treating menopause symptoms requires a holistic approach – she may want to make adjustments to her diet and exercise routine, or look into sleep and relaxation techniques. It can take time to get symptom relief and she may need to alter her treatment, for instance with a different dose or type of HRT. Also, keep in mind that although you may want to “fix” your partner’s problems, it’s not always helpful for a woman to feel she needs fixing – again it’s about being a stable presence.

3. Don’t take it personally

It can be hard to not take your partner’s mood swings personally – when someone is suffering, they can be difficult to be with and yet this is when they need their partner the most. Understand that her mood swings aren’t to do with you and that irritability is a common mood complaint for women during perimenopause [10]. Try not to snap back and try to ensure you have coping mechanisms in place for times when you may feel hurt.

4. Go with the flow

Many women feel overwhelmed during perimenopause and menopause and you might be surprised if she seems daunted by making decisions over seemingly trivial things. Don’t put too much pressure on her and offer to help. Some women struggle with self-confidence during this time and may not want to socialise. Or she may feel so tired she’s not able to keep up usual social engagements. Try to be her safe space – there’s a lot of pressure to be “on” at work or with friends and family – but she will appreciate it if she can be herself with you.

5. Factor in libido

Some women notice a change to their sex drive during perimenopause and menopause, and for some, less lubrication can mean sex becomes painful. Your partner may feel more self-conscious about her body, or feel shame that there is something wrong with her, and so avoid physical contact. Your reassurance can help – be sure to tell your partner you love her and don’t underestimate the power behind your words. Conversely, some women can feel liberated once their periods stop and find a confidence in this freedom.

6. Make time for each other

While it’s important to communicate with each other, accept that sometimes your partner might not want a big talk. Try to build in some short amounts of time where you can be together. Date nights can feel pressured – it can be more helpful to have a regular habit where, for instance, you might go for a 10-minute walk together in the evenings. Many people feel more free to talk when they are outdoors, walking side by side, rather than looking at each other. Some nights you might not even need to talk, but the time spent walking together, holding hands, can be an effective way of staying connected.

7. Be her champion

Remember, perimenopause and menopause symptoms can improve with treatment, including the right dose and type of HRT with testosterone. You can be your partner’s advocate by encouraging her to seek advice and treatment from a clinician who is experienced in hormones.

By having an understanding of what your partner is going through, you can support her through the physical and emotional changes of perimenopause and menopause.

References

1. Born L., Koren G., Lin E., Steiner M. (2008), ‘A new, female-specific irritability rating scale’, J Psychiatry Neurosci, 33(4) pp344-54.
2. NICE: CKS: Menopause
3. Woods NF, Mitchell ES. (2005), ‘Symptoms during the perimenopause: prevalence, severity, trajectory, and significance in women’s lives’, Am J Med. 118 Suppl 12B:14-24. Doi: 10.1016/j.amjmed.2005.09.031
4. Cheng CH, Chen LR, Chen KH. (2022), ‘Osteoporosis Due to Hormone Imbalance: An Overview of the Effects of Estrogen Deficiency and Glucocorticoid Overuse on Bone Turnover’, Int J Mol Sci. 23(3):1376. doi: 10.3390/ijms23031376
5. Iorga, A., Cunningham, C.M., Moazeni, S. et al. (2017), ‘The protective role of estrogen and estrogen receptors in cardiovascular disease and the controversial use of estrogen therapy’, Biol Sex Differ 8, 33 https://doi.org/10.1186/s13293-017-0152-8
6. De Paoli, Monica et al. (2021), ‘The Role of Estrogen in Insulin Resistance’, The American Journal of Pathology, 191(9) pp1490 – 1498 https://doi.org/10.1016/j.ajpath.2021.05.011
7. Jett S., Malviya N., Schelbaum E., Jang G., Jahan E., Clancy K., Hristov H., Pahlajani S., Niotis K., Loeb-Zeitlin S., Havryliuk Y., Isaacson R., Brinton R.D. and Mosconi L. (2022), ‘Endogenous and Exogenous Estrogen Exposures: How Women’s Reproductive Health Can Drive Brain Aging and Inform Alzheimer’s Prevention’, Front. Aging Neurosci. 14:831807. doi: 10.3389/fnagi.2022.831807
8. Desai M.K., Brinton R.D. (2019), ‘Autoimmune Disease in Women: Endocrine Transition and Risk Across the Lifespan’, Front Endocrinol (Lausanne). 29;10:265. doi: 10.3389/fendo.2019.00265
9. Wu Z., Xiao C., Wang J. et al. (2024), ‘17β-estradiol in colorectal cancer: friend or foe?’, Cell Commun Signal 22 (367). https://doi.org/10.1186/s12964-024-01745-0
10. Experiences of the perimenopause and menopause, December 2022

The post Perimenopause and menopause: a guide for partners appeared first on Balance Menopause & Hormones.

The usual definition of menopause is a year after a woman’s last menstrual period. However, it’s not this simple for many women, including those who no longer have periods as they have had a hysterectomy, have a Mirena coil or are using some types of contraception where they do not have a monthly bleed.

Menopause is related to a decline of the hormones oestrogen, progesterone and testosterone, which are produced in the ovaries and also other organs and tissues, including the brain. They have many important functions in the body.

Menopause should be recognised as a hormone deficiency which lasts forever (for life) regardless of whether or not a woman experiences symptoms. Hormones work as chemical messengers throughout your entire body – reaching and having an effect on every single cell.

The hormones oestradiol (the beneficial type of oestrogen), progesterone and testosterone have been shown to improve thousands of cellular actions which then improves function of your body systems and organs. In particular, they have many beneficial actions on bone, brain, circulation, urinary, genital and nervous systems.

When does menopause typically happen?

The average age a woman in the UK experiences menopause is 51 [1]. However, it can occur earlier or later than this – health conditions, medical treatment, genetics, ethnicity and your social economic background can influence the age you experience it.

Your menopause is described as early if it occurs before you are 45. If it occurs before the age of 40, it’s called Premature Ovarian Insufficiency (POI). Around 1 in 30 women experience their menopause when they are under 40 years [2].

What else can cause menopause?

Menopause can occur at an earlier age if you have a medical treatment such as having your ovaries removed (oophorectomy), breast cancer treatment, chemotherapy or radiotherapy.

If you have a hysterectomy (removal of your womb), then your ovaries are more likely to stop working properly earlier than they would do otherwise, which can lead to menopausal symptoms.

What is perimenopause?

Perimenopause is the duration of time from when you first start experiencing symptoms right up to the ‘menopause’ point in time. During perimenopause, levels of oestrogen and progesterone can fluctuate hugely on a daily, even hourly basis. Perimenopause can vary in length from a few months to around a decade. Symptoms of perimenopause and menopause are the same.

Often women start to have these symptoms when they are in their early 40s. Other women can be younger. Some women do not realise their symptoms are due to perimenopause – they may put them down to stress or being busy.

What are the symptoms of perimenopause and menopause?

Symptoms are commonly felt before actual menopause occurs (before your periods stop all together) and some women find that they have more severe symptoms during perimenopause.

The majority of women, around 80%, experience symptoms [3] and for around 25% of women, these symptoms are severe [4]. Symptoms affecting your brain (especially memory and mood symptoms) are more common than vasomotor symptoms (flushes and sweats). [5]

Symptoms vary between women and can change with time. Fluctuating hormone levels lead to many symptoms, including:

• Brain fog – symptoms such as poor concentration, slips, difficulty absorbing information
• Memory problems
• Reduced energy
• Low mood
• Anxiety
• Irritability
• Mood swings
• Poor sleep
• Lack of libido
• Muscle and joint pains
• Hair and skin changes (such as dry or itchy skin)
• Panic attacks
• Worsening headaches and migraines
• Worsening PMS (premenstrual syndrome)
• Vaginal dryness, itching or soreness
• Pain during sexual intercourse
• Urinary symptoms such as increased frequency passing urine
• Heart palpitations
• Changes to periods – lighter and more irregular or more frequent and heavier
• Hot flushes
• Night sweats

There can be other, often surprising symptoms of perimenopause and menopause, including dry eyes, brittle nails, dizziness, altered sense of taste and smell, mouth issues such as bleeding gums, and tinnitus.

Levels of hormones fluctuate during perimenopause then become, and stay, low during menopause and then stay low for ever. Lower levels of hormones are associated with an increased risk of developing other health conditions including osteoporosis (bone weakening disease) [6], cardiovascular disease (conditions affecting the heart and blood vessels) [7], type 2 diabetes [8], dementia and cognitive decline [9], auto-immune diseases [10] and some cancers [11].

How is perimenopause and menopause diagnosed?

Most women over the age of 45 who have typical symptoms of perimenopause or menopause do not need any hormone blood tests to make the diagnosis.

If you are under 45 years old, hormone blood tests may be advised but they are not usually helpful as hormone levels can really vary. Sometimes other blood tests are recommended to ensure there is no other underlying cause for symptoms.

It can be very useful to keep a detailed account of all the symptoms you are experiencing so you can see how things are changing over time, look at what patterns there might be and consider what impact they are having on you.

What is HRT?

Hormone replacement therapy (HRT) is usually the first line treatment for the management of perimenopausal and menopausal symptoms [12]. The type of hormones you need and the doses you’re given vary between each woman – it is not a “one type fits all” prescription. HRT will usually contain oestradiol, progesterone and testosterone. These hormones are usually prescribed separately and it is important that you are given the right type and dose.

Women are prescribed hormones to both improve their symptoms as well as their future health.

Oestradiol: this hormone is produced predominantly by your ovaries, and levels fluctuate during perimenopause before declining in menopause and staying low for the rest of your life. Oestrogen helps to regulate your menstrual cycle, plays an important role in bone health, memory and cognition and cardiovascular health and is essential for many bodily functions.

Progesterone: if you still have your uterus (womb), taking oestrogen can cause the lining (endometrium) to thicken. To prevent this, you will usually need to take progesterone to keep the lining of your womb thin and regulate or stop bleeding. Progesterone can also relieve perimenopausal and menopausal symptoms such as sleeping problems, low mood and anxiety, and can be taken by women who’ve had a hysterectomy or use a Mirena coil as part of an individualised consultation for their symptom control.

Testosterone: this hormone is perhaps best known for improving libido, but you have testosterone receptors all over your body so the decline in levels can also lead to a loss of energy and brain fog, muscle and joint pains, low energy, poor sleep as well as other symptoms.

Who can take HRT?

For the majority of women, the benefits of HRT outweigh any risks. Most women can take HRT and usually natural, body identical hormones are prescribed. These are the same structure as the hormones you make in your ovaries, brain and other organs when you are younger. They are different to synthetic hormones that have been chemically altered and are associated with some risks.

There are often some misconceptions about HRT so it’s worth remembering:

• HRT can be started during perimenopause.
• You do not have to wait for your symptoms to become severe before taking HRT.
• There is no maximum length of time for which you can take HRT. Many women take HRT forever.
• Taking HRT reduces future risk of diseases.
• You can take natural, body identical HRT even if you have certain health conditions, such as migraine [13], high cholesterol [14], raised blood pressure [15] or if you’ve had a clot [16].
• Older women can start taking HRT.

What types of HRT are there?

There are numerous types of HRT, and it’s important to know what might be best suited to you.

Oestradiol (a type of oestrogen)

Transdermal preparations are those that are given through the skin as a patch, gel or spray. All types of transdermal oestradiol are natural (body identical) unless they are a combination patch, which also contains a synthetic progesterone. They are derived from yam plants and soy, and have the same chemical structure as your body’s natural hormones.

There are some oral oestradiol tablets that are body identical, such as Elleste Solo and Zumenon.

Other types of tablet oestrogen are synthetic – their chemical structure is different to that of oestradiol, which is the beneficial type of hormone produced by your body before menopause.

Progesterone

Like natural oestradiol, natural (body identical) progesterone in HRT is derived from yam plants or soy and has the same chemical structure as the progesterone your body produces.

Progesterone can be difficult to absorb through your skin and gut. It is therefore micronised (reducing the particles to a very fine powder and suspending in an oil) and putting it in capsule form so that it is easily absorbed. Utrogestan and Cyclogest are common brand names of natural progesterone. Utrogestan can be prescribed orally or vaginally and Cyclogest is given as a suppository (so can be used vaginally or rectally).

Sometimes, synthetic versions of progesterone are used, which are called progestogens or progestins. They have a slightly different chemical structure to natural progesterone and are associated with small risks, including a risk of clot [17] and heart disease [18].

The Mirena (and Levosert) coil is another option to protect the lining of your womb as part of HRT. It contains a hormone called levonorgestrel, which is slowly released into your womb. Although it is a synthetic progestogen, it is a much lower dose and usually just works locally on the lining of your womb.

Combined patches and pills

Combined HRT is oestrogen and progesterone and is available in patches and tablets. Patches contain natural (body identical) oestradiol but the progestogen part is synthetic. Many combination tablets contain natural oestradiol but the progestogen is synthetic. However, one tablet, branded in the UK as Bijuve, contains both natural oestradiol and progesterone.

Testosterone

Testosterone comes in gels (Testogel) and a cream (AndroFeme). They are all body identical and are derived from the yam plant or soy.

How do I take my HRT?

Oestrogen

Patch

Oestrogen patches are usually changed twice a week – for example if you put one on a Monday, you change it on a Thursday. They should be stuck onto your skin below your waist. Most women stick them on their bottom or upper thigh.

Gel

Oestrogen gel usually comes in a pump-­action bottle called a ‘pump pack’. The gel should be applied to the outer part of your arm, from your shoulder to your elbow, and to your inner thigh. It can also be rubbed on other sites of your body (although not advisable on your breasts). Some women use the gel in the morning, others in the evening and some women use it in both the morning and evening. You can watch a video that explains how to apply the gel at https://www.balance-menopause.com/menopause-library/how-to-apply-oestrogel

Oestrogen gel is also available in small sachets.

Spray

The spray should be applied to clean, dry, healthy skin of the inner forearm, in areas that do not overlap. If that is not possible, it should be applied on your inner thigh. The manufacturer of the spray suggests absorption may be lower if you apply it to your abdomen.

Tablet

Oestrogen-only tablets should be taken daily at a similar time of day, with or without food.

Progesterone

If you are still having periods when you take HRT, then the type of HRT you will be given (sequential HRT) will lead to you having regular periods. If it has been more than a year since your last period or you have been taking HRT for around six months to a year, then the type of HRT usually prescribed is one where you will not have periods (continuous HRT).

Sequential HRT

Also known as cyclical HRT, this involves taking oestrogen all the time, and then adding in progesterone for only part of the month. It’s generally used if you are still having periods, or if they have only stopped in the past few months.

With sequential HRT you will typically take oestrogen every day, and then for 12 to 14 days each month you take progesterone as well. After you finish the progesterone part of your HRT, you will usually have a period-like bleed, which is due to the hormones stopping rather than an actual period.

Continuous HRT

Continuous HRT is when you take your oestrogen and progesterone all the time without a break. If you take tablets, this will be every day, while patches are changed once or twice a week. Continuous HRT is usually used from about a year after your last period or if you have been taking sequential HRT for around 6-12 months.

The Mirena Coil (or IUS)

The Mirena coil can be left in place for five years (or longer if you are over the age of 45 when it is inserted, and just using it for contraception). This works locally on your womb, usually resulting in periods stopping. It also works as a contraception. Some women also take additional progesterone (as a capsule), which can have beneficial effects throughout your body. This is outside of the product licence and is recommended on an individual basis.

Testosterone

This is usually given as a gel or cream and should be rubbed on to clean, dry skin; usually on your upper outer thigh or buttocks. Applying it at the same time each day will usually have the best effect.

What dose will I need?

Every woman is woman is different so your dose of HRT will be decided with your healthcare professional. The dose and type of HRT may need to change with time.

There may be a noticeable improvement initially but then not as much as you were hoping for, or there may be a return of some symptoms. You may need a higher dose, to try a different way of taking the hormone or a different brand. You might benefit from adding in testosterone, as well as oestrogen (and progesterone). This is something your healthcare professional will work with you on to determine your optimum dose and balance of hormones.

Benefits and risks of HRT

HRT is a safe and effective treatment for the vast majority of healthy women with symptoms who are perimenopausal and menopausal. The benefits and risks of HRT often vary according to your age, your medical history and any existing conditions you may have – your healthcare practitioner will discuss this with you and personalise your HRT.

Benefits

Simply put, the main benefit of HRT is that the right dose and type can improve symptoms of perimenopause and menopause. Many women find their symptoms improve within a few months of starting HRT and feel like they have their ‘old self’ back, improving their overall quality of life. Hot flushes and night sweats usually stop within a few weeks of starting HRT. Many of the vaginal and urinary symptoms usually resolve within a few months, but it can take longer. You should also find that symptoms such as mood changes, difficulty concentrating, aches and pains in your joints, and the appearance of your skin will also improve.

HRT also benefits your future health. Around one in two women over the age of 50 will develop a fracture due to osteoporosis – a condition when the loss of bone density is severe and there is a greater risk of bones breaking [19]. Taking HRT can help prevent and repair bone loss and reduce the risk of fractures by around 50% [20]. 

There are also heart benefits – taking HRT will lower risk of developing heart disease and a lower risk of death from heart disease compared to women who do not take HRT [21].

Women who take HRT also have a lower risk of developing type 2 diabetes, bowel cancer and some studies have shown a lower risk of dementia [22].

Risks

The risks of HRT depend on the type of HRT you are given and factors such as your age, your family history, your general health and medical history. This is why it is so important to have an individualised consultation where you can discuss your actual risks.

Women who take synthetic types of HRT as tablets have a small increased risk of developing a clot in their veins or a stroke. You are more likely to develop a clot or have a stroke if you have other risk factors for these conditions. These include being obese, having a clot or stroke in the past or being a smoker.

This risk of clot or stroke is not present for women who use oestrogen as patches or gel rather than tablets. This risk is not associated with taking natural progesterone or testosterone.

Many women worry about breast cancer when taking HRT. Taking combined synthetic HRT (oestrogen and progestogen) may be associated with a small risk of developing breast cancer [23]. However, the Women’s Health Initiative study (WHI) showed that this risk was not even statistically significant [24]. The risk of breast cancer is reduced if micronised progesterone is used [25]. Any risk of breast cancer is very low; to put this in perspective the risk of breast cancer is greater in women who are overweight, do no exercise or drink moderate amounts of alcohol compared to taking any types of HRT [26].

The WHI study found that women who took oestrogen only HRT actually had a lower future risk of developing breast cancer.

There have never been any studies showing that taking HRT increases the risk of death from breast cancer. In addition, there is no increased risk of breast cancer in women who take HRT under the age of 51 years.

What can I expect when I start HRT?

While every woman is different, symptoms such as hot flushes and night sweats should subside within a few weeks of starting HRT, while other symptoms, such as low mood, muscle and joint pains and vaginal dryness, may take longer to resolve.

There are some temporary side effects that can happen in the first few weeks after starting HRT, including bleeding, tender breasts, bloating and you may find your mood is affected or you may feel more emotional. These side effects should settle and improve with time. If you experience side effects that are unexpected or persistent, it’s important you consult your clinician.

Is there anything else I need to know?

It’s worth remembering that HRT isn’t a contraceptive and it doesn’t work by delaying your menopause.

A holistic approach to your perimenopause and menopause, which incorporates a balanced diet and exercise, as well as considering hormone treatment, is the most effective way to manage your symptoms and future health.

There is a wealth of evidence-based information on the balance website and app, and your healthcare professional can help decide what is the right treatment choice for you, depending on your individual circumstances.

Resources

Understanding the benefits and risks of HRT downloadable visual aids

Easy HRT prescribing guide

The influence of oestrogen, progesterone and testosterone posters

References

1. NICE: CKS: Menopause
2. Li, M., Zhu, Y., Wei, J., Chen, L., Chen, S., & Lai, D. (2022). ‘The global prevalence of premature ovarian insufficiency: a systematic review and meta-analysis’, Climacteric, 26(2), pp95–102. https://doi.org/10.1080/13697137.2022.2153033
3. Woods NF, Mitchell ES. (2005), ‘Symptoms during the perimenopause: prevalence, severity, trajectory, and significance in women’s lives’, Am J Med. 118 Suppl 12B:14-24. Doi: 10.1016/j.amjmed.2005.09.031
4. Woods NF, Mitchell ES. (2005), ‘Symptoms during the perimenopause: prevalence, severity, trajectory, and significance in women’s lives’, Am J Med. 118 Suppl 12B:14-24. Doi: 10.1016/j.amjmed.2005.09.031
5. Newson Health, Experiences of Perimenopause and Menopause Survey, 2022
6. Cheng CH, Chen LR, Chen KH. (2022), ‘Osteoporosis Due to Hormone Imbalance: An Overview of the Effects of Estrogen Deficiency and Glucocorticoid Overuse on Bone Turnover’, Int J Mol Sci. 23(3):1376. doi: 10.3390/ijms23031376
7. Iorga, A., Cunningham, C.M., Moazeni, S. et al. (2017), ‘The protective role of estrogen and estrogen receptors in cardiovascular disease and the controversial use of estrogen therapy’, Biol Sex Differ 8, 33 https://doi.org/10.1186/s13293-017-0152-8
8. De Paoli, Monica et al. (2021), ‘The Role of Estrogen in Insulin Resistance’, The American Journal of Pathology, 191(9) pp1490 – 1498 https://doi.org/10.1016/j.ajpath.2021.05.011
9. Jett S., Malviya N., Schelbaum E., Jang G., Jahan E., Clancy K., Hristov H., Pahlajani S., Niotis K., Loeb-Zeitlin S., Havryliuk Y., Isaacson R., Brinton R.D. and Mosconi L. (2022), ‘Endogenous and Exogenous Estrogen Exposures: How Women’s Reproductive Health Can Drive Brain Aging and Inform Alzheimer’s Prevention’, Front. Aging Neurosci. 14:831807. doi: 10.3389/fnagi.2022.831807
10. Desai M.K., Brinton R.D. (2019), ‘Autoimmune Disease in Women: Endocrine Transition and Risk Across the Lifespan’, Front Endocrinol (Lausanne). 29;10:265. doi: 10.3389/fendo.2019.00265
11. Wu Z., Xiao C., Wang J. et al. (2024), ‘17β-estradiol in colorectal cancer: friend or foe?’, Cell Commun Signal 22 (367). https://doi.org/10.1186/s12964-024-01745-0
12. NICE Menopause: diagnosis and management
13. Hipolito Rodrigues, M. A., Maitrot-Mantelet, L., Plu-Bureau, G., & Gompel, A. (2018), ‘Migraine, hormones and the menopausal transition’, Climacteric, 21(3), pp256–266. https://doi.org/10.1080/13697137.2018.1439914
14. Beazer J.D., Freeman D.J. (2022), ‘Estradiol and HDL Function in Women – A Partnership for Life’, J Clin Endocrinol Metab, 107(5):e2192-e2194. Doi: 10.1210/clinem/dgab811
15. Issa Z., Seely E.W., Rahme M., El-Hajj Fuleihan G. (2015), ‘Effects of hormone therapy on blood pressure’, Menopause. 22(4) pp456-68. doi: 10.1097/GME.0000000000000322
16. Morris G., Talaulikar V. (2023), ‘Hormone replacement therapy in women with history of thrombosis or a thrombophilia’, Post Reprod Health. 29(1) pp33-41. doi: 10.1177/20533691221148036
17. Scarabin P.Y. (2014), ‘Hormone therapy and venous thromboembolism among postmenopausal women’, Front Horm Res. 43:21-32. doi: 10.1159/000360554
18. Shufelt C.L., Manson J.E. (2021), ‘Menopausal Hormone Therapy and Cardiovascular Disease: The Role of Formulation, Dose, and Route of Delivery’, J Clin Endocrinol Metab. 23;106(5) pp1245-1254. doi:  10.1210/clinem/dgab042
19. van Staa T.P., Dennison E.M., Leufkens H.G., Cooper C. (2001), ‘Epidemiology of fractures in England and Wales’, Bone. 29(6) pp517-22. doi: 10.1016/s8756-3282(01)00614-7
20. Gambacciani M, Levancini M. (2014), ‘Hormone replacement therapy and the prevention of postmenopausal osteoporosis’, Prz Menopauzalny, 13(4):213-20. doi: 10.5114/pm.2014.44996
21. Hamoda H., Panay N., Pedder H., Arya R., Savvas M. (2020), ‘The British Menopause Society & Women’s Health Concern 2020 recommendations on hormone replacement therapy in menopausal women’, Post Reproductive Health. 26(4) pp181-209. doi:10.1177/2053369120957514
22. Langer, R. D. (2021), ‘The role of medications in successful aging’, Climacteric, 24(5), pp505–512. https://doi.org/10.1080/13697137.2021.1911991
23. Rossouw JE, Anderson GL, Prentice RL, LaCroix AZ, Kooperberg C, Stefanick ML, et al. (2002), ‘Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results From the Women’s Health Initiative randomized controlled trial’, JAMA, 288(3):321-33 10.1001/jama.288.3.321
24. Bluming A.Z., Hodis H.N., Langer R.D. (2023), ‘’Tis but a scratch: a critical review of the Women’s Health Initiative evidence associating menopausal hormone therapy with the risk of breast cancer’, Menopause. 30(12) pp1241-1245. doi: 10.1097/GME.0000000000002267
25. Asi N., Mohammed K., Haydour Q., Gionfriddo M.R., Vargas O.L., Prokop L.J., Faubion S.S., Murad M.H. (2016 ), ‘Progesterone vs. synthetic progestins and the risk of breast cancer: a systematic review and meta-analysis’, Syst Rev. 5(1):121. Doi: 10.1186/s13643-016-0294-5
26. Dydjow-Bendek DA, Zagożdżon P. (2021), ‘Early Alcohol Use Initiation, Obesity, Not Breastfeeding, and Residence in a Rural Area as Risk Factors for Breast Cancer: A Case-Control Study’, Cancers (Basel), 13(16):3925. doi: 10.3390/cancers13163925

The post Perimenopause, menopause and HRT: everything you need to know appeared first on Balance Menopause & Hormones.

• More women are asking their doctor for HRT for treating their perimenopausal and menopausal symptoms
• Tracking your symptoms and researching the perimenopause and menopause can help
• Understand your rights and why shared decision making is important

Only 15% of menopausal women in the UK take HRT [1], and in some areas it’s as low as 7% [2]. This is despite HRT being the first-line treatment for perimenopause and menopause, as recommended by NICE (National Institute for Health and Care Excellence) [3].

We often hear from women who have had trouble getting a correct diagnosis for their perimenopausal or menopausal symptoms, or who are denied the treatment that they would like. If you are experiencing symptoms and would like to discuss HRT with a healthcare professional, this can feel daunting. And even if you’ve already been given HRT, you might need to adjust it, need to talk about any ongoing symptoms or want to talk to your doctor or healthcare professional about testosterone.

It’s worth remembering that doctors and healthcare professionals want the best for their patients. However, they might disagree with you or, if your situation is complicated, want to find out more, or worst-case scenario, not be up-to-date with the evidence and guidelines.

Dr Louise Newson, balance founder and menopause specialist says: ‘I feel very strongly that it’s about having a choice and knowing that there are options available. Women can empower themselves, they can get information, and they can advocate for themselves.’

Here’s our six-step plan to do just that:

1. Do your research

Dr Louise advises: ‘Before that first appointment, download the balance app where you can track your symptoms, and your periods, if you still have them. Read as much information as possible, again there are lots of resources on balance.’

Become an expert in what’s going on in your body – what the changes are, how long they’ve been going on. Complete the menopause symptom sheet and, for a really deep dive, you might like to sign up to Newson Health’s Confidence in Menopause Course.

Then brush up on the guidelines healthcare professional use to advise their patients. The General Medical Council (GMC) guidelines, Decision Making and Consent (read them in full here), states that doctors need to: keep their professional knowledge and skills up to date; work in partnership with patients; listen to, and respond to, patients’ concerns and preferences; and respect patients’ right to reach decisions about their treatment and care.

Similarly NICE’s Shared Decision Making guidelines (NG197) state that clinicians should: encourage the patient to take an active role in making decisions about their treatment; take into account what is most important to the patient, their expressed needs and priorities, and explain treatment options in light of these; have an open discussion about the risks, benefits, and consequences of each treatment option; allow time to answer questions and time to make decisions, making it clear that the patient can change their mind down the line; come to a joint decision that is satisfactory to the patient.

Finally, the NICE menopause guidelines are a useful set of guidelines for doctors in diagnosing and managing the menopause.

Doctors are not always aware of these recommendations, so you may want to print off particularly relevant sections for you and take them to your appointment.

2. Go prepared

‘Once you have tracked your symptoms, and any periods, on balance, you can print out a health report, which pulls them all together,’ says Dr Louise. This will be really useful for your doctor. Also make a note of any questions you might have.

If you feel the usual 10-minute appointment time isn’t going to be long enough to discuss things adequately, then ask for a double appointment before you book. And if you feel nervous or just want some moral support, it’s perfectly acceptable to ask a friend to come with you – they can act as a note-taker too.

RELATED: empowering women unheard during menopause

3. Know what to say

As Dr Louise advises, appointments are usually only 10 minutes so every second counts. Try to be as succinct as you can when explaining things to your doctor. ‘Show them your health report, tell them you’ve read up on your symptoms and say, “I’ve made the diagnosis myself, I’m 99% sure I am perimenopausal or menopausal, I’ve read about HRT and this is what I want,’ says Dr Louise.

4. Aim to make a joint decision

Your healthcare professional may ask you to explain your reasons for your decision, your understanding of what is involved, and your expectations of how HRT would improve things for you. You have the right to choose what treatment you would like as long as you show you fully understand all the implications of the decision, including any risks. This includes any treatment option that your healthcare professional does not think is the best option. Regarding your decision as ‘unwise’ is not enough of a reason to refuse, if you can show you are informed and have considered the consequences of your choice.

Your doctor should answer your questions accurately, and as fully as they can in the time allowed. They should be clear about the limits of their knowledge and, if they can’t answer a question, they should explain whether it’s something they just don’t know themselves or something that no one knows yet because the research hasn’t been done.

If, after discussion, the professional does not consider your treatment choice an appropriate course of action, they do not have to provide it. They should explain their reasons for refusing it to you and explore what other options might be available, including your right to seek a second opinion.

If your doctor wants to provide a treatment for you that you disagree with, say so. Professionals need to show that you consent (agree) to any decided course of action.

5. Face obstacles

‘If your doctor says no, you are allowed to challenge that decision. Say “is there is a reason why you are refusing?”,’ says Dr Louise. Some reasons women have been incorrectly told they can’t have HRT include: ‘You’re too young to be menopausal’, ‘But you don’t get hot flushes’, ‘HRT is too risky’, ‘The drug is not licensed to be used in this way’, ‘You’re still getting periods’. This is where your research comes in – your doctor may need to see your evidence.

A Newson Health study of 5,744 women showed that over a third of respondents (39%) were offered antidepressants instead of HRT as the first course of treatment [4].

In this case, Dr Louise advises you to point out: ‘Menopause guidelines are very clear that antidepressants should not be given first line for low mood associated with the menopause because there is no evidence that they will help. Research has shown that if women are given HRT when they are perimenopausal then this can reduce the incidence of clinical depression developing.’ 

Other women have found their access to HRT is delayed as the doctor wants to conduct a blood test. This may be necessary in some cases, but if you’re over 45 and experiencing symptoms, there’s mostly no need as blood tests are unreliable. ‘It’s more important to listen to the woman regarding her symptoms. If your periods have changed or stopped and you are having symptoms, that’s enough,’ says Dr Louise.

Alternatively, your doctor may say they need to refer you on to a menopause specialist, which can cause long delays. ‘This shouldn’t be necessary unless you have a complicated situation and even women with family history of breast cancer can still safely take HRT,’ says Dr Louise.

Don’t be afraid to advocate for yourself and disagree with the doctor. Listen and consider their explanation. If you still don’t agree, Dr Louise advises saying: ‘I know there are benefits for me taking HRT and I’m prepared to take any risks, they are very small. If you won’t give it to me now, when can I come back and when can I get it and who can I see?’

6. If at first you don’t succeed…

Be persistent! If you don’t get the desired outcome at the first appointment, try again another time, and in the meantime research the evidence base for the reasons why your preference was denied.

You can ask to see another doctor (or nurse) within your practice – ask who has an interest in menopause or women’s health. If there is no one, consider changing practices or consider having an appointment with a private menopause specialist.

Don’t give up. You may need to talk to several doctors or nurses, explaining your reasons for wanting HRT, the information that’s led you to this decision, and that you know what the associated risks might be but that it is still what you choose to do. Persistence often pays off when you can give a clear and rational argument that shows careful consideration of the evidence of the risks and benefits to your health.

References

1. GOV.UK
2. NHS BSA Healthcare inequalities: NHS Prescribing of Hormone Replacement Therapy to Treat Symptoms of the Menopause 
3. NICE Menopause Guideline [NG23]
4. Experiences of Perimenopause and Menopause, December 2022

Resources
NICE Shared Decision Making guidelines: https://www.nice.org.uk/guidance/ng197
GMC guidelines on decision making: https://www.gmc-uk.org/-/media/documents/updated-decision-making-and-consent-guidance_pdf-84160128.pdf

The post How to talk to your doctor about HRT – and get results appeared first on Balance Menopause & Hormones.

• Heavy bleeding is common during the perimenopause
• Various treatments can help, including HRT
• Learn how to manage heavy bleeding and ask for help

One in three women describe their periods as heavy [1], a condition that’s medically known as menorrhagia. If this affects you, it might be something you’ve had to deal with for most of your life or it might be a new, unwelcome symptom of perimenopause. Either way, heavy periods can cause disruption, distress and difficulties in every area of your life, including work, exercise, your social life and your sex life.

What is classed as a heavy period?

It is difficult to measure the blood lost during your period, but they are considered heavy if you need to change your pad or tampon every one to two hours, or empty your menstrual cup more often than is recommended. If you regularly need to double up on sanitary products, such as using a pad and a tampon together, if your periods last more than seven days, or you bleed through clothes or bedding, this can also suggest heavy periods.

Other signs include passing blood clots larger than the size of a 10p coin, avoiding daily activities like exercise, or taking time off work due to your periods and feeling tired or short of breath.

Heavy periods don’t necessarily mean painful periods, but they can bring you pain and discomfort.

What causes heavy periods?

In more than half of cases the exact cause of heavy periods is not known [2]. Common causes can include:

• Fibroids, which are benign enlargements of muscle in the wall of your womb, or endometrial polyps, benign outgrowths of the lining of your womb
• Endometriosis, when cells similar to the lining of your womb grow elsewhere in the body, and adenomyosis, when these cells grow in the muscular walls of the womb, can both cause heavy periods.
• Pelvic inflammatory disease, an infection which can affect your womb, fallopian tubes and ovaries
• A sexually transmitted disease or by bacteria that normally live in your vagina
• Polycystic ovarian syndrome (PCOS)
• If you have a copper coil, this can also lead to heavy periods
• Some auto-immune conditions and some thyroid disorders can put you at higher risk of heavy periods

During perimenopause, it’s not unusual for women to experience heavy bleeding [3], and changes to your periods are often an early sign of the perimenopause. During this time, oestrogen and progesterone, the hormones that regulate your menstrual cycle, fluctuate and decline, which means your cycle can become unpredictable and irregular. This can lead to longer cycles, or shorter ones with more frequent periods, and can make your periods heavier or lighter.

RELATED: Changes in bleeds: your FAQ

Sometimes, and this often becomes more common during perimenopause, your ovaries may not release an egg (anovulation). Normally the release of an egg triggers the production of progesterone, which controls the development of your womb lining. This doesn’t happen in anovulation, and can lead to heavier, longer and irregular periods.

What should I do about my heavy periods?

The first and most important thing is to not put up with heavy periods. Make an appointment with your healthcare professional so they can look into the cause of your bleeding. They will ask you about your bleeding, whether you bleed between periods and whether your periods are painful or come with a feeling of pressure. They are likely to examine you, and you could be referred for further tests to rule out other conditions such as cancer of your womb lining, called endometrial carcinoma, and some other conditions which can cause heavy periods.

You may have an ultrasound to look at your womb, biopsies to study a sample of the lining of your womb, a hysteroscope (where a thin telescope is passed through your cervix to check look at your womb) and internal swabs to check for infections. Your doctor may carry out a blood test to see if you are anaemic. Anaemia can be caused by blood loss from heavy periods, leaving you feel tired, lacking in energy, feeling breathless and your skin looking pale.

RELATED: Iron factsheet

What are the treatment options?

For those experiencing heavy menstrual bleeding, there are several medical treatment options available. One effective long-term option is a hormone coil such as a Mirena coil. This is a small device placed inside your womb by a doctor or nurse which releases a type of progestogen. It is licenced for both heavy bleeding and also works as a contraceptive. While the progesterone within the Mirena coil is not classed as body identical, it is a low dose of progestogen and it usually leads to them stopping or can lead to your periods becoming lighter and shorter.

RELATED: The Mirena Coil or Intrauterine System (IUS)

There are various hormonal options that can help regulate menstrual cycles and lessen bleeding.  These include the oral combined contraceptive pill and the progesterone only pill.  These work primarily by suppressing ovulation, which means they prevent the ovaries from releasing eggs. This action minimises the hormonal fluctuations that typically cause the lining of the womb to thicken, leading to lighter and more regular menstrual bleeding. However, these are synthetic hormones so are not structurally the same as our own natural hormones.

Some women find that taking natural progesterone (one type is Utrogestan) in the second half of their menstrual cycle improves periods and reduces periods. This can also often help with symptoms of PMS and PMDD.

If you are taking HRT, changing your regimen can help manage and reduce heavy bleeding during perimenopause. One common approach is to adjust the balance of oestrogen and progesterone in your HRT.  Your clinician may increase your dose of progesterone or suggest changing it from being taken orally to vaginally. This can reduce heavy bleeding. Sometimes switching the type of HRT can make a difference. For example, if you are on a sequential HRT regime (where oestrogen is taken every day and progesterone is taken for part of the month), changing to a continuous regime (where both hormones are taken every day) might help. This extended exposure to progesterone can help to control the womb lining and reduce bleeding.

Non-hormonal treatments include medications such as tranexamic acid, which can reduce bleeding, and prescription-only anti-inflammatory painkillers, such as mefenamic acid or naproxen, which can also be effective in reducing blood loss and alleviating pain.

RELATED: sequential and continuous HRT: what’s the difference?

If medical treatments are not effective, there are surgical options to consider. Endometrial ablation is a procedure that destroys the lining of the womb to reduce or stop bleeding. For a more definitive solution, a hysterectomy is surgical removal of the womb. However, these options can affect your fertility. There are also treatments for conditions that are causing bleeding. For example, a myomectomy, which involves removing fibroids, and uterine artery embolisation, a procedure that blocks the blood supply to fibroids, causing them to shrink.

What else can I do?

• Keeping a period diary may help you and your healthcare professional to understand the pattern of your bleeding and decide which test or treatment may be helpful. The periods section in the journal area of our free balance app is designed with this in mind.

• You can also use the balance app to log any symptoms you are experiencing.
• Using double protection, such as tampon and towels, or also using period pants can help with heavy unpredictable flow and give some extra peace of mind.
• Switching to higher frequency absorption such as night-time products during the day, can also help you withstand heavy days.

Your healthcare professional will help you find the best approach to minimise the impact of heavy periods on your life, and if the first treatment does not improve bleeding then you should consider alternative treatments.

Resources

NICE (2018): heavy menstrual bleeding: assessment and management

References

1. Women’s Health Concern: Heavy Periods
2. Women’s Health Concern: Heavy Periods
3. Paramsothy P., Harlow S.D., Greendale G.A., Gold E.B., Crawford S.L., Elliott M.R., Lisabeth L.D., Randolph J.F. Jr. (2014),  ‘Bleeding patterns during the menopausal transition in the multi-ethnic Study of Women’s Health Across the Nation (SWAN): a prospective cohort study’, BJOG. 121(12):1564-73. doi: 10.1111/1471-0528.12768

Seeking support and care from a healthcare professional

If you need menopause treatment advice, seek help from your healthcare professional or book an appointment with Newson Health.

Newson Health offers evidence-based treatment and care for women going through the perimenopause and menopause. With clinics nationwide we offer in-person and virtual consultations. We are also able to see patients who reside outside the UK following a first appointment either face-to-face in one of our clinics or virtually while in the UK.* All follow-up consultations can then be held virtually in the country you resided in.

Our team of menopause specialist doctors, nurses and pharmacists will take time to listen to you, discuss your symptoms and offer a comprehensive treatment plan, tailored to your needs and preferences.

Use the button below to find out more and book your appointment.

*This doesn’t currently apply to residents of the US and Canada. All medication will need to be sent to a UK postal address; this includes PO Box addresses.

The post Heavy periods during the perimenopause: what you need to know appeared first on Balance Menopause & Hormones.

Q I’m perimenopausal, not on HRT and am having irregular periods. How long can I expect this to last?

All women are different and factors such as your age, ethnicity and body size can influence your cycle during perimenopause. Periods can change in frequency and duration during perimenopause. Many women find their periods become heavier and closer together, whereas others experience lighter and less frequent periods. Your periods may be regular but last longer or less time. The early changes in menstrual cycle occur on average six to eight years before the final menstrual period [1]. Perimenopause can last for around 10 years but this varies between women.

Q I went a whole year without bleeding but now I’ve just had a bleed! What’s going on?

If bleeding occurs more than a year since your last period then you should be checked by a doctor. Your doctor is likely to examine you and may arrange for you to have a scan of your womb. There are many causes of bleeding, including thickening of your womb lining, a polyp or fibroid. Occasionally there are more serious causes so it important to have bleeding checked [2].

Q I’m perimenopausal and fed up with erratic, heavy periods. Can I go straight to continuous HRT or do I have to try sequential first? I don’t want any more bleeds!

Cyclical (sequential) HRT can often help regulate your cycle. Many women find their periods become lighter too when they take HRT. However, some women prefer to take continuous HRT so the progesterone is taken every day. Periods can become more erratic initially but then often stop completely.  

Another option to consider is the Mirena coil, which can make periods lighter and shorter, and usually causes them to stop altogether.

RELATED:  heavy periods during the perimenopause: what you need to know

Q Is it beneficial to bleed every month? I’m considering switching from sequential to continuous HRT but have heard it’s healthy to have a monthly bleed.

There are no health benefits or risks to a monthly withdrawal bleed. It is a bleed due to taking cyclical hormones rather than a natural period. There is no build-up of blood if you do not have a bleed each month and many women prefer not having bleeding. The decision to move from sequential to continuous HRT can be made with your healthcare professional.

Q I’ve had persistent bleeding since starting HRT six months ago – what should I do?

It can be quite common to experience bleeding in the first 3-6 months after starting HRT or changing dose (or type) of HRT. However any bleeding that persists or occurs after six months should be investigated by your doctor. If you have bleeding at any time which is heavy, troublesome, painful or you are worried then you should see your doctor.

RELATED: what to expect when you start HRT

Q I’ve been using combined HRT patches for some time but my bleeding has increased. How long is this bleeding considered normal and when should I see someone?

Irregular bleeding is common in the first few months after starting combined HRT but you should speak to your doctor if you have been taking HRT for more than six months and are having unexpected bleeding. For some women, changing dose or type of HRT improves any bleeding.

Q I am perimenopausal, taking sequential HRT and still having periods. Will they eventually stop when I’m menopausal or will I keep on bleeding unless I switch to continuous HRT? If so, how do I know when to switch over?

Menopause is defined as one year after your last period. However, bleeding will usually keep occurring when you are taking sequential HRT. Usually women change to continuous HRT after 6-12 months and then bleeding stops.

RELATED: sequential and continuous HRT: what’s the difference?

Q I have the Mirena coil and am getting random bleeds, sometimes light and sometimes heavy – why?

The Mirena coil can cause some irregular, longer or more frequent bleeding, which may continue for up to six months. You may also have some light bleeding between your periods. After this time, it usually settles down but if it persists, see your healthcare professional for a check-up.

RELATED: the Mirena coil or Intrauterine System (IUS)

Q I was having a regular withdrawal bleed after the 12 days of Utrogestan but now it’s completely random and can be 8-10 weeks apart – what does this mean?

It may mean that you own hormones are reducing and many women decide to change to continuous HRT and their bleeding then stops all together.

RELATED: micronised progesterone or Utrogestan factsheet

Q I’ve moved from sequential to continuous HRT and am having erratic bleeds – how long will it take for them to stop?

Irregular bleeding is common in the first 3-6 months after starting combined HRT. If it is heavy or painful within this time, consult with your healthcare professional. Also see your doctor if it has not settled after six months.

References

1. Harlow S.D., Paramsothy P. (2011), ‘Menstruation and the menopausal transition’, Obstet Gynecol Clin North Am. 38(3):595-607. doi: 10.1016/j.ogc.2011.05.010.
2. NHS: postmenopausal bleeding
3. Harlow S.D., Paramsothy P. (2011), ‘Menstruation and the menopausal transition’, Obstet Gynecol Clin North Am. 38(3):595-607. doi: 10.1016/j.ogc.2011.05.010.

The post Changes in bleeds: your FAQ appeared first on Balance Menopause & Hormones.

This week on the podcast, Dr Louise is joined by Elin Sullivan, a young woman who suffered a myriad of symptoms for years before getting the right treatment.

Elin first experienced recurring urinary tract infections at 19 years old, and twice required hospitalisation. She also suffered from sweats, sleep disruption and fatigue, shaking and lichen sclerosus. After a chance encounter with Louise, she tried local hormones, which was transformative, and now takes testosterone to balance her low levels.

Elin talks about how hard it can be to experience perimenopausal symptoms at a young age and shares her tips for other younger women experiencing issues that they think might be down to their hormones:  

1. Although it can feel really hard, don’t stop advocating for yourself. You may have self-doubt or worry that you’re wrong but keep pushing. My doctor was sick of seeing me, I was there probably every week, but don’t give up.
2. Rather than just giving your doctor a list of your symptoms, show them when they were happening as well. Have a log of symptoms and anything that might have affected them on that day. This will help your doctor rule out things but also show if your diet, etc, has an influence.
3. Don’t be scared to try medications or suggestions. It might help but if it doesn’t it can potentially help your doctor decide the next step. I never believed local HRT could make such a big difference but am so glad I tried it.

Click here to find out more about Newson Health.

Transcript

Dr Louise: [00:00:11] Hello, I’m Doctor Louise Newson, I’m a GP and menopause specialist, and I’m also the founder of the Newson Health Menopause and Wellbeing Centre here in Stratford-upon-Avon. I’m also the founder of the free balance app. Each week on my podcast, join me and my special guests where we discuss all things perimenopause and menopause. We talk about the latest research, bust myths on menopause symptoms and treatments, and often share moving and always inspirational personal stories. This podcast is brought to you by the Newson Health Group, which has clinics across the UK dedicated to providing individualised perimenopause and menopause care for all women. So today on my podcast, I’m delighted to introduce to you someone called Elin, who is young actually, she’s only 27 and I recently met her in a weird way. I meet all sorts of people in things that I do, and I’ll explain more in a minute. But firstly, I’m just going to welcome Elin to the podcast. So thanks ever so much for joining me today. [00:01:20][69.2]

Elin: [00:01:21] Ah, thank you for having me. [00:01:22][1.0]

Dr Louise: [00:01:23] So I really believe in connections happen for a reason. And it’s really, really weird actually. So I am very conventional. I’m very traditional. I’m not very artistic at all. And when one of my children a couple of years ago now had some piercings done in her ear, I was really like shocked because she, they had a cartilage. And then my middle daughter’s had all sorts of piercings, and I thought I’d be one of these mums where my children maybe have doubles, and that’s about it. Clearly not. So I shocked them a few, a couple of years ago and had my conch pierced, which they thought I would never do, and I did it as a bit of a rebellious thing so people could realise that I’m not quite as conventional and conformist as maybe I have been in the past. And it was really painful, and it took ages to heal, and the wind blowing in my ear was awful. And then my oldest daughter and I Jess decided to go and get another piercing done, and I wanted to get my cartilage done. So we went to a different place and we met you. I don’t know if you remember, Elin. We both came in… [00:02:20][56.9]

Elin: [00:02:20] Yeah, I do. [00:02:20][0.0]

Dr Louise: [00:02:20] And Jessica went first and we chose and it was such an amazing experience because you were so calm and you explained everything, and you put me at ease. And I didn’t feel like I was far too old to be sitting in a tattoo parlour, like having my ear pierced and like, I walked out and we walked through London, Jess and I, and my ear the wind didn’t hurt on my piercing and it’s just been incredible. I’ve really enjoyed having it. And I remember you saying when you were piercing my ear that you were feeling quite tired and you had some sort of condition. And obviously I think everything’s related to hormones, but it wasn’t appropriate because I was nervous to ask you any questions. And then Jess, my eldest daughter, then had her eyebrow done and something went wrong with it. I think there was a one of the bits came out, so she went back to see you, didn’t she? [00:03:11][50.6]

Elin: [00:03:11] Yeah, she did a couple of days later. [00:03:12][1.3]

Dr Louise: [00:03:13] Yeah. And she came to talk to you and you can explain what you said to her. But then she came out and phoned me and she said, Mummy, I’m really worried about Elin. And I said, who? I’m sorry. And she explained, she said, I’ve just gone in back into the piercer and I think some of it’s related to her hormones. And I told her to listen to your podcast and find out more about what you’re doing. But I feel really sad for her because she’s really struggling. So then I said, just give her my details and I’ll talk to her. And that’s what happened. So what happened with Jess? What did you say to her or what happened for her to think about your hormones? [00:03:48][35.3]

Elin: [00:03:49] We just got chatting quite very organically. Like none of it was forced but just chatting about how our day’s been, turned on to how are week’s been? And then just saying, I’m tired. And it turned into a question of oh, how long have you been tired? Like, gosh, when I think about it, it’s been months. And then it’s like, but doctors don’t seem to find anything wrong. And then I think that piqued Jess’s interest to be like, oh, have you, have you tried this? Have you tried that? Yeah. Nothing’s really flagged anything up with the doctors. And then we both said, oh, I think it might be hormonal. She said funnily enough you should mention that, my mum actually knows all about this and said, have you ever heard of this podcast? Have you ever heard of my mum? And I was like just when I met her when I pierced her a couple of weeks ago. And I went home and well, she came back later on that day and said she’d spoken to and I think we spoke very quickly after that. But she was very, very knowledgeable, explaining she basically reeled off every symptom I had, just like, do you suffer from this, do you suffer from that? And she said that she’d experienced it too. And it was really just refreshing knowing it wasn’t, I’m not the only young person that felt like that. It made me feel like I wasn’t crazy. So she just helped me feel like I wasn’t the crazy one. [00:05:11][82.0]

Dr Louise: [00:05:12] And isn’t that important? You know, in medicine, we don’t always have answers. We absolutely don’t. And I learned as a GP many years ago to deal with uncertainty and share uncertainty with patients. And often I say, I don’t know. Or I say it could be this, but if it’s not this, we can try something else or we can think about something else. So you’re 27 now, but you’ve had years of symptoms in different ways, haven’t you? [00:05:37][25.8]

Elin: [00:05:38] It probably started when I was about 19. It all started with urinary tract infections I just couldn’t shake. And that was going on up until probably about a year ago. And then starting on some steroids and everything seemed to get a little bit easier. Realising my skin was quite dry and everything I’ve read into the doctors they were kind of shocked that they couldn’t figure out what exactly was causing it. They couldn’t figure out why I wasn’t able to shake the infection. I’d be chatting to Harley Street, chatting to my urologist. And I tried everything and every diet, every drink, every tablet, every plant I could have tried and nothing helped. So it just escalated from there to the point where my body just didn’t feel like my body anymore. [00:06:28][50.3]

Dr Louise: [00:06:29] No and did you have sepsis at one stage with your, one of your urinary tract infections? [00:06:33][4.3]

Elin: [00:06:34] Yeah, it turned into a brief trip to A&E, probably twice I’d say I think, if I look back. Once when I was 20, once when I was 23, that would have been in lockdown. [00:06:49][15.1]

Dr Louise: [00:06:51] So very scary. [00:06:51][0.5]

Elin: [00:06:52] Yeah. It almost felt normal by that point, which is sad. And no-one really seemed to take it seriously. When I went back to the doctors and just getting those three days of antibiotics, it almost wasn’t made out to be a big deal. And then you would start reading into it. And sadly that’s how my grandma passed away, was from a result of urosepsis. So you realise the full extent of it then. [00:07:15][22.3]

Dr Louise: [00:07:16] Absolutely. So you had urinary symptoms. You had recurrent urinary tract infections, under urologists for many years, but then you had other symptoms as well, didn’t you? [00:07:26][10.3]

Elin: [00:07:27] The more recent ones where when I couldn’t sleep, I couldn’t sleep through the night, always waking up covered in sweat to the point where you just know it’s not normal. I’ve never had issues with that before, unless I did have like a urinary tract infection that was normal at the time, but constant shaking, like not being able to walk far distances without shaking and feeling like I was going to pass out, or having to lie on the floor with my legs in the air. And doctors just telling you to eat more, to sleep more to, oh if you exercise and push through it it will pass, but it never passed. It just kept getting worse and worse. And I, I loved going to the gym. I loved going on long walks, and I couldn’t even walk up a hill without sitting to try and catch my breath. I mean, the gym was just almost like, I started to think I was getting something like Parkinson’s in the end. I had really got into my own head with it but thankfully it wasn’t. I’m very glad to be… [00:08:23][55.8]

Dr Louise: [00:08:24] But it’s very scary, isn’t it? Because, you know, you want to exercise, you’ve got the motivation, you go, your stamina is not there. And, and you were saying that you were falling asleep on the Tube before going to work or coming back from work. [00:08:35][11.4]

Elin: [00:08:36] And I’m not a napper. I’m not a napper at all. I’m very strict with my bedtime. I wake up and go to sleep the same time every day and night. But yeah, that’s how I knew it was bad is missing my stops on the way to work, or missing my stops on the way home and yeah, it wasn’t good, I was falling asleep on the sofa before I’d even finished my dinner sometimes as well. [00:08:56][19.9]

Dr Louise: [00:08:56] Which is hard. And I know you’ve got a partner, and it’s hard when you’ve got a partner as well, because it involves them too, doesn’t it? [00:09:03][6.9]

Elin: [00:09:03] Yeah, yeah. But he helped me realise there was something wrong as well and kept pushing me to go to the doctors. And as soon as your name came up, it was like, you have to talk to her. Please talk to her. You’re not yourself anymore. [00:09:16][12.9]

Dr Louise: [00:09:17] Yeah, and it’s difficult because you were still having, you’ve still been having periods, haven’t you although they’ve changed and became quite sort of painful and heavy at times hadn’t they? [00:09:26][8.4]

Elin: [00:09:27] Yeah. Sometimes they didn’t even come at all. [00:09:28][1.8]

Dr Louise: [00:09:30] And so, you know, when we talk, and I’ve spoken before in this podcast about premature ovarian insufficiency or POI, it’s called, which is common. It affects at least 1 in 30 women. But that’s when periods have stopped. But we also know that perimenopause can last for ten years or so before periods stop. And so in medicine, I think it’s cruel and wrong to wait for something to happen if, as in the menopause, which is a year since your last period, if you’re getting symptoms. And so there’s no diagnostic test for the perimenopause at all. And then that makes it quite difficult. And obviously I felt quite guilty almost that I’ve hoicked you out of, you know, from piercing my ear to saying, let me try and help you. And I’m sure I said to you when I saw you and I often say to patients, I have no idea how much is related to your hormones. I can take a really thorough history and let’s see, and certainly I was worried because you had recurrent urinary tract infections and you told me you had lichen sclerosus as well, and your skin in your perineum was breaking down. You were using steroid cream, and that was a real problem. So you had these, I hope you don’t mind me saying, these local symptoms that were really and I remember you saying you saw someone and they had never seen someone so young with such severe lichen sclerosus. [00:10:48][78.6]

Elin: [00:10:50] Yeah, just explaining, oh, it’s an older woman’s problem. It’s an older person’s problem, it shouldn’t be affecting you. And they never explained with how I looked, they weren’t sure if I’d gain any colour back or if any of the sort of tearing would heal, and I couldn’t find any information online about it. There were no pictures to compare to, there were no, there was no-one else my age I could find information from. So I found a couple of groups, and was chatting to people on there, trying to get their experiences. But everyone, there’s maybe a couple that are under 30 in there but same. We’re all looking for the same answers. And since starting the local HRT, it was almost like a gamechanger. Like my skin. You wouldn’t even guess now, it looks normal. [00:11:38][48.1]

Dr Louise: [00:11:39] It’s amazing, isn’t it? And so for those people listening, and Elin’s given me full consent to share, but I started just giving you some local hormones. So that’s vaginal hormones. And I decided to give you Intrarosa, which is prasterone, which is DHEA, and it converts to oestrogen and testosterone in the vulva, but it helps all the tissues surrounding. And because you’re young, I didn’t want to just start giving you systemic hormone therapy without thinking what else could be going on, getting to know you more. And we also, I did some blood tests as a guide. We can’t do a blood test to make the diagnosis, but I wanted to see if your testosterone level and oestrogen level was on the low side, because it would help sort of build this picture in my mind that something was going wrong with your hormones. But the first thing I did was give you vaginal hormones. And actually they’re very safe. They’re very safe for everybody. And although people think that they can only be used in the menopause, we can give them in the perimenopause, but we can also give them to younger women. There are a lot of young women who maybe have had a baby or who are using contraception, or who are just prone to urinary tract infections. And so I knew it was safe. And I knew with vaginal hormones, if you stop using them, they wear off so they don’t build up in the system or anything. And your localised symptoms were so severe I just wanted to see because in my mind, also, if your skin and that area of your body improved with local hormones, it was more likely your rest of your body would improve with hormones as well. But I didn’t expect you to respond quite so quickly because your symptoms were so severe. But that area is very forgiving. You know, we know that if people have a baby, sometimes they have tears and awful, you know, just the whole stretching and everything, having a baby. And then, you know, the body heals itself very quickly. But it’s very reassuring. And just for those people listening who might have lichen sclerosus, it often can be a reversible condition with the right treatment. But often people are given steroids, which can reduce inflammation, of course. But one of the side effects of steroids is that it can thin the skin. And if your skin’s thin already, you have to, it’s a really fine balance, isn’t it, when you use local steroids. [00:13:49][130.2]

Elin: [00:13:50] Yeah, thankfully I haven’t experienced issues with that as it was all very quick diagnosis. Only on steroids for about a year and a half, maybe a year, just between a year to a year and a half before we started the local HRT and yeah, it’s so much better because it’s a lot easier. It quicker. You don’t have to wait for it to dry before you get dressed. It gives you all that time in the morning or the evening again that you wouldn’t normally have just sat on the bed just waiting for it to dry. [00:14:17][27.2]

Dr Louise: [00:14:18] It does make a difference. You know, I think as much as possible we want to just be normal. We don’t want to be labelled. We don’t want to sort of think about treatment that we’re using. So anything that’s easy and quick and also we’re more likely to do it. So this is a daily pessary once it’s, you know, been used often people don’t really realise that they’re having it because they feel well. And it’s a long-term treatment. Often people, once they start it, continue it forever and it’s fine, it’s safe to do that. So then you did that and then I did some hormone tests. And your testosterone level was very low. And testosterone levels are only a guide. And a low level doesn’t mean that’s the cause of your symptoms, of course, but you know, you’re otherwise super healthy. You look after yourself, you eat well. You tried, as you say, so many things before so I decided to give you some hormones systemically to try, thinking I’m sure most of it is related to testosterone, maybe oestrogen as well. But I don’t know how you felt, like a stranger from the street giving you hormones. Did it feel strange or did it feel the right thing to do? [00:15:20][61.7]

Elin: [00:15:21] Well, I’d just gotten to a point where I will try anything and after the local HRT reducing all of that tearing, my skin had gone from white to pink. I was able to wear certain clothes again I thought I wouldn’t be able to wear, just because the discomfort of clothing against my skin. So I was like, I’ll try it. I’d say HRT helped me feel about 40-50% better, the local one. And then I just feel like that last little bit was what I needed to get me back to how I felt when I was 17, 18, everything. It did feel a little bit strange, like the first time you’re putting it on, you’re like, I was never taught about this in school. Doctor never mentioned any of, the GP was very much pushing towards the coil route, which I’d already tried and didn’t want to try again. So I was just glad there was something else I could try. But yeah, I did feel a bit weird, but it’s a lot nicer than I’d say what my other options were that I’d been offered. [00:16:18][57.5]

Dr Louise: [00:16:20] Yes. And I think, you know, we were very clear that it might or might not help. It’s completely reversible. It’s worth trying. And having the blood test is reassuring I think as well to know that there was something that was, you know, low and hopefully treatable. And then I remember, usually when we start HRT often I arrange a blood test before someone comes back to the clinic. And again, blood tests are only a guide, but it helps guide sometimes the absorption to see if levels had improved. And I saw your results and they were significantly better. And I emailed you actually before I saw you, because I was so desperate to hear how you were getting on. And it’s just so lovely. I mean, I’m very privileged in my clinical job because the stories that I hear are dreadful initially, but it is the most transformational medicine I’ve ever practiced. You know, I’ve done a lot of diabetes care and asthma care and raised blood pressure care and, you know, I’ve obviously treated people with infections and all sorts, but the difference is incredible. And so you sent me this lovely email and then we had a consultation a few days later. But even if I all I could see were your eyes, I could see there’s such a difference in you. It’s just wonderful. [00:17:29][69.0]

Elin: [00:17:30] Yeah, my bags aren’t down to here anymore, down to my chin. [00:17:33][3.2]

Dr Louise: [00:17:35] But you tell me you’re working longer hours as well, which is good. [00:17:37][2.5]

Elin: [00:17:37] Yeah, I’ve picked up extra days. I’m back into a sleep routine which I hadn’t had for a while. So it’s always bed around midnight, wake up about eight, half eight, which felt impossible before. I’m back in the gym. I’m stronger than I was probably before I even started to get unwell. So everything is complete U-turn to how it was when we first met. [00:18:00][22.5]

Dr Louise: [00:18:01] It’s amazing, isn’t it? And, I, with your permission, told Jessica as well, my daughter, who’s obviously been instrumental in joining us together, and she’s done that a lot for quite a few other people. But she also says, which I feel as well, very sad for two reasons. Firstly, if I’d not had my ear pierced we’d never have met. And you’re only 27, so would you have carried on for 20 years before you reached the average age of the perimenopause, you know, into your 40s? And how would your life have been? [00:18:34][32.1]

Elin: [00:18:34] Yeah, because I would just never have even heard your name. My GP was, although they did what they could have done, they weren’t taking it as seriously as you did. So yeah, I think I’d still be going. [00:18:46][12.0]

Dr Louise: [00:18:47] So yeah and so your individual life would have been affected, but there are still lots of people out there who are affected. And, you know, we can’t reach everybody through our clinic. And globally there’s a lot of people who are really struggling, and there are people in other countries where it’s less easy to talk about the symptoms and they end up not talking about them because they’ll be judged incorrectly and seen as a failure as a woman, which I find really sad. But I know that if I’d met you ten years ago, before I started my menopause clinic and doing as much work as I do, I would have been the same as your GP. I would not have known what to do because no one taught me about menopause. But more importantly, no one really taught me about testosterone and how important it is throughout our body. And even now the guidelines are, you start HRT, you add in testosterone later if people have reduced sexual desire. But actually testosterone is a biologically active hormone that goes throughout our body, affects every single cell. And increasingly we learn through patients. That’s often what we do in medicine anyway. But we learn that stamina improves, strength of muscles improve because we have testosterone receptors in our muscles, in our bones, and even in our joints. But also energy and sleep improve, which are really important to help us function. That mood, motivation can improve, and also urinary symptoms often improve with testosterone in addition to oestrogen and testosterone’s very anti-inflammatory as well. It reduces inflammation. So there’s lots of reasons why it can help. But no one’s really done any research properly in women looking at testosterone deficiency on its own. You know, you’re still having periods, you’re still producing some oestrogen and progesterone, probably less than you would have done compared to other 27 year olds. But actually, for you, a lot of it was the testosterone that was really low. And we don’t know why some women have lower testosterone sooner than others. And that’s something that is really important because it’s an independent hormone, if you like, that is crucially important for many people, but they’re not, it’s not being diagnosed, it’s not been recognised and then the people are not having the treatment. So, you’ve been discharged from your urologist, haven’t you? Which is great. [00:21:11][143.5]

Elin: [00:21:11] I have, I thought that wouldn’t, I’d never see the day. [00:21:14][2.3]

Dr Louise: [00:21:14] And what did your urologist say? Was he. Well, I’m saying he could be she, were they pleased? [00:21:19][4.3]

Elin: [00:21:20] There was a group of students there as well. We’d done my last cystoscopy, and we’d done my last I can’t remember what it was called… the amount of urine that you can hold and pass. [00:21:32][12.5]

Dr Louise: [00:21:32] Was it urodynamics? [00:21:32][0.0]

Elin: [00:21:34] Yeah. That’s the one. They were really shocked to see that I didn’t have a problem with my urodynamics. That’s what they’d had their money on from the start. Even though I’ve had all these tests a few years prior and no-one could find anything wrong. And they said, so what’s changed? You’ve gone eight months now without… What’s changed? And I gave them your name. I told them about your podcast. I explained about the hormone insufficiency and everything and they were just shocked. They were like, oh, we heard it could affect things. But again, not on someone so young. So it just felt a little bit like, well, I’m here and I’m telling you, and I’d already met so many other young people in the waiting areas in the past that I know haven’t had access to information yet. So again, I’m super happy for myself but then it does make me very angry that there are so many people without the knowledge that you’re spreading. [00:22:25][51.6]

Dr Louise: [00:22:28] It’s really important. And certainly my, I don’t know if you know, my husband is a urologist, and last year I lectured at the British Association of Urological Surgeons, and it was really great because they’re a very dynamic group of people, and they really wanted to learn. There’s a lot of sort of scepticism when I talk to some groups of doctors, but actually they see it already, they see that local oestrogen pessaries can make a real difference for some women with urinary tract infections, but they didn’t know about testosterone, and they don’t often give systemic hormones the same. But they’re really keen to learn. And I think that’s the most important thing in medicine. Certainly, I’ve always been taught to have a really open mind and try, you know, as long as something’s safe, like, I would never try, there’s lots of new drugs that come on all the time that I’m really cautious of starting a new drug if we don’t have data. Some people say we don’t have enough data about testosterone. But then if you look how it works physiologically in the body, you know our natural testosterone. And if people have good understanding of how it works in our body, then that’s very easy, because all I’m doing is giving testosterone. I’m not giving you a testosterone-like substance. There’s lots of, young men in various gyms that are taking testosterone analogues and having all sorts of problems because they’re like testosterone, they’ll help build their muscle, but they have problems as well. But I’m not doing any of that. So it’s quite simplistic medicine. But the problem is, is that no-one’s been taught. And then a lot of people say, well, we need to wait for the studies. Well, the studies won’t be done because there’s never or hardly ever any funding for female studies or studies involving women. But in the meantime, what I would hate to do is have said to you, well Elin, we haven’t got any studies, it might help you, but let’s wait for the studies to be done. Come back in 20 years’ time, because that’s not right and not fair, is it to have that approach, I don’t think? [00:24:23][115.4]

Elin: [00:24:24] I think I’d have cried. [00:24:24][0.3]

Dr Louise: [00:24:25] Yeah, yeah. So we’re hoping, testosterone at the moment is only licensed for women in Australia. It’s not licensed in other countries. And we’re not really sure why. I think it’s just because there’s so much misogyny really that goes on. And it’s never been a priority thinking about female hormones in the same way. There’s always a fear that people will abuse and use it wrongly, and I think that’s why it’s actually labelled as an anabolic steroid, because if you use too much, it can build your muscles too much. But actually, I’m not aware of any women that abuse a natural hormone. And they’re so relieved, like you are that you’re feeling better. But as long as it’s been given in the right way and people are monitored. So always in the clinic, we monitor everyone. Every year they have a blood test to make sure the levels within normal ranges and make sure they don’t have any systemic side effects. But very few people have side effects when it’s used in the right way, because you’re just topping up what’s missing, and your testosterone level is probably still lower than other people’s who are 27, and it might be higher than others. But it’s right for you. And everyone’s different. And so that’s the most important thing, is monitoring and making sure that you’re feeling better. And sometimes in medicine it’s very hard to measure feeling better. You know that you can do these studies looking at blood pressure or weight or, you know, sort of objective measurements. But feeling better can be quite hard to quantify. But just being able to increase your hours at work, to not fall asleep on the tube on the way home, to be able to go to the gym, to be able to sleep at night, in my mind are really good measurements that things are going in the right direction for you. [00:26:08][103.0]

Elin: [00:26:08] And there’s lots of other weird symptoms as well, like you’d have like weird reactions to certain things. I’ve not had that since starting and then weird nightmares, weird dreams and things, there’s so much more than just those little top ones that I feel like are really common for everyone. Just those little ones that affect your day-to-day life have all gone. And like you said, it’s such a tiny amount I’m using, when I actually put it on to my leg you think that’s not going do anything. It’s such a tiny amount and, like, such a big difference. [00:26:37][28.5]

Dr Louise: [00:26:37] Yeah. No. It’s amazing. It really is such a joy to listen to you and hear. And I’m really grateful for you sharing your story as well, because we all learn from other people’s stories. And obviously it’s not going to be as transformational for everybody. But certainly it’s something to consider for people who are having similar symptoms. So I’m very grateful. But before we end Elin, I always end with three take-home tips in the end of my podcast so people can just reflect a bit more. So I’m really thinking about younger audiences, you know, people like you who are in their 20s. What are the three things that you would say to women, girls, you know, who are in their teens and 20s, who think they might have some hormonal changes, but they’re either not being listened to or they’re too scared to go and ask for help. [00:27:25][47.3]

Elin: [00:27:26] The top one thing is it’s really hard at times, but just don’t stop advocating for yourself. There are times where you do have a lot of self-doubt, and you do feel like you’re battling yourself. You feel like you’re wrong but you’re not. Keep pushing. My doctor was sick of seeing me, I was there probably every week. Just don’t give up on that side. And I found what was really helpful to finally get the blood tests on the NHS or to start that discussion with a doctor that actually listened to me was to not just list your symptoms but list when they were happening as well. So having a almost like a log of what happened on what days, just to make sure everything they want to quickly rule out so they’re not ruling it out. So for example, if you’ve not eaten very well for that day, you’ll know if it’s affected by food or if it is affected by hormones and things like that. So if they say, you need to eat better you can say no, I’ve eaten really well this week. I think the other one will be, don’t be scared to try medications. Don’t be scared to take suggestions. And whether it’s to just see if it helps or whether it is just to keep the doctor happy to potentially to get to the next step. So if it is potentially try some hormonal contraception and see if that helps. Or try the local HRT because I’m shocked at how much that helped. I thought that would be completely wasted when we discussed it, I was like, I’m happy to try it, but I don’t know how that’s going to help and if I hadn’t have felt it and hadn’t have done it, i wouldn’t have believed you that was such a big difference it made for me. So just don’t be scared to try things as well. [00:29:05][99.5]

Dr Louise: [00:29:06] Brilliant. Great advice and thank you so much for your time tonight because it’s late at night, you’ve had a long day at work, and I hoicked you in to do this, because I just felt your story is so important to share with others, and I’m sure it will resonate either to people directly or people who have children or know people who are young. So thanks again Elin for your time. It’s been great. [00:29:28][22.1]

Elin: [00:29:29] Thank you for having me. [00:29:30][0.8]

Dr Louise: [00:29:35] You can find out more about Newson Health Group by visiting www.newsonhealth.co.uk. And you can download the free balance app on the App Store or Google Play. [00:29:35][0.0]

ENDS

The post I’m 27 and perimenopausal: how testosterone helped my symptoms appeared first on Balance Menopause & Hormones.

Think you might be perimenopausal and looking for a simple explanation of perimenopause? This article sets out what you need to know.

What is the perimenopause?

The menopause is when your ovaries stop producing eggs and levels of hormones oestrogen, progesterone and testosterone fall. The clinical definition of menopause is when you haven’t had a period for 12 consecutive months.

The perimenopause is the time directly before menopause when hormone levels start to decline and you are still having periods, however you may notice a change in frequency and flow.

RELATED: What is the menopause?

When does the perimenopause happen?

The average age of menopause is 51, so as a general rule, the perimenopause tends to begin in your early to mid-40s. However, it can happen later or earlier for reasons including genetics or due to surgery or treatment.

What sort of symptoms can I expect?

Fluctuating hormone levels during perimenopause can trigger a range of symptoms.

For starters, your menstrual cycle will usually be affected ad changing periods are often an early sign of perimenopause. Fluctuating oestrogen levels mean your ovaries may not release an egg as regularly as they used to. You may ovulate one month, but not the next, and the quality of eggs also declines as you get older.

In addition to changing periods, if you have experienced premenstrual syndrome (PMS) or premenstrual dysphoric disorder (PMDD) in the past, you may notice these symptoms become more severe.

Other symptoms you may experience in perimenopause include:

• Mood-related symptoms
• Hot flushes and night sweats
• Fatigue and insomnia
• Poor mental focus and concentration
• Headaches, including more frequent migraines
• Joint and muscle pains
• Reduced sex drive
• Vaginal dryness
• Urinary and bladder problems, including urinary tract infections (UTIs).

It’s important to remember that everyone’s perimenopause is different: you may have no symptoms at all, or you may experience a range of symptoms. The balance app has a handy symptom tracker where you can track the type, frequency and severity of menopause-related symptoms, including your periods.

How can I manage my perimenopause?

The balance website has a host of resources on helping to manage your perimenopause and menopause, looking at treatments, lifestyle changes and mental health resources. Head to our menopause library to find out more.

The post What is the perimenopause? A quick guide appeared first on Balance Menopause & Hormones.

This week on the podcast, Dr Louise is joined by Tova Gillespie, a working single parent to two daughters, one of whom has severe disabilities and complex medical needs. Here she talks about the challenges of being perimenopausal while being a carer and how it’s easy to not recognise or understand your symptoms.

Louise and Tova discuss how it’s easy for your own needs to end up at the bottom of the to-do list when you’re a carer or have a busy family life, and Tova shares three tips for anyone who may not be looking after themselves:

1. Learn to ask for and accept help. People want to help, but very often they don’t know how to offer it and our usual response can be ‘no, I don’t need anything’. Instead, say straight out: ‘Please do my washing up. Or I have five loads of clean laundry that needs sorting. Or can you bring over some food?’ Anything really.
2. If your health isn’t what it should be, go to your GP. When you ring your GP, ask for an appointment to talk about perimenopause and hormones. They’ll know from the get go what it is you’re after and if they have anyone in the clinic with an interest in that area, they’ll put you in with that person.
3. Try to see the good every day. I do gratitude journalling, where I write down a minimum of three positive things that have happened that day, and they’re not big. It could be the sun is shining. It could be the taste of that first sip of coffee in the morning. I train myself to look for the positive because it’s so easy to get overwhelmed in the bad stuff.

Learn more about Tova on her YouTube channel. Or follow her on Instagram @parentXP

Click here to find out more about Newson Health.

Transcript

Transcript:

Dr Louise: [00:00:11] Hello, I’m Doctor Louise Newson, I’m a GP and menopause specialist, and I’m also the founder of the Newson Health Menopause and Wellbeing Centre here in Stratford-upon-Avon. I’m also the founder of the free balance app. Each week on my podcast, join me and my special guests where we discuss all things perimenopause and menopause. We talk about the latest research, bust myths on menopause symptoms and treatments, and often share moving and always inspirational personal stories. This podcast is brought to you by the Newson Health Group, which has clinics across the UK dedicated to providing individualised perimenopause and menopause care for all women. So today on the podcast we’re going to talk a bit more inclusively actually, because there’s lots of women we know that are struggling, but also as women, we often put ourselves right at the bottom because we’re too busy, often looking after others, concentrating on various things in our life. And so I’ve got someone with me today, Tova, who has been really inspirational. Hopefully after this podcast, many of you will follow her on YouTube and see how incredible she is. She’s got a really interesting but not unique story, and I want her to really share it with us and talk about how hard it can be, when really it’s impossible for us to concentrate on ourselves in the way that we should. So thank you so much for coming on to the podcast today. It’s great having you here. [00:01:46][95.9]

Tova: [00:01:47] Thank you so much for inviting me to be with you today. It’s really fantastic to be here. [00:01:51][3.9]

Dr Louise: [00:01:52] So do you mind telling me about what’s been happening to you over the last, well, since your oldest daughter was born really? How your life changed? [00:02:00][8.3]

Tova: [00:02:01] Yeah, absolutely. So I had children quite late in my life. I was 36 when I had my oldest daughter. And I went through a pregnancy that, from the baby’s point of view, was perfectly healthy and it was a highly monitored pregnancy because I live with a thyroid condition, so it feels like I had a million ultrasounds throughout to make sure that everything was fine with the baby. Then at the very end of the pregnancy, the baby stopped moving. I went into hospital to find out what was going on, and eventually she was born through an emergency C-section with something called meconium aspiration, which is when the baby’s open her bowels inside and inhale that, which can be extremely dangerous. In Elin’s case, this resulted in over ten minutes of no oxygen, and she suffered severe oxygen deprivation, injuries on her brain and all the other organs of her body. And all these other organs, they heal. But the brain unfortunately doesn’t. Once the brain cell is gone, it’s gone. And she now has brain damage. She has quadriplegic cerebral palsy, which means that she has very little to no control over any part of her body. She has very severe learning delays. She is non-verbal. She is non-mobile. Obviously she’s a wheelchair user full time. She has a lot of health issues. She has a feeding tube. It is not safe to feed her orally. And she has, quite complex epilepsy seizure disorder that lands her in hospital several times a year with medicine-resistant cluster seizures. So we try to record this a couple of days ago, Louise and I, and I was I was still in hospital then, and unfortunately, the NHS Wi-Fi wasn’t quite up to scratch. Yeah. So I’ve literally just come home from hospital after my daughter had to be taken in by an ambulance with medicine-resistant seizures. [00:03:57][115.9]

Dr Louise: [00:03:58] And you’ve got another daughter as well, haven’t you? [00:04:00][2.3]

Tova: [00:04:01] Yes. So my oldest daughter is ten, and then I also have a seven year old. [00:04:04][3.5]

Dr Louise: [00:04:04] So very, very busy at home. And most of us can’t imagine what it must be like because many of us, including myself, have children. But children with special needs and physical, mental, any disability, can be incredibly difficult. And I know when my middle daughter had sepsis and was in hospital for many days and took a long time to recover, you just forget about yourself because you’re only as happy as your least happy child. But when your children are ill, you just want to take that pain. You want to do everything you can. It’s a very weird thing until you’ve had children yourself, how you feel. But the last thing you think about is yourself. And so I can’t actually imagine, I can try and imagine, but I can’t imagine what it’s like living with a daughter that has a illness that is changing all the time as well, that you’re totally there, totally devoted to, and you have another daughter as well. So support is really difficult. And I’ve spoken on this podcast many, many, many times before, and I will do again, about the physical and psychological impact of perimenopause and menopause and how often we don’t know it’s happening. It’s not often actually until we have treatment, we realise how bad we’ve got. But tell me about your story, because obviously you’re here to talk about the perimenopause or menopause otherwise I wouldn’t have invited you. [00:05:28][84.1]

Tova: [00:05:30] Yeah, absolutely. And I think, you know, I’m just going to very quickly touch on what you said here, that it’s so easy to forget about yourself when you are busy caring for another. And that’s not exclusive to special needs parents, anybody who a lot of people care for partners or spouses or they care for elderly parents. But also even if you just have kids, as you said, and I’ve got a cat tail right in my face here. This is my emotional support cat. But, you know, I have somebody in my life who I have to be there for. She has to come first because if I don’t put her before anything else, it is dangerous. And if I spend well, when I spend so much caring for her that there’s no space left to care for me. And my perimenopause story is very much one of hindsight, which I’m sure a lot of you who are watching or listening to this recognise that it’s not until afterwards you go, oh, hang on. So I well, we all remember that fantastic year when Covid came and lockdown hit and my marriage did not survive lockdown, which I was rather expecting. So a few years ago I left my husband. I found a place to move into, and I was made redundant in a time span of six weeks. [00:06:47][77.2]

Dr Louise: [00:06:48] Oh gosh. [00:06:48][0.3]

Tova: [00:06:49] Because I’ve don’t do things by halves. And in the aftermath of that, I burnt out. I went into a deep burnout, depression, very severe anxiety. I completely lost my energy and my mojo. I was in survival mode. I was looking after my kids and that was it. And then I sort of slowly recovered from that. But I never recovered from the anxiety. I had other symptoms too. And if I give you a little list of symptoms, I’m sure you’ll recognise this. We have things like anxiety, fatigue, joint and muscle ache, irritability, brain fog, and all of these are very common symptoms of being a special needs parent. And they’re also very common symptoms of perimenopause and menopause. And I also had night sweats. And I think the night sweats were the only thing I could not explain away. Through other things. But everything else was, well, of course my muscles hurt I have a child who requires 100% manual handling. Of course I’m anxious. I’m a single, working, busy, special needs mum. Of course I’m irritable. I’m stretched way too thin. You know, all of these things. And I kept telling myself that I had these reasons to feel the way I was feeling. But really, it was the irritability that was the final sort of, no, hang on a second there’s more to it here. I dropped a bottle of vinegar and it smashed and it smashed spectacularly. I had glass splinter and balsamic vinegar in three rooms. That should not be possible. And I just stood there and I screamed every swear word I know in both English and Swedish. And my oldest daughter, she jumped at every shout. And my youngest daughter, she slowly backed out of the room and it suddenly just dawned on me. This can’t continue. I need help. So from there I booked a GP appointment and I called up my GP surgery and I said, I want to talk to somebody about perimenopause. And the receptionist said, I’m going to book you in with one of our women’s health specialists. And I got an appointment within a week. I came in to see a doctor. I explained how I was feeling and what I wanted and she went, we’ll get you onto HRT straight away. [00:09:08][138.3]

Dr Louise: [00:09:08] Amazing. [00:09:08][0.0]

Tova: [00:09:09] Yeah, really good experience. And, I know I’ve heard from your podcast, I’ve heard so many times that women are struggling to find doctors to listen to them, or struggling to find doctors who know about this. And I’m with a GP surgery that has no less than three women’s health specialists on the staff. [00:09:25][16.0]

Dr Louise: [00:09:25] So brilliant. And I do think things are changing. You know, I see the tip of the iceberg. I see people who are really struggling. But I know because I know a lot of GPs who are absolutely brilliant and find like I do menopause care so rewarding. And the earlier we can start people on HRT, the less they’re suffering. And it is interesting because it can be so easy to misdiagnose as depression or anxiety or like you say, even burnout. But when we actually ask the right questions and that’s all it is in medicine, is asking the right questions often and thinking about the right questions to ask because you don’t know what you don’t know. So you can’t ask questions if you don’t know what you’re asking them for. But actually, and I wish I could go back in time as a GP and a hospital doctor, because anybody who’s having any psychological symptoms, like you say, the low mood, the anxiety, the fatigue, we always need to be asking, are there any other physical symptoms such as the palpitations, the night sweats, the flushes, muscle and joint pains? And also, are there any changes? Are there any other reasons why this could happen? So, you know, you’ve been lifting your daughter for many years, so to suddenly get muscle and joint pains is a bit unusual, if you see what I mean. Having night sweats, of course, is a new symptom, and there are medical reasons why people can get night sweats. But the most common reason, of course, is changing hormones. But the other question that I also wish I had asked for many, many years is to women. Do you think any of this could be related to your hormones? And I think asking that because if you say, could it be related to your menopause? Often, myself included, would say, oh no, I’m not old enough for that. But which is rubbish, of course. But saying hormones does make us then think, oh yes, I have been a bit like this before my periods over the years, but it’s just been a day or two and I’ve not really thought about it. And it’s, I think so much for us as when I say us, I mean us as menopausal women or perimenopausal women. For us to join the dots to help the clinician because in ten minutes it’s very overwhelming having a short appointment and trying to get everything in. So that was amazing that your GP was so helpful in such a prompt way. [00:11:42][137.5]

Tova: [00:11:43] Yeah, I think I was very lucky as well. We have a fantastic charity here in Bedford where I live. Called Bedford and District Cerebral Palsy Society, and they support families with any complex needs, not just cerebral palsy. And they don’t just support our children, they support us parents. [00:12:01][17.8]

Dr Louise: [00:12:01] That’s wonderful isn’t it? [00:12:02][0.9]

Tova: [00:12:02] Yeah. And a few years ago, I cannot remember her name now, which is a real shame. But they invited a menopause specialists to do a presentation to us parents. And she came with a long list of symptoms and talked through what we might be experiencing and why it might happen and things that could happen. And I remember sitting there and that was sort of the first thing of, well I do have the night sweats and they don’t fit into, you know, symptoms of special needs parenting. And I thought maybe I am perimenopausal and then going, oh but I’m only 44. And it still took me a couple of years to actually go and seek help for it. [00:12:44][42.0]

Dr Louise: [00:12:45] And then did the HRT, has it made any difference at all do you think? [00:12:48][2.9]

Tova: [00:12:49] Has the HRT made any difference? It’s made an amazing difference. I started off on patches and the combined patches because one of my perimenopause symptoms was a very short but also very irregular period cycle. So my period was anything between 22 and 28 days, not the period, the cycle. So I never quite knew when it was going to come. And we were sort of talking, when do you start progesterone? And she went if you go on the combined patches, it takes all of the guesswork out of it. And so I went on the combined patches and it took two days and I felt improvement in my symptoms. And that was really amazing. I did three months on the combined patches, no two months on the combined patches, and then I changed and I went onto gel and progesterone tablets instead. I just didn’t get on with the patches. I found them very itchy and uncomfortable and I always felt them. And then when I swapped from patches to gel, my symptoms started coming back because somehow I seemed to be absorbing better from patches than from the gel. And my GP had already given me permission to play about as she said. She basically went, you can adjust your own dose. And so I increased. So I had two pumps. I increased to three pumps. My symptoms immediately improved. I have recently gone up to four pumps because over time symptoms have come back. But my anxiety is so much better. My irritability is much more manageable. The brain fog is I mean, the brain fog got to some not so funny and some kind of hilarious effects. In June last year, in the month of June alone, I lost my car keys between unlocking the car and sitting down in it six times. And now that’s funny, at the time is super frustrating. More dangerously, I forgot my daughter’s medicines. She’s on ten different medicines a day in different doses and different times to be giving. And I can’t forget that. And now I feel I actually have my brain with me. I can do things. [00:14:55][126.6]

Dr Louise: [00:14:55] So that’s really scary. We talk about the impact of menopause in the workplace, and often it’s with reference to changing temperature of rooms, which drives me crazy because it’s not just about flushes and sweats, as you know. And we talk about the impact of not remembering at work, but actually, I’ve been doing a lot of talking recently about the impact in the workplace and saying it’s not just at work, it’s at home as well. These women don’t change when they get home, but when you have someone who’s completely dependent on you, it’s really important. And I was talking to someone on Friday who’s suffering and is unable to get help from her GP, and she’s got a son with special needs, and she said her sister now comes over every day after school to look after him because she doesn’t trust herself, because she can’t remember things the same way. But she’s now worried because her sister is five years younger than her. So she said, what’s going to happen in four or five years time when she becomes perimenopausal? But actually, we shouldn’t be having to make these adjustments like that. This woman is desperate to try hormones and all she’s being given is antidepressants. But you know, if your daughter didn’t have her medication for a length of time, there are very difficult, hard consequences. And there’s, you know, you’ve already said you’re a single parent, so who’s going to remind you, who’s going to help you? [00:16:16][80.5]

Tova: [00:16:16] A seven-year-old child? I mean, my seven year old is amazing. But it’s also part of my responsibility to protect her from too much caring responsibilities too early because it’s not her job. It’s not her responsibility. [00:16:30][13.5]

Dr Louise: [00:16:31] So we forget this when people are thinking about the menopause. And I spend a lot of time thinking about the injustice to women and how or why people are refused an evidence based treatment that can really be transformational. And you look in history about the misogyny of women and it’s gone on and it’s going on for ages, but actually it’s a whole different level when it’s affecting others as well. There’s one thing being directly affected, and women can hopefully be advocates for themselves and work out what’s wrong and how they can get help, but it’s completely wrong on a different level when innocent people, especially children, are being affected by the menopause. And I know it happens a lot. And, you know, in a very small way, when I was experiencing symptoms, I was just so tired and irritable. I wasn’t really interested in cooking, so my children didn’t eat as well. I didn’t really want to play board games because I couldn’t remember how to do them, and I was, they always ended in tears because everyone was frustrated. So I ended up just switching on the telly and just go, oh go on just go and watch something. And the children obviously would love that. But my parenting was not great. But I’m very lucky. I’ve got a stable relationship, you know? I mean, a nice home that’s warm. I have three children that get on with each other. If I was a single mum of many children and had difficulties at home and then you throw the menopause in. We know that domestic abuse increases during the perimenopause and menopause. And when I first read about that, I couldn’t really understand why. And I do. And some of it is emotional abuse and it’s not intentional. It’s because we are just worn out and then we think it’s because we’re not good parents or, you know, we… And I certainly did I internalised this, I thought, well, I maybe I can’t be a working mum. Maybe having three children has broken me, whereas two was OK. And maybe it’s, you know, and you just don’t realise that it’s something that is reversible, that could, with treatment, really make a difference not just to you as an individual, but your whole family unit. [00:18:44][132.9]

Tova: [00:18:46] And I think HRT is so important. I mean just looking at the effect it’s had on me and how it’s regulated my entire body, I don’t feel I’m at 100%, I know I’m not at 100%. But compared to where I was and I said this to myself even when I started HRT, that if I can get back up to 60%. That to me is an enormous win. It really is. I mean, I full on hear what you’re saying there in terms of not having the energy to parent, not having the energy to cook. And of course I have to cook. Because, you know, there are two children here that have to be fed and I have to function. And so many times it’s just been to my youngest here are the headphones, here is the tablet. Because I don’t have more capacity or just curling up with both of them on the sofa and turning on the TV and just trying to hold it together and not break down in front of them because it’s not good for them. [00:19:46][59.5]

Dr Louise: [00:19:46] No. It’s so difficult because, you know, there is fatigue and there’s different types of fatigue, and many of us are tired. I mean, I’m quite often tired, especially in the evening. And I think, oh, have I got time to go through my emails or should I go to bed? And I’ll often push myself and go to bed a bit later. But actually the fatigue often of perimenopause and menopause, I used to think it’s a bit like drugs, you know, when you’re drunk. Not that I’ve ever been drunk, but I imagine. But also like when I was pregnant, the early stages, because it is a biochemical thing. And I kept saying to my husband, I just cannot stay awake. I feel like a zombie. It’s a very weird tiredness to explain if people haven’t had it. And it’s really like thinking through treacle. You can’t just think, right, I’ll have a coffee and I’ll keep going, or I’ll just go outside and get some fresh air and then I’ll be fine again. It’s a very crippling tiredness and with children it’s so unpredictable when they need you as well, that you can’t just have a nap in the day or go to bed a bit earlier. It doesn’t work like that when you’ve got children. [00:20:54][67.9]

Tova: [00:20:55] No it doesn’t, it doesn’t. And then if you add a complex needs child in the mix, it is getting up in the middle of the night because she’s had a seizure and she needs help, or she’s just had a muscle spasm and ended up in a position that she doesn’t like being in, and she can’t get herself back again to a position where she needs to be. And I mean, if we take this week as an example of just the broken or non-existent sleep you get. It was Tuesday evening, I took her into hospital, so we arrived in A&E around 8 pm. I went to bed the first time at 1 am, and then at 4 am she was having cluster seizures again and I was up for another hour before we had a medicine that worked. And then I got another three hours sleep and the parent beds in hospital they are not comfortable. [00:21:41][46.7]

Dr Louise: [00:21:42] No they’re not. [00:21:43][0.4]

Tova: [00:21:44] And you know, these are things that you just have to do. And of course, when I’m in the middle of it, I am the most capable person on the planet. I know exactly when the last seizure was, what the last medication was, what the history is, all of those things. You know, I’m standing in the middle of that room with an oxygen mask, a suction pump, and I’m directing the doctors as to what they need to do. And I’m the calmest woman ever. And then on Friday, when we came home from hospital, my brain trickled out of my ears and I could not function whatsoever for the rest of the day. [00:22:14][30.3]

Dr Louise: [00:22:15] Well, it’s very, very hard. It’s really difficult. And I think it’s amazing that there was a group where you could have support and information, because it’s often when others tell you, you get that lightbulb moment and I know, like just watching some of your YouTubes, you know, that’s what you’re trying to do with others. You’re, when I say normalise, nothing is normal. I realise that but and I would not want the conversation, the menopause, to be normalised so much that people think they have to cope with symptoms. But what you have done is you’ve normalised the treatment of the menopause. You know, when you’re talking about the treatment that you’re getting and what you’re doing and how it helps you in a, not a sensational way, just a matter of fact, it’s the same as cleaning your teeth. It’s just something that you’re doing to help improve how you are. And there’s a lot of demands on us anyway. But when we have children, especially children that are dependent on us, there’s a whole new dimension. Many of you might know my oldest daughter is registered disabled with chronic migraine, and when she’s well, it’s amazing. I don’t, you know, if I have a day without hearing from her it’s wonderful. But so many times she’s in despair and she can’t, you know, her speech goes, her coordination goes, you do this remote parenting. And so many times my husband and I have just got in the car or the train and gone to see her. And you don’t understand what it’s like to have someone completely dependent on you until it happens. And it’s so unpredictable. And that’s why you want to be as healthy as you can as a parent. Of course you always do. But if you’ve got someone who’s more dependent rather than less dependent on you, then you have to look after yourself. And that’s, you know, we don’t have a choice, unfortunately, because we can’t say to someone else like you can with a baby. Here you go, just look after her for the afternoon. It doesn’t work like that when you’ve got children with different disabilities and they need their mother. And you, like you say, you know your daughter inside out. It’s not the same as someone else taking her to a hospital or lying in that hospital bed next to her. So there is so much that we need to do to educate people. And the other thing before we finish really is thinking about cerebral palsy, thinking about physical and mental disabilities. Your daughter’s only ten. But, you know, give her another ten, 20, 30, 40 years. Who knows when her hormones are going to be changing in a negative way. And I recently did a presentation for people living with cerebral palsy. And it was really wonderful. I really enjoyed doing it. And the feedback was quite humbling, but huge because a lot of women said, oh, I’ve been told it’s my cerebral palsy that’s progressing. But it was only just before my periods I was getting more muscle spasms or unusual symptoms, and I knew it wasn’t quite because the women know their bodies as well. And there’s so much gaslighting going on generally in menopause and perimenopause. But I was really saddened to hear. And even at the end someone said to me, Dr Newson, you seem to be the first person I’ve ever met who really understands cerebral palsy. And I thought, gosh, I am not a cerebral palsy specialist, but I have a huge amount of experience in general medicine and empathy. And I’m also very, very open about saying the things I don’t know or don’t understand. But I would never make up a diagnosis to suit that patient because I don’t know what’s going on. And that’s often what happens in medicine when we don’t know what’s going on. We try and shoehorn people in to a diagnosis. So for these people being told, oh, it’s a progression of your cerebral palsy, it probably makes the doctor feel better because they’re saying something that they probably think is right. But if the patient is not agreeing or doesn’t think it doesn’t quite work, then it’s OK in medicine to say, I’m not sure what’s going on, but let me have a think and let me talk to other people. And in medicine, that’s what we’re doing all the time. We’re learning all the time. And ten years ago, I would never have been able to give any presentation because I didn’t understand the important role of hormones in our brains and our muscles and joints and our nervous system as well. But now I do, it’s really important to share that knowledge. And a lot of these women were really reassured, but also because they’ve got physical problems, many of them are being told they can’t have HRT because of the clot risk. Well, we know there isn’t a clot risk with the natural body, identical hormones with the oestrogen through the skin as a patch or gel. So just for them to know there are options for treatment. And as you know, anyone with any physical disability, especially when they’re not mobile, have an increased incidence of osteoporosis. So, you know, we’d need to be looking at future health of people with disabilities. And so it’s an area that’s really important, every area is important thinking about menopause and perimenopausal women. But this is really important. And I’m sure a lot of people with physical and mental disabilities will have an earlier menopause at a younger age, and if their behaviour is changing, they won’t necessarily know that it’s due to their hormones. And so it’s something else to be thinking about. For your daughter it’s in the future, but there are a lot of women out there now who are experiencing symptoms and not able to get treatment. [00:27:35][320.2]

Tova: [00:27:36] I mean, we’ve got puberty to look forward to with my daughter, and that thought terrifies me. And I think, you know, you’re, there’s so many people out there who have no idea just how much hormones work on the brain. And if you then have a brain with injuries on it, and this is what’s cerebral palsy is a type of brain damage. So you have a brain where the signals aren’t moving as they should do, the synapses aren’t firing as they should do, and then you’re adding a crazy hormonal cocktail to the mix. It’s not pretty puberty in these children, and I don’t personally know of women of perimenopausal age with cerebral palsy or with similar brain injuries. But I mean, if I’m looking at my brain that isn’t damaged and how massively it affected me, I can’t imagine how bad it is when when you have additional… [00:28:30][54.5]

Dr Louise: [00:28:30] It’s very interesting actually, because we know actually the first thing our brain does, if we have any injury is to actually produce more oestrogen, progesterone and testosterone. So these hormones are really powerful in our brain. They help improve the transmission of nerve impulse. They help build the myelin sheath, which is a conduction part of the outside of the nerves. They actually help the plasticity of the brain. So the way the brain develops and functions. And it would be amazing if people were doing some research in cerebral palsy looking at the benefits of oestradiol, progesterone and testosterone on the brain, because for so long we just think about them regulating periods or making moods worse. But actually, and for men too, men have oestrogen, progesterone and testosterone in their brains and produced in their brains. And so, you know, there’s a huge amount of work that should be done. And it’s not being done because HRT is very cheap. There’s no big pharma behind it. There’s no priority. It’s thought about just due to menopause. But, you know, we have got some data showing that there’s beneficial effects of hormones, especially progesterone and oestrogen in our brains. So there’s a lot we need to do to think about, you know, the hormonal benefits in brains of people who either have normal or abnormal brain function. So lots to do, lots to think about. But I hope this podcast has allowed people to really reflect and think again about perimenopause and menopause in different ways, and the potential impact it can have through other generations as well. So I’m really grateful for you sharing your story, because I know it’s always hard talking, and I know you’re so pragmatic and it’s not a sympathy vote because you’re just someone who just gets on and does things. But big respect for what you’re doing and your children are very lucky to have someone as caring as you, there’s no doubt about that. So.. [00:30:26][115.8]

Tova: [00:30:27] Thank you. [00:30:27][0.3]

Dr Louise: [00:30:27] Before we end, there’s always three take-home tips, so you’re not escaping without them. So three things, if people have been listening, they might not have a disabled daughter. They might not even have a daughter. They might have children though or a relative or a friend or somebody that they’re caring for. And they’re not looking after themselves in the way that they should. And they might be perimenopausal or menopausal, what are the three things that they should be doing? [00:30:53][25.9]

Tova: [00:30:54] OK, so my first take-home tip, and this is something that I say a lot on my YouTube channel as well, is learn to ask for and accept help. People want to help, but very often they don’t know how to offer it and that, you know you’ll get a, oh, let me know if there’s anything I can do to help. And then you do your usual. Oh, no, I don’t need anything. Say straight out. Please turn up and do my washing up. I have five loads of clean laundry that needs sorting, can you help me? Bring over some food for me? Anything really. Learn to ask for and accept that help is so important and people want to help you. They just don’t know what it is that they need to offer. So that is my first tip. And that also obviously goes to, you know, if you feel that your health isn’t what it should be, go to your GP and ask for help. Another take home tip is to do what I did when I rang my GP. I didn’t just ask for an appointment, I asked for an appointment to talk about perimenopause and hormones. They know from the get go what it is you’re after and if they have anyone in the clinic with an interest or an expertise in that area, they will put you in with that person. And third take-home tip, look after your mental health and try to see the good. Little tiny good things every day are so important. I do a lot of gratitude journaling, where I write down a minimum of three positive things that have happened that day, and they’re not big. It could be the sun is shining. It could be just the taste and feeling of that first sip of coffee in the morning. Or hearing from a friend on WhatsApp or just little things. But I train myself to look for the good and the positive. Because it’s so easy to get overwhelmed in the bad stuff. [00:32:41][107.0]

Dr Louise: [00:32:41] I really, really like that third tip. I’m quite a negative person, and I’ve really trained myself the last five years or so to just focus on the positive and let the negative trickle off. I feel often I visualise that I’m wearing a Teflon jacket or armour and I won’t let negativity come inside. I just deflect it out because otherwise it’s overwhelming. And then you wallow in self-pity, and that doesn’t do anyone any good at all. Especially not the people you’re caring for. So thank you again. It’s been really enlightening and emotional a bit and wonderful too. So thanks ever so much for today. [00:33:18][36.9]

Tova: [00:33:19] Oh, thank you for letting me come on here. It’s been amazing. [00:33:21][1.9]

Dr Louise: [00:33:26] You can find out more about Newson Health Group by visiting www.newsonhealth.co.uk, and you can download the free balance app on the App Store or Google Play. [00:33:26][0.0]

ENDS

The post Coping with the perimenopause when you’re a carer appeared first on Balance Menopause & Hormones.