The Menopause Show With Sue Moxley – Dr Rebeccah Tomlinson, Health And Her Company

Hi, this is Sue Moxley. This is women's radio station. This is The Menopause Show. My guest today is Dr. Rebecca Tomlinson, and she's from her own company called Health and Her. Hi Rebecca, how are you? I'm doing really well, Sue. Thank you for inviting me on the show today. Oh, thank you so much. Where are you, by the way? So I'm based near Cardiff in South Wales. Is it raining there? It's gray and overcast. It rained this morning, but hopefully it's going to hold off. Well, it's raining here in Essex and London as well. It's just brightening up a bit. All my washing is on the line. It's all soaking wet. Mine too. I'm fingers crossed it's going to dry. And all my patio set as well. You know, the covers, they're all soaked. But there you go. This is English, English weather for you, isn't it? So, right, Rebecca, please tell us about you and your company and what it is that you do. So I'm an NHS GP for, for half of my week, so just general practice work, but I also work for a company called Health and Hair, which is a company that supports women for all aspects of their health, specifically things like the menopause, offering supplements and nutrition support, lots of educational resources on our website. Okay, so is it— does it offer HRT as well, or are you trying to go down the natural route? We're a non-prescribing service, so not kind of dedicated to HRT, but you can get a lot of support and advice regarding that if that's the route you would like to go down. We have an ethos in Health in Hair that You know, women should be able to access their HRT specifically via their GP, you know, so that the prescriptions are either free like they are in England or Scotland, or at a much reduced rate that they are since April this year for the, for our English ladies. But, you know, we've got lots of kind of support regarding supplements, regarding diet, nutrition, exercise, all of those things, because a lot of times women's health We're really dedicated to kind of supporting everything to do with it rather than just the prescribable treatments. Yeah, that's true, because there's so much more that you can do, isn't there? Most definitely. And when I have consultations with women, it's really looking at the woman as a whole, you know, rather than just focusing on one thing, because there's so much that we can put in place to support women. And, you know, women need to know that so that they can feel supported and know what's out there for them. Yeah, oh, that's, that's excellent because it's been a long time coming, hasn't it, really? Most definitely. It was a really kind of, well, the subject that wasn't ever discussed. Our parents and our grandparents' generations grew up with on the backlash of a study that was done when I first started in medicine, you know, 20-odd years ago, that HRT should not be something that we should be using because it's got lots of risks associated with it. But thankfully, over the last 20 years or so, what's been happening is we've taken that research, we've kind of picked it to bits, we've had a look at the research, we've created newer, safer treatment options for women. And so now we can kind of support women by saying, you know, come one and come all, most ladies could try treatment if they wanted to. But we've got to get away from that fear factor, and that's where the education part of my job comes, comes in. Yeah. Someone said to me the other day that when men go to the— I'm men-bashing again here, shouldn't be doing it, you know— when they go to the GP and ask for testosterone, they don't get, they don't get a cancer warning with it, whereas lots of women do, don't they? Seems to be anyway that we get— well, not so much now, but we was put off of it, you know. Well, exactly. And things like testosterone, unfortunately for women in the UK, there isn't a, you know, currently a licensed preparation of testosterone specifically for women. So we're having to use male testosterone, which is off-licensed. And off-license doesn't mean it's not safe, it just means we're using the male testosterone for women. And so there's no, um, kind of guidance on how much we should be using. But that's where things like the British Menopause Society and the Faculty of Sexual Health, um, come in, because we're doing so much research, um, on, on all the different aspects so that we are able to support women and to give them the best education and advice regarding the medication. So yes, there should be warnings about medications, you know, depending on what we're using, but as I said, we should take away the fear factor that comes alongside it. Do you think that testosterone will become available for women, you know, they'll have their own one so that you don't have to use the men's one? Do you think that will be a thing that will happen? Yes, most definitely. There is a licensed preparation for women that is licensed only for women in Australia currently. We can get that on private prescription. So that means that obviously there's going to be a private cost associated, but your GP, if they're happy to do so, can offer that, or you can get it via one of the online prescribing teams. So, you know, it is coming, and we are pushing for this product— it's called Androphem— to be brought over to the UK so that we can have it on prescription for our ladies. And I know that there are currently a lot of work being done. I spoke to one of our clinical trainers in South Wales, and they are trialling testosterone patches for women. So there is a move to be able to support women with testosterone specifically. So that's all really encouraging. That's absolutely brilliant. But do you think that you're in the minority knowing about that? As you say, yeah, most definitely. And I think that's a confidence thing. And you know, it, it is one of those things that I always say to my patients, you know, if you come to me and you talk about women's health, you know, absolutely, you could get, you know, an hour-long conversation out of me if you wanted to, if we had the time. Time. But if you came and talked to me about diabetes or respiratory, then I would be less, you know, up to date with my knowledge. So it's really kind of picking your GP. And so I always encourage ladies, you know, speak to the GP receptionist. Ask your GP receptionist who is the GP that is most au fait with women's health within the practice, and there's likely to always be one. It could be a nurse prescriber, you know, it could be a pharmacist in the practice. But ask your receptionist because they are the fountain of knowledge in all of this, and then make an appointment with that doctor or clinician. And it's going to be that appointment, even if you have to wait a couple of weeks more to get to see that person, it's going to be that appointment that's going to give you the most information. You're going to get the best consultation, um, speaking to that person than somebody who doesn't have that knowledge behind them. That's really, really, really good advice, honestly, that is. Because, yeah, when I first started having problems, I went to the wrong doctors as well, if you know what I mean. You know, they were— wasn't— they wasn't very sympathetic, didn't really get it, all of those kind of things. And then when you do find someone that understands, it's kind of mind-blowing because you think, oh, this person really, really understands me, and I know that I can get help now. So that's a really good piece of advice. So if anyone's going to their GP about, you know, symptoms of the menopause, ask the receptionist who is the most knowledgeable in the, in the surgery. That's really, really good. Okay, so what do you think about bioidentical hormones? Do you go down that route or not? So there is a difference, and I think unfortunately it's a very confusing difference, between bioidentical and body-identical hormones. And I think, you know, it is one of those things that, you know, hopefully we can kind of discuss and sort out whenever we have a consultation. So the difference is your bioidentical hormones are ones that you are probably going to be, um, buying, um, um, as on a private prescription, either from a specialist, or, um, you know, they can be advertised online. Your body identical are, um, prescribable HRTs that can be prescribed within the NHS. Now, the difference is the regulation of the hormones. So we know that the body-identical hormones that we prescribe in HRT, um, are all regulated. We know the risks and the benefits associated with them. We know the dosing regimes, what they kind of counteract with, and what we should give them with, and how to use them. Whereas the, um, bioidentical ones, we are unsure, um, because they're not regulated in the UK, as to the guidance. So a GP will never kind of be able to prescribe the bioidentical types. And the British Menopause Society have put guidance out to support us with this. But the body identical ones that a lot of the time, I think, you know, we see in social media being talked about are your ones that are now being created from the yam. Yeah, so history has HRT first being produced from pregnant horses' urine, which when you think about it, it's quite an odd one. They then started to make hormones synthetically, so that's, you know, all of our contraceptives, the majority of our HRTs. But now they are coming out with these new body-identical hormones produced from the yam. So they found that the yam is a really good resource of both oestrogens and progesterones, so they've been extracting these hormones. They're called body identical because if you looked at them under a microscope, they resemble your body's hormones more, they're more alike than if you used one of the synthetic hormones. And so in research, what it's shown is the body tolerates it better, so less side effects for the user, but also there seems to be less risks associated with its use. So when we, you know, kind of have risks in terms of things like breast cancer risk and clot risk, we're moving towards the more body-identical hormones because we know that women are getting better responses from using them. Do you think we're going to run out of yams though? Because don't they get them from— is it somewhere in Peru or something? Or I'm not quite sure where, but I think it's one of those things, isn't it? It's kind of demand. So hopefully if they see the demand, then the yam industry will benefit from our use. Yeah, because I just got this vision. It's a bit like the Slimming Jab at the moment where people with diabetes can't get the Slimming Jab because everyone's using it for weight loss. It's like, I wonder what's going to happen. There's not going to be any yams at all because we're all going to use it for hormones. But it is, and we will get the peaks and troughs because I know stock issues of HRT is a really big thing and we will get peaks and troughs of this as there are new HRTs being created, as social media starts talking about these ones. So at the moment it's the body identical progesterone that we've had a shortage with. Because that's the one being promoted in, in the media. And, you know, the benefits of using that over the other ones. So, you know, it can cause a lot of chaos with women's menopause because you can get stable on an HRT regime and then suddenly have to change it because we can't get the patches or we haven't got the tablets. So it is a real disruption to women. So we're trying our best behind the, behind the covers to just sort everything out so that we can make sure we we can keep our women stable. Yeah, okay. It's a bit of a worry, isn't it, that Slimming Jab thing for people with diabetes, don't you think? Mind you, there's quite a few options out there now, I suppose. It is, unfortunately. Again, it's the, you know, social media kind of pushing and showing the benefits, and we know there are real good benefits associated with the use of it, but a lot of stock has gone over to America Yeah, and now we're seeing the demand now having an impact on, as you said, our diabetic patients, and so that is going to have to be highly regulated so we can support our chronic conditions as well as supporting our ladies who are struggling with weight. Yeah, oh, so tell me about Health and Her apart from— so is this not your company then, is it someone that you work for? Yes, so I'm employed as one of them, the clinicians that work alongside Health and Hair. So we are there in a very supportive capacity in terms of things like this, so kind of media and checking research. So I work with, you know, some of our research fellows that work alongside Health and Hair. I support our nutritionalist who looks after women, so you can talk to her about the supplement side of the Health and Hair Company. You know, so it's all kind of, you know, an emerging company that's just looking to support women in all aspects. So when anything new comes along, kind of, I'm there to kind of look at it and support and guide and put out lots of resources for women in terms of things like their breast care app. So they've just launched that. Is it an app? Are you— have you got apps now, or is it a website? No, so it's an app that you can download onto your phone. So it's got all the information you would find on the website, but it's got a symptom checker app so that you can start to log your symptoms, right? And it's also got a new breast check app which was launched this year, and that's supporting women to get to know their own breasts so that they can kind of know if anything changes, if there's anything to worry about, and it can kind of give you a reminder every month so that you can check your breasts regularly. And it's really just giving the support back to women so that they're aware of what they're looking for and when to actually seek advice from somebody if something doesn't feel quite right. Yeah, it's odd, it's odd that, isn't it, checking your own breasts, because you feel— it makes me feel a tiny bit anxious because You know, because you think, oh yeah, you know, I know I have to do it, but it makes me feel a bit anxious sometimes. But I think that's because I suppose it's the unknown, isn't it? Yeah, well, the app talks you through how to do it, you know, what you're looking for. And once you get to know your breasts and you know what you're feeling, if you're doing it on a very regular basis, you will know if something feels different. Right, okay. And so if you find a lump, or you see a skin change, or something changes with your nipple, you know, you know, Ashley, that's not been there for the last 6 months that I've been checking. That's the point I'm going to make an appointment with you, with the GP. And having that knowledge, you'll be able to say to your GP, I check my breasts every month, and this is a new finding. And that, to a GP, is what we call a red flag. Something new, um, that has changed most definitely needs further investigation. Okay, okay. Well, that's, that's, um, that's good advice as well. So, so out of curiosity, um, what supplements are good, would you say? And what, what things can you eat that would support when the menopause, you know, um, people going through the menopause? So, you know, going back to the, the increased weight and kind of diet, it's a question I'm asked by the majority of ladies. And research has shown that over 50% of women will struggle with their weight during this time. And it can be up to a 10kg weight increase, like a slow progression without— it's like a, you know, a runaway train. Women say, you know, it's like they just blinked, the weight got on them, it's centered around their middles. Yes, yes. And it just stuck there, and whatever they do, they cannot shift it. I know, I'm saying yes, yes, yes, because it's exactly what happens, isn't it? And, um, you know, because I think back when I was younger, if I— I didn't really put on weight, you know, I could eat pretty to what I wanted. But if I did put on a little bit, it would always go around my thighs. And I used to hate my thighs because I thought they looked, you know, a bit bigger or whatever. And then now I've got quite small thighs because it all goes around the middle, around the tummy and the boobs, and especially the bit at the back, the back, you know, the love handles, the back fat. Exactly. Um, is that because we We don't— that's because— is that because we don't have as much estrogen and we have more testosterone, or does the testosterone become more apparent? Why is that? Well, it is— it's more that we are falling into a more male hormonal balance. Yeah. So obviously, you know, our testosterone is actually decreasing from the time we're 20, but our female hormones are kind of, you know, keeping us female, but as they start to drop with the menopause, our, you know, kind of overall profile looks that more of a man. So that has effects on where we distribute our weight, which is centrally, and it also has an effect on our gut biome. So the bacteria that we have in our bowel. And so when I'm talking to ladies about weight, you know, we're talking about gut health as being a really an important factor. So probiotics is a really big thing in terms of women's health at the moment, and looking at your gut flora as a priority for lots of different reasons, because we know that the bowel can get quite sluggish during this time. So we can feel like we're getting kind of irritable bowel symptoms. And so when I say to ladies, you know, fermented foods are great, so your Greek yogurts, your kombucha, your kefirs are really good for promoting good gut health. What's kombucha? Kombucha is the kind of fermented drink. It kind of came into the— I read about it the other day. It's the first time I've read about it. Yes, you can make your own. Exactly, yes. And you can find it quite readily now. But all fermented foods are really good for benefiting bowel health, and then eating all the colours of the rainbow. So in your fruits and vegetables, you know, getting at least 20 plant-based items into your diet on a weekly basis can really improve the variety of gut bacteria. And the more different bacteria you have, the better your gut health will be. And research has also shown that you have some of your happy hormone receptors, your serotonin receptors, within your bowel. So a happy kind of gut flora will also help your mental health and well-being as well. Oh, okay. So is there— can I ask you, is there— if someone was going to go and buy a prebiotic, get that round the house, is that— or a kombucha, or is it kombucha? So you— we do you know, there's lots of different probiotics. Health and Hair have their own probiotic range. If you don't feel that you can get enough into your diet. So if you're quite picky and if you, you know, have a very limited diet, then probiotics can be a real benefit. So we know, you know, you can just log on, as I said, to the app or the website and you can see the research that Health and Hair have done regarding probiotics. And you can also see their probiotic Probiotic range. And, and, you know, they will also have kind of supplemental benefits as well, you know, depending on the supplements you take. So it's a really good one. And I think bowel health is one thing that we should really be pushing in terms of weight, mental health, or, you know, it's kind of very holistic. Yeah, no, I will definitely go on and have a look because I've been wanting to take one myself because IBS and things like that, but you never know the right one to buy, you know. You just think, well, it's like there's so many supplements out there, and I'm sure there's good and bad in everything, isn't there? So yeah, you never know what one to buy. So I'll go along to your website and have a look at yours. All I would say is just make sure it's coming from a UK reputable company. You know, with any supplement that we take, you know, we really benefit from the UK having a lot of guidance and support. So, you know, places like Holland Barrett, you know, places like Health Hair, we know that they're regulated. We know that what's in them, you know, on the, on the bottle is in the capsule itself. So we can be trusted to know that that's the case. And if we've got any recalls of course we know we can go back to the supplier as well and have a good recourse with them as well. Right, okay, so UK-based manufacturers and companies is good advice there. Okay, so how did you get into women's health then, would you say? So I think it's in general practice sometimes you fall into roles when there's spaces, because all clinicians will have their own different kind of area of expertise. So when you join a practice, you know, when you're first qualified, you tend to kind of go for a specialty that doesn't exist within your practice so that you can fit a gap. And so my first practice, there was no female health being provided, so I started off doing you know, kind of basic contraception clinics. I then got my training so I could fit coils and fit implants. So I'd done a lot of sexual health, young patients clinics in another practice where we had a lot of students, you know, so that kind of got my love for women's health support. And then it was actually a course that was run on my 40th birthday in terms of the menopause, and I thought, well, I'm going to get there at some point, so I might as well go along and see, see what I'm going to face. And it was so interesting. It was really kind of eye-opening because they were talking about things like the perimenopause, which is not something that I'd really learned about. We'd never discussed it in kind of our training. And now, you know, there's, there's research that is to show that, you know, our training in terms of the menopause is quite poor. And so there was this perimenopause, this bit of time before the menopause. When it feels like— then that's when you can get even— that's when you can get the worst problems, isn't it, really? Because your hormones are so, you know, in bad— and that's why you can see women are being turned away because they don't fit stereotypical norm of menopausal women. You know, they are 42, potentially. So they're not in the right age category. They're still having regular periods. So, well, they can't be menopausal. And that's the kind of narrative we have to be changing because the perimenopause can actually occur for up to 10 years before periods stop. Wow. So if you have a natural menopause at 51, so that's the norm, at 41 you can start, you know, potentially start to have symptoms. And, you know, we've got between 30 and 50 different symptoms that we can put down to the perimenopause. So if you're coming with a very unusual symptom, so a balance issue or dry eyes or general kind of aches and pains, your GP is going to investigate you for that without thinking hormones. Yeah. And then, you know, so you get further investigated, you get started on medications that don't work. You know, you're having all these tests, referrals, and nothing's helping. And it's only then when that lady gets into a normal, quote, normal age range or her periods start going abnormal that they go, oh, well, you could be hormonal, we'll try HRT. And amazingly, these symptoms seem to dissipate on HRT or supplements or whatever the woman is using. So it's a really fascinating So I can see where women's barriers towards getting support have come from. And I'm really trying as a GP to be able to support clinicians. So my aim is really to support NHS clinicians, be that nurses, be that GPs, to be able to have a better understanding about the perimenopause specifically, but also the treatment options, because I think all women deserve to have good support. Do you ever get reluctant GPs to listen to you though? I'm just curious. Well, yes, I think, you know, you will get those in all walks of life, but as I said, if we can get one GP and one nurse trained up in every practice, then there's going to be a point for support for that woman. And I think, you know, if I can do something something like that, then I will feel happy because my passion is with the NHS. I know we're struggling and I know we cannot offer what we want to offer, you know, and so it's not a lack of willingness on the clinician's side. We really do want to offer really high quality care, but there's lots of barriers in our way at the moment. But if we can do— if I can do my part to try and support our clinicians than I will. Well, well done, Dr. Rebecca. Amazing. Yeah, because you are right. But don't you think it's, it's been so long coming, hasn't it? I know, like, recently the menopause has gone a little bit mad, hasn't it? I mean, we've got, we've got menopause clothes, we've got menopause teas, we've got menopause this menopause. It's kind of like gone berserk in the last couple of years, which, which is a good thing in a way because it has, it has highlighted it. But it's taken so long, hasn't it, for this awareness to happen? Like you said, I don't think people even knew what— they hadn't heard the word perimenopause. They hadn't heard it. No. And that's because You know, because of that research paper done for our grandparents and now our parents' generations, our, our, the females above us were really told to put up and shut up. Yeah. So when you speak to that generation of women, most of them will say they sailed through it. Yeah. Some would have been given HRT, some will be very anti-HRT. So our generation of women are not getting, you know, consistent reports from our parents, which is where we get a lot of our education from and a lot of our support in terms of healthcare, you know, because we listen to what the older generation say. Whereas our generation will hopefully be able to communicate women's health better to the younger generation coming up. So Yes, we're pushing now, which is fantastic, but we should then kind of be supporting the women coming up below us as well, so that knowledge will be out there, freely accessible, and our clinicians will be able to support us better. Yeah, I agree. So what— why do you think, um, the older generation do say they sail through it? Because they had to? I think so. They say that, or do they— are they a bit like, oh, we were tougher in our day and we just got on with it? You know, I think there's a little bit of both because that's all they knew. Um, you know, so they— if they weren't ever offered HRT, they might have been given other medications or declined other medications such as antidepressants and things like that, which have their side effects. Um, and so it was just something something that they got used to. And the menopause, you do get used to, you know, you don't have to have treatment for it. When we're giving, giving treatment, whether it be just holistic conservative management advice, whether it's supplements, whether it's, um, HRT, what we're doing is trying to support the side effects of that menopause from happening. We're not trying to shorten it or lengthen it because nothing will do that. And treatment doesn't stop it from happening. It just supports the side effects of it happening. Yes. And improves quality of life, hopefully. Yeah. Because women will have better sleep. They won't have the hot flushes. Their energy levels will improve. The aches and pains. I had a lady who just said, I can get out of bed in the morning and actually be able to stand straight away. And her, her, just, she was so overjoyed that she could walk downstairs within 5 minutes of getting up, which she hadn't been able to do. But in the olden days, she probably would have just thought, okay, oh well, this is how I am now and I can't make it better, so I'm just gonna have to get on with it. That can't matter. And she, she probably wouldn't have talked to her friends about how she was feeling because there was less of that discussion. You know, social media and support. So Health and Her did a lot, does a lot of support within the workplace. So going in and supporting women in the workplace, because a startle, um, research paper I read 2019 showed that over 900,000 women left the workplace citing menopause as being the reason. Really? 900,000? 900,000. And so what we're now doing within the workplace is supporting the discussion. So that's not only with women having like menopause café supports within the workplace, but men are joining in too. So they're understanding what their partners might be going through. Yeah, I heard, um, I don't know, uh, it was about the government have employed their first menopause menopause champion or something that goes around the workplace and, you know, has discussions with the staff and men about what women go through. And that's good, isn't it? It is, it is. And hopefully that will be something that stays. So I know that my community has a menopause cafe, you know, so they are, you know, ever-growing with women who meet up once a month and discuss. And when you sit in those meetings and you see women talk, and then other women kind of light up because they realize they're not alone. Yeah. And they have a laugh and a joke about it. But then, you know, they're getting supported within the group. And then people— I mean, we've in our local menopause cafe group, we've had nutritionists come and speak. We've had people who do kind of holistic therapies, you know. So there's been some really good interactions about what we can do. And just if anybody finds a link or a funny meme, you know, they just add it to the group and everybody feels connected. So you actually go to a physical place and have these meetings? Yes. That's nice. Well, maybe I should start one. Well, definitely. And you will find that people people will come, you know, because somebody will come and then they'll tell their friend, you know, and then the group will slowly evolve and people get out of it what they need, you know. So it is just finding that you are not alone because, you know, if there are 60 different perimenopausal symptoms, not everybody's going to have the same ones. So if you have one of the kind of not classical symptoms such as, you know, dry eyes. And you go along and you think, oh well, that's not going to be. And then somebody goes, oh well, I had dry eyes and, you know, somebody said it was hormonal. I tried HRT and it's completely cleared up. That person there sitting with the dry eyes goes, ah, okay then, I'm not— this isn't— I'm not making it up. It's not all in my head. This is something that I need to kind of speak to my doctor about. And so that starts the conversations. This is a weird question. What, what are the rarest kind of symptoms that you've come across? I know you've just said dry eyes, and, but, you know, just some unusual ones that people might be suffering from, but they have no idea that it could be hormonal. Yeah, well, I had a lady who had a thing called plantar fasciitis, which is inflammation of the sole of the foot, and It's really common. Women get it a lot in the summer because we wear flip-flops and that can kind of inflame the sole of the foot. But she'd struggled with it for years. She tried everything. She'd had steroid injections. We'd been rubbing gel in it. She'd been doing some work with the podiatrist. She started on HRT. She came back from her 3-month review and it had gone. Wow. And, you know, so that was the bizarrest kind of link of that I found, but generalized pain is a really common one that we just put down to being a woman and getting older. And a lot of women find a lot of relief from that. And we actually know that fibromyalgia is a common diagnosis of women in the perimenopause, when actually it could be a hormonal trigger. Yeah, yeah, because they're very— they can be very similar, can't they, with the aches and the pains in the joints and all that kind of thing. Exactly, it mimics a lot of things in the perimenopause. Yeah, oh, just going back a little bit because I was curious when you said, you know, back in, not the olden days, but say my mum's era, was, you said that HRT was around then? Yes, yes, and the GP been around? Oh gosh, well, it's been around a really long time. As I said, they started using the pregnant horses' urine, but when the kind of education was out 20, you know, 20, 25 years ago, it stopped being so widely used. So it was still in use then, but the details that came out just meant that as clinicians we were advised that we shouldn't be using it first line. Which is a complete change to now. We should try the non-hormonal treatments first. So that's where the antidepressants came in, things like clonidine for flushes. And then if they didn't work and the woman was still symptomatic, you were told it had to be a small dose for a really short period of time. So it was like a maximum of 2 years women were advised that they should be on it, and then they had to come off it even if they weren't really, you know, if they were benefiting from it, they were told that they still had to come off the HRT. So the discussion now with women is you take as much as you need for symptom control for as long as you need. Yes. And, and I have an 82-year-old who is still on HRT because she knows how beneficial it was to her and she doesn't want to give it up. Yeah, good for her. Because this is another misconception. So like even my husband used to say to me, well, you have the menopause and then you're, you know, you have these symptoms for a few years and then it goes. I've had to reeducate him, say, well, it never really goes. You never really get that estrogen back or the progesterone or any of those things. It really is there for the rest of your life. But supposedly sometimes you do get used to it or you get used to that, or you just stay on hormones for the rest of your life. Yeah, you, you balance into a new normal. If you don't take treatment, there will be a new normal that you will kind of accustom yourself to. But we also have to remember the the kind of beneficial effects of oestrogen on the body. So women who go through the menopause, we have an increased risk of osteoporosis. So our bones are more likely to thin, and that means that we're more at risk of fractures if we fall, even if we do a low-impact fall. And obviously, you know, a broken thigh will cause lots of problems down down the line. And so if we can avoid that by supporting our bone health, fantastic. We know that our estrogen is supportive over our heart health, and we can see that because women prior to the menopause have a lot less cardiovascular incidents than men of the same age. But we go through the menopause and our cardiovascular risk will increase. And so HRT has been shown to support lowering blood pressure, lowering cholesterol, and reducing the buildup of cholesterol plaques within the coronary arteries, so reducing our risk of heart attacks. Studies have shown that HRT can reduce the risk of bowel cancer, and a really new study out at the start of the year is showing that they're doing a lot of research to seeing if HRT actually supports women prone to developing Alzheimer's dementia. Yeah, I thought you was going to say that actually, because that would be amazing, wouldn't it? Most definitely, because dementia is the number one cause of death in women currently in the UK. Women are living a lot longer, and it's about a 2-to-1 split, so 2 women to every 1 man get diagnosed with dementia. And it's not just because women live longer, longer than men. Oh, sorry, did you just say that? That's not— yes, it's longer. Okay, no, no, I just spoke over you and I said because, um, women live longer and you're saying no. So that's the answer to that question. Yes, so there is a genetic element, but estrogen is, is looking like it's going to be quite protective over brain health. I'm definitely staying on it then. No, I have dementia in my family, so you do think that, don't you? And you just think, yeah, is it going to happen to me? So, but then I always thought that I would stay on it because I can't think of a reason to come off of it, to be honest, because it's got so many benefits. And you know, when you say that people get used to, if they don't have treatment, and women get used to feeling like that. Do they actually start to feel a bit better then, or are they just used to feeling bad? No. So, so the menopause is a very metabolic process. So everything kind of gets churned up. And with the female hormones dropping, other hormones go awry. So especially things like your cortisol levels. Yeah. So your cortisol is your fight flight stress hormone. So that's the bit that when risen, and for lots of different reasons, you know, but in the menopause specifically, can make us feel very anxious. So that's where we're very quick to burst into floods of tears for no reason, where we're very snappy or feisty, you know, some women have described it. Our other half. Yeah, exactly. So very, very ready to snap and shout and just feel intolerant. Towards others. But the cortisol also causes us to kind of shut down. So I describe it to women like lockdown. So when our cortisol levels are high, our body goes into this kind of lockdown mode. So our essential workers, if we're using the COVID analogy, they go to do their work. So that's the bit keeping us alive. But the non-essential workers, like our hair, nails, skin, our vaginal health, our joints, everything kind of then falls by the wayside. So that's where we get those symptoms that come along. But what will happen over time is the body's estrogen levels obviously are dropping, but the cortisol then decides that it's, you know, quite fine. It knows that we're not going to get any more estrogen and it starts to kind of balance. So you won't stay at the level you are now with the side effects. So those side effects will all start to diminish. Okay, so you do get over it then, eventually? Yeah, but unfortunately we can't say when that will be, and some women have longer lengths of symptoms than others. So we just have to be there to support women at every age to make sure that they know what they can take. Yeah, yeah. And you do hear quite a lot of younger women that are going through the menopause quite early as well, don't you? Well, exactly. And there's, there's kind of research as to, you know, what makes an earlier menopause, because genetically, you know, if our mum has gone through a natural menopause, our menopause is going to be roughly between 2 years either side of that timescale. So we can get a rough estimation, but we know that things like IVF treatment, smoking status, weight, things can have an impact. And obviously we're having more IVF in our generation than our parents' generation may have had. Polycystic ovaries, ovarian cysts, anything like that can have an impact and draw us a little bit earlier. So I think that's also why we are seeing women— we're understanding the perimenopause a bit better, so we're catching women earlier. But also there may be things in our environment that are maybe bringing us towards an earlier menopause than, than some we would have expected. You don't think it's got anything to do with how early you start your periods? A couple of questions people have said to me about Well, because I started my periods really early when I was like 8 or something, and I think I probably won't, like, you know, go into my 50s before I have the menopause. But I just wondered what you thought on that. There's a lot of kind of conflicting, you know, because a lot of the time women who start their periods early, there seems to be some protective kind of elements to having, an earlier period start. But there is no rhyme or reason. Just starting maybe, you know, kind of late primary school age doesn't mean that you're going to go into an earlier menopause, and you, you could just naturally go into a later one. Yeah, it would be great if we could create a predictor tool so we could actually kind of say, well, this is people, so these are the symptoms you're going to get and this, but that probably would never happen, unfortunately. It's interesting that you said that you could use your, your mother as a kind of guideline, possibly, you know, a rough guideline. I'd never really heard that before. Yeah, so within 2 years either side is kind of a good estimate that we give ladies, but a lot of times, you know, they either don't know or their mum might have had a hysterectomy early, you know, so we haven't even got that consistently to go on. Yeah, my mum was one of those ladies that said she didn't know that, you know, it happened really. But maybe she didn't, you know, maybe she didn't get very symptomatic, so, whereas I did. Do you think there's any truth in the fact that if you don't have children you can have a worse menopause. Have you ever heard that before? No. Again, like the kind of age— I had a doctor say that to me one day. Yeah, go on. Yeah, I was thinking, like, like with the age you start your periods, I don't think there's any consistent links. There are risks and benefits of having children and not having children in terms of female health, but they're not consistent either. So It's really kind of when you speak to a clinician, they will ask you those things and they'll want to know, you know, have you had any pregnancies? Have you had any IVF and things like that? Because it will give them a little bit more understanding. Less so regarding the menopause, more so about other things like ovarian cancer risk and things like that, breast cancer risk, all of those things. So it's a very kind of holistic bubble, and we look at all aspects so that we know what we need to be looking at for women given different histories. Yeah, that's why I love medicine. It's very detective work. Oh, are you a secret detective? That's it, yes. I love an escape room and things like that. But yeah, it's really just— I love taking time to listen to women, because I think it's fascinating. I think we've not been able to listen to people enough, and so that's where a lot of complaints arise, because we're not listening and women are trying to tell us things, and we might assume if we don't listen and go down routes that are not beneficial to anybody. Just having the time to be able to sit down and talk and listen means that that woman's going to get the best care possible. Yeah, that's true. Yeah, no, I mean, I'm all for the NHS. I think they do a great job and they get a lot of stick, and it's not their fault if they're understaffed and don't have enough money and that kind of thing. But I do think that being educated, like what you're doing, being educated about women's health is important and shouldn't be, you know, overlooked really. Yeah, because Health and Care did a fascinating study. They questioned 37,000 women as to what triggered symptoms, right? And number 1 and 2 were stress at work and stress. And what, that triggered symptoms of the menopause? Or yes, so kind of if you are in work and you are handed, um, a piece of work that you weren't expecting, you have a deadline for that afternoon, your emotions are going to be higher. You might get the flushes, you know, all the symptoms that you've got may be exposed during that time. Um, and so my first port of call with women prior to talking about any medications, any supplements, is look at stress. Yeah. Um, because That's a big factor, and women are amazing at looking after everybody around them. So we might have small children, we might have elderly relatives, a partner, a job. Our WhatsApp is bleeping every 10 minutes because of all the different groups that we're in that need our, you know, input into them. But how often do we actually go, right, I'm going to take half an hour out for myself. I'm going to just stick a podcast in and I'm going to go for a long I'm going to go to the gym because that's my happy place. And so my main thing is do something every day just for you. Yeah. Whether it be 15 minutes, you know, or if you've got the luxury of an hour. Is that enough, 15 minutes? Yeah. You think so, yeah? And things like the Balance app, you know, that you can download again onto your phone Calm app, again Headspace, things like that are really good for taking you out for 15 minutes and just putting you into a mindful state. Yeah. So you can just kind of decompress. I do, I do, I've got to be honest, Dr. Rebecca, I do find that really hard to switch off. I have to be honest. Like, I'd like to be able to go, like I was talking to someone the other day and She meditates every afternoon between 3 and 5, and she works really late, and then she works in the afternoons, but she always has this time. I wouldn't— I would find it really hard to switch off. I'd still be thinking like, I've got to do this, I've got to do that, and I shouldn't be laying here. Well, you know, that's because it's hard. We just live in a society where our emails are bleeping, our phones bleeping. And if you download the Balance app, you know, in the first couple of sessions it's going, you know, if your mind is wandering, take it back. And it keeps reminding you that because you're sitting there going, oh, have I remembered to take the chicken out of the freezer? You know, has my child got his lunchbox today? You know, whatever it is. My child up from school. Exactly, it's completely random, but I think with practice, like everything, you you will get better at it. So your friend has just got it down to a fine art. Yeah, yeah, she's that person, you know, she's, um, very holistic and meditation, and that's, that's what she does. So yeah, and I, I think it's an essential part for all women. Yeah, I'm gonna try, I'm going, I'm actually gonna download the Balance app then and I'm going to give it a really good try. And I feel like you shouldn't have to say that. You shouldn't have to say, I've got to try to relax. You should just relax. You know, that word try is putting pressure on yourself. Exactly. But we've all got to try and, you know, change our diet and eat a little bit better and exercise a little bit more. There's a lot that we've got to do. But I think tiny steps, just do one thing. And make a change, make it consistent, and then work on the next one. I'm not, you know, I never ask for miracles in a week because it's not going to happen. You've got to do things that fit in with you, and if it doesn't fit, then think of something different. But, you know, it's never going to stick if we can't kind of make it a routine. Yeah, like you say, it's a learning thing. I have to learn to do it. I need to learn to like the gym. As with everything, yeah, it will come and go. But as I say to ladies, you know, the fact is a lot of ladies, especially related to their weight, will go, well, I go to spin class 3 times a week, I absolutely hate it. You know, don't go to the spin class if you hate it. Yeah, guess what you don't do, will you? Exactly, do some weights, you know, go and try weightlifting or go to a pump class. You've got to do something that you enjoy. There's no point in going because if it makes you miserable, you're not going to want to keep doing it. But, you know, walking is so underrated, you know, so it's just getting out for half an hour and doing that can be more beneficial than half an hour doing a spin class that you absolutely detest. That's maybe why I am kind of like physically okay, because I've had dogs my whole life and I walk every single day, even if I don't want to walk. Yeah, I feel guilty if I don't take the dogs for a walk, so I go every single day. And I think that's been the best thing. And my husband comes with me, and it is lovely to take the dogs dogs out and, you know, um, just see the green, green fields or on the beach if you're, you know, near the sea or something. It, it— that does— that is my thing, I think, that I'm quite good at because I love seeing those dogs enjoying themselves. Makes me happy, you know. So get a dog, but not for that reason. Don't get a dog, please. No, you need to want a dog or love a But yeah, so, well, we're nearly at the end of this. What— who— could you tell the listeners the website to go to, or, you know, the— yeah, so it's just healthandher.com. So quite easy, and it's all one word, health and then A-N-D-H-E-R dot com. Or you can find us in any of the app application stores, um, just type in Health and Hair and we will, um, it comes up there. Are you on, um, Instagram or Facebook or any of those as well? Yeah, so you might see my face on Instagram. I do some, um, kind of just, uh, 1-minute little, um, pieces to the, to the camera, um, on Instagram and Facebook. So, um, yeah, you can click on there and and they do regular postings to support women as well. How do you feel about doing that? Have you got used to doing that? Those kind of things? Yes, I enjoy it, but it's quite a shock when you're flicking through and you suddenly see your face come up. And you're talking and you think— oh, so with me, I don't like my accent very much, and I think, oh, why did I say that word like that? You know, so Yes, silly little things you pick on yourself, don't you? Definitely. Yeah, so, okay, just a few more minutes. So if you can round everything up, what would you just say to the average lady that's suffering symptoms, and what advice would you give her? So I would definitely say look at your stress levels. See if you can manage that. Then kind of look at diet, exercise, lifestyle. So getting your exercise, looking at weight management, reducing alcohol intake, stopping smoking. I know GPs bang on about that all the time, but it is really important for women's health to be focused on that. But if your symptoms are impactive, then speak to somebody, whether you kind of look at places like Health and Hair for support or you book in to speak to your doctor. If you're going to your doctor, what I would also advise is write your symptoms down, have things in black and white with timings, you know, so if you can remember when your symptoms started or, you know, the symptom tracker app from Health and Hair is really good because if it's in black and white, your GP can't dismiss that. They can see it and it's clear then, and they can make a better formal assessment of what's going on. That's really good advice as well, because sometimes you go to the doctor and you've waited forever to get the appointment, and then you can't remember what you wanted to say to them. Yeah, so if you write it down before you go, that's a really, really good idea, and better for the doctor as well. Like you just said, Yeah, okay, well, thank you for coming on the show, and I, I will say goodbye now and thank you very much, and hope the weather improves in Cardiff. It's still a bit grey and miserable here. Yeah, we do have funny summers, don't we, really? The whole of Europe is, you know, in a massive heatwave, and we've We've got rain and gray skies, but there you go. I would rather be here than in 45 degrees, to be honest. So definitely, it's lovely to talk to you, Rebecca. And yeah, hopefully all our listeners will go over to your, to your apps and your website and get some good advice. So thank you for coming on. Brilliant. Thank you for inviting me. That's okay. So goodbye from me anyway. This is Women's Radio Station.