• Race, ethnicity and cultural beliefs can affect a woman’s experience of the perimenopause and menopause
• Language barriers and a lack of awareness can stop women accessing help and treatment
• More resources are needed for ethnic minority women

All women will go through the menopause, but not all of us will have the same experience or symptoms. We’re all different of course and our genetics, existing health conditions, income, race and ethnicity can have an influence. Research into how the menopause specifically affects ethnic minority women in the UK is limited, which can make it frustrating when you’re trying to find out more information about your health. But on top of any physical differences, there are cultural ones and attitudes to menopause can be affected by our community.

Do symptoms vary in different ethnicities?

While there is limited research into menopausal symptoms carried out in British ethnic minority women, we know from other studies that ethnic variances occur. The Study of Women’s Health Across The Nation (SWAN) is an important longitudinal study that began in 1994 – it examines menopausal changes on a racially and ethnically diverse cohort of women [1].

It has found that women of Afro-Caribbean origin reach menopause earlier (49.6 years as opposed to the average of 51) and experience a longer menopausal transition. They are the most likely to experience hot flushes and sweats and experience them more severely and intensely than women of other ethnicities. They are more likely to suffer sleep problems, including shorter sleep, more awakenings and poorer quality sleep, and weight and mental health issues.

In women of southeast Asian origin (such as China or Japan), while they may not be as likely to complain of severe flushes, they suffer more from low libido and sexual pain, and may suffer more from forgetfulness, joint and muscle pains. A new study has found that, for women in Singapore (of Chinese, Malay and Indian origin), joint and muscle pain is the top menopausal symptom [2].

Meanwhile, south Asian women (India, Pakistan, Bangladesh, Sri Lanka, etc) are likely to experience the menopause at a younger age than Western women – the mean age for Indian women is 46.7 years and for Pakistani women is 47.16 years. Indian women are more likely to complain of vulval and uro-gynaecological symptoms.

Finally, the SWAN study found that, for Hispanic women, vasomotor symptoms were more prevalent as was vaginal dryness.

It’s worth remembering though that the data is limited, and this is a broad overview of the information available. Women of any ethnicity can experience any symptom – your experience will be unique and may be vastly different from what’s described here.

RELATED: empowering women unheard during menopause

What about the impact of medical conditions?

While the reasons behind women’s varying symptoms can be varied, pre-existing medical conditions and some physiological differences can contribute.

South Asian women are more prone to weight gain, according to scientists, particularly around the middle, increasing the risk of insulin resistance and diabetes. Hypertension is more common, increasing the risk of cardiovascular disease [3].

A study of pre-menopausal south Asian women living in the UK found they could be more at risk of developing osteoporosis in later life than white women [4]. There is also a potential for vitamin D deficiency for women who cover up, for instance with the burqa or niqab [5]. Low vitamin D levels can increase the risk of osteoporosis.

Afro-Caribbean women have been found to suffer from a higher allostatic load than Caucasian women [6]. This refers to chronic, ongoing stress that can have a wear and tear effect of the body – a potential factor behind their severe menopausal symptoms and longer menopause.

What about lifestyle?

While physiological differences play a part in women’s menopause, it’s important to remember that there can be variations within ethnic groups and that some differences may also be down to socio-economic factors, rather than ethnicity, or cultural attitudes or lifestyle.  

Exercise can have a positive impact on wellbeing during the menopause, but participation levels can vary. Among women aged 45-54 in England, 50.4% of Asian women are physically active (compared to  55.2% black women, 61.9% Chinese women and 69.8% white British women) [7].

Diet can also help alleviate menopausal symptoms and some believe that the Japanese diet, with its high soy content, could be a reason behind Japanese women experiencing fewer menopausal symptoms. Soy contains isoflavones, which mimic oestrogen, which declines during the menopause.

The impact of cultural beliefs

Another interesting thing to consider about Japanese women’s experience of menopause is their attitude towards it. The Japanese word for menopause is ‘konenki’, which means ‘renewal’ and ‘energy’. Having a positive outlook can make a physical difference – women with a positive attitude are reported to have lower severity of menopausal symptoms [8].

Conversely, in some cultures the menopause is firmly associated with loss. Dr Maqsuda Zaman, a GP who works in a practice with a significant number of women from various ethnic communities in Greater Manchester and who is a menopause specialist at Newson Health, says: ‘Women of Bangladeshi origin tell me menopause is associated with loss of fertility and youth. A patient of Iraqi Kurdish origin also told me it’s generally not discussed in her community as women feel embarrassed about getting older and the loss of fertility.’

For others, menopause is a taboo subject – it’s not talked about, and women may be expected to stay silent and not complain about any symptoms they may be suffering from.

RELATED: menopause taboo in women from different ethnic groups: Dr Nighat Arif

Barriers to accessing help

In conservative cultures where the menopause isn’t talked about, women can suffer in silence, which means their symptoms may worsen before they do seek help, or that they try other treatments before seeking out support from a doctor. Dr Maqsuda says: ‘A common presentation is women with vaginal itching who have believed it’s due to thrush so have tried over-the-counter treatments before seeking help.’

Mental health is not frequently talked about in some ethnic communities and there can be a prevailing attitude to just get on with it [9]. Alternatively, some women may be reluctant to seek medical help for something they believe is a natural process.

A lack of awareness and knowledge about the menopause can also be a barrier to accessing treatment. Even when a woman from an ethnic minority background does see her GP, language can be a barrier.  A woman may need an interpreter or arrive with a family member, which may inhibit her further if she needs to talk about vaginal dryness, or a doctor may miss a subtle cue they might otherwise have picked up on. Alternatively, a woman from an ethnic minority might not be familiar with the language commonly used to describe symptoms or may get misdiagnosed because of her description of symptoms and a clinician’s understanding.

Dr Maqsuda says: ‘Bangladeshi patients commonly say “I keep getting fevers” – this term is often used to describe hot flushes and night sweats, or “I have a urinary infection” – to describe urinary frequency, urgency and dysuria. Or they’ll say they feel tired all the time and have concerns over possible anaemia or diabetes, or are worried about “body pains everywhere”. Many present with heavy or irregular periods but are unaware that this may be due to the menopause. They often request treatment to regulate their periods as they are concerned about “where all the blood is going”.

Language may be one reason behind the differences in access to care and treatment amongst women in ethnic minorities. The Fawcett Society’s 2022 report Menopause and the Workplace found black and minoritized women reported increased rates of delayed diagnosis (45% compared to 31% in white women) and lower rates of HRT uptake (8% compared to 15% in white women).

However racial bias may also be a factor – black women are less likely to be offered pain relief in childbirth, and a study found black patients are about half as likely to be prescribed pain medications in hospital emergency departments than white patients [10]..

RELATED: Menopause specialists advocating for women of colour

What needs to be done?

Clearly more resources, posters and videos need to be created for ethnic minority women – not only in their languages but women need to see, through imagery, that menopause is something that affects them, not just white women. Dr Maqsuda agrees: ‘In the six months that I’ve been working for Newson Health in Altrincham, I have only seen one Pakistani and two Indian women; one was a pharmacist and the other a hospital consultant. I have had no patients from an Afro-Caribbean or Arab background.’

For women, the first step is to keep a symptom diary – the free balance app is an easy way to do this, or write down your symptoms on a paper calendar that you can share with your GP.  Remember that there is no need to suffer in silence or deny yourself treatment, and that you can’t get help if you don’t ask for it. Open your mind to treatment options and, if it will help, take a friend or relative to any appointments for support.

Where to get help

• The balance website has videos, articles and factsheets on the menopause that have been translated into Punjabi (click here) and Hindi (click here). There are also podcasts with clinicians advocating for women from ethnic minorities, which contain helpful advice.
• Pausitivity has a Know Your Menopause poster in Urdu.
• Jane Lewis, author of My Menopausal Vagina, has translated her Leaflet on vaginal dryness into Urdu.
• @shadesofmenopause is an Instagram group for ethnic minority women to be heard and seen
• The British Menopause Society has a useful article on Menopause in ethnic minority women

References

1. SWAN study

2. Logan S, Wong BWX, Tan JHI, Kramer MS, Yong EL. (2023), ‘Menopausal symptoms in midlife Singaporean women: Prevalence rates and associated factors from the Integrated Women’s Health Programme (IWHP)’, Maturitas. 178:107853. DOI: 10.1016/j.maturitas.2023.107853

3. Pandit K, Goswami S, Ghosh S, Mukhopadhyay P, Chowdhury S. Metabolic syndrome in South Asians. Indian J Endocrinol Metab. 2012 Jan;16(1):44-55. doi: 10.4103/2230-8210.91187. PMID: 22276252; PMCID: PMC3263197.

4. A.L. Darling, K.H. Hart, F. Gossiel, F. Robertson, J. Hunt, T.R. Hill, S. Johnsen, J.L. Berry, R. Eastell, R. Vieth, S.A. Lanham-New. (2017), ‘Higher bone resorption excretion in South Asian women vs. White Caucasians and increased bone loss with higher seasonal cycling of vitamin D: Results from the D-FINES cohort study’, Bone, 98, pp 47-53, doi.org/10.1016/j.bone.2017.03.002.

5. Marie France Le Goaziou, Gaelle Contardo, Christian Dupraz, Ambroise Martin, Martine Laville & Anne Marie Schott-Pethelaz (2011) Risk factors for vitamin D deficiency in women aged 20–50 years consulting in general practice: a cross-sectional study, European Journal of General Practice, 17:3, 146-152, DOI: 10.3109/13814788.2011.560663

6.  Richardson LJ, Goodwin AN, Hummer RA. Social status differences in allostatic load among young adults in the United States. SSM Popul Health. 2021 Apr 2;15:100771. doi: 10.1016/j.ssmph.2021.100771.

7. GOV.UK: physical activity

8. Kwak EK, Park HS, Kang NM. Menopause knowledge, attitude, symptom and management among midlife employed women. J Menopausal Med. 2014;20(3):118–25.

9.  MacLellan J et all. Primary care practitioners’ experiences of peri/menopause help-seeking among ethnic minority women: British Journal of General Practice 3 March 2023; BJGP.2022.0569. DOI: https://doi.org/10.3399/BJGP.2022.0569

10. Astha Singhal, Yu-Yu Tien, Renee Y. Hsia. (2016), ‘Racial-Ethnic Disparities in Opioid Prescriptions at Emergency Department Visits for Conditions Commonly Associated with Prescription Drug Abuse’. https://doi.org/10.1371/journal.pone.0159224

The post Menopause in ethnic communities appeared first on Balance Menopause & Hormones.

Menopause often happens at a time when you are juggling a career, relationships and caring responsibilities.

Here Dr Nadira Awal, a GP and menopause specialist, joins Dr Louise to discuss her work in raising awareness of the menopause and the importance of partners and families understanding what their loved on is going through.

Dr Nadira’s personal experience of the menopause helped drive her passion for educating and supporting other women, especially those in ethnic minority communities who may not feel able to speak openly about it. She talks about increased health risks owing to genetics, particularly with diabetes and increased blood pressure, and the challenge of treating a woman’s symptoms holistically in a ten-minute GP appointment.

Follow Dr Nadira on Instagram @pauseandcohealthcare and on Facebook at Pause and Co Healthcare.

Click here for more about Newson Health

Transcript

Dr Louise Newson: [00:00:11] Hello, I’m Dr 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, I’ve got a fellow GP, someone who I’ve met a few times in real life, unlike some of my other podcast guests. Who’s very inspirational. Who’s doing a lot of work behind the scenes actually to really help women in many ways. So, Nadira, thank you so much for coming on my podcast today. [00:01:20][17.6]

Dr Nadira Awal: [00:01:21] Thank you, Louise. Thank you for inviting me. [00:01:22][1.4]

Dr Louise Newson: [00:01:22] So we’ve known each other for a while and recently we met again in Liverpool, actually. I’d gone up to the Royal College of Psychiatrists conference, annual conference, and you were there as well. And we were in the same group, actually. They kindly invited me to be on the panel. And you were talking about your own experience, actually, weren’t you? [00:01:40][17.8]

Dr Nadira Awal: [00:01:41] Yes, that’s right. Which has gone down very well on your Instagram post, which I’m very grateful for you sharing. So thank you very much for that. [00:01:47][6.5]

Dr Louise Newson: [00:01:47] Well, I felt a bit naughty because I stepped away from the panel to go in the front row so I could take a few videos. And your one was just amazing. And we just look just now and it’s had nearly quarter of a million views. It’s resonated with a lot of people. And I’ve been told off quite a few times for talking about my own personal menopause experience in the media by other health care professionals. But actually, if I wasn’t a menopausal women and if I didn’t take HRT and if I hadn’t struggled, I think doing my work, I could still do it, but I couldn’t do it with as much energy and passion and determination as I do. So I think people like to know, this is going to sound really awful here, they like to know that healthcare professionals suffer and are human and actually sometimes struggle. We don’t get it right the first time, and I had to see a specialist to get the right dose of HRT that was right for me, and I learned a lot from him actually. He really taught me, actually, and I’ve still got his clinic letter telling me to increase my dose because my level was low and I clearly wasn’t absorbing it well and increased the dose. And it really made such a difference. And I’m very grateful to him. But you talked about your struggles to get the right dose from your own doctor and having to see a gynaecologist. And you know, we are humans, aren’t we? And we can’t always access the right person first time or know everything. And it’s very different when it’s ourselves that are experiencing symptoms. [00:03:11][83.1]

Dr Nadira Awal: [00:03:12] Completely agree with you, Louise, actually. And almost as clinicians, we’re probably the worst patients, aren’t we? We’re completely in denial of what’s happening to ourselves and it’s actually makes it a little bit more fuzzy to connect the dots together. And you actually need that outside approach to sort of say, actually these are the things that are happening to you. But yes, you’re completely right. It’s made me more passionate talking about the menopause, educating my patients, educating anyone who will listen, really. So it’s not just about the patient, it’s about their family as well, and how the menopause can affect everybody, really. So it’s not just women, it’s the men need to listen as well and really appreciate what’s going on. [00:03:49][37.1]

Dr Louise Newson: [00:03:50] Because you’ve got two young children. When I was experiencing symptoms, my three children were obviously a lot younger and really were suffering, but not realising. I just presumed I was very irritable and short tempered because having three children is difficult. Having any children can be hard. And I just thought, oh I can’t cope very well. And then I sometimes think about this one time that I was called in by two of the partners because I’d prescribed a lady some morphine who had some really awful arthritis of her knees. Terrible. She was housebound and I just gave her Oramorph. So it’s not even, as you know, a controlled drug. And I put it on a repeat prescription because she couldn’t get out to the pharmacy and her daughter lived a long way away and it was causing a lot of work. So she just had one bottle every month. And I said to her, well look, I’m leaving the practice soon so if I put it on a repeat, it will be very easy for you to get it. And I used to inject her knee every three or four months or so if it was a lot more painful. And she tried so many other painkillers and this was the only one that worked for her, she’d just take a spoon in the morning and a spoon in the evening. Anyway they called me in to say, how dare you do this? This is absolutely outrageous and you shouldn’t do this because people could overdose on morphine. I said, well, she’s 91. She probably would have overdosed if she was going to. And I will take full responsibility because I’ve signed the prescription. I’m an independent prescriber. And then I walked away into my room and I burst into tears. And Helen, who now actually works for me, came to my room to cheer me up because she’d never seen me cry at work before. And looking back, I know it was related to my hormones and I knew I was going to get too cross to sort of retort to these two male doctors who were telling me off in their room. So I withdrew and then just thought, well maybe I am really dangerous, maybe I shouldn’t be doing this, maybe I shouldn’t be looking at what’s best for my patient and catastrophising, really, and then had no self-confidence, feeling of low self-worth and being very tearful. And those are all classic perimenopausal symptoms, aren’t they? [00:05:45][115.6]

Dr Nadira Awal: [00:05:46] Absolutely. Yes. There’s so many women and myself included, that you do feel like you’re questioning what you’re doing on a daily basis. And, you know, we’re always describing, we’re always hear about it on social media, that we’re the sandwich generation. We’re looking after our elderly parents. We’ve got young children. As you know, in that podcast I talked about, you know, I was renovating my house and I had my young children as well, dealing with builders on a daily basis. And it was really difficult. So you think, oh, gosh, you know, there’s all the stress that’s coming with it. You know, we lead busy lives. I mean, think about it, 100 years ago, women weren’t working. They were looking after the children, but not really. We had potential. We had maids. We had people who were helping, looking after our children, the sort of family network as well. And so, we’re well worse now. We’re busier. You know, we’ve got full time jobs. We’re trying to hold down a job. We’re trying to hold down a relationship. We’re trying to look after our children. There’s a lot of social media sort of presence as well, and saying that actually we should be better at things. We’re always negating ourselves, aren’t we? And I think it’s important to actually be really empowered and say we’re doing a great job. You know, we’re working really well. We’re looking after our kids. They’re happier. You know, if you think about it, we were talking about this the other day, that actually our parents’ generation only took us to the zoo. You know, we didn’t have things like soft play. We didn’t have iPads and we didn’t have mobile phones. We went out on our bikes and we just came home at dusk didn’t we? So, you know, whereas now we have to entertain our own children. And it’s hard work. [00:07:16][90.2]

Dr Louise Newson: [00:07:16] It is, it’s very different. Yeah, we used to just play in the street and sometimes remember to come home for a meal and so it’s very, very different. But also I was talking to somebody in America yesterday, actually it was Sunday and I was trying to arrange all week to speak to this person. The only time I could find was on Sunday. I’ve just got back from being with my husband in the Lake District and my mother-in-law wanted to come for supper, which is great, lovely. But then I had to cook supper. So as I was talking to this woman, I said, oh, look, I’m really sorry you’re going to hear the oven door open and close. And I’m chopping some vegetables because I’m cooking at the same time. And she said, I love the fact that you’re multitasking. And I said, but, do you know what? I sometimes joke with my children and say, Goodness, I could do so much more if I didn’t have children? But actually I also laugh about it because I’m a lot more productive because I’ve got three children, because if I have five minutes between, I don’t know, picking one of them up or taking one of them somewhere or doing that, I will do that work in five minutes. Whereas before, with or without children, I’d probably be thinking, I’ve got all day, I could just have a little cup of tea and I’ll just listen to the radio and then I’ll sit down and my nice tidy desk whereas I literally just am something on my phone while the kettle’s boiling and then I’m going to the next thing. [00:08:27][70.3]

Dr Nadira Awal: [00:08:27] But on the other hand, you’ve got women who’ve not had children. And they’re busy with their life, aren’t they? And they’re busy doing all their extracurricular activities or holding down their job as well, and busy and yeah, so. [00:08:38][10.6]

Dr Louise Newson: [00:08:38] But I think it’s also the way that women’s brains are wired and it is a gender difference. So it’s not just about children, of course it’s not. But I think women are used to multi-tasking. They’re used to, you know, if they’re working, sitting in meetings, thinking right, what am I going to have for supper or what am I going to do at the weekend? Whereas men, and this is a generalisation of course, but in general men a lot more focused. So I think it’s good and bad, actually. Women probably need to focus maybe sometimes a bit more. But actually that ability, which is often lost in the perimenopause because our hormones work very well on our brains, don’t they? And for many years we’ve just learned about flushes or vaginal dryness and the menopause just being a natural process. But actually, for a lot of us, it can really affect the way our brains work and think and function can’t they without hormones. [00:09:30][51.5]

Dr Nadira Awal: [00:09:30] Absolutely. And I actually use the analogy and I’ve used this in interviews actually as well, where women spin lots of different plates and they’re spinning, yeah, the work plate, the kids’ plates, you know, kind of life at home plates, the relationship plates. And sometimes it’s okay to drop your plates. And what you don’t do is you don’t try and pick up that plate, piece it back together again. How about you just drop all your plates, smash them, make something new? And that’s kind of how I describe the menopause as well. You know, this is a new stage of your life. Don’t try and be what you were in your 20s. Let’s try and embrace it. It’s actually, you know, don’t think I can do everything I did in my 20s and I can do it now. Make it new, make it exciting. And that’s that’s what I’ve done. [00:10:12][42.0]

Dr Louise Newson: [00:10:13] I really like that. I think that’s a really good analogy, actually, because we are different. Our life experiences are different, aren’t they? And I feel it’s a bit like, if you’ve got the privilege of being able to plan maybe when you want to have a baby, you want to make sure if you can that you’re healthy, that you’re not smoking, that you’re not drinking alcohol, that you’re taking folic acid, that you’re fit and hopefully not too overweight or whatever. So you can make sure that, you know, you’re giving everything the best chance for those next nine months. Obviously, for some people it doesn’t work like that, but it’s still something that we always advise as medical practitioners. If people can, this sort of pre-conception counselling really, isn’t it? Whereas I think with menopause it’s even more important because for most women it’s decades, not nine months. And so actually to have some time before your brain goes that you can’t read a book or listen to a podcast or think about everything, almost think about, right, how is my hormonal health? How is my perimenopause and menopause going to be as healthy as possible? And you’re right, you know, what we ate when we were 20, we probably can’t get away with eating in our 40s or 50s. [00:11:20][67.7]

Dr Nadira Awal: [00:11:22] No, and we digest things differently don’t we as we enter the perimenopause because the oestrogen declines and so the gut becomes more inflamed. So when it’s inflamed, you don’t absorb the good bacteria. And you know, the gut microbiome makes a big part of the menopause, doesn’t it? So if the gut’s inflamed, you know, obviously you’re not absorbing all the right nutrients, therefore you might get that gut changes as well, the diarrhoea or the constipation, and therefore you might get joint aches as well. So, yes, you know, which we’ve both experienced, I think so. [00:11:50][28.1]

Dr Louise Newson: [00:11:51] Absolutely, I mean it’s this anti-inflammatory properties of our hormones throughout our body are really, really important and misunderstood. And and you’re right, actually the sort of bowel symptoms are very, very common. I mean, for many years I’ve seen so many women with irritable bowel syndrome, didn’t think about the hormones at all and even heartburn and like you say, diarrhoea can be related to hormones. So there’s all these symptoms that affect people in different ways, different stages, different types of women, but often they’re not recognising and I know a lot of the work I do, but also the work you do, is trying to educate and allow women to understand what’s going on. And traditionally, if you Google menopause, it will be a white middle class woman who is, usually got a fan or just has a glass of water with her hand on her brow, and that’s not most women. And I did a presentation recently, at an international conference about ethnic disparities with menopause. And we were asking women what their views of the menopause were. And some people from ethnic minority groups said things like, It’s a dirty secret, it’s a shame, it’s an embarrassment, it’s something I want to hide away. It’s something that we just have to endure and suffer. And all these words I feel, are really sad because it shouldn’t be something that you have to just battle through. And there are certain groups of populations that I think it’s harder to reach as well, isn’t it, culturally? [00:13:22][90.7]

Dr Nadira Awal: [00:13:23] So, absolutely. I mean, if you can think about it, my parents’ generation, so my mother never, ever talked about sex, ever. You know, my mother never talked about it. My sister, who’s ten years older than I am, didn’t talk about sex. And it’s a cultural thing. It’s something to be feeling almost ashamed about. Or it’s about being hidden. You can’t really openly discuss about it. My cousins and I, you know, there’s five of us, and there’s six months between all of us, and I remember about ten years ago, and I’ve already been married 18 years, so ten years ago we were talking about sex and I’d been married eight years by that time. So you can imagine it’s something that is just not culturally talked about and not open about it as well. So my my focus is about talking in the ethnic minorities. It’s about being open with them and saying it’s okay to talk about it. So yesterday, you know, we’re trying to change the mindset of the older generation, but the newer generation who are, you know, have social media, they can see that actually they’re getting their education through that, which is great, you know, but change doesn’t happen instantly. Unfortunately. It comes about slowly. And so people are becoming educated through social media, through your podcasts, for example, as well. And, you know, Instagram and Facebook, it’s great. Tik Tok. But change needs to come and it is rolling in, it is getting better. And I think it’s really important to be educated. So I go to mosques and I very openly talk to women about the menopause and there’s lots of giggles. We know we do it very, very, very informal. And it’s so important. And I use questionnaires as well. I think it’s important. So anonymous questionnaires and I have people, you know, saying do you find sex is important? Do you find that sex hurts? And it’s anonymous so they don’t feel ashamed of it, which is great. But I think we need to talk about it more openly, Louise. [00:15:09][106.3]

Dr Louise Newson: [00:15:10] And I bet you hear stories that are sad. I know I’m overwhelmed with sadness actually listening to so many stories from women from all over the world. But I’m sure when you go to the mosques and people know it’s safe to talk about. [00:15:24][13.5]

Dr Nadira Awal: [00:15:24] I have to say the most interesting one is I worked in a quite a socially deprived area, quite locally to where I am, and actually I had a lady come to me and she went, My vagina is so dry, I just can’t have sex. But my husband really wants to have sex, so I just have to lie there and just basically take and I hate it. And I said, Well, do you say no? And she said, no, because it’s part of my role as a wife. I need to have sex with my husband. And I went, You can say, no, it’s almost like rape. And she went, No, it’s not rape. It’s my husband. I went, If you say no, it is rape. And it was really quite distressing, actually. And I said, Look, let’s give you some vaginal oestrogen and let’s talk about HRT as well. And she came back to me, went, actually, sex is so much better with some vaginal oestrogen. [00:16:10][46.2]

Dr Louise Newson: [00:16:12] Yeah, and it’s, I’ve heard so many stories that are similar. A first lady who spoke to, it was many, many years ago. And I suppose the beauty of the clinic that I have I have longer to talk to women. In general practice to having eight, 10 minutes is quite hard to ask intimate questions. But because on the questionnaire it talks about libido, I will usually, if it’s appropriate, ask women about sex and if it’s uncomfortable because vaginal dryness means nothing to a lot of people. And it’s one of those horrible terms. It’s really difficult, isn’t it? Because then you talk about vulva vaginal atrophy, and if you look up the word atrophy, it means withering or wasting away, well I don’t want to think any part of my anatomy is withering or wasting away. So and it’s not just about penetrative sex sometimes, it’s actually externally can be very painful. So a lot of women don’t want to be touched or explored or anything happening in that area. And one lady said to me many years ago, she said she had no libido, She loved her husband. And really, you know, their relationship was good, but she had no interest. She said, I would prefer to drink toilet water than have sex with my husband, but he needs to have sex. And we do sometimes. And I said, Well is it painful? She said, Oh, gosh, yes. It’s like having a red hot poker shoved inside me. And I said, Well, do you tell him? She said, No, because I know it won’t last very long. So I just lie there and just wait for it to finish. And I said, Don’t you tell him? She said, No, but I can’t because I know how much he wants sex. And there’s so many layers to that conversation aren’t there? And I feel really sad to think that people are in relationships that they can’t even talk, but also more sad that there is a treatment that’s available that women are not able to access in an easy way. [00:17:57][105.4]

Dr Nadira Awal: [00:17:57] Yes, I completely agree with you, Louise. The impact on relationships can be quite horrific, actually, can’t it? And you can actually see that some people actually have marital problems as well. And you see people separating sometimes, unfortunately. [00:18:09][11.5]

Dr Louise Newson: [00:18:10] Yeah. I mean, divorce rates really do increase in the perimenopause and menopause. And often, like you said earlier, you know partners need to understand, really need to understand as well. And we see a lot of people in same sex relationships. And if two of them are perimenopausal or menopausal at the same time, it can be a double whammy, of course. But it’s not just the immediate partner, it’s the wider community, as you were saying. And certainly a lot of the work that you’re doing, with ethnic minorities, the communities are there, more than for a lot of us Caucasians, actually. But they don’t know how to help because they can’t understand. And I think that’s really important. And I was talking to someone recently who’s based in India, and I really worry because menopause age is often younger, you know the average age is probably in their early 40s as opposed to early 50s. And there’s an increased risk of diabetes, heart disease in these women. And we know that in the menopause there’s an increased risk of heart disease and diabetes. And so it’s a double whammy that really needs to be discussed more, doesn’t it? [00:19:15][64.9]

Dr Nadira Awal: [00:19:15] Absolutely. Unfortunately, sort of our genetic makeup is that we are increased risk of heart disease. We are increased risk of diabetes. Often our parents and grandparents have had these health conditions and yes, we can change it through lifestyle, but actually we can’t change genetics. And you can appreciate actually, you know, our diet is often made up of a lot of carbohydrates, and so we’re increasing our risk even further as well. So it is really, really important. Yes, we maintain a healthy lifestyle and have a look at our guts. Having a look at kind of our exercise and we are getting better, definitely. But if you can appreciate when you see that lady who comes in from an ethnic minority background, we’re having to deal with her diabetes that might be poorly controlled. We’re having to deal with her blood pressure that’s maybe poorly controlled. As GPs, we’re having to do that in ten minutes. And yes, you know, there’s a lot of information out there that says no this is menopause related. Not everything is the menopause, it’s not the panacea, you know, giving someone HRT, it’s not the panacea, it’s about the holistic approach to that woman as well. [00:20:17][61.8]

Dr Louise Newson: [00:20:17] I totally agree. And I think it’s a shame, actually, because there’s so much conversation that’s trying to be negative about HRT. We know that in the UK, about 14% of menopausal women take HRT. Worldwide, it’s as low as 6%. So it is low, but it’s a bit like treating blood pressure. I never as a GP and I’m sure you hopefully agree, I would never just put someone on a blood pressure lowering treatment. It would just wouldn’t be doing my job properly. I would talk about lifestyle, I would talk about exercise, I would talk about the different types of drugs and the different side effects they might get and how we might need to change the dose or maybe add in another drug because often two lower doses of drugs is better than just increasing one. And I would review and things would change. And often there their treatment actually, if you get it right and their lifestyle improves, you can lower the dose as well. But it’s the same with menopause. It’s not just, oh, here you go, have some HRT. That would just not be doing our jobs properly. It’s about what it means, because I’ve done and I’m sure you have done many home visits where you open the kitchen cupboard and literally packets of medication fall out. But you think you’ve been prescribing really happily for years. And the women and men have said, Oh, no, doctor, I read the insert. There’s no way I was going to take that medication. And I’m thinking, Well, no wonder your blood pressure hadn’t gone down because you’ve never taken this medication. So if we want to improve concordance, compliance, if we want to really work in a partnership with our patients, they have to have a full understanding. But they also need help to change and improve their lifestyle, to look at their mental health and other things that are going on. You know how you said before this sandwich generation, well, you know, HRT is not going to improve the fact that they’re looking after their mother in a care home who’s 100 miles down the road and they’ve got children and whatever else. And certainly, often as a GP, a lot of my role was sort of also listening and understanding and saying to women and men when they were having difficult times, I can’t change your life, but I can help you improve the way you deal with it. And that makes quite a difference, doesn’t it? [00:22:26][129.1]

Dr Nadira Awal: [00:22:27] Absolutely, Yes, sort of. I always use the analogy with my patients. I’m like your satnav. I can help guide you and tell you which way to turn. But really, it’s up to you to make the decision making. And whichever way we go, the ultimate destination is going to be the same. And the ultimate destination is death I’m afraid, you know, which where we get it or how we get there. It’s, you know, we can either have a great journey together or we don’t have a great journey together. [00:22:51][24.4]

Dr Louise Newson: [00:22:52] Yeah. That’s so important, isn’t it? And I learned so much in my training year as a GP, actually, with Dr John Sanders, who is my trainer in Manchester, about looking together with your patient. And everyone’s different and everyone’s expectations of what they want. You know, I could be expecting all my patients to do a regular yoga practice and do a headstand three times a week because that’s what I do. Well, of course, some women are very happy just sitting on the sofa watching telly. And actually, who am I to judge? They probably have a far better time than me, constantly working and fitting in yoga in between a hectic schedule, but actually it’s working out what they want. And this is the same with HRT. If a patient or a woman really doesn’t want it, that’s fine. But they have to understand the risks of not taking medication as well as the risks of taking it. The same as the risks of eating McDonald’s or, you know, smoking. I would never judge a patient and treat them differently because they decided to carry on smoking. But I do feel it’s my role to tell them that smoking is not the best thing for their health. But I think being a GP actually gives you some great skills where we’re not judging, we’re not preaching and that helps with all the education work certainly I do, and you do as well, because we’re used to dealing with different people and speaking to people in different ways and giving them the information in the way that they want it as well. Because you know what I might give a professor of neuroscience who’s a patient might be very different to someone in inner city who doesn’t speak English as their first language. They both are entitled to as much information as possible, but they might want it in different ways and different stages by different people as well. [00:24:38][106.0]

Dr Nadira Awal: [00:24:38] Absolutely. And I think it’s really important. As you say, it’s a professor of neuroscience or neurosurgery, for example. Even though they’re a doctor, they probably know nothing about the menopause, actually. And actually, it’s really important to explain it in layman’s terms as best as possible. And actually, I often find that my patients actually have more education than I do. And it’s great. I love it. I love hearing from my patients, actually, what the latest research they’ve found. And I will embrace it because you have to embrace it. [00:25:07][28.2]

Dr Louise Newson: [00:25:07] Yes, I love it. I mean, when we when I first started as a GP, the internet only really started going. And it used to be the front page of the Daily Mail saying, I would like this treatment. And then you look at it and it’s been a study of four people have found that something and you’re like, Oh, but now actually they learn from their communities as well. And there’s a lot of pushback about social media, but actually it can be very useful if it’s done in the right way. And it can also allow people just a bit of space to think and they can communicate with others that they might not meet in a mosque or the supermarket or a church or with their local communities. And it allows them probably to ask things in different ways because they are more anonymous as well, which I think is really important. So the huge amount that we need to do. There’s a huge amount, we need to carry on educating women, men, families, but also health care professionals as well. And all the work you’re doing is helping with that. Well it’s great to connect and I hope we can carry on doing things together. So before we finish, though, Nadira, I’d really like to ask you three tips, actually. So three tips of how women and healthcare professionals and anybody so professional or nonprofessional people can just become more educated, more empowered to help more people. [00:26:23][76.0]

Dr Nadira Awal: [00:26:24] I think the key thing is, as a GP, I would really appreciate if somebody, if they were concerned about the menopause itself, I think my top tip is download the questionnaire. Have a look at it. Fill it out beforehand. Tell me your symptoms within that first two to three minutes. So we’re both singing on the same hymn sheet just so that we know we’re tackling with menopause. Please don’t be alarmed if I’m going to be ordering blood tests, looking at vitamin D deficiency, looking at iron levels, looking at your thyroid function. I won’t be prescribing HRT on the first consultation. I have ten minutes as a GP. I need more information from you. And the menopause isn’t the, you know, it’s not the only diagnosis out there. You know, it’s really tough as a GP, we need to rule out more sinister causes. So I think that’s my top top tip. Two other tips. I’d say be wary that actually women of ethnic minority, we often need higher doses actually compared to our Caucasian counterparts, everybody absorbs their oestrogen differently. And that’s my third tip. So please, if you’re going to the maximum doses, check oestradiol levels. You know, we’ve got a lab for a reason, you know, so just everybody is individualised. Everybody has a different story. So please tailor it to your patients. [00:27:41][77.1]

Dr Louise Newson: [00:27:42] Very good. Very good. Everything we do in medicine should be tailored to our patients. So important. So I’m very grateful for your time and keep doing the work you’re doing. And thank you again. [00:27:53][11.0]

Dr Nadira Awal: [00:27:53] Yeah, thank you, Louise. Thank you. [00:27:55][1.4]

Dr Louise Newson: [00:27:59] 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. [00:27:59][0.0]

ENDS

The post The juggling act: how to navigate menopause and midlife appeared first on Balance Menopause & Hormones.

In this week’s podcast, food writer, author and award-winning entrepreneur Freda Shafi talks about her work raising awareness of menopause and recording the experiences in the Pakistani community in West Yorkshire.

Freda shares her own menopause story, and she and Dr Louise discuss key barriers women face accessing care, and ways to improve knowledge to empower women to advocate for themselves.

‘I’m a South Asian woman, I’m a Pakistani, I’m a British Pakistani woman, and I know I represent a certain demographic,’ says Freda.

‘I feel as though I can reach many women through the fact that I am from the community. That may be platforms for women like myself who are able to cascade that information and let that reverberate across those communities.’

Freda’s top three tips: 

1. Help represent your community to spread awareness of menopause symptoms, treatments and services and help tackle the stigma that still surrounds this area.

2. Get a second opinion if you don’t feel your healthcare professional has given you the right diagnosis. Explore the materials that are out there, including the balance app, so that you’re informed when you see your doctor. 

3. Boost training in the menopause for community leaders so that they can signpost women to local services that can help support them.

Follow Freda on Instagram @fredishafi_spiceitup

Transcript

Dr Louise Newson: [00:00:11] Hello, I’m Dr. 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 very excited for today’s podcast. I’ve got with me in the studio someone called Freda who approached me, like lots of people do, and told me about the incredible work that she’s doing. And for those of you that might know, I spend a lot of my time trying to work out how to reach people who have really been unheard, have been sort of vanished from society with their perimenopause and menopause. And the more work I do, the more I realise, sadly, there’s lots of those women. And it’s actually, I think the majority of women who are not able to access really good quality care, advice and treatment. So Freda has been doing some really great work. So I’m very privileged to have you here today at my studio. So welcome today. [00:01:44]

Freda Shafi: [00:01:44] Thank you. Is it’s a privilege to be here, actually. [00:01:46]

Dr Louise Newson: [00:01:47] Oh, thank you. So just tell me a bit about you first and your background and why you’re doing what you’re doing, if that’s okay. [00:01:53]

Freda Shafi: [00:01:55] As you may have gathered from some of my background information, I am a creative person who works across the cultural sector and at the moment I’m working in the culinary world. So everything to do with food, health, wellbeing and being equipped to understanding our bodies and how we can make really the best of our our health through food, through nutrition, through lifestyle. And in the current world that we’re living in, we need to be fully aware of how our longevity impacts our family and our communities. So just making sure that we are, I suppose, making the best choices when it comes to food, nutrition and even lifestyle. And that extends to, as I said, the creative sector, the creative industries. I came across the work that you are doing obviously through my own journey and wanting to know more. And I equipped myself with a lot of knowledge, a lot of background, and being in a perimenopausal state myself, I felt I needed to reach out and talk to you about some of the, I suppose, the inequities that still exist, even though there are some brilliant services out there and some great research and work. Sadly, there are still pockets of communities that are not accessing the right care and the right treatment, especially when women of my age bracket approach menopause and perimenopause. [00:03:26]

Dr Louise Newson: [00:03:27] Hmm. Absolutely. It’s an interesting one. I trained in Manchester many years ago now, there is a huge ethnic minority population, and when I was working in casualty, lots of women would come in with total body pain and they would be almost dismissed to say, well, they’re on antidepressants. There’s nothing wrong with them. We’ve checked their thyroid. There’s probably other issues at home. It’s very difficult to get a history because they’re not speaking English. They haven’t got an interpreter with them. You know, what can we do? And I look back in horror because I know a lot of these women were either menopausal or perimenopausal because they were the right age. And I don’t know how much of their symptoms were related to their hormones, but no one even gave them opportunity to have any education or even to talk about it. [00:04:15]

Freda Shafi: [00:04:16] I think that’s very sad. And I think that pertains to a lot of the cultural taboos and stigmas associated with perimenopause and menopause, especially when you think that a woman’s currency in many communities, not just Pakistani and Asian community or ethnic communities, but across the whole spectrum, I would imagine, a woman’s currency is linked to fertility, to use, to abundance, and sadly, it is overlooked and not actually talked about, not even overlooked. That’s probably the wrong word. It’s not even addressed because it is considered almost like a failure on the part of a matriarch, on the part of a woman and part of a family, which is very, very sad. [00:05:00]

Dr Louise Newson: [00:05:01] It’s the same as so many people, because when we’ve looked at the menopause for so many years, it’s been about periods which is associated with fertility, like you quite rightly say. And because we know a lot of women are younger when they’re menopausal as well, at an age where perhaps they would be expected to conceive. It’s a double whammy for those people that are young when they’re menopausal. But actually, even when people are older, you want to cling on to your youth, if you see what I mean. But our youth should not be defined as whether we’re fertile or not, but there is this identity for women. And like you say, in some cultures it’s more than others. But actually the menopause isn’t about losing fertility. And there are some women actually who have an early menopause who are still fertile. Their fertility isn’t as good, but they are still fertile, yet they’ve got this shame that they don’t want to talk. And we see a lot of women who’ve been to fertility clinics and they have reduced fertility and everyone’s been blaming their anxiety, their mental health issues, their poor sleep on their worry about whether they can get pregnant or not. But actually it’s because they’ve got a hormonal deficiency due to their perimenopause or early menopause. So there’s been this misinterpretation of what the menopause actually means and some people refer to the time after menopause as post reproductive health, well it’s not actually. And that’s really confusing for a lot of people. But like you say when you’ve got this added burden actually of being a woman who has to be fertile, it adds a whole new dimension, doesn’t it? [00:06:36]

Freda Shafi: [00:06:36] Absolutely. And as I said before, I’m not dismissing some brilliant work that’s going on in terms of outreach and engaging more representation. There are some brilliant doctors out there like Nighat Arif reaching out to the ethnic minority communities through her social media platforms. But what worries me is that there are still pockets of ignorance within communities. And again, ignorance is not used as a derogatory word here. It’s ignorance, because a lot of the women I have been exposed to sadly have been misdiagnosed, and many of them are on anti-depressants. And as a result of that, they are being labelled as mentally ill. And that’s what probably perturbs me more than anything, is the fact that they are not being, first of all, diagnosed properly or even aware of their local amenities and resources. Even in West Yorkshire there are some brilliant resources that exist like Livve UK run by Melissa Sookia and she is doing some great work. I spoke to her and she said if they approach me, that’s the only way I can help them, Freda. And she absolutely would go in and do some voluntary work. But the fact is they are not even in a position to access those services because they are not aware. And just looking at the actual statistics, 78% of women from ethnic minority communities are actually still very much unaware of their menopausal symptoms. And given that there isn’t a definitive word for it, there is a very broad spectrum word which is very similar to the menopause. You know, the Greek word meno pausis, which is literally everything’s shuts down, which isn’t a very glamorous word either, but it pertains to shut down, which again, is not a word that makes women feel good about their bodies and their health and their sexual health, which again, should not be a taboo subject. But sadly, it is and it has a cascading effect onto their families, onto their husbands and across the community. And it resonates. And that’s one of the reasons why I feel it needs to be addressed. Even though there are some great resources out there are still women not accessing them. [00:08:49]

Dr Louise Newson: [00:08:50] Yeah, it’s very interesting and it’s so frustrating actually, isn’t it, when this is something that happens to 100% of women at different ages, of course, yet we still don’t understand what’s happening. And in fact, seven years ago I used to work with West Midlands Police and we did a survey then to try and understand what women understood by the menopause and about their symptoms, and it’s a very similar figure. It was about 75% of women didn’t realise that their symptoms that they were having were related to their menopause, and the commonest symptoms affecting them at work were anxiety, mood problems, fatigue, memory problems. And they’d been signed off work with depression, headaches, with migraines. And a lot of them were just telling me that they were retiring early because they couldn’t carry on. And this was seven years ago. So hardly anyone was talking about the menopause then. And I remember sitting in this room with these lovely officers and police staff and just saying, but you’re only 50. You can’t give up your job now. And they said, well, we can’t even go to the playground and lift our grandchildren to put them on the swing because we’ve got such bad muscle and joint pains. We’re on antidepressants and they’re not helping. And so you don’t seem depressed, why are you on antidepressants? Oh, well, because that’s all I could be given. And it was then that I really had this sort of almost lightbulb moment thinking, goodness me, this is to me, very obvious, but people aren’t accessing it and obviously developing then the website and then the app. Isn’t it great? It’s got a wonderful reach and everyone says, oh, isn’t it amazing, Louise, you’ve had over a million downloads of balance app. And I think, no, it’s not. It’s 1.2 billion women worldwide. How do we access them and how do we enable them to find out information? Because I think women are very good, lots of communities of women are very close, but they’ve got to know how to start the conversation, how to open up the conversation, isn’t it? And I know you’ve been working really hard in some areas haven’t you to really start that going. [00:10:48]

Freda Shafi: [00:10:50] I feel really passionate about it because I feel if you fail one woman, you are failing a whole entire community. And within the South Asian community there are lots of different demographics. You have a Bangladeshi community, you have an Indian community, have a Pakistani community. So it’s a whole demographic there. And it can take one person’s mindset changing for that to cascade and reverberate through an entire community. And it can be as simple as that, Louise. And I’m on a mission, actually, I’m on a mission because I’ve seen generations before me. I actually have an older family. I’m the youngest of quite an older family, so I have sisters in their 60s and I know I’ve actually interviewed women of different age groups and I’ve interviewed women in their 60s and asked them if they would have done anything differently. And it’s very sad to hear them saying, had I known about this, I would have done things very differently. And now they are on a whole spectrum of medications ranging from thyroid right through to blood pressure and antidepressants. I was offered antidepressants when I approached my GP, but thankfully, Louise, I’d already found you. I’d already found you, and I knew exactly what the protocol would be. And as an articulate Pakistani woman, British Pakistani woman, I was capable of knocking on the GP’s door three times. And in fact, that’s how we met, because it took me three knocks on the door to get my HRT. And can you imagine a woman whose language is not English? Who’s not very confident, who trusts completely and implicitly what the GP is saying, which we should actually, I’m not undermining that. But sadly, even somebody like myself who is articulate and adept at getting through to my GP and armed with a whole arsenal of research and statistics, even then I was refused three times. So I think therein also lies a problem because it’s still happening. And I think if we enable and empower one woman to knock on that door however many times it takes, and if it means me going in and making sure this is happening at a pedestrian level, I’m not a clinician and I don’t profess to be anybody from a medical background. But as a person who can give women a voice and enable them and maybe empower them to just keep pushing and not accept the first port of call, which sadly is always antidepressants. From what I’ve learned from the communities I’m working with. And like I said, the system is still failing many women. [00:13:33]

Dr Louise Newson: [00:13:34] It is. And I don’t quite know why. One day maybe I’ll find out. But I really don’t understand why. And I am, I’m a fellow of the Royal College of GPs and I did speak to some people quite high up, I won’t mention any names, recently and asked them where the antagonism is for my work and for menopause and why is it the women are being underserved. And one of the responses was, well, Louise, your media attention to the menopause is quite difficult because it means so many women now are coming asking for hormones to the detriment of other patients. And I feel really sad about that because I think if we can invest time-wise, but also economically in women in their first or second consultation, sometimes it can take more than one consultation to go through everything. But then these women will then often be liberated and not come back into the general practice or to other healthcare systems, because many women and we know that from just doing some research in our clinic, once they are better and have the right treatment and looking at treatment, when I say holistic treatment, looking at changing, improving their nutrition, exercise, sleep, wellbeing and hormones, if they want them, then actually they don’t then go back to their GP in the short term because they don’t have symptoms. But in the longer term we know they’re less likely to have cardiovascular disease, diabetes, osteoporosis and so forth. And we know that women from certain ethnic minorities have a higher risk of obesity, type two diabetes, cardiovascular disease. Many of these women have a younger menopause. We know women who are younger when they’re menopausal have a higher risk of these diseases as well. We wouldn’t allow women to be walking the streets with raised untreated blood pressure or raised untreated type 2 diabetes. Yet we’re allowing them to have very low hormone levels with risks and symptoms affecting the quality of their life and almost being annoyed that they’re coming to ask for treatment. I don’t really understand that. And the more work we do, empowering people, this side of the stories are that I hear of people being turned away and I can’t quite understand, and I wish someone could tell me in a very reasonable way why it’s so awful. But I haven’t had a reason yet. [00:15:51]

Freda Shafi: [00:15:51] Well, therein for me lies the injustice, Louise. And I think you hit the nail on the head. If a woman is misdiagnosed, then it does sadly lead to many of the conditions which you have shown to be linked to the menopause, dementia, osteoporosis. All of these conditions could quite easily have been, I’m not saying remedied, but you know, HRT isn’t always the answer, but an awareness of just something as simple as diet and, you know, changes to a woman’s diet when certain hormones go out of kilter. I specialise in food, whilst I’m not a nutritionist, I understand what foods work and it’s pretty common sense for me. I’ve been cooking for many, many years where things were cooked from scratch in most instances. And I know that fresh unprocessed foods help certain menopause conditions, and it’s as simple as just awareness and information in many instances, which that in itself doesn’t necessarily involve a medical intervention. That isn’t something that a woman necessarily needs to reach for the antidepressants. It’s just on the first port of call it should be have you accessed this service that is available to you in your community? That’s something I really want to do. If that’s a bridge that I represent, then I would be happy to do that, to signpost women from my community. And I suppose I have a special interest in my own community. I can’t speak for the wider community, but having worked and being from that community myself, I understand the cultural sensitivities, the taboos and everything else I’ve mentioned, but I certainly can support women and signpost them to accessing the right healthcare before they go down a slippery slope of once they are on something, sadly, there are side effects and those side effects can lead to more and more medication. I’ve seen it happen. I’ve seen it happen in the older generations of, say, for example, of my mother’s generation, when a lot of the women in her generation were bedridden at the age of 50 plus. Thankfully, my mum’s very, very well in her 80s, but she had a very different approach to it and it was more about mindset, health, wellbeing and food actually, which is probably where I took my inspiration from food and do what I do. But there are a lot of women who did even at that time, and we’re talking about the 80s and 90s, well before you came on the scene Louisel, even less knowledge and understanding of menopause, many women became bedridden and I often used to wonder why. And I know now and I know lots of it, you know, a certain percentage of that would have been definitively linked to menopause. [00:18:46]

Dr Louise Newson: [00:18:48] So tell us about some of the work that you’ve been doing, some of the research you’re doing. I know you’ve been speaking to a lot of people, and I’m really keen to hear a bit more about that, if that’s possible Freda. [00:18:58]

Freda Shafi: [00:18:59] Well, I’ve interviewed over 20 women. I have case studies of 20 women written down, the ones that I found quite interesting and as I said before, quite definitive in terms of some of the really interesting points that came out. And it’s a very broad demographic from very highly adept and articulate, educated women right through to and again, I’m not using this as a way to undermine women who have come from South Asia, who are housewives and just as adept but in a different way. So women who are articulate enough to access services. I interviewed them and I interviewed housewives from certain communities who are not necessarily medically literate enough to access services. My findings are very interesting, Louise, because even within the more capable, as in able to approach their GP confidently, even those women are not necessarily accessing the right treatment. And the women in the community centres they have been offered certain treatments but are refusing. And I also interviewed daughters of some of the women I interviewed to see what effect it was having in a more family environment and men as well. And looking at the way men approach or don’t approach or even want to engage in the conversation. So my findings are interesting. Some of the older participants sadly said that they felt that they’ve been let down by the system. Had they known about it they would have accessed treatment because now they’re on a spectrum of medications which they are certain in themselves that they probably wouldn’t have had to because of some of the joint pains that they’re suffering, some of the cardiovascular symptoms that some of them have suffered. Had they accessed treatment maybe 10 or 15 years ago, they wouldn’t have done that. So it’s almost like it’s a little bit too late for them. They think, even though I’m trying to push them to have a look and see if there are still options available to them. I’m not pushing for HRT. I’m not pushing them to go down any road other than to be more aware. But like I said, my findings are a lot of stories and anecdotes about the effect it had on their lifestyle, their marriages, their family life, right through to, as you’ve mentioned, some of them stopping work and feeling as though they couldn’t carry on in the workplace. Their brains weren’t functioning. There was the classic symptoms, brain fog, anxiety, and their husbands sadly not being very amenable or supportive to that. And the words like psychosis were being used to describe how they were being labelled by the community, by close family members. And that resulted in many of these women taking alternative treatments, which again, I’m not a clinician, but I know that it just didn’t seem to fit very well with what I was hearing. So it’s quite alarming that the system has failed a generation before us. But looking at some of the younger women, thankfully they are more aware of what’s going on, even though they’re not in a perimenopausal, menopausal age bracket. They know from their mothers. They know from the experiences of what their mothers are going through and are more adept and probably will be more adept at accessing the services. But even then, many of them, because they’re not in that age bracket or even thinking about perimenopause, they’re still very, very much unaware of what’s to come. Some of them even use the word frightened and scared. You know, the idea of the menopause fills them with dread. And again, one of my roles, I feel, is to advocate that it shouldn’t have to be like that for a woman who is perimenopausal. And I feel it’s a game changer. And I feel that there are so many things and opportunities available. If all I can do is reassure a lot of the younger women, then I feel as though there is an awful lot of value in that. I also interviewed some of the people who were running some of the community centres. They too recognise there is a problem. Their hands are tied. It’s a very political situation. As I’m sure you’re aware of when it comes to medicine. But my job is to make them aware of services outside of the GPs that exist, such as I’ve already mentioned in West Yorkshire, we have some great resources like Livve and other things, and high profile doctors like Nighat Arif are doing brilliant things and just seeing if they can be woven into some of the sessions, some of the workshops, some of the coffee mornings. But these gatherings usually are about lifestyle and accessing healthcare and make it a point of menopause being a very targeted thing that they talk about once a month. I’ve gone in and spoken about it and some of the perceptions that came out were very, very interesting. We did posters, we did some notes and some of the quotes that came from that. I wrote them down and some of them were quite discouraging, but some of them were very positive in the sense of that women felt empowered enough to feel like there was an opportunity for them to come back. And one of the quotes was, I’m going to start driving again. I can’t believe I’ve stopped driving. You know that in itself. Right now, it’s sad because it means that a lifestyle, something that’s so relevant to somebody’s lifestyle, driving somewhere, somebody stopped because of the debilitating anxiety. If there is an opportunity to reverse that or address that and, you know, get that woman back. There’s a bit of work to be done. So that’s what my findings have revealed across a range of demographic, as I’ve mentioned. [00:25:23]

Dr Louise Newson: [00:25:24] Which is no surprise from me, because I hear stories all the time from people from all backgrounds saying similar things. But it is absolutely shocking that we’re talking like this in 2023. You know, I speak to a lot of women who are too scared to go out the house, they’re too scared to use public transport. They’ve stopped driving. Like you say, they’ve given up their jobs, but also their role in society. And, you know, older women often have a really pivotal place and role in society, even within families and communities, to really educate and learn and be part of something. And if they can’t do it they’re losing out, but other generations are losing out. So there’s so much that we need to do because there’s the older generation that you say have been lost out and they went on all these other medications. They’re not too old to consider the right treatment that’s individualised for them. But really crucially, and I clearly think about this a lot, having three daughters, the new generation coming in need to be educated really early so they can make choices when they haven’t become this shadow of a person that has withdrawn from society because it’s too hard when you’re riddled with anxiety and you’re a shell of yourself and you’ve knocked on that door too many times to try and get help or you’ve received the wrong help. So it’s empowering women. And the work you’re doing is incredible. It’s really making a dent and a start. And we’re making lots of dents in the work we do. Every day I feel inadequate about the work I do, but actually, it can be amplified by us all working together. And I think that’s where it’s absolutely crucial that we all work together to help as many people as possible, because if each of us just helping a few, if there’s enough of us, then it really gets amplified and resonates. And that seems to be what’s happening. But we certainly have to do so much more work to get to certain communities. So I think your work is incredible and any of you that follow you on Instagram will see how amazingly talented you are, not just, you know, with the work that you’re doing beyond home and everything else, but the way that you design and cook food. I just feel incredibly inadequate looking at some of the things that, you know, it’s wonderful and it’s actually a very, very calming Instagram page just to look at actually with all the craziness of everything that’s going on. So there’s so much you’re contributing to. Before we finish, are you able to give three take home tips for those women who may have listened to this and are struggling, or those women who think, yes, I might be able to help people in my community just by talking and how do I start or what do I do? Are you able to help at all with three tips? [00:28:11]

Freda Shafi: [00:28:12] I think my three tips would definitely start with representation in terms of possibly seeing something that’s culturally relevant. And I don’t want to duplicate what’s already going on because I know that, you know, there are some materials that have been transcribed into South Asian languages, but just to reinforce that, you know, through marketing, videos, posters. I’m a South Asian woman, I’m a Pakistani, I’m a British Pakistani woman, and I know I represent a certain demographic. I feel as though I can reach many women through the fact that I am from the community. That may be platforms for women like myself who are able to cascade that information and let that, as you said, reverberate across those communities. Because if you’re amenable and you’re relatable, I think you will get through. If there is something that is accessible about a woman of colour speaking sense and taking away the taboo and the fear and a lot of the flawed research that as a clinician, you know, you know, just dispelling all of that, that representation I think is really important that Pakistani women of all demographics can relate to somebody from their community that is in the same space as them. I think the other important thing, is diagnosis being more considered. So when that first port of call, may be getting a second opinion. So if the first port of call to the GP based on symptoms and that first diagnosis is sadly or is antidepressants, I would urge many women to get a second opinion and explore the materials. I recommended the balance app. I’m trying to introduce the balance app into various community centers so women can chart their experiences and go to their GPs like myself, fully armed with an arsenal of research stats, even charting their day-to-day symptoms. So the doctors and the GPs, who are much more aware now, more capable at proper diagnosis and then maybe finally training not necessarily for clinicians, but training for gatekeepers such as leaders within the community. And they often are the community centres who look after the wellbeing and the lifestyle of these women who are approaching are in the menopause or even post menopausal, those women displaying classic symptoms of menopause. Those community leaders should be more aware of what they are and able to signpost them to resources outside of GP services. So to summarise, representation, diagnosis, and more training, I would say. [00:31:03]

Dr Louise Newson: [00:31:03] Very good. And keep going with the work that you’re doing and look forward to doing more together in some way as well. So I’m very grateful for your time Freda. Thanks ever so much for coming today. [00:31:12]

Freda Shafi: [00:31:13] You’re very welcome. Louise. Thank you for your time. [00:31:15]

Dr Louise Newson: [00:31:20] 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. [00:31:20]

END

The post Empowering women unheard during menopause appeared first on Balance Menopause & Hormones.

Dr Laurena Law is a general practitioner working in Hong Kong who has a special interest in nutrition and lifestyle medicine to improve healthy aging and prevent chronic illness. When Laurena gained personal experience of perimenopause and saw the impact it was having on her own life, she decided to learn more about hormone health and evidence-based treatments for the menopause so she could help herself and her patients.

In this episode, Louise and Laurena discuss cultural differences and similarities between British and Chinese approaches to menopause from both an individual and healthcare perspective. Laurena emphasises the importance of educating women so they know how to recognise their perimenopause or menopause and to empower them to make their own health needs a priority. She educates healthcare professionals in Hong Kong and further afield to ask women the right questions in consultations and to know how to prescribe body identical HRT.

Dr Laurena’s three tips for women:

1. Complete a menopause symptom questionnaire and repeat it every few months. This can form the basis of a conversation with your healthcare provider
2. Find a healthcare provider that is educated and updated in menopause care
3. Find a support group of women also going through the menopause to talk about the problems and challenges you’re going through – you’re not alone.

Episode Transcript:

Dr Louise Newson [00:00:09] Hello. I’m Dr Louise Newson and welcome to my podcast. I’m a GP and menopause specialist and I run the Newson Health Menopause and Wellbeing Centre here in Stratford-upon-Avon. I’m also the founder of The Menopause Charity and the menopause support app called balance. On the podcast, I will be joined each week by an exciting guest to help provide evidence-based information and advice about both the perimenopause and the menopause.

Dr Louise Newson [00:00:41] So today I am going to introduce to you someone called Laurena, who I’ve recently reached out to. And a lot of my work is thinking about women who I’m never going to help through my clinic, but my clinic enables me to reach other people with the education work that I do, both for women, and also for men of course, but also for healthcare professionals. So I’m really keen to talk to you today and hear about sort of you and your journey and who you are and where you are as well. Because the menopause is a global problem. There’s 1.2 billion menopausal women. But we’re here to stay. We want to be looked after. We want to be listened to. We want to be treated. And I think it’s outrageous, actually, that women get different treatment depending on where they are and where they live, because most other conditions, people can access good quality evidence-based care. So welcome to the podcast.

Dr Laurena Law [00:01:39] Thank you so much. Thank you, Louise. I’m so happy to be on this podcast and I have been a follower for just recently in the last 12 months and I’m actually here in Hong Kong, so I work here as a GP in my own solo practice, and I’ve been in Hong Kong since 2002. Originally, I grew up in Hong Kong, but I did my medical education in Australia. So I was having basically experiences in both the sort of Western culture but also in my own Chinese culture. So I speak both Chinese and English, although I have to admit that I didn’t really quite go to a Chinese school. I went to an international school while I grew up here. So I came back to Hong Kong and in 2002, I remember there was an article in the newspaper, in the media reporting some of the risks of HRT, and that was really just – that was it. And ever since then, the conversation around HRT has been fought with a lot of confusion on my part because there wasn’t really much training, undergraduate, in terms of managing this transition. And I really didn’t have to think about it too much because personally I didn’t really suffer many symptoms. And it seemed that there were other strategies to treat menopause related symptoms with other drug therapies. And I kind of just effectively stumbled around for quite some time in managing women with symptoms. And it wasn’t really until I myself personally started going through that transition – and in fact I kind of missed it, I didn’t realise that I was actually going through that myself.

Dr Louise Newson [00:03:25] Yes, we’ve all been there!

Dr Laurena Law [00:03:27] So then I was looking for what potential treatment modalities were and what was the update, because there hasn’t really been anything and to be honest, I didn’t really have a lot of information around it and a friend of mine actually sent me a link to your website and I started looking at your website and realised that there was actually a course for health professionals. So I did the course and it really opened my eyes up to what the updates have been and also what treatments are safe, as well as understanding actually what perimenopause is. Because up until then I didn’t even understand what it was. So that then helped me to treat myself actually and realise that those were not just symptoms of ageing but they were symptoms of perimenopause.

Dr Louise Newson [00:04:15] It’s really interesting isn’t it? Because as many of you listing know, there isn’t a single diagnostic test we can do for the menopause or the perimenopause. And I remember actually when I started doing more menopause work, I had all the theory in my mind and I had all the knowledge of the basic science and the pathophysiology. But it’s a practical treatment sometimes, isn’t it? When you’ve got a patient sitting in front of you for a short consultation, how do you treat them optimally and also how do you make the diagnosis? And so if we think someone might have diabetes for example, it’s very easy, often we do a blood test, we look at the result. If we think someone’s got raised blood pressure, we take their blood pressure. And, you know, whereas it’s really difficult for perimenopause and menopause. And so I learnt the most actually by sitting in other people’s clinics. And that’s not always practical to always sit in and travel and it’s not so fair for the patient also, when they’re discussing often quite intimate symptoms and details with a complete other stranger sitting there. So that’s why we decided to create this educational course where we’ve used actresses to pretend to be patients suffering with different scenarios. And so people can be a bit of a fly on the wall in a consultation, but we’ve sort of gone beyond that and linked it to evidence as well. So people can really read for themselves what the evidence is showing us and how we are enabling people to make choices as well. Because like you, I wasn’t given any proper education and no one would have mentioned perimenopause at all in any of my training. But actually, that’s really important that we pick up people early so that they can make the treatment choices that are right for them. And often it is in combination with hormones. But we have to also, I really strongly feel and I’m sure you do too, that as a menopausal woman, I have to look after my future health in looking at diet and exercise and everything else. And it all works together, doesn’t it?

Dr Laurena Law [00:06:13] It does. And in fact, I think one of the biggest gaps that I have seen is unless as a health practitioner, we’re consciously aware of this, we don’t actually ask the right questions. And so it’s not necessarily because we dismiss patients, but it’s just because it’s not in our awareness to check for the constellation of symptoms because there are so many. And it’s not just hot flashes or vasomotor symptoms, there are so many other symptoms, and they can be grouped and confused with other conditions like stress, for example, that again, those things actually do play a role and impact on each other. So I also find that a lot of women in Asia are very scared because they’re very conserved in terms of reporting symptoms. So I really have to sit down and just ask them if they’re present and if they are experiencing those, because unless you ask those questions, they’re not necessarily going to volunteer because they may not realise they are associated with menopause.

Dr Louise Newson [00:07:16] And that’s very interesting. And in fact, even when I go to menopause conferences, there’s still a lot of talk from other healthcare professionals about the menopause causing hot flushes, which of course it can for a lot of women. But it’s almost like that’s why we treat is for hot flushes. And then people don’t always realise the other symptoms. And I even was reading something last night that  quite an esteemed healthcare professional had written saying about all these symptoms that people are claiming to be menopausal, such as headaches and muscle and joint pains and mood changes, and saying it’s ridiculous that people think they’re menopausal. Well, actually, it’s not because there are a lot of people that it does cause those symptoms. But if we don’t talk and understand, we’re not going to move the needle at all. And certainly, when I did some menopause training, I was told that Chinese people don’t get hot flushes, so therefore they don’t become menopausal. And I just thought, actually whether you have symptoms or not, you have low hormones, don’t you? And then it’s really difficult. You’re not defined as a menopausal women by your hot flushes.

Dr Laurena Law [00:08:20] That’s exactly right. And I often find that Chinese women or I think, I’m not trying to generalise, but I do find that a lot of women, they feel somehow a sense of weakness if they come to reach for help and advice around menopause. So they almost feel as if if they don’t have hot flashes, then it’s like they don’t have a right to complain of these symptoms because they just have to push through it. And this is a conversation that I keep having because even before I was perimenopausal, I worked out. I was probably, you know, I’m very passionate about my fitness. I went into medical school because I wanted to learn how to prevent health, how to detect disease early. So I was very much trying to role model what I was trying to teach my patients in terms of lifestyle. And I was exercising. I was doing all the things about eating whole foods. I rarely ate any junk food, in fact. And yet I was still having migraines and I was fatigued, for the first time in my entire life I just had no motivation to exercise. And at that time, I actually even thought that I had to cut down work hours because I was just not coping and it didn’t make any sense to me. So saying that it’s just hot flashes, I think we’re just really minimising some of these symptoms and they are very, very debilitating because I found that with the brain fog that I experienced myself, that I couldn’t remember words, I couldn’t remember what I was trying to say. I’d be mid-sentence and forget something which I had known for a very long time. So I think having been there and having been able to find resources and to educate myself, to understand more about this really helped me to create a very non-judgmental space for women to talk about these symptoms and to ask these questions and explain that there is a biological reason that they’re going through this and to be able to support them through whatever decision that they make, but to at least give them the evidence around HRT and how that’s changed. And also to explain how the imaging around menopause is negative. And so there’s so much tied around our hormones and how we age. And because we’re living longer and women are also in the workforce. It’s something that’s very important to discuss. In fact, I was doing a seminar for India online and 50% of their staff are actually women and they realise that if they don’t address this early and they put it as a last priority, then kind of, you know, really not taking care of their health. So I think it’s important that we prioritise this and start to have conversations and educate women that they have options.

Dr Louise Newson [00:11:16] It’s so important, isn’t it? And I do often get very frustrated and feel very sad about the injustice to women and the barbaric nature that people are deciding the future health of women by refusing them to have hormones. And I was reading some papers the other day about osteosarcopenia. And for those of you that don’t know what it is, there’s osteoporosis, which is thinning of the bones. We’re more likely to break under very little pressure, actually. We know how common osteoporosis is. I’ve spoken about it many times before. And sarcopenia is this loss of muscle mass that happens. So when we exercise or even when we fall and we want our bones to be strong, we have to have good muscle strength as well, because our muscles are supporting our skeleton. And so we know with age and I’m sure you got taught at medical school, it’s an ageing thing. Is this sarcopenia, this loss of muscle mass? And that doesn’t sound too bad. You know, a lot of people don’t want their so-called bingo wings on their arms, but actually far more than that, we want to be able to use our zimmer frames. We want to be able to take ourselves out of the bath. We want to be able to put our maybe our grandchildren or our partner if they’ve had a fall. We want to be strong, physically, skeletally as well. And we know that there are receptors for estrogen on our muscle cells, on our brain cells, and they’re really important. So when estradiol stimulates these cells, there’s a whole cascade of events, isn’t there? There’s lots of cytokines that are very protective and building. So these cytokines, these chemicals work throughout the muscles in the bones. And they’re so important for our bone architecture and our muscles to work and function. So you go through or forward through the perimenopause and menopause, and what you’re describing is very classic. But we know there’s a pathophysiological process going on because if you haven’t got estrogen stimulating these cells, of course you’re going to get reduction in muscle bulk. You’re unable to exercise, you won’t have the same stamina, your muscles won’t have the same endurance. And so – and then we also know how important hormones are in our brain. So like you clearly say, if you don’t have the motivation because your brain isn’t being stimulated by hormones, then your brain’s not telling your muscles to exercise. There’s you know, the hormones are everywhere. So this whole thing that we’ve been denying the world female hormones, actually, even if you think about just allowing women to exercise more efficiently, that’s really important, isn’t it? And to be able to think better and then obviously spill over into the workplace. How can you remember things the same way if you haven’t got the same hormones in your brain, you know, you wouldn’t cut off other hormones to our brain that are really important. I’m not saying that everybody misses their hormones, but actually, you know, we should have a choice because you wouldn’t deny people other hormones that are biologically active in the body. I can’t think of any other hormones that are denied in the same way.

Dr Laurena Law [00:14:19] Yes, I do agree with that. And I think definitely when I talk to some patients who have been referred by other patients, they often get the message also that if they have been taking HRT, that they should come off it at some point and that they have been on it for ten years. And so therefore they need to come off it and from doing your course actually start it to, you know, again, realise that that’s actually a very individual choice and it really depends on the woman and their past health. And many of these women are physically active and they have maintain physical activity. Their blood pressures are good, they are not diabetic, they don’t have any kind of contraindications for HRT. And yet they’re being told that they now need to come off it. So that’s also another concern, in my opinion, because if they come off it and they’re symptomatic and actually some women are, they again start to get hot flashes and there’s no age limit as to when they stop. We all think, oh, well, it will stop in the ten years, but it doesn’t. It doesn’t necessarily occur that way. So again, there’s no one size fits all in terms of symptoms.

Dr Louise Newson [00:15:31] And that’s really important to know, isn’t it? I think I remember when I did my first lecture actually about menopause, it was to a group of GPs and before me there was a gynaecologist talking about fibroids and she just stayed for my lecture and one of the questions at the end was ‘What age do you stop taking HRT?’ And I said, ‘Well, there isn’t an age actually, because it’s just a hormone. And even if women don’t have symptoms, as soon as you stop it, you’ve got health risks such as osteoporosis and heart disease.’ And this consultant stood up and she said, ‘Louise, I completely disagree with you. I stop every single woman at the age of 70. A lot of women don’t thank me for it, but I don’t feel comfortable prescribing after 70.’ And then I thought, ‘Well, what are you doing to women if they want to carry on?’ And I’ve seen a lot of women who have really deteriorated physically and mentally when they’ve stopped hormones. And there’s some people who have very openly actually, in some of the Twitter abuse I get have been talking about how the hormones are addictive, the addictive quality of hormones and how we have to be limiting women hormones. And I have a real issue with that because exercise is quite addictive. Eating good food is addictive. You know, how do you define an addiction? Not all addictions are dangerous, actually. So does it matter that women are feeling better? Does it matter that women are able to exercise more and work better? What are the harms? I don’t know. Maybe you could tell me. Am I missing something?

Dr Laurena Law [00:16:55] I also have to share another personal experience, actually in my mother. And one of the reasons why I started weightlifting and resistance training was because my mother actually had a low impact fracture when she was in her late forties, and it was because she was osteoporotic at that age and at the time I had no idea. And she never mentioned about menopause or perimenopause. And this is another issue is that we’re taught about fertility and getting our periods, but there’s never been a time where someone has a conversation about menopause and how important it is to really start looking at lifestyle and the things that we can do to mitigate some of these things, regardless of whether or not we choose to take HRT for symptoms. I think that’s still another part of the piece because we have this false sense of security that, well, we don’t have as high a risk of heart disease as men, that once we go through menopause, the risk is just the same. And I was also reading research that women are less likely to be treated for heart conditions because it’s assumed that we have less of a risk. But the reality is that we do still have the risks. And if we don’t start treatment early, we are putting ourselves at high risk of heart attacks and heart disease. So there’s so many issues around not having knowledge about this earlier, which I honestly wish that my mother had had that because subsequently she went on to have two more fractures after. So although she’s relatively physically fit and healthy and very independent, I still believe that her quality of life would probably be that much better if she had been offered that early on. So I really wanted to talk about not just osteosarcopenia like all those things are really important for women to consider because we tend to look after other people.

Dr Louise Newson [00:18:56] Yes.

Dr Laurena Law [00:18:56] And we don’t really place ourselves as a priority until the very end. But so many of these risks can be mitigated if we know early how to do that. So that’s the reason why I’m so passionate about doing the education and the programming for women and just opening the discussion in this area.

Dr Louise Newson [00:19:17] Which is fantastic. And so in Hong Kong, I can’t imagine it’s better than the UK and it’s probably worse, isn’t it? So how are people responding to the work that you’re doing? Because, you know, you haven’t been doing it for that long. But I know you’re having some great conversations with all sorts of people and also companies as well, which is great, who’s starting to listen. But I mean, over here women are really loving it because there’s a lot of women who are really being very transformed by the knowledge. You know, they’ve got the power to decide what’s right for them. And I love this feeling that they’re helping themselves and in many different ways. But that’s really important. So is it empowering the work that you’re doing over there?

Dr Laurena Law [00:20:00] It is. It is. It’s very empowering. And every time I have this conversation, the women come back and all of them feel that now they have better knowledge. They feel more confident about making choices for themselves. And they understand how to have a conversation with a health provider, what risks to look out for, and just sharing openly that no one person has the same symptoms, but also sharing it with their partners, their employers, the men who they work with. Because I think it’s also difficult for men because they feel that’s such a mysterious condition. So demystifying a lot of that actually also helps open up the conversation and it becomes less embarrassing and not judgmental at all. In terms of treating and treatment options, there’s really only one licensed hormone transdermal product, Estrogel, in Hong Kong. We have micronised progesterone. And apart from that we don’t actually have licensed patches here so we can get them through but very, very specifically through specific imports for each patient. So it is possible, but it’s not widely available even in the public health system.

Dr Louise Newson [00:21:18] And what about testosterone for women?

Dr Laurena Law [00:21:21] Yeah, testosterone. We only have the licensed product for men here in Hong Kong. So a lot of women find it very difficult. But again, it is possible to get that through licensed for women, Androfeme is available through special importing, so that’s something that we are able to do or so far I’ve been able to do. So fortunately, in the learning where to source it and all those things have been very helpful and a lot of women definitely with low libido issues, they do find that testosterone helps them a lot with their relationships and partners. So I have to sort of say that once they start to have the conversation and they go through the process, they actually start to realise – I remember one woman saying that she felt like she found herself again, that she almost gave up and thought that she had lost herself and wasn’t her own person anymore because of the changes in her mood and her energy levels, both mental and physical. And then when she started the treatment, she just felt like she had regained herself. And so these types of stories help me to continue on looking for ways of providing better access to women so that, you know, we all have the option and the choice. And I think that’s important.

Dr Louise Newson [00:22:41] Absolutely. And, you know, it’s such a shame, isn’t it, that HRT isn’t readily available to everybody that wants it, so it’s a real battle, actually. And that doesn’t help the decision to take something, because if, you know, it’s so hard to obtain, then you automatically think, ‘Well, there must be a reason. Is it because it’s dangerous or because there’s a problem?’ And, you know, there are a lot of countries where it’s just impossible to get hormones and, you know, it would prevent a lot of disease if people were given HRT at the right time for the right reasons. We know there’s good evidence, like you say for heart disease risk reduction, osteoporosis, and there’s increasing evidence about dementia, type two diabetes, even obesity. And we know these are global health problems, aren’t they, that are here to stay.

Dr Laurena Law [00:23:27] Yeah. And also, Asian women are particularly at risk because of the slim body frame for serious sarcopenia. And so if we’re not actually looking for that early and having that discussion about that as well, you know, nobody’s actually assessing and screening women for bone health and DEXA scans are very accessible here. They’re not expensive at all to do. They really only add probably about a couple hundred Hong Kong dollars. And the university here in Hong Kong provides DEXA screens. They also provide physical assessments for sarcopenia, and it’s not costly at all. So it’s just surprising that, you know, having access doesn’t always mean that people are aware that it should be done. And healthcare providers are also not screening for this.

Dr Louise Newson [00:24:16] Which is really, really important, isn’t it? I mean, we have a DEXA scan here in my clinic, and when I opened the clinic, I really just fleeced my own bank account of every single penny and got a bank loan. But one of the things I bought in the first few months was a DEXA scan, and everyone thought I was mad because they were saying, ‘Come on, this is not a priority. This is the menopause, you’re not running an osteoporosis clinic.’ I said ‘No, because this is really important, actually, that people are aware of their bones.’ And I think so often people don’t talk about osteoporosis because again, it’s not something that is necessarily easy to know you’ve got it until suddenly you have a fragility fracture and it’s never too late. But what you want to do is prevent it. Like you said at the beginning, you want to prevent disease. And we can prevent a lot of osteoporosis, if it’s picked up early enough and we’re educated enough and we personally choose the right diet, the right exercise, often with the addition of hormones as well. And it’s the same for men too, of course. You know, one in five men will develop osteoporosis and one in two women over the age of 50. So, you know, there’s not many diseases that are that common with treatment, with a preventative plan as well. But it’s just being ignored.

Dr Laurena Law [00:25:31] Yeah, it’s definitely something that is, I believe, 100% preventable and treatable. And even here in Hong Kong there’s the cultural bias that, ‘Oh, because you’re a woman, you shouldn’t be lifting anything heavy.’ So the idea that I go to the gym and lift 100 kilos, it’s ridiculous. And I could hurt myself.

Dr Louise Newson [00:25:55] God.

Dr Laurena Law [00:25:56] Yet, you know, the studies clearly show that resistance training benefits women, but there’s still that fear. Although I do know that in some circles that’s changing and companies are supporting that. And also some gyms are actually specifically designed for women. I think that’s helped a lot. But still, there’s a lot of women that I talk to about you know, ‘What about your bone health? What are you doing?’ There’s still a lot of resistance because it is quite challenging. It’s scary, especially if it’s not something that we’re used to doing. So again, I say that, you know, you just start with small steps, start with small things and we’re here to support. And a lot of the providers, personal trainers that I know personally, are very, very experienced and they are very supportive of that. So again, we just we have to check it. If we don’t, there’s no pain, there’s no symptoms around that. So it’s something which it’s a silent condition.

Dr Louise Newson [00:26:51] So it’s really important. And I think what you’re doing to educate women and others about what the menopause means, what the future health risks are, and ways of to improve your health is pivotal, actually, and it’s going to make a big difference. So it’s great that you’re doing this. So before we finish, have you got any tips? So I always do these three take home tips and really keen actually to hear the three sort of top tips that you will give patients and women that you speak to to try and improve their future health.

Dr Laurena Law [00:27:25] Well, the first thing actually I say to women is get a hold of the menopause symptom questionnaire and do it yourself, because there’s so many more symptoms than you think there are. And do them regularly because the symptoms will change over time. Just because they’re not there this month doesn’t mean they won’t be there in six months time. So knowing what your symptoms are means that at least you have a talking point with your health provider when you want to know what your options are in your country, wherever you are. And the second thing is to find a health provider who actually has been updated with the information and has done the courses and knows what the contraindications are and what the clear indications are as well, who’s going to be able to help you go through this transition. And the final thing is to find a support group of women who are also going through this, because we’re not alone and we think we are. But until we start actually sharing this information, we don’t realise that other women are going through it as well. And so having that support while we’re having physical changes, I think that’s very important to have someone to talk about the problems and the challenges that we’re going through. I think that’s very important.

Dr Louise Newson [00:28:38] Absolutely. I totally echo that. And I think because as women, we are actually quite good at talking once we’ve got the right information and helping each other and looking out for each other as well, I think is really important and you know, getting men on that journey as well to help. So it’s a big team effort and you know, it’s really good to have a global effort as well. And, you know, being able to access information that’s right for you and the language that you want is really important as well. So I’m really grateful for your time and it’s been really enlightening hearing how things go. And I’m hoping with time you’ll be able to come back and tell us how much work you’ve done and how much improvement there’s been over in Hong Kong for menopause care for women.

Dr Laurena Law [00:29:19] I look forward to that and so thank you so much for having me on this podcast. It’s been a wonderful journey.

Dr Louise Newson [00:29:24] Thanks ever so much and take care.

Dr Laurena Law [00:29:26] Take care.

Dr Louise Newson [00:29:30] For more information about the perimenopause and menopause, please visit my website balance-menopause.com. Or you can download the free balance app which is available to download from the App Store or from Google Play.

END.

The post Improving menopause care in Hong Kong with Dr Laurena Law appeared first on Balance Menopause & Hormones.

Rupa Lyall is a clinical pharmacist who works in a GP practice in Buckinghamshire seeing patients with minor illnesses and prescribing medications. In this episode she tells Dr Louise Newson how she became interested in the perimenopause and menopause and how, through the training on fourteenfish.com and resources on the balance website, Rupa now supports and educates other clinicians in HRT prescribing.

Their conversation covers raising awareness among professionals, working with patients from BAME communities, the importance of empowering women to improve their quality of life and the transformational effects of hormone replacement.

Rupa’s 3 tips for pharmacists interested in the menopause:

1. Go to https://www.fourteenfish.com/menopause/welcome and do the ‘Confidence in the Menopause’ course
2. Don’t be frightened of the menopause, learn more and talk to others
3. Speak to patients about their HRT, ask them how they’re doing, especially in the community. You will learn a lot by doing this.

Episode Transcript:

Dr Louise Newson [00:00:09] Hello. I’m Dr. Louise Newson and welcome to my podcast. I’m a GP and menopause specialist and I run the Newson Health Menopause and Wellbeing Centre here in Stratford upon Avon. I’m also the founder of The Menopause Charity and the menopause support app called balance. On the podcast, I will be joined each week by an exciting guest to help provide evidence, based information and advice about both the perimenopause and the menopause.

Dr Louise Newson [00:00:46] So today with me in the studio, I’ve got Rupa, who I’ve never actually met before – like a lot of people I seem to podcast. I’ve corresponded quite a lot over the internet and now I’m delighted to meet her virtually. But at least I can see her face and listen to her now. So hi Rupa, thanks for coming.

Rupa Lyall [00:01:02] Hi Louise.

Dr Louise Newson [00:01:03] So tell me a bit about – you’re a healthcare professional but you’re not a doctor, you’re not a nurse, you’re a pharmacist. And pharmacists, in my mind, have a really, really crucial role for many reasons. But obviously all I think about is the perimenopause and menopause. And when it comes to care of women, actually, pharmacists, I think, have been neglected for quite a long time about how important they are and the pivotal role that they can really have at improving the future health of women and actually avoiding them going to see their GP sometimes as well. So tell me a bit about your work and why did you even decide to be a pharmacist in the first place?

Rupa Lyall [00:01:40] Wow, that was 18 years ago I made the decision – a long time, and pharmacy has changed since then. We were only really looking at working in community or hospital. But now as years have gone by, we can now be prescribers, which is what I am and we are now able to go and work with GPs in GP practices, which is amazing. But a lot of pharmacies have bad experiences in GP practices and are used as admin work rather than yes, really utilising our skills, but I am fortunate that I work with an amazing practice. Dr Bhupal, Dr Morrell, they’re my mentors. I’ve been there for about two and a half years and any interest that I have, they’ve supported me. I can knock on their door, I can do anything and ask questions about patients. They’re there always.

Dr Louise Newson [00:02:22] Amazing. So you’re actually consulting patients as well.

Rupa Lyall [00:02:26] I am, I’m consulting them face to face as well as video and telephone calls. I specialise in minor illnesses, depression and now menopause, and that ties in nicely with the depression side of things, because we tend to treat women and men separately for certain conditions, women, especially for the conditions that are linked to their hormones, we’re treating them separately for and I have found that now we can treat them as a whole and really get into those symptoms that they’re suffering from. And it’s amazing and I’m seeing really good results. Likewise with the GP’s that I work with, they’re getting into it as well. They’re getting more confident with your teachings, to be honest. Louise.

Dr Louise Newson [00:03:07] Great, it’s lovely to hear.

Rupa Lyall [00:03:08] Your platform really made us all confident and I’m talking for GPs as well, and it gives that patient the empowerment to feel – you get the sigh of relief from them when they say, ‘Oh my God, that’s me’.

Dr Louise Newson [00:03:21] Yes.

Rupa Lyall [00:03:21] When you show them the menopause questionnaire especially, that’s my tool that I use. I always say to them, ‘Here, have a look.’ And they’re just ticking all the boxes. ‘That’s me, that’s me. That’s me’.

Dr Louise Newson [00:03:31] And some people find it really reassuring to know that there is something that is causing their symptoms, isn’t it? Because I spoke to a lady this morning and she told me she had to give up her job because she was unable to string a sentence together, let alone hold a board meeting, turn up for work. And she said it was awful, actually, and it’s still taking a while for the hormones to work. She’s so much better than she was, but it’s very scary. And how do you admit to people that something’s happening when you don’t know the reason? It’s so much easier. If I had a big rash on my face, I could say, ‘Oh, if I look at this, this is really painful’. And you’d say, ‘Oh, I’ll give you some cream’, or ‘I’d recommend you have some treatment and it will improve’. But when it’s, especially when it’s emotions, that’s something that you don’t know… another lady I spoke to today was having really bad palpitations and she was under the cardiologist, she’d had some heart investigations, they were all normal. And she was just told, ‘Well, there’s no cause, your heart’s normal’. But it’s probably related to her low estrogen. But she was just sent away and that was it, you know? And that’s very hard, isn’t it?

Rupa Lyall [00:04:43] It’s very hard yeah. But we, you know, the women that I’ve treated so far, I’ve had good results from. With some it does take time and a bit of tweaking with the doses which they’re aware of. We go through everything with them, but on the whole, it’s serving a bigger purpose.

Dr Louise Newson [00:04:58] Yeah.

Rupa Lyall [00:04:58] It is working.

Dr Louise Newson [00:04:59] So how did you get into the menopause then, because did you get any training as a pharmacist on the menopause?

Rupa Lyall [00:05:05] Zero, zero, there’s no training at all. I actually came across your FourteenFish training material. Which I joined and then I just started listening and looking at your videos and I thought, this makes sense. This isn’t as hard as I thought it was. And then I started talking to other GPs and who are using your material as well and have gone through your training programmes. And it just started gelling, especially with the depressed ladies that I see. And now I’m targeting people in the BAME community.

Dr Louise Newson [00:05:34] Yes.

Rupa Lyall [00:05:35] Because I speak Punjabi, so I can explain to women who are Punjabi speaking.

Dr Louise Newson [00:05:42] And how are you finding that? Because I find just in my experience that certain groups of women, it’s so much harder to talk about it openly as well. And certainly in BAME communities, there’s a lot of stigma and shame almost associated with menopause.

Rupa Lyall [00:05:56] There is, yeah. And a lot of them don’t actually – because I see a lot of women from Pakistan and a lot of them aren’t even aware of it, to be honest. They don’t know. And sometimes explaining it in Punjabi can be difficult. But I try to do the best I can. Or they bring other family members like their daughters or, you know, sisters or whatever it is, and it’s working, but it’s just them being compliant on it as well.

Dr Louise Newson [00:06:20] And how do they feel about taking HRT, some of these women?

Rupa Lyall [00:06:23] So far it hasn’t been a problem, but there is a bit of scepticism around it. They’re not sure or they want to investigate it more, but I would like to target those women a bit more now. And that’s important because again, we’re treating them for separate things and it’s not working.

Dr Louise Newson [00:06:40] Yeah, and certainly certain groups of the BAME community, other women as well, have an increased risk of heart disease and diabetes, don’t they. And so I really worry because there are so many women who are on statins for their raised cholesterol and blood pressure treatment. They’re often on painkillers because they’ve got pains in their joints and muscles and as you say, antidepressants as well. So that’s four, at least, medications that they might actually not need, isn’t it?

Rupa Lyall [00:07:08] Yeah, that’s right. And likewise, working in community as well. So community pharmacist now, I think we really need to be upbeat about this because, you know, over the counter, we see women coming with prescriptions for HRT more and more now seeing the patterns: the gels and the progesterone capsules and all of this kind of thing going on. And we should be counselling them. We should be asking them how they’re getting on with it. What benefits are they seeing? Are they consulting their doctor? So, I do a lot of coaching with patients over the counter just to make sure that they’re getting the right advice and treatment ongoing from their doctors as well. And they appreciate it because now they can come back to you and say, ‘right, okay, what do I do? ‘

Dr Louise Newson [00:07:45] Yeah and I think that’s really important because certainly for those of you who’ve listened before, HRT is not a one size fits all. And I spoke to a lady this morning who was really frustrated. She’d started HRT three months ago, and she said, I’m reading about all these women that feel great and I’m not. And she said, ‘Some of my symptoms have improved, but a lot haven’t’.

Rupa Lyall [00:08:07] Yeah.

Dr Louise Newson [00:08:07] Well, you know, firstly, three months is a short period of time. Secondly, she was on quite a low dose of estrogen, which needed probably increasing. She’d only recently started testosterone, which can sometimes take several months to have an effect. But just to know that it can take time and also to know that women are allowed to increase the dose if they’re still getting symptoms is fine because the hormones are so safe. And I think it’s absolutely right to empower women so they can make decisions with some support, but they don’t have to have consultations with their GP every single step of the way, do they?

Rupa Lyall [00:08:44] That’s right. That’s exactly right. And the resources that they can go to as well, like the balance app, balance website, the factsheets and information booklets that you’ve got on your Newson Health. I tend to direct patients to that, and they get a wealth of information and then confidence as well because a lot of their questions are answered in those resources.

Dr Louise Newson [00:09:05] Yeah, which is important because it’s a lot to take on board, isn’t it? And certainly, if you’re like me when I had low hormones, I couldn’t remember anything anyway. So you could have a consultation and think, ‘Great, I’ve done a good job there.’ But then the woman goes out in the room. And ‘well what does that say, I’ve got no idea?’

Rupa Lyall [00:09:21] Yeah, that’s right. So, you know, this is something that I feel very passionate about and pharmacists now need to be confident to take on this topic. You know, it’s not difficult and it would make them feel good, actually, because they’re going to be having such a great impact on so many lives.

Dr Louise Newson [00:09:38] You’re absolutely right. And I think in the past, people have thought it’s complicated. And I was at a meeting yesterday and people were saying it’s become very complicated, prescribing all these hormones separately. We shouldn’t be doing this. And I think it’s very straightforward when you do the hormones separately because women can then be in control, they can work out which bits are working for them or if they’re getting side effects, which bit that might be. And actually, I think to take the mystery out of the menopause is really important because when you’re not taught about something, you sort of avoid thinking about it almost, don’t you?

Rupa Lyall [00:10:15] That’s right yes.

Dr Louise Newson [00:10:16] And in my mind, it’s always been thought of as something that causes some hot flushes. It’s just something – an inconvenience, really, that women would experience – part of a natural process. Whereas when you think actually what it means, with a hormone deficiency, with the myriad of symptoms that can occur – someone was saying to me yesterday, ‘well, a lot of the symptoms of course are just natural ageing and not due to menopausal symptoms’. But actually, we know that when you replace hormones, they improve. And you could say the other conditions are due to natural ageing, such as raised blood pressure or arthritis, but we still treat them don’t we? So I don’t see why we have to ignore the menopause or some of the symptoms associated.

Rupa Lyall [00:11:00] Yeah, and all the risks involved. I think people have already made their minds up, some of them, oh you know, ‘I don’t want to because, you know, breast cancer’ and all sorts. But now – especially with your material – we can reassure them that, you know, that we said we can do this.

Dr Louise Newson [00:11:13] Yes. And I think it’s very hard, isn’t it, because we’ve always been fed about risks, risks, risks. And there are risks as you know, more than me being a pharmacist, of any medication, isn’t there? There’s always a potential problem. But actually, we have to then think about the benefits. And the evidence is so clear about the many health benefits of taking HRT. And a lot of women have never heard of any health benefits, have they?

Rupa Lyall [00:11:37] No, they haven’t. But yeah, I think, you know, the ongoing work that I certainly plan to do this for a while.

Dr Louise Newson [00:11:46] Great. But it’s also very I mean, I find the work frustrating because so many women are suffering. But actually, day to day, when I see patients, it’s absolutely transformational medicine, isn’t it? I can’t think of any other area of medicine where I can pretty much guarantee that in 3 to 6 months my patients will start to feel better and their future health will be better as well.

Rupa Lyall [00:12:11] That’s right. And giving them the additional lifestyle advice diet, which you provide on your website. I mean, I have some of the courses that I do for my GP work, tutors that I have, they’re coming to me for advice. Just for information. And they’re like, ‘Oh, this is great’. But it’s because I talk about it so freely and positively, but also give them that the one size doesn’t fit all. And I know they’ll just be sure of that. But it doesn’t matter because we are raising that awareness. We’re telling them to look into it and then they can make their decisions as well that they need to.

Dr Louise Newson [00:12:46] Yeah. Which is so important, isn’t it. And are you involved in any training of pharmacists at all?

Rupa Lyall [00:12:52] The GP practice where I am, they do do training for junior doctors and pharmacist prescribers are on the course, so sometimes they sit in with me as well, which is nice. They can see what I’m doing and we work together on a lot of things as well. So yeah, I am involved in a little bit of it, but not to a major extent. But yeah, I’d like to.

Dr Louise Newson [00:13:13] Yes. And it’s having this ripple effect, as you say, that I think, I feel for every one person I tell there’s probably 10 or 20 people that benefit because they all talk, whether it’s patients talking together or whether it’s healthcare professionals talking together. And it is about confidence I think, is really important because I know that I learnt the most from sitting in consultations and for some of you that know the FourteenFish course, we’ve got some videos of consultations where we can see how it works actually. And in fact we’re videoing some more today to add some more different cases on. And we’re also using those consultations in the balance app, the balance plus area, people can watch those consultations and they can just try and hopefully learn what the conversation should be like. And also allowing women to be really involved in their consultations, I think is really important, isn’t it?

Rupa Lyall [00:14:12] 100%, definitely. Yeah. So we just need to keep going and raising the awareness. I think pharmacists as well can do a lot in terms of outside of pharmacy going into workplaces as well. I think that’s quite important how we can support women there.

Dr Louise Newson [00:14:27] Yes, because there’s a huge amount in the workplace and I feel actually quite sorry for some of the workplaces because they’re almost being forced to doing their policies, increasing awareness, but they don’t quite know how to do it. And then there’s all this narrative of, ‘well, perhaps women could sue you if you didn’t treat them properly or listen to’. But actually, what women really want is the treatment. So then they can not just carry on in the workplace, but they can hopefully get promoted or they can increase their hours or they can change their job role. And so many women have said to me, ‘well, of course, now I’m menopausal, I’ve taken a different job, I’ve reduced my hours. I couldn’t expect to have the same high-powered job’. And I feel really sad about that because we’re losing a lot of really good workforce. And, you know, when we think 40% of the NHS workforce are menopausal women, yeah. And we hear about midwives, nurses, GPs, people leaving all the time. Yeah, of course it’s not all going to be menopause but I can one thousand percent say that some of it will be.

Rupa Lyall [00:15:30] I had a lady who used to use the same route to work driving on the motorway 20 odd years or so, and suddenly she just became anxious about using that route. You know, it’s just the smallest things, but it has such a massive impact.

Dr Louise Newson [00:15:44] Absolutely. There’s a huge number of women that stop driving or like you say, stop driving on a motorway. One lady I spoke to recently said she used to forget how to fill her car up with petrol. She used to have to phone her husband and say, ‘talk me through what I do, how do I fill it up and where do I go to pay?’ And she said it was very, very scary. But as soon as she started taking HRT, that came back it was just a natural process. But she really thought she had dementia. She was going to stop work. I mean, how can you work if you can’t even fill your car up with petrol? It’s very scary, isn’t it?

Rupa Lyall [00:16:17] Very. And if we can share stories like this as well, I think that’s important. You know, the good and the bad ones. I think that would be another empowering aspect of us raising the awareness. So yeah.

Dr Louise Newson [00:16:27] Yeah. I think it’s really important that women know that they’re not alone. And actually, if women are still experiencing symptoms on HRT, then they should still get help because there are lots of women who say, ‘well, my night sweats have gone, my headaches have gone, but I’m still finding my memory or my mood affected’. And of course, we don’t know whether it’s related to their hormones, but I feel that women should have their hormones optimized, and then they can see what’s left almost.

Rupa Lyall [00:16:54] Yes, definitely. You know, it’s definitely where I am. You know, it’s definitely something that I am finding that women are interested in and want to know more about. I’m on a GP pathway course at the moment. It’s an 18-month course I’m coming to the end of. And I was on a tutorial session and I just mentioned you and what I’m doing and everything and the session just turned out to be about menopause and everyone was taking notes, ‘what’s the website?’, ‘Doctor who?’

Dr Louise Newson [00:17:22] That’s great.

Rupa Lyall [00:17:23] That’s why I have tutors calling me and asking have I got some time just to discuss a few things. But why not?

Dr Louise Newson [00:17:30] I think so. And I think it’s crucially important. Everyone knows because it’s every woman, you know, you’re talking about people who are depressed earlier. Of course, that is very important, but not 50% of the population will be depressed. But I’ve been looking at some of the antidepressant prescribing, certainly in England and twice as many women than men receive antidepressants. And obviously there are other reasons, but I’m sure hormones are related. And I really, really strongly feel that any woman taking an antidepressant should have the question asked, ‘Could your hormones be associated with your low mood?’ And some women need both antidepressants and HRT, but there’s still a lot of inappropriate antidepressant prescribing when we should be considering HRT first line.

Rupa Lyall [00:18:19] Definitely. And a lot of women do feel better when they get the feedback from their husband or their partner. And, you know, it’s made a difference. ‘I can see a difference in you’. So that’s what women tell me after the three-month review that I have with them, that ‘my partner, my husband’s noticed that I’m in a better place’. So that’s another sort of tool that they use for their monitoring I suppose.

Dr Louise Newson [00:18:38] Well I think is very important it’s like anything isn’t it I think, any illness or any chronic disease, when you’re living with yourself all the time, you don’t notice the difference and you really need other people to monitor. And sometimes when I see patients in their first follow up they’ll say to me ‘Oh I don’t feel any better’. We get them to fill out a symptom questionnaire and you can see that their ticks have moved to the left. And I said, ‘Well, actually you do seem better and your symptoms are less’. And then I read out the notes that I’ve made in that first consultation. And they go, ‘Oh yeah, I forgot I was that bad. I forgot I was shouting all the time and had no sleep. And, you know, getting out of bed was so uncomfortable.’ Because it’s a gradual change, but I think it’s great because these women are getting better. But then in the same way, there’s a gradual deterioration often during the perimenopause and menopause. And you sort of accept that you’ve maybe put on a bit of weight and that you’re a bit more irritable and life’s a bit more difficult. And I mean, I was getting to a stage where loading some washing was just more of an effort, and I would just delay it by a day cause I thought I can’t be bothered to unload the washing machine. It’s going to hurt my joints. I just want to sit down, and you just accommodate and change in a very negative way, really. And it’s only when your husband comes home and says, ‘why are there no clean…’ whatever, you’re like ‘because I’ve not done the washing’. I mean, that sounds very sexist. He does use the washing machine, but, you know what I mean, there are things that fall apart a little bit that no one probably would notice other than those who are nearest and dearest to you or someone in the workplace. You know, I know when I was working, I just found everything overwhelming. I’d look at the visit book and think, oh, my goodness, how am I going to get all those visits done, getting in my car how am I going to find out where to go? And I couldn’t tell anyone because I felt that I was just failing. But if someone had said, ‘Oh, Louise, you look a bit worried, are you okay?’ Then start that conversation. And ‘had you thought maybe some of it could be your hormones?’ I wish someone had said that to me and it’s those just open conversations, isn’t it?

Rupa Lyall [00:20:47] Definitely. And for the women that are, you know, in their early forties, it’s important that they’re aware of it. They’ve not started on anything yet that, you know, the long-term benefits are going to be very important here as well. Just think about it yes.

Dr Louise Newson [00:21:00] And there’s a lot of women I don’t know if you see them, but we certainly do who have missed out on HRT. You know, they’re sort of now in their 60/70s.

Rupa Lyall [00:21:07] That’s very right. There’s a lady that I worked with at Boots, she’s in her sixties and she never went on HRT and I always said to her I wish you could have done because she’s suffering from so many of the symptoms, especially joint aches and pains, and she’s crippled by it as well. And she’s on all sorts of medication now for it. And I just always say I wish she had been on HRT before.

Dr Louise Newson [00:21:27] Well it’s never too late, is it?

Rupa Lyall [00:21:30] Yeah, I advised her to go back to a doctor now and, you know, discuss it fully. But I hope won’t get brushed off.

Dr Louise Newson [00:21:35] Well, I hope not. And there is a leaflet on the balance-menopause website about starting HRT many years after your menopause. And for a lot of women now, as you know, because it’s the body identical hormones, the estrogen through the skin without a risk of clots, you can usually safely start HRT in older women. Even I’ve had some patients in their eighties or even nineties started HRT because, you know, we don’t know if their symptoms are related, but we know that even small doses of estrogen can increase bone density. And osteoporosis is so common. A lot of women who are older have vaginal dryness, urinary symptoms, don’t they? So even if they didn’t want to try systemic HRT, they could still safely use vaginal estrogen preparations. And certainly, pharmacists who are selling cystitis relief type preparations should really be thinking about that, shouldn’t they?

Rupa Lyall [00:22:36] Exactly, well we’re missing the bigger picture. You know, when we do, like I said before, treat the individual symptoms. A few patients at the surgery that I treat for recurrent UTIs, I’ve now put them on the Vagifem and let’s see how they get on because it’s bound to be associated with that. So, we’ll see about what’s causing it and you know what triggers it off.

Dr Louise Newson [00:22:57] Yeah, absolutely. So it is really important, the whole awareness and I think lots of people think it’s a GP problem, the menopause, and it’s not just for GPs to be educated and informed. And certainly, I look at the data of the FourteenFish course, it’s a free course called Confidence in the Menopause that anyone can access. We found that there’s a good proportion of pharmacists that are doing the course, which is great actually.

Rupa Lyall [00:23:25] Yeah. You know, I’m hoping that more and more pharmacists now will find the confidence and the interest really to really talk about this and develop themselves further. That’s important.

Dr Louise Newson [00:23:37] Yes. And a lot more pharmacists now can prescribe, can’t they?

Rupa Lyall [00:23:40] Yep. It’s growing. And when you do the prescribing course, you’re always asked for an area specialty. If I had known about it, I did it about four years ago, I would have done the menopause for sure. But now, you know, hopefully they’ll be selecting that as their area of specialty. So, not then, you keep developing yourself further.

Dr Louise Newson [00:23:58] Yes. And I think it certainly is an area that covers so many other areas as well. So even if someone was interested in diabetes, well, obviously, menopause is, you know, a risk factor for diabetes. If they’re interested in heart disease, we know there’s an increased risk, you know, mental health, it sort of ticks all the boxes. But the other thing I think pharmacists are really important for is trying to reduce medication. So we have this whole thing called polypharmacy, which basically means lots of drugs. And it’s very easy as a clinician to add on more and more medication without removing medication. And we do this even with blood pressure. We know about probably a third or so of people with who take antihypertensives probably could reduce them with time. And I always used to, if the annual review of blood pressure was normal and it had been normal for a little while I try and reduce medication because most medications do cause some side effects and people can feel better. And you know, I’ve done it lots before with people who have type two diabetes. They’ve changed their lifestyle, they’ve reduced weight, but they’re still on loads of diabetes medication – well, they don’t need to, they come off and they suddenly feel even better. And so with menopause, especially when people have been menopausal for many years, they are often on layers and layers of drugs to treat their individual symptoms, aren’t they? And so I’m sure you do it, and I certainly do it is once a woman is more stable on HRT, we then start to think about medication that she can reduce.

Rupa Lyall [00:25:32] That’s right. Yes. And I think it’s great that this pharmacist and GPs can work closely now as well, especially with this topic. I certainly do and it’s a great discussion that we have as well. So you know the GPs and the pharmacists in the area of menopause are probably at the same level, if you could say, of developing themselves.

Dr Louise Newson [00:25:49] Yeah. And I think that’s so key I mean, all the work I do is multidisciplinary and involving all members of the team. And I don’t think anyone is more or less important than anyone else. And I think if we can learn from others, it’s only going to excel our knowledge, but also it will be transferable to our patients, which are the most important part of this conversation. And having time is actually really important. But also, I think some patients find it less threatening, actually talking to pharmacists or nurses than they do to doctors. And it shouldn’t be like that. But I think they often open up a bit more, don’t they?

Rupa Lyall [00:26:25] I’m like I said, I’m privileged. I’m blessed actually to be working in this practice because we’re all clinicians, you know, there’s no hierarchy. That’s why I’ve been able to develop myself further, because I’ve come from a complete retail background and when you’re in a retail background, you lose all your clinical skills. And I found that daunting to go and I think open up a BNF. I haven’t done it for years, to be honest, because I’ve had that support from the doctors, so I’ve been able to really expand myself and help so many people. And I think everyone needs to be in the practice like this and if not then encourage the GPs to work with pharmacists, you know.

Dr Louise Newson [00:27:02] Yeah, absolutely. And it’s so brilliant and so liberating hearing the work that you’re doing and so just keep it up and thank you very much for your time today. So just before we finish, can you give three tips? And I’d really like if there – I’m sure there will be some pharmacists listening – so three tips for people who are pharmacists who are thinking, how can I do more in the menopause? So what are the three things that you would recommend for them to do?

Rupa Lyall [00:27:26] First of all, go onto the FourteenFish website, get yourself signed up to it, and listen to Louise’s videos and watch her role plays because that’s what gave me the confidence. Secondly, don’t be frightened of this topic. Go for it. Just learn more about it. Talk to others about it. And thirdly, the world’s your oyster. Just speak to patients about their HRT prescriptions, especially if you’re working in community. I think that’s the key. When you see women coming in, just ask them how they’re doing. No need to, you know, start a whole discussion about it. But in terms of just ask them how they’re getting on, you’ll get a lot of information from them to help you develop as well.

Dr Louise Newson [00:28:06] Lovely, great advice and really empowering and just keep up the good work. Thanks ever so much, Rupa, for coming today.

Rupa Lyall [00:28:13] No, it’s a pleasure. Thank you, Louise.

Dr Louise Newson [00:28:17] For more information about the perimenopause and menopause, please visit my website balance-menopause.com. Or you can download the free balance app which is available to download from the App Store or from Google Play.

END.

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Dr Nneka Nwokolo and Dr Martina Toby are both consultant physicians in sexual health and HIV medicine, and together they have joined forces to help educate and advocate for women of colour experiencing perimenopause and menopause.

In this episode, the experts share what prompted them to set up the ‘Shades of Menopause’ Instagram group and the benefits of using social media to support women of colour. Together with Dr Louise Newson, they discuss some of the socioeconomic and cultural factors, as well as gender inequalities that affect a woman’s experience of healthcare, and the unfortunate lack of research around use of HRT in women of colour.

Nneka and Martina’s three tips to women of colour:

1. Do your own research and ask other women about their experience
2. See your GP for help. Ask who is the best person to see at your practice. Go equipped with knowledge already, and you will get a much better outcome.
3. You are not alone, millions of women like you are going through it. If you feel you can’t speak up, find a friend who is willing to do it for you. Your voice matters and needs to be heard.

Follow the podcast guests on Instagram: Shades of Menopause.

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