Free Your Mind With LKJ – Dr Katie Barber, Menopause, Let’s Talk The Real Results

Hello and welcome to this week's edition of Free Your Mind. Let's talk about it. Today we are going to be talking about menopause and how menopause affects us and why we need the law to change and include menopause as a protective characteristic. I have Dr. Kate here, Dr. Katie Barber, who I'm going to bring straight in to say who she is. And she's such a wonderful specialist here. So, Kate, can I bring you straight in? Absolutely. Hi, do you want me to introduce myself and tell you a bit about myself? Yes, that'd be wonderful if you can. Fabulous. So I'm Katie Barber. I live in Oxfordshire. I'm a GP first and foremost, but a women's health and menopause specialist. I've been working in Oxfordshire as a GP for well over 15 years, um, and really I started loving women's health as a GP trainee when my trainer was really passionate about it. And so I did extra diplomas from the Royal College of Obstetricians and Gynaecologists and the Faculty of Sexual Reproductive Healthcare during my training, and then I did quite a lot of extra specialist attachments in gynaecology during my medical school years and my junior doctor years. I started working at the John Radcliffe in the gynaecology department, um, all good, well over 7, 8 years now. Um, and that's where my love of menopause really started because I was seeing lots of women with gynaecological problems but also menopause issues. And so I did some training and additional specialist clinics in menopause and really loved it so much I went on to become a British Menopause Society specialist with the accreditation that they offer, and I also train. So I'm a menopause trainer and train other healthcare professionals to become menopause specialists. So that's really my background. I'm now clinical lead for community gynaecology in Oxfordshire, so I see women with lots of gynaecological problems that we can address in the community without them needing to go to secondary care, including menopause. And I launched a private menopause service about 18 months ago called Ox of Menopause, which is going from strength to strength. And with all the publicity about the menopause, it's, it's, it's something that I'm really passionate about, making sure women are empowered to have the right information and get evidence-based treatment and options available to them. Yes, because it has changed, hasn't it? You know, when we were going to talk about HRT in a moment, and I was in the category of these surgically induced menopause and didn't have much knowledge about HRT at the age of 25. Was put on the day after surgery and then was told, I went to see my doctor for my checkup, oh, you can't have this. There's a risk of breast cancer because of, you know, family history. And I was taken off it and basically had to go cold turkey and had a horrendous time with it. You know, the immense nightmares, the sweats. You know, you would be there and be like, I can't breathe, I can't breathe. I just need to get that air straight away. And irritability and everything like that. So it does affect— it affects men as much as it does women, as well as your work colleagues, people around you, because you are really suffering at the hands of menopause. And it is something that you're not told about as a child, because when you're a child— and for myself, when I was introduced to adolescence and in the bathroom thinking I was dying and screaming for my mother, who then explained the birds and the bees in her shy way of explaining it. And about the reproductive system, but never touched on menopause because it would be quite scary to be told that then and to then hear about the menopause. So it's not something that you're really taught or spoke— was spoken about, you know, through adolescence and going through. Just if you was to be pregnant, you wouldn't have your normal monthly menstrual cycle. And for that, I think for any mother that is listening, and I know at that time when you're telling your child, you haven't experienced menopause yourself, so you haven't gone through it. But I think if you have gone through it, you are 45 to 55 and you have gone through that, to explain to your daughter or even to your son that, you know, these are things that happen, you know, that you have a conversation, it's your son and say, God, you know, I think I drove Dad round a twist, you know, because with my mood swings or things like that. So you're teaching them when you're facing it what to go, what's to be there. And we should speak more openly and freely. And it should, I believe, under law be characterized in the fact that our— it should be protected characteristic. Because before we talk about HRT, it's been in the press. I mean, we are talking menopause a lot more, but that poor lady subject before she got sacked by her boss was, um, had menopausal comments thrown at her. It's just wrong, isn't it? I mean, you've touched on so many things in what you've just said, which I think is just brilliant because they're really common themes that are often not correct, you know, not correct about menopause. Um, you know, yes, natural menopause, we expect women to have menopause at 45 plus, so that's our natural ovarian decline when our ovaries are essentially running out of eggs to ovulate. We have a lifetime finite amount of eggs which we ovulate, and when they stop being available to ovulate, they're all gone. That's when our ovarian function deteriorates. So the hormonal changes we get are a result of ovarian failure, as it is known. Now, for most women, that's 45 plus, and that's an expected age of menopause. But, you know, you've, you've described your personal story where you've had a surgically induced menopause at 25, which is far earlier than we would recommend women are having any loss of ovarian function because it has massive impacts not only for well-being and symptoms, but also on things like your cardiovascular health, your risk of dementia, your risk of bone density loss, which are all increased if you have an early menopause. So for young women, women under 40, we actually advocate them taking HRT until the natural age of menopause, which is around the age of 51 in the UK. To protect against those adverse life effects from those chronic health conditions. And it's really important that that cohort of women recognize that using HRT at a young age does not significantly increase your breast cancer risk. You're just replacing the hormones that you're not producing in abundance. And that's a different category of women to women of 45 plus who are using HRT to control symptoms and wellbeing. But also that group of women have benefits aside from wellbeing. So we know that women who use HRT within 10 years of the onset of symptoms and before the age of 60, their cardiovascular risk is reduced, their osteoporosis risk is reduced, but also diabetes, colorectal cancer. So these are huge lifetime benefits. I mean, cardiovascular disease in the UK has a more significant impact on women every year than breast cancer, but you always see the headlines talking about breast cancer. The other thing that you've touched on beautifully is, is education and, um, It's really interesting. I've got a 10-year-old, nearly 11. She's in her final year of primary school and she's been doing PHSE classes at school over the last year. And she obviously hears mummy, me, talking about menopause incessantly at home. And bless her, she said to the teachers when they were talking about puberty, can we talk about menopause as well? Because my mummy knows all about that. And I think it's really important we talk about what happens after we stop our periods as well as what happens when we start them. So that conversation is starting, and I know schools are fantastic now about introducing more and more relevant topics. But you're right, menopause menopause needs to be discussed, whether you've got a son, whether you've got a daughter, with your family members. They can recognise this for you, and it has an impact not just only on you but them, your work environments, and your colleagues. Yes, without a doubt, because it does affect, as you were saying, Dr. Katie. And, you know, when we're talking about the education for the children, we have to start at the core of, um, with anything in mental health, whatever. You have to go back and see, you know, what is the core part of where this happened. So the core, when you're going through this change, is that you should know the full story. The full story should be evident so that you understand. I do believe if we teach at that small age now, which the schools are doing, and it's wonderful to hear that menopause is being you know, put on a much higher platform for people because it affects anyone's life journey, whether male or female, because, you know, you will suffer at the hands of this. You know, there are consequences if it is not controlled. It is like diabetes, you know, epilepsy, and you have to control it. If you don't control it, it spirals out of control. And then we can go on. I mean, it's been known that women who go into the menopause who have never committed a criminal act, their whole personality, their persona, their character changes. They don't know how to cope with this. You know, there's changes that happen to them. And if they're not getting the right support, then this leads on to visits more to the GP, which you are yourself, and then saying, are you depressed? And more medication coming up. But we're not dealing with the core subject. There's lots of people out there that can help you— life coaches, there's people, your GPs. There are people that can help with menopause. And if you are struggling, it's always use that voice inside you and speak out and explain who you are and how you are feeling, because it will affect you. Now, going back to What I say, when I was 9, for myself, of my journey, I bet— I'm sure I was— God put me here to be a surgeon's dummy, you know. For many of my listeners, my God, you have so many problems. Yes, I have had lots of problems, and why I became a mental health advocate, because when you are inflicted with so many different things that happen to you, you have to address them. And do it. And yes, you know, I've suffered. And as my listeners know, I've suffered at this. So my voice speaking to you is get the help that you need. And I believe that strongly. I believe if I was told at 9 years of age, which is very young, to have gone through the menopause cycle, which led to me to have serious gynecology issues all throughout, that I had the hysterectomy at the age of 25. But speaking to Dr. Jan Sari, Ashcott is a neuroscience guy, fantastic in his field. I had meningitis when I was 5, and he believes that caused my whole body to change and, and go into it. So 9-year-old, I went and I was now classed as a woman. I would be able to fall pregnant at 9 years of age. I then suffered through these heavy periods, etc., to have been put on the contraceptive pill, to being bullied because of that. Because when you're given that because the bleeding was very heavy, etc., when you're at school, girls then bullying and torturing, thinking you were having sexual intercourse at school because you're on the contraceptive pill because they were uneducated. We must educate children from a small age. And when you're going through it, and when they are doing this education at school, to understand if this packet does fall out of one of these children's bags, there is a medical reason why they're on there. But it leads on to abuse, you know. And I was abused horrifically for that. I then had, um, 5 ovarian cysts removed, 11 laparoscopies. I had one ectopic pregnancy. I had a molar pregnancy and then I lost— I had my son and then I lost my daughter at 29 weeks pregnant, which led me to have a hysterectomy and thrown into this then horrific world of menopause and my brother visiting and being killed after visiting me. So with only the menopause, that's my story, which my listeners know. But as a doctor, you know, that's the trauma, the simple multiple traumas my mental health went through was horrific. So yes, I can speak on different platforms that are on there, but I've generalized that to say at the age of 9, you know, and I am pleased to say that menopause now is being highlighted, that your daughter felt she could speak to her teacher and say, Could we talk about menopause? My mommy knows a lot about that. But you need to have that whole picture. And for the listeners, if you are listening to this, take your own experience and feed that on because it does help. Your education on your own journey will help. Your voice is important to express. And we are not all the same. We're all made up. Our DNA is very different. But, you know, to clarify on these things, to go through. You know, there's people there that will suffer if they've, you know, got cancer. It will bring on, as you say, one of my guests, Jane Snell from Menopause Life, who I interviewed, you know, who was given 2 to 6 years to live. She was diagnosed with very, very rare blood cancer and was forced into early menopause, which lots of people are suffering before. We're not seeing this normal 45 to 55. This is why education needs to be much stronger. People need to be aware that there is a simple trauma that can affect the brain by being pushed into something that also can cause problems with the menopause. So our character and what we're dealing with, and when people just think, oh, she's just menopausal, You know, never say she's just menopausal. No, I think that's really important. And I think the other thing to say is that we all assume wrongly often that menopause is, is women in their latter 40s, 50s, 60s. But I think the youngest person I've looked after with menopause was well under 10, 8, 9 years old. And I look after people right through to their 90s. And I think You know, menopause can arise for various reasons. It can happen very early for no reason at all. It may be a genetic inherited tendency. It might be because that, that child has had leukemia or lymphoma as a baby and been given treatment that then essentially means their ovaries don't function normally, and they're menopausal from a very early age. And I'll never forget the 16-year-old that I looked after in a clinic that came to see me and said that Could I do something to help her? Because she was fed up of having to justify to the pharmacist when she went to get her HRT why she was on it. Because the pharmacist in every— if it was a new pharmacist, would pull her to one side and say, this is HRT and you're 16, this isn't right, as your doctor got this wrong. And then she'd have to explain, I had leukemia as a baby, I'm on HRT because my ovaries don't work properly, this is for me, it's prescribed correctly. And I think, you know, it can happen to so many women at such an early age, and it's really important we recognise that it needs to be treated, it needs to be spoken about. So yes, I have to say that medical school education historically has been pretty dire with regard to menopause, but I'm delighted that particularly the local hospital near me, the John Radcliffe, has asked me to do menopause teaching for the last 5 years. So all the medical students are taught about menopause, even if they don't become GPs or women's health specialists. It affects so many different aspects of our lives, whether it's our heart, whether it's our bones, whether it's our brain function, that actually we need to know about menopause as doctors in general, whatever specialism we go to, because it impacts on lots of different elements of our health. And, and like you say, it can have huge impacts on our ability to live, work, function normally, and that needs to be recognized. It's because, um, as you say, menopause— the change is now here, isn't it? There is a new style of programming coming where we've got individuals, health professionals, businesses, and I'm speaking out, and change is most certainly here. Um, so regarding the protected characteristics that will protect people under this, what is your view on how we may be able to get these protective characteristics for menopause. I mean, I think there's lots of work being done. Carolyn Harris MP has really helped with this because the— there was a second bill in the House of Lords just before Christmas, November time, where we were talking about ensuring this is recognized as an ongoing issue for women. And if you think about, if you have a natural menopause, i.e. At the expected age, 45 plus, for lots of us, we spend half our lives in perimenopause, postmenopause. And for some women, there are some very lucky women who will breeze through the menopause and not have an issue and quite happily get on with life and their symptoms aren't bothering them, and they're very lucky. But about 80% plus of women will have problems with their menopausal symptoms that affect their quality of life, whether that's happening at an early age or an expected age. You know, we, we are part of the economic development of this country and the world as women, and we have a huge part to play. And so to dismiss menopause and say it's something we should be just getting on with is just wrong. So anything that can be done to improve access to help and acknowledgement of menopause being something that women need support with and should be recognized is extremely important. I mean, obviously we have the move forward to reduce prescription costs for women, because at the moment prescription costs for HRT can be, for some women, prohibitive. And if we can think about giving women more of their HRT on a longer repeat prescription so they can access the right treatment and get the right help, then that's, that's absolutely brilliant. So it's going to take a while because this is a transition, isn't it? Nothing ever happens overnight, and you can't click your fingers and it's all magically sorted. But if that conversation is happening, and we've got lots of high-profile celebrities wanting to highlight the menopause and really get action action going forward. Yeah, I think it's a great idea. What I think is really interesting is how many employers have come forward to me to ask for support with helping their employees. And when we know about Timpsons last year, who said that they would support women with the cost of their prescriptions— that was announced on World Menopause Day back in October 2021— but more and more agencies are coming forward and saying, look, we have specific things with our employees that we need them to do. The menopause is affecting them. We're noticing more and more women going off sick or struggling to achieve their full potential. What can we do to help them? Can we ask for your help to support these women? How does menopause affect them specifically in their role as whatever they're doing within that employment sector? And, and that's just marvellous, the fact that they're recognizing it and saying, we don't want women to not take their next promotion that they're due or resign from their position because they feel they can't work anymore. We want to keep them these are fantastic women who are functioning suboptimally because of their menopause. How can we help them? That's fantastic. Yes, because with the perimenopause and menopause symptoms, they come in many different forms, which is actually forcing an alarming percentage of women to leave their careers. Their physical and their mental effects and well-being. So it's been a long— for a long time, it's been a lot of stigma that surrounded the menopause for them. We've got women leaving their work because they're feeling underrepresented. They're ashamed with how they're feeling. But now, with the help that's there with individuals and health professionals, and as you say, business speaking out and supporting them, change is certainly coming here, isn't it? I do know that when you're saying about World Menopause day that this has been partnered with ITN. I believe that they are going to bring a new program. I think it's called Changes Here: Empowering, Supporting, and Educating Women to Improve Their Menopause Systems as Well as Protect Their Long-Term Health. And I think that's hosted by Louise Minchin. That's weights on there. I'm sure that's, you know, one of the things that are in there, which is highlighting on the platform that you're saying, like with the cost of HRT, this monthly bill that they have to pay. And as you know, we've got increasing— this year we're going to be facing the consequences of the pandemic. Things are increasing— food, energy bills, a lot of pressure. Is coming on. So even with our own mental health, etc., going through, we give up on certain things. So if that woman, uh, you know, and the husband are at home and they've got, say, an income of £500 in for the month and their expense is £510, the thing she's going to give up— she'll look at cutting and say, oh, well, do you know what, I'll try and deal with these issues myself and I'll come off HRT. I'll try it by going on the internet for a natural way to go, but can catapult them into unforeseen and, you know, the really strong current waters that can actually drown them because of what they're going to be facing without this help that gives them. Like you're saying, with the onset of osteoporosis, for me, as you were saying, being somebody that's had early surgical-induced menopause. I, at 25 now, I am a diabetic. I have suffered with the osteoporosis that comes in there, and I have a machine in my heart. So for myself, that's why I said to the people, I feel like God placed me here to be the surgical dummy. But I do believe my voice from that is, you know, on that platform to speak out from that, to speak out. Please look after your body. Because I didn't, I didn't listen correctly to the information that was there because they saw you don't need to have that. And at 25, I thought, oh, you know, I was going through a huge breakdown mentally. With all what was going on with the loss of my brother, loss of my child, not being able to be a mother again. So, and then they took me off this HRT, the depression, everything. I went down to a place that I was so low, I didn't know if I was ever going to come up from. But I did. But because of that, I had abused my body by not taking care of itself, smoking, eating the fatty foods. Oh, you know, having it. Going, I don't need to exercise, but I do. So my advice, like you are saying, Dr. Katie, is it is important. This information that is out there is there to help you. Don't look at it in a naive way. Now I'm at an age of 53— where, 54 this year— where I have decided to take change, and I have to look after this body. My body thinks I am 80 years of age, and by my goodness, some days when I get up in the morning, I feel like an old person. You know, you still get those, um, days, oh God, I can't bend to get that. I need to be out exercising, just take that walk. But obviously, um, as you know, again, you know, my whole medical is a nightmare. I suffer with narcolepsy, epilepsy, and if I have a really bad attack, I have tos paresis that can leave me paralyzed anywhere for anything from 4 minutes to 4 days. So I have this wonderful drug called modafinil and a good team of neurologists that support me. But yes, I still get up now. I could give up, but I choose to get up and Learn that with women's radio station and business that do support whether you have a disability. We are all equal. We need to get up. So it's great with the businesses. Please support somebody that's menopausal. Show, have a club, join together, girls, have a club, something we can just chat, chat on the group, you know, give tips together. Work with your employer, because if you're not concentrating and do— you won't produce the results that your employer wants. Then you will feel more stressed because you're not doing it, because you, you haven't spoken out, they don't understand. Then you go home, you're tired, you're exhausted, your sleep pattern, everything gets affected by the cold sweats. And working together, you have to open up, you have to use your voice and understand This is a process you're going through, but there is a lot of help there, you know, and don't be pushed to one side. Explain to your doctor if you are depressed. There are ways, many ways to beat depression other than taking a tablet. Am I correct? Yeah, you are. And I think the other thing to say is that, um, I always say to women when they come in, because they'll often present not with flushes and sweats— I think a lot of women will say, 'I haven't got hot flushes and sweats, so maybe this isn't menopause'— but we've got estrogen receptors all over our bodies and our bodies respond to estrogen deficiency at menopause in so many different ways. So every woman's experience of menopause, whatever age they are when they're having it, is unique. You know, having your ovaries removed surgically, what for one woman is flushes and sweats, for the other is fatigue and insomnia and mood change. And really, more and more women will come to see me not with flushes and sweats. They'll come because they'll say, I can't sleep, I'm getting headaches, my mouth's on fire, I feel depressed, I've got vaginal dryness or soreness, my libido's low, I've got no energy, I just feel fatigued all the time, my joints hurt, my skin's dry, my hair's thinning. You know what I mean? I could go on forever about menopausal symptoms because there's so, so many, and every woman's experience of menopause is unique. So as well as addressing those symptoms, which is what first and foremost drives a woman to seek help from a healthcare professional. The other things that you're doing is really talking to that woman about changes they can make in their lifestyle, which you've beautifully alluded to. So it's not just about, here, have a prescription. It's okay, let's talk about your lifestyle. Do you smoke? Do you drink? Do you exercise? What's your weight? Can we do anything to optimize that? As healthcare professionals, we've got the most fantastic opportunity with women that come to ask us for help about their menopause to really make changes and suggestions and support them. At the time of life when those lifestyle changes have huge positive impacts on long-term health and well-being. And we know that losing a bit of weight, reducing alcohol, stopping smoking, incorporating exercise into your lifestyle not only improves well-being, helps mood, but also reduces long-term health risks such as cardiovascular disease and all forms of cancer. So we know that obesity smoking, excessive alcohol are linked with an increased risk of cancer, particularly with breast cancer in women. So when you're having the discussion with a menopause patient about HRT and breast cancer risk, it's actually quite important to then also talk to them about their lifestyle risks and how that increases their risk of breast cancer. For the majority of women, HRT is extremely safe and has very low risk associated with it, and I think that's the thing to get over, is it's— even if you've got a family history, Even if you're anxious about breast cancer risk, there are lots of very good options there, and depending on how old you are when you start it, depending on what symptoms you've got, that can also have a positive impact on your ability to then do exercise, motivate yourself. Because if you're not sleeping, if you're tired, if you've got flushes that are waking you up in the night, or you're getting up to go to the loo frequently, you're not going to feel, 'I'm going to go out and do some exercise today.' So if that can all be improved as well, you're on a win-win. So for the listener, that's obviously— we are talking completely openly and freely here. And, uh, you know, as I say, your expertise and coming on here, and, you know, we do talk freely on Free Your Mind with LKJ because it is important that the listeners get from this show, um, I suppose advice and support. Yeah. And when we finish this, that you go away, that when I finish my interview with my guests, that we feel— and also, how do you think that went? And they go, I think that went great. And when you get the feedback, you think that did work, because it's not about us. So they were telling us, or you're saying, but we are opening up to that listener that is listening to go in there. So how would you— if somebody is struggling with their menopause, they're sitting here and they're battling with it, even if they're on HRT, they may be struggling with the HRT. What would they do on that situation? So I think the first thing I'd say is that at the moment there's fantastic resources online. There's some really superb validated resources. The British Menopause Society, who I trained with, have almost like a patient arm. They have the Women's Health Concern, which is an online website where you can look at lots of different information about the website. For young women, the Daisy Network is phenomenally helpful and a support— there's a support forum on there for women who are going through an early menopause under the age of 40 specifically, but even women over 40 can definitely have benefit from those websites. There's loads and loads of others. I mean, I could spend all day talking about the different websites available, and specialists like myself tend to put lots of information on our websites. That's all free to access. Get some information, have a think about it. There's some useful questionnaires and tools on various websites as well where you can sort of identify symptoms. Am I menopausal? Is this me? Do I need to go and ask for help? For all these things, your GP surgery is a wealth of information. You've got your GPs, but you've also got often practice nurses, pharmacists, associate physicians, and nurse prescribers. And I'm doing more and more teaching courses with nurses and nurse prescribers. They're often in the best position to talk to you about menopausal symptoms because you go to them for your cervical smear every 3 or 5 years depending on how old you are. And often my practice nurses pick up women with really severe vaginal dryness where smear test is so excruciating, they recognize this and say, 'Do you think you could be suffering with some menopausal symptoms because everything's very, very sore and dry down here?' And it often opens up that conversation of, 'Actually, yeah, I'm really struggling. I've got flushes, sweats, fatigue, whatever, insomnia. Go and speak to your GP. Here's some information. Go and have a chat with your GP.' Feel empowered, you know, print off something if necessary from online. I've looked at this, This is me, can you help me with this? If you don't get the advice you want, or somebody is dismissive, see another GP within that practice. It's really important you push to get that right information, and if you are struggling, that you get the treatment options explained to you in a clear, easy-to-understand way, and the risks and benefits are discussed and individualized with each patient, because no two women are the same, and what is high risk for one woman is not high risk for for another. But this is a lifestyle, quality of life discussion. This is not about, you've got to take this medication because otherwise you're going to have a stroke tomorrow. This is, this medication will do XYZ, these are the risks, these are the benefits, what would you like to do? And it's empowering that woman to make a decision about what the best choice for her is. And as I said, that is different for every woman. So it might be HRT for one woman, for another woman it's a non-hormonal option. I had a lady in clinic at the weekend who's doing brilliantly with hormone therapy, but she said, 'Can I ask you a question about my friend?' And I said, 'Go for it.' She said, 'She had breast cancer 2 years ago, and she's been told she just has to suck it up. She's got to deal with the symptoms because HRT is not an option.' And I said, 'Absolutely not. HRT may not be the safest option for her, but there are lots of non-hormonal alternatives to improve her quality of life, address her symptoms, and make her feel well. Please tell her to get in touch.' And I think it's sad that some women are being told there are no options out there. So if you get batted back, if you find it difficult, look for someone else in that practice. Do your research online and go with that information prepared. If your GP healthcare professional is doing their job, they should be receptive to that information being given to them and presented to them. And always say, you know, I'm a GP first and foremost, although I'm a women's health menopause specialist. That's my special area, and I know an awful lot about that. I don't know everything about everything, and you You can't as a GP, you're a generalist, so it's quite reasonable if your GP is not sure for them to say, I'm not sure about this, but I'm going to go and ask someone who might know more, or I'm going to email a colleague in the hospital setting to get some advice if perhaps that woman's got risk factors that might make certain medication choices difficult, or I'm not the women's health expert in this practice, but I know someone who is, I'm going to ask them. And frequently at lunchtime on my GP days, I sit around the lunch table and my colleagues will say, 'Can I ask you, Katie, about this patient? What would you do for her? Can she have some treatment? If she can, what would you do?' And that's where we really grasp on the expertise of our colleagues to make sure we're providing the best treatment. Thank you very much for that, Katie, because that leads me on to another question. Because when you have your GP, there may be a lot of listeners there that think that when you go and you're trying to get through to your GP and, you know, you may not feel that you can open up if your GP is male. Some women find it difficult to open up to a male, but others find it— and sometimes they— you'll find your GP quite dismissive. You're very limited on time now, you know, you're under immense pressures as GPs, and so 'Right, right, this is that, fine, off you go.' I think, 'Oh, I'm not going to bother ringing them,' or you get through. And sometimes I have to say this because a lot of people— I'm having my own conversations in different areas and fields that, you know, I cover— because you can never get through. The receptionist think they are the doctor. So they're trying to ask you all these personal questions. I know they have to break down and say, hey, you know, how severe it is for your appointment. But some do in these GP services try to become the doctor, and you can't even get through, or you leave that patient when they go off. And it's something that I know there are people looking into those areas which make it easier for yourselves because you only have this limited time, why you have nurse practitioners, and breaking down the time because you may not need to see the doctor. You may— you can be diverted to go off. But if you do feel, and you are the listener, that the receptionist is being too full, write an email to the practice manager and that will go through and ask that it's shown to your doctor. You as a GP will see that and you will deal with that because You know, you are there to protect, you are there to support in any healthcare issues to go through. And like you're saying, if you are having an issue with your menopause to go through, and if you're not getting through, and that's couple, you, you're not going to get in trouble, you're not going to offend your doctor by saying, well, could I see somebody else? I'm not quite happy. That you— they then think, oh, when they go back to to see their doctor, he's going to be cross with them. But sometimes, like you say, you know, somebody else in that practice may have it because you are generalised, as you said, in as a general practitioner. But some of you go on to specialise in different areas of medicine. And also, as you said, have a look online. But one of the things you said is like, you know, check online, but we have to be careful on it because with the internet, as well. Some people then try and self-diagnose themselves and think, oh, I've seen that on the internet, I've got this, I've got that. Don't you— you have to be careful when you are looking for advice that the internet can— you can self-diagnose yourself and say, oh my God, I'm dying, when actually you're not. You've got these symptoms that go on. And so it is about balance. And when you are researching or reaching out, it's why use that voice check, you know, if you're not getting results Don't give up. Try somebody else. You know, as I said, I do believe we should have more menopausal units, groups, you know, to go in online sessions that are people there that can help, you know, even if you think, oh, you know how you're feeling and you're going to a life coach, you may open up to your life coach and say, hey, do this, this is affecting you personally. If you're there with your husband, you know, and you're having your date night trying to keep yourself in that mode going on to feel happy in there. We do know with sexual intercourse that you do get problems with the dryness, and you think, 'Oh God, you know, that hurts,' or you're having— and then because you don't want to let your partner know, but they do know. If you're having sexual intercourse with your partner, he will know that you are suffering with this, because your reaction, your natural reaction, which is natural for us as human beings to show passion, show love, and to do it— and if you're doing that pain and you're grimacing, you will not be naturally flowing in your body and in the passion of that. And then because it hurts, and then it stops, and you've had pain I'm really sorry, I'm really sorry, I can't help that. You know, there are things there to help. You know, you can go to speak to your pharmacist if, you know, to get something that will help. But if this problem is persisting, and I always say that with any form of medication, and that's a GP, if you have a headache that's lasted 3 or 4 days, you have to consult a doctor. You know, you can't go online to do that. Going back to access, I think, um, you know, there's been a lot of publicity via access to GPs, and we all are finding there's increasing demand and often difficulty in recruiting new GPs and providing enough appointments. But my experience is that often menopause isn't something you can do in 10 minutes. It's, you know, if I want to have a really thorough discussion with a patient about their symptoms and explain all the risk-benefit treatment options available, it's well more than 10 minutes. You know, it's more than double that time, and that's going quickly. So sometimes it's a case of have some information, go away and think about it. Look at reputable sites where the information is written by doctors who know what they're talking about, um, and other allied healthcare professionals with accreditation. The British Menopause Society is a really good first port of call. They have a Find a Specialist page, and that includes anybody like me who's done formal accredited training where they've had a certain standard they've had to achieve in menopause education and training to be able to practice either independently like myself or under the umbrella of a menopause service. Now that might be NHS or private, and that British Menopause Society website find a specialist section shows all of us across the UK, which is a really good first port of call. The other thing to say is that, you know, from the point of view of accessing your GP We've got lots of platforms now where we can be contacted, so it isn't just a face-to-face contact. It might be a telephone call, e-consulting, online platforms for submitting information. So if you're not happy or you feel you've got more information that you'd like to share, there's a way of conveying that to your GP, as you've said, and making sure that you get the right advice and treatment. Look at other professionals within that practice that you can go and talk to for advice. The other thing you said, which is really great, is about these sort of forums and groups. There's, there's some fantastic groups that I've taught recently, from a sort of a localised menopause café right through to recently a school educational trust where lots of schools joined together and all the teachers and staff were invited to an education evening that I presented on, which was all about sharing information. You know, in those situations, I don't know everybody that's at that meeting because often there's hundreds, don't know their medical history. I'm not giving medical advice, but it's about sharing my knowledge with them and saying, look, this is what menopause is all about. These are the benefits, these are the risks of treatment. This is what you can be asking for help with. And it's, it's lovely to see the positive feedback when those women have then felt they've really struggled to acknowledge what's going on, and then they can get support. The other thing you've just said is about obviously intimate issues and sexual problems. I have no embarrassment talking about these. I've spent most of my life as a doctor talking about these, but women will find it difficult. If you're going to see a GP for the first time to talk about your menopause, and actually high up on your list is vaginal dryness— typically women will not mention that. They'll talk about everything else. They'll often feel more comfortable talking about hot flushes or memory loss or sleep disturbance, but they won't ever discuss the vaginal symptoms and discomfort during intercourse unless you mention it. So I'll always say to women, these symptoms are always typical of perimenopause, but you've not mentioned vaginal symptoms or issues with intercourse. Are they a problem for you? And the number of women who then look at the floor and say, yes, but I didn't like to mention it, or they don't mention it even at that point, but they put their hand on the door handle to leave. And then they say, actually, you know, you said about that, I do have that problem. I'm just a bit embarrassed to talk about it. Well, have a seat. Let's talk about it. Let's try and address that. There's some fantastic treatments that aren't necessarily HRT that can help those. And you're right. Your pharmacist can advise. There's some non-hormonal treatments that you can use over the counter from a chemist or buy online, but also some vaginal oestrogen is extremely useful for the majority of women to improve vaginal symptoms, and that can be used often on its own if that's your main issue. So do ask for help. Yes, because, you know, again, we, we don't talk enough about that, and I would like to express a little bit more if we can on that. Dr. Katie, because I want the listener to really bring them into the platform where you are talking at. Like you said, the lady will put her hand on door to leave, say, because you don't want them to come and leave. It's like the glass half empty, half full. Let's go out your glass, you know, half full. I'm gonna go, I'm going to get there, I have that prescription that will send them mobs, like, you know, I can get this, that it does start. So then you do start feeling better about yourself. So when you're having your date night with your husband, when you're trying to— like, this is us, you know, we're going to do it. I love the fact that people are doing this date night and we're allowing time for each other so we don't get lost in with children, etc., that we're still individual people, that we have our time together. And part of that time together is the arousal until everything goes in, but you're ready. But don't put yourself under pressure to think, oh God, is it going to work? I'm not going to be able to. Just try it in the day. Just try it naturally to see how it is. And there's nothing wrong with checking yourself out, is there, to see how that is through the day? And then when you get there, to be in the situation of having sexual intercourse and thinking, you know what, that was okay. And it wasn't. If you are still suffering and this is hurting, then there is another reason that then you would come back and say, this is still causing me a problem. So then you would look further to go into that. Um, it's really important to say there's often some other skin issues or vaginal concerns that may not just be purely menopausal, that are more common as we age, and I've picked up lots of things over the years, and women have been really reluctant to let me examine them. I said, look, I'm not sure this is just menopausal dryness. Please let me examine you and check everything's okay. Over 50, the routine cervical screening in the UK is every 5 years, so you may have a woman who's had a smear at 50 presenting at 54, 55, and nobody's actually had a look at their vaginal, vulval reason— vulval area. And it's really important that we look for any other reasons why things might be sore, painful, not possible. Yeah, so when you're saying, um, for somebody, you know, where they're going in and how would you explain to the listener, um, if they're having those issues? Like you said, we've touched on, on that. It's a different— we're really getting into this thing because I want the listener to understand Would there be— there's many different sexual positions, Dr. Katie, to go in like that. And if people are doing it, you know, like the missionary, would you just start off as a missionary using this to— so that you're not having a problem because you don't be, you know, not going too deep in— into that section? That would be a complete different show. It's just— or find the way that when you do have sexual intercourse with your partner, it's in a comfortable way that you feel more fitting for your body to react while you're starting this process to go through. So it naturally will help. Absolutely. I think it's, it's not necessarily about being prescriptive of how women have intercourse, that's entirely up to them, but it's about improving comfort. So at menopause, when we lose oestrogen, we lose oestrogen vaginally as well, and that makes everything a little bit more dry, often a bit more fragile, thin, inflamed, and sore. So vaginal comfort is reduced, which means whatever you do, it can be sore and uncomfortable and sometimes not possible. So the key thing for menopause is lubrication and replacing vaginal estrogen in the majority of women. So you can put back estrogen into the vagina with a cream or a pessary, and you can use non-hormonal lubricants, and there's some fantastic fantastic products out there, um, which are designed for perimenopausal and menopausal women. They're not containing perfumes or colors or irritants to the very delicate menopausal vagina. And it's about using those and incorporating those. So not just, I'm going to put them on now in anticipation of intercourse, because it takes the fun and the spontaneity out of it, but use them during intercourse. Get your partner to use them on you. Use them on yourself if you need to or want to, and actually get a feel for how things should be comfortable. And often that then improves your enjoyment, and that naturally enhances libido. Women, you know, we have a very psychological response to intercourse and arousal, and actually if we have a really negative experience and things are really uncomfortable, it has a negative impact on our desire to want to do that again. Whereas if it's enjoyable, pleasurable, we have something positive out of it, it'll force our libido naturally. Not always, but in a lot of women that is the case. And increasingly in the menopause, especially as well, we're using testosterone as well, which is another key hormone. Our ovaries produce about 50% of our body's testosterone. The rest comes mostly from our adrenal glands, which are above our kidneys. But when our ovaries stop working normally, our testosterone levels also fail and fall down. And so what happens is women then have a natural loss of libido from that., and combined with vaginal symptoms, that can really impact on sexual function. So increasingly, women are using testosterone alongside oestrogen as part of their HRT, and progesterone obviously, to try and improve things further. Do you feel, Dr. Katie, that a woman's libido is less than a male's? I think yes, we do. Our testosterone levels are lower than a man's, even premenopausally, and generally there's a bit of a mismatch with men and women. There's, there's a variety of libido and response and testosterone in women. And you know, what's low for one woman might be normal for another and no issue. And it's not just necessarily what their testosterone is doing, it's how that impacts on them. So for some women, it's not a problem. And it's really interesting, I gave a talk the other day and one of the, the men on the talk actually said, um, do you talk about male factors when you talk about a woman with sexual function? And yes, I do, because I always say, you know, 'Do you have any problems with your libido?' And women will say, 'Well, I don't have one.' And for some women, that's a huge issue. 'Yes, it's impacting on my relationship. I really want that to be improved. I'm not happy with it.' For another woman, it might be, 'Actually, it's not a problem for me.' They might be on their own, they might have a partner who has health conditions that make libido for them an issue. But, but it's about looking at the individual woman. So it's It's not just about testosterone and what your level is and whether you're in the normal or low range. Inherently, women post-menopausally, their testosterone levels are generally low, but it's whether that impacts on them. And if for one woman it may be a problem and for another it may not. So for the listener, which again, thank you for giving these wonderful, clear insights and answers. To questions that I'm putting out there too. So for the listener that's out there that is having a problem with their partner and they, they're feeling worthless, they're feeling all these issues of menopause around them, speaking out, don't feel like they've been understood, overworked and stressed with stuff, what would you guide them to do first and foremost? Speak to your healthcare professional. They can advise, they can support. Speak to friends, speak to family members. I think that the lovely thing is how many more women are talking about this in friendship circles, coffee mornings, dinners out. I mean, I'm— I drop my children at school and people know what I do, and increasingly I'm getting mums at school approaching me and saying, um, would— can I come and talk to you? Would you mind? Um, can I ask you a quick question? You know, would I justify coming and seeing you? I mean, um, one of the things on my, my services website is, is, would I benefit from an appointment? Because a lot of women think, I'm not menopausal, but I've got a few symptoms, should I go and see her for help? And actually, it's a case of just come and talk about it. Um, you know, if you're pre-armed with information sometimes, and sometimes that's all women want from me. They want to come and have a discussion. I want to know where I am. I want to know what options I've got. I don't want anything at the moment because I feel I'm managing okay, but I want to know I can get that help when I need it, and I know where to get it from. And a lot of the time it's just about information gathering. Look at reputable information sources, talk to your healthcare professional, and particularly that healthcare professional should be looking at lots different elements, not just what you're going on with, that going along with, but also any other healthcare problems that could be negatively impacted, like your bone density, like cardiovascular health, like your memory, like diabetes, like bowel cancer risk. All these things should be covered, and that's why it's not a simple 10-minute consultation. It often takes longer. It's about giving the information, going away, come back to me, have a think about it, Not hugely often, but sometimes women will say to me, actually, I don't think I'm ready to make a decision now. I want to go away and think about it. Can I come back to you? Yes, absolutely. No pressure. You just go and have a think about this. Have— do your research. I mean, more and more women— I absolutely love them when they come in and say, I've researched, I watched a program on TV, I've been on this website, I want to try this treatment. And then they often say, and this is the treatment I want to try, or this is what my friend has told me she's using. And the other thing to say is it's, it's not one size fits all forever. Your requirements for medication change with time, and the safety-benefit ratios change with time. So what hormone therapy is right for a 48-year-old starting their menopause may not be the same treatment she's on at 60, 61. It might need to change for safety reasons, it might need to change because of other medical conditions, but the the information is out there for you to access and get help. I'm glad you touched on that because that does take us back because, you know, I work on a daisy chain process as a journalist. We're taught you start the story, go back, as for yourself, you'll look at the history, go around, you get to build that picture. One thing we were saying was about education and pointing question that I gave you was we should know about this before entering it. So when you're saying that people can make an appointment, Katie, to see you, or, you know, other health people, make the appointment so that you said— people say, I'm not ready for it. But if you're forearmed, you will know, and it will help you. And this is the way to go forward. Don't wait for it to come and knock on your door. Be prepared so when you open the door, you can allow it to come in in the right level of speed, you know, you know, to come through. And if somebody wanted to contact you directly to make that appointment, do you do online as well as, or physical appointments? Yes, so my company is called Oxford Menopause, and the website OxfordMenopause.com has all the information you need. We do FaceTime face on the whole because I really love to meet people in person. It's a safe environment. I have a fantastic team of administrators and nurses working with me. I have a lovely associate, Helen Kennedy, who's also a GP women's health specialist, and the two of us have both undergone the same training, same expertise. I also offer— we offer virtual consultations, so we use an online platform platform where we can see you, because it's really important to look at facial expressions. It's— I love to watch women at their first consultation, and really, when I'm listening to them talking, see how they are, because they'll often come in and their shoulders will be high, they'll be tense, they often have quite a fearful look on their faces of what's she going to say. And the change, even over an online consultation, of their shoulders will drop, it's— oh, phew! I've actually shared this information I've got something off my plate, I'm being listened to, I'm engaged with this person, they're going to help me. It's just wonderful to see. So face-to-face on the whole is great, but we do offer virtual consultations, and we need to be able to see you so that we know that you're there and listening and you can ask questions. And we give you plenty of time to talk about all your symptoms, go through the options, and find a plan of action for you. The same applies in general practice. We're using online consulting tools a lot more, particularly in view of the COVID-19 pandemic, where women maybe have been isolating at home for other reasons family member off sick or whatever, and they still need to have their consultation with us to get that information. It's done online more and more. Great. And that's just— we are just coming towards the end of the show now, but just this last quick question: what would you say to somebody if they were struggling at work with their menopause? How would— we've got about a minute to answer that question? I'll be quick. So basically, talk to your occhi health and occupational health and HR advisors at work and seek help from your healthcare professional. And for some women, their symptoms are so extreme that they need that link-in with work and their GP to be able to advise and support. And, and it's interesting how many women will say they've been to occupational health or HR. More and more companies are trying to support women with the menopause, so there is help out there. And if not, be positive, be proactive, get them on board and say, should we do an education event about the menopause? And I always do things like that as well, just to try and improve access to advice within employment sectors. And what if they're a smaller company and they don't have those facilities? Again, speak to your GP. They, even if they're a small company, they should be using some form of advisory services, even if it's not within the company, through an external support service to give you that advice, and your healthcare professional can also advise you about how to access help. That's great stuff. And for myself, we are coming to the close of this wonderful hour with Dr. Katie Barber, who has opened up, freed her mind with her knowledge, so that the listeners on womensradiostation.com can And I hope have enjoyed this wonderful hour where we have really, you know, opened up on some subjects there, including, you know, some bits like the vaginal dryness that people may not feel that they can speak to. But I thank you, Dr. Barber, on behalf of Women's Radio Station and myself at Free Your Mind, Let's Talk About It. And thank you and goodbye, everybody.