Video Transcript:

I am Dr. Louise Newson. I am a GP and Menopause Expert in West Midlands.

So, the menopause is actually a retrospective diagnosis, which means it’s a ‘look back in time’ diagnosis. For the menopause, you do not have a period for at least 12 months and that’s quite difficult because there are a lot of women who are going through the menopause or approaching the menopause who don’t have a period for 3 or 4 months and then have one, and then in another after 6 months.

So, we actually talk more about the perimenopause and ‘peri’ just means ‘around’ – so around the time of the menopause.

So, some people have perimenopausal symptoms some 5-6 years before their menopause. So when people read about menopausal symptoms it’s the same as perimenopausal symptoms and I think that’s very important because lots of people think they can’t be menopausal because they are still having their periods but sometimes periods can be the very last thing.

So, perimenopausal and menopausal symptoms are essentially the same.

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Video Transcripts:

I am Dr. Louise Newson. I am a GP and Menopause Expert in West Midlands.

Antidepressants can be useful for hot flushes for some people. So for some people who cannot take HRT for medical reasons we do sometimes give anti-depressants and they can work but we are often limited by their side effects.

One of the side effects can actually be the loss of libido. So if someone has poor libido anyway, that can make it worse but they are often anyhow short term. So for some people it is an option.

Unfortunately, I come across a lot of women who are given anti-depressants as first line…HRT is not even discussed with these people. I think sometimes people…doctors… don’t have the right training in the menopause. It is something often not mentioned in undergraduate and postgraduate training. So a lot of doctors are not confident in managing the menopause. Because of this they do something they are confident with.

And in general practice there is a lot of depression…and we treat a lot of depression. So a lot of menopausal women have symptoms that are similar to anxiety and depression; so they get given treatment but it does not often work because it is a different etiology…different reasons for having these symptoms. So I see a lot of people given anti- depressants and it makes no difference.

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Video Transcript:

I am Dr. Louise Newson. I am a GP and Menopause Expert in West Midlands

The main reason that people don’t take HRT is the risk of Breast Cancer. Now that’s not all types of HRT and I think it is very important that people know that. So if you have had your womb removed, as a hysterectomy, and you need only oestrogen as HRT, there is no increased risk of Breast Cancer. So that means a lot of women can very safely take HRT without worrying about the risk. The other thing is, if women are younger, so certainly premature ovarian insufficiency or early Menopause and if they go through the change they can very safely take HRT – so up until the age of 51, the average age of Menopause, without any risk of Breast Cancer.

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Video Transcript:

I am Dr. Louise Newson. I am a GP and Menopause Expert in West Midlands

HRT are just three letters: Hormone Replacement Therapy. There are different hormones that we use and there are different levels and different preparations. It is not like giving an antibiotic because someone has a chest infection when it is the same dose for the same length of time. HRT is very different and what is really important is that we tailor-make it for the patients so the levels – especially of estrogen – are varied depending on your age, depending on your symptoms – all sorts of things. The other thing is there are different preparations so it is not always an oral tablet. It can be given as a patch or a gel and certainly for people that have risks, for example, of clots, it is very safe to have it as a patch or a gel so because they don’t have an increased risk of clot. Or, for example, for people who have migraine, people who are obese, people that might have had a clot in the past; in the years gone by, they would have been told they couldn’t have HRT because it was only available orally. But if you have it as a patch or a gel, there is no increased risk. So that enables more women to access the treatment, which is great.

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Video Transcript:

I am Dr. Louise Newson. I am a GP and Menopause Expert in West Midlands.

It can affect people really in so many ways. Up to 10% of women actually consider giving up work because of the menopause and I think that could be an underestimation. Because of the symptoms that you can experience – especially the concentration and the energy symptoms that can really affect and like I said before, the lack of confidence that you have – so lots of people really struggle.

In the past they might have given up work – retired earlier…but it’s harder…the pensions are different. And also as women we work very hard to get to certain stage in our career and to give it up because of menopause is very hard.

The other thing is as a GP it is very difficult when people want time off work because of their menopausal symptoms…to actually write “menopausal symptoms” on a sick note isn’t good and it can cause a lot of problems with the employers because lots of people don’t understand how severe menopausal symptoms can be. So for a woman to explain to her employer that they are menopausal just gets a bit of a laugh and maybe not taken seriously. So maybe they want to have something like “anxiety and depression” written on their sick note but then that again deals with collusion and their employer might think “Oh my goodness! I don’t want someone who is depressed and anxious working for me” and it builds up barriers.

So I think it’s very hard. It’s not just a taboo for women; it’s a taboo for people in general and when I talk to people and say I am really passionate about the menopause… I deal with women and help women, lots of people laugh and say “Why would you do that?” and it’s so interesting because it makes a massive difference if you can help these women in a very difficult and a very vulnerable time of their lives.

Watch more from this series.

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Video Transcript:

I am Dr. Louise Newson. I am a GP and Menopause Expert in West Midlands.

And every woman is different and that’s why every woman’s experience of the Menopause is very different.

And often, every woman’s treatment of the menopause is very different.

It’s not a ‘’one size fits all’’ and I think that is very important for people to realise.

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Video Transcript:

I am Dr. Louise Newson. I am a GP and Menopause Expert in West Midlands.

I think a lot of it is down to people’s training and their understanding about the menopause.

So women don’t understand much, but unfortunately the doctors too don’t.

But it is improving and certainly the NICE Guidance has helped and there is among the GPs that I have talked to, a thirst and appetite for more knowledge and information.

But again, it is just…trying to get the message over and empowering people with more information so they can give the right choices and the women can make the right choices about the menopause.

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Video Transcript:

I am Dr. Louse Newson. I am a GP and Menopause Expert in West Midlands.

There are other treatments available.  Some of them work…some of them we don’t have the evidence for and it is very difficult getting evidence for some of these alternative treatments. Partly, because we know that placebo has an effect and you give someone a placebo and it has an effect.

The other thing is menopausal symptoms fluctuate quite a bit. So some women say “I feel better” and they might feel better anyway because they are getting some estrogen from their bodies. It is difficult to know.

So my concern as a GP is to know if some of the products are harmful. So, some of the herbal products have not been tested properly. You don’t know what’s in them…and harm. There have been some that are associated with liver failure. Some of these have been associated with interactions with other medications. So women I think are quite confused what’s safe. There are lots of toxic plants out there. Sometimes people think its herbal so it’s safe and that’s not actually true.

It’s very important that something given is regulated and we know what’s contained in it.

The other thing is as a GP I am interested in the way hormones can help your bones and your heart. Some of these other treatments may help your symptoms but they won’t provide bone protection and won’t help your heart as well. So you have to think about what you are taking it for.

For some of these people who choose not to take HRT or can’t for medical reasons, some of these products can be effective and can really help.

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Video Transcript:

I am Dr. Louise Newson. I am a GP and Menopause Expert in West Midlands.

So libido is quite interesting as it can affect different women in different ways. Some women talk about an increase in libido just before they go through the change and this often can be…it is all how your hormones play with each other and the difference between them. So some people get a little surge of testosterone before they go through the Menopause and they have an increased libido. The vast majority of women, however, are not so lucky; they have reduced libido. And sex is very important for men and for women but especially for men…so a lot of women explain to me that they’re just not bothered…there is no light down below…nothing really works. They just go through the motions because that’s what their husbands want. And interestingly, taking oral HRT can affect something called your Sex Hormone Binding Globulin. So it can lower your libido. So sometimes a patient’s libido is just about all right and you give them an HRT and down it plummets and you don’t get that effect with transdermal estrogen.

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Video Transcript:

I am Dr. Louise Newson. I am a GP and Menopause Expert in West Midlands.

As women we are designed to have babies. That is our one main role in life.

So if you think in the 1900s – the early 1900s – the average age of the Menopause was 57 and they would on average die at 59. So we had only a couple of years of Menopause to experience. Now the average age is 51…so a few years earlier. But the average life-expectancy of the woman is in her eighties, which is amazing. It is great. So it a 30 years of potentially having menopausal symptoms or being post-menopausal.

Some women only experience symptoms for a couple of years and they are the lucky ones. But I have patients who still have hot flushes in their seventies and their eighties. So not only do they have symptoms for a long time but the lack of estrogen can affect their bones and can affect our hearts adversely as well.

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