The Menopause Show With Sue Moxley – Dr Shirin Lakhani, A Passion For Advocating Womens Health

Men and Women's Radio Station was originally launched after one of the directors was chatting in a pub to some people about the suicide rate in men, which he discovered was so much higher than it is in women. In fact, it's incredibly high. It's 80% and women 20%, and you know, he was shocked at that and thought, okay, I need to, to do something out there so that men can talk about mental health and all of those things that, that they find it difficult to talk to their friends. You know, like us women, we, we chat more easily to our friends and we're more likely to go and tell our GP if if we're not feeling good or if we're depressed or anxious, all of those things. So that's why I started the station. And of course, menopause isn't just about hot flushes and weight gain. It can be so much more than that. It can cause anxiety, depression, and can become really problematic. So On this show, we will be dealing with those kind of issues as well. Hi, this is Sue Moxley. This is women's radio station. This is my show, The Menopause Show, and today we have a wonderful guest, Dr. Shirin Lakhani. So hi, Shirin. Hi, Sue. Thank you for having me on today. That's okay. Tell me what it is that you do. Um, so by background, I'm a former anaesthetist, and then I went into general practice. Um, and as part of that, um, during that time, I trained to do aesthetics, so things like facial injectables, etc. Um, and then during my time in aesthetics, I implemented women's health into my clinic as well because I've always been interested in that. While I was a GP, I did a lot of women's health. I got my diploma of the Royal College of Obstetrics and Gynaecology as well. And because the demographic crosses over so much between the people looking for facial aesthetics and people who are perimenopausal— yeah, same age— and the reason actually people are coming in is because of changes associated with aging and menopause. Yeah. And through the women's health side, I was treating incontinence, sexual dysfunction, menopausal atrophy with different treatments. And I also became involved in prescribing HRT as well because a lot of my patients couldn't get it from their NHS GPs. Yeah, I've heard that. Yeah. Is that when they're underage? I mean, oh no, it's— you have to stop having a period for a whole year before you can get it. Is that correct? And that's not correct, actually. That's what most people say, but actually that period that you're describing where you haven't had a period for a year is the one day in your life that you are menopausal. Everything before that is premenopausal or perimenopausal, and everything after that day is postmenopausal. Yeah. But when you need the help the most is when the hormones start fluctuating in your perimenopause and you will sort of peers at that time. So, well, I don't, I don't take sort of standard HRT. I take bioidentical. Do you do those? Yes, I do those as well. So before you could get bioidentical hormones on the NHS, which are now called body identical to distinguish between the two, it was either the old-fashioned synthetic HRT or you have to go to a compounding pharmacy for bioidentical hormones. I do both in my clinics. I do body identical hormones and bioidentical. What's the difference with those two? Because this flummoxes me a little bit. It flummoxes everyone, including the doctors who prescribe body identicals. But the difference is body identical hormones are like bioidentical hormones, but they're licensed and they're made by a drug company like your normal drugs. So they come in standard doses, and those are the ones that are available on the NHS. Right, okay. Now, yeah, unlike the bioidentical where you can, you know, you can adjust the dose according to the patient. But it's really important that you use a reputable pharmacy that's regulated and that have got their quality control in place. So that you know the quality of what you're getting is up to standard. Yeah, we are, but I trust those two. I trust their processes. I've actually been to visit their manufacturing centres, so I see the quality control that goes into those. Yeah, and they test what they produce to make sure that actually what you're getting is what's been prescribed. Yeah, yeah. Okay, so, um, you said to me, I think, that you used to do the mesh operations. Um, I used to anesthetize. Oh, you used to anesthetize? Yes, I used to anesthetize for the TVT procedures, and I remember it being like a conveyor belt where we'd have 15+ women on a list and there'd be 2 of us. So one would do one person, take them in, take them out, while the other anesthetist was getting the next one ready. And that used to— Florence Smithside— um, so many women were having to have mesh procedures. So that's how I got into women's health in aesthetics, because when I came into aesthetics, there's a lot more to it than just Botox and fillers. Yeah. And there's a lot of treatments being developed that never make it to the mainstream medical arena just because of funding or lack of randomized controlled trials, etc. But then I became interested in a treatment called the O-Shot, which is platelet-rich plasma. So that's when you take blood from the patient. Yeah, in a centrifuge, and then inject it into the tissue you want to regenerate. And the O-Shot is PRP for the vulva and the vagina. Yeah, I was absolutely amazed that there was a possibility of treating stress incontinence without an operation. And you find that it's working? It does work. Like with everything, there's no 100%, and PRP tends to be effective in about 80% of patients that undergo it. Right. There are other treatments available now that also help, and you can use all of them in combination as well. So I tend to use vaginal tightening to improve the collagen in the vaginal canal, and that puts the support back for the bladder and the urethra. Is that the laser? That's radio frequency. Oh, we said this, didn't we? Yeah. So the machine that you have, the radio frequency, I was kind of reading about it on your— what, on your— is it Fem something? Yes, it's the Fem360, and that's not a laser, it's a radio frequency. No, it's radio frequency, and what that does is it heats up the tissues. It penetrates deeper into the tissue than laser does. Oh, okay. Um, so that's how you get the neocollagenesis, which is new collagen, and you get elastic formation, which helps with the stretchiness of the vagina canal. Yeah. And you get tightening, and, um, because One thing that happens to a lot of our tissues as we age is they become lax and saggy. Yeah. So that's why things like stress incontinence get worse as you get older, because you're losing your natural collagen. Yeah. So you can restore some of that with treatments like the Fem360, but there's the other aspects of it, which is your pelvic floor muscles. So you need to address that as well. That's the exercises, isn't it? That's the exercise that nobody ever does unless they actually hear the words pelvic floor. Yeah, but I don't think anyone ever does it when you tell them to do it. Because when you say it, when, for example, if I'm doing a lecture and I say pelvic floor exercise, I can literally see the whole room start to do them. And that's the only time anyone ever does them. And I bet your listeners are doing them now. Yeah, probably. I'm doing it. That's so funny, but you're right. I mean, if we kept it up, it's a bit like exercise with me. If we kept it up, the pelvic floor, because I never know whether I'm doing it right, to be honest, because you, you're pulling up and in and tensing. But how do we know that we're actually doing it correctly? The exercise is really difficult, and the only way to properly know is to go and get a pelvic floor physiotherapist to show you. Um, in Europe, in France for example, every woman who has a baby sees a pelvic floor physiotherapist afterwards. Do they? Is that NHS? That's part of their NHS, yes, that's part of their healthcare. We don't have that here. The only time you see a pelvic floor physio is if you've got issues and they're not resolving with your own pelvic floor exercises, and only then if you're really lucky to be referred to one. Yeah. Or if you pay privately. Yeah, yeah, yeah. It's a bit like going back to the laser just for a sec, or the, the, what we was talking about, the machine. Sorry, I keep saying it's a laser. I had the, I had that a few years back. I had a course and to be honest, it was amazing. I mean, I think I had the Mona Lisa one, but I thought it was amazing. And then I met the actual man that invented it, because they are— the company asked me to speak because I'd had such good results. So I spoke in a room full of doctors and he said that in Italy the women can have that on the NHS as well. Yeah, I mean, it's amazing how different women's health is treated in different countries and we are so far behind. Is that I was at a talk on Wednesday at the Royal College of Obstetrics and Gynaecology, which was for the BSI. They've just released guidelines on menopause and menstruation in the workplace, right? And it's, but it's just now that they're releasing guidelines for employers to implement policies to make life easier for 51 to 52% of their workforce. I know, because I saw they have— didn't the government employ its first menopause champion? I think Helen Tomlinson, she was actually there. Oh, was she? Yeah. Is she still the one and only? Yeah, she is still the one and only. I think her position is voluntary as well. I don't think the government are actually paying her. Yeah, so I thought, well, She's gonna have an awful lot of work to do going around the whole country, isn't she? We need a few more than just her. But yeah, I think she's got a small team as well. But yeah, there is so much work that still needs to be done out there. Yeah. So that women aren't discriminated against because of their biology. Yeah, but don't you think it is starting to happen now, especially in the last kind of 6 months, year. Yeah, it's due to a lot of hard work and campaigning from many, many people over the last decade that we're now starting to see little changes. Yeah. But I'm really hoping— I know our generation is more aware of the menopause than my mum's generation. Yeah. But I'm hoping by the time my daughters, who are in their teens, end up going through perimenopause and menopause, that there aren't any taboos around it, that they're allowed to speak about it freely and openly without embarrassment. Yeah. Without feeling ashamed that they're going through it, because I think a lot of women feel ashamed that they're struggling with menopause symptoms. That's if they even know that it's due to menopause. Yeah, they do. And I mean, I know, like, but obviously doing the show, I've met a lot of different people that are involved in menopause, but everyone says the same thing. They— women still kind of whisper about it, you know. It's not something that they just come straight out and say, well, I have this problem. They'll kind of whisper it because they're embarrassed and they think it's something to be ashamed of, which it isn't. It's so sad. Women then feel like they're the only ones going through it. Yeah. And I see with all sorts of women's health issues, not just menopause, that they don't know that other people suffer with it and they think they're the only one. And that adds to to the shame and stigma. Yeah. Whereas if we all talk about it openly, um, for example, I mean, if you look at the stats for incontinence, which happens even before perimenopause, yeah, um, and even without childbirth, women can suffer from incontinence. Yes. Um, the published stats of 1 in 3 women, okay, the actual number I think is a lot higher. Yeah, do you? What do you think it is? I think it's almost every woman. Really? Yeah, incontinence at some point. Yeah, yeah, all my friends, I mean, we joke about it, you know, we used to say that we used to laugh when our mums crossed their legs and now we don't laugh anymore. Now you just cross your legs. But the thing is, the number of women I speak to, and I'll say to them, well, do you have an issue with incontinence during the consultation? And they'll say, no, I don't have any problems with that. And then I'll reframe it and I'll say, well, do you ever leak urine? Yeah. Even stops when you don't want to? Yeah. Like unexpectedly. And they say, oh yeah, I don't go on trampolines anymore, or I don't jump around with the kids, or I can't go for a run. Incontinence. That's what it is. I mean, it's quite random, isn't it, that we'd go on a trampoline anyway, if you know what I mean? But you've got young kids and you go to the trampoline parks, which are more and more common. Yeah, but I remember, um, going to one of my friends' houses, uh, grandchild was bouncing up and down on the trampoline. I thought, oh, I'll have a go. Big mistake. Ruined my diet, did. Oh, I mean, we're laughing about it now, but it is a serious issue and it it. I think if you're a young mum as well, that affects your relationship with your children and what you can do with them freely. And as you get older as well, it can affect your sex life, it can affect your social life. You have to always think about where the nearest toilet is. Yeah. And it has a massive impact. And yeah, we are laughing and joking about it because that's the way to educate. Yes. Uh, um, it is a really serious issue. I think if you laugh about it, takes the embarrassment out of it a bit. I'll make way. Yeah, so just going back to the, um, the mesh thing, because I'm interested in this myself, have they stopped doing that operation? Um, I think they've stopped doing it in most cases. I think there are a couple of situations where they would still do it, but I'm not involved with the surgical side and I don't work Yes, because was there something wrong with the mesh or something? There were a lot of issues with the mesh eroding, causing pelvic pain, and all sorts of problems with it, which is why it was withdrawn. So really, it's, um, that's off the menu now. And, um, is there any other surgical procedure that you can have done for, like, incontinence? There is one where they actually lift up and the bladder as well, but again, that's major surgery. Yeah. But generally, unless you're one of the most severe cases, you're looking at being told to go and do pelvic floor exercises, wear pads, and there isn't anything much more than that available on the NHS now. Yeah. Thank God for your PRP and the lovely new machines that are out there because And that's— sorry, there's a lot more coming. So when I first started, I think all that was available was the PRP and the laser. And then as times evolved, we've had the radio frequency devices, we've had the muscle stimulating devices. So there's a chair that I have in my clinic. Oh yeah, I read about the chair. Oh, fantastic, because you don't even have to get undressed for it. No. So what does it do? I'm really interested in this because we were talking about the chair, but we don't really know what it does. I just imagine sitting there jumping up and down occasionally. Um, don't actually even jump on it. So you sit on the chair, there's a strong magnet in the base of the chair, and that stimulates contractions in your pelvic floor. So, so does— do you actually contract then? You can feel your pelvic floor contracting, your whole body doesn't contract. So you're not sitting there on the chair, you're sitting there looking quite comfortable where you can read a magazine. Wow. I say don't use your phone on it because the magnet might affect the phone. Right. So we've gone back to old school magazines for that one. So how often do you have to have that done? You know, the initial treatment course is usually 6 treatments over the course of 3 weeks for women. Or 10 treatments for men at 3 a week. And then the maintenance is 1 or 2 treatments every 3 months. It depends a bit on your pelvic floor and things, but it's like any sort of exercise. If you do a course of exercise to build your muscles and then never do anything again, you're going to go back to how you were. Yeah, so you do need maintenance. And if we're really good at doing our own Kegel exercises, then you might not need to come back and have the chair so much. As we know, we're all useless at it. Do you think, um, Kegels work? Absolutely, when they're done properly and in enough quantity and you start them early enough. So the only time pelvic floor is ever mentioned to women is childbirth, if you're lucky, the midwife might tell you to do pelvic floor exercises. Or we're, we're all a bit more aware now, and there's books and internet and things like that that tell you that throughout your pregnancy and afterwards you need to be doing Kegel exercises. But I actually think you need to start doing them in your teens. Okay. In secondary school. And I really want it to be made part of the PE education in secondary school. Because if you can get girls and boys doing their pelvic exercises from that age, they're going to have far less problems later in life. And I said boys as well because we don't talk about pelvic floor for men, but men have pelvic floor muscles as well. It's part of their core muscles. So by doing pelvic floor exercises for men, they can help with erectile dysfunction, they can help with incontinence that happens later on. And just to confirm, is this a similar exercise to the women? Do they just kind of pull up or, you know, that? Yeah, they pull up their pelvic floor, but with men they feel it more around their anus rather than— obviously they don't have a vagina, so they feel it more around the anus. Okay, yeah, I'll have to tell my husband about that. Yeah, absolutely, do them together. Yeah, that would be funny. Okay, so that's so— yeah, that's so interesting, and I'm so glad that there are other things out there now that we can turn to. And like I said, like you said, I'm sure new things will come out all the time. Absolutely. I mean, I'm looking at a couple of new devices at the moment, and one of them is intradermal radiofrequency for the vulva and vagina, right? So I don't know if you've heard of Morpheus 8. I have, yes. That's the one Andy Murray's mum used and hit the national press with, with amazing results on her face. Right. Um, the company that make— I'm not sure why Andy Murray's mum is so famous, are you? Um, I think it was the result she had with this treatment because it was before and after pictures were phenomenal. And I mean, everyone knew who she was because she was there courtside every match, wasn't she? Suppose so. It's just a bit weird, you know, she's been on like reality shows and things like that. And yes, she's Andy Murray's mum. But anyway, that's something in my head anyway. So she had great results with the Morpheus8 on her face. The company have developed one for the vagina and the vulva. Okay. Talked about radiofrequency, which is what I use with the Fem360. Yeah, that is a non-invasive radio frequency. The Morpheus8 V actually uses needles, so microneedling, to deliver the current deeper into the tissue. Is this, is this in external? It is internal and external. Okay, that just might be— that just made me do a pelvic floor exercise. If you keep your pelvic floor exercises up, so you can avoid coming to see me. Oh, but how— so how does that work? Do you put some kind of internal numbing or something, or don't you feel it? You don't feel the internal so much because if you think about the vagina, there's no need for heat receptors and pain receptors in the same way that we have in other parts of our body. All right, so I do injections into the vagina with PRP. I don't use numbing for that because it's not needed. Wow. No, but when I do the, um, internal radio frequency, I do put numbing internally even though they don't feel that as much as the external one, and we definitely numb the external. Okay. Yeah, no, I didn't, I didn't feel anything. Is, is the Mona Lisa machine slightly different? Again, you don't feel the pain in the vaginal canal. So if you had a laser treatment similar to the Mona Lisa on your face, you would need numbing for that. Yeah, I know. Yeah, yeah. Well, the vaginal canal does not have the same pain receptors. Yeah, but he actually— when I had it done, I actually had a bit on the outside as well, but I didn't feel pain there either. Um, a little bit. Yeah, a little bit. It depends on different people's pain thresholds. Yeah, I think mine's good. I think people with internal menorrhagia jump when they've had it, so they do feel it, but it's tolerable. Yeah, okay. Oh, so we're looking forward to, um, so are you going to get one of these Morpheus8 machines? I've got, I've got one at the moment, and I'm actually trialing it for a condition called lichen sclerosis. Which is a genital skin condition, affects women more than men. Yeah. And it peaks at periods where you've got low estrogen, so pre-puberty and at menopause are the two big peaks of incidence. Yeah, yeah. When I was trying to find out what was, what was wrong with me, because the reason I, I'm so into menopause is that I had a really bad menopause and At one point, someone said they thought— one doctor said they thought I might have had that, but I actually didn't. I didn't have lichen sclerosus. Yeah, so the thing is, severe menopausal atrophy can mimic lichen sclerosus as well. Yeah, but lichen sclerosus is one of those conditions that gets misdiagnosed as recurrent thrush or other things. I've had women come in saying they've been told they've got eczema on their vulva. I had that. Yeah, well, I hope that— yeah, so the thing with that is if you leave it untreated, it can destroy the genitals. Yeah, I know, because it fuses into itself, doesn't it? And because, yes, then you get fissures. And a lot of my ladies who come to me get tearing on intercourse and actually can't wear jeans and Yeah. Um, can't wear underwear as well because it's so severe. Yeah. And it's way back to the perianal area as well. Yeah. Um, so they get anal fissures, they can't go to the toilet without tearing and bleeding. It's absolutely— that's what I had. That's— that was what I had. So, um, but I would tear without even doing anything. I could just tear like doing a yoga pose or something. Yeah. Or if Yeah, walking. Absolutely. It was, it was awful. And this, this was like 10 years ago. And I did go to a lot of— like, you're so— you are very, very knowledgeable. You can hear it. But when I had it, I did really have a hard time trying to find out because I didn't really know what was wrong with me, to be honest with you. And I think the worst part of all was obviously I couldn't have sex, but I had nerve pain around the entrance of my vagina. And it was only when I finally got to see my lovely gynecologist who suggested the laser treatment, he said to me, well, your skin is so thin and so, you know, it's just not, not healthy anymore that your nerve endings are almost kind of exposed. So that's why you feel the pain. And, and it was like a light bulb moment. I didn't really— it was like a simple thing being told to me like that, um, was that, well, yeah. And I'd been on nerve pain, um, tablets and medication. I tried everything. And then, yeah, it was like a light bulb understanding that really I just had severe vaginal atrophy. That was it. Yeah, you say that was it, but I mean, it's so sad that women's health, so things like menopause, aren't compulsory in medical student education. It's not compulsory in GP training. It's not even compulsory in obstetric and gynaecology training. You choose to do the training if you've got an interest in it. Yeah, and I think that's absolutely shocking. I think we make up more than 50% of the population, and because medicine's traditionally been patriarchal and women have been put to the side because we're seen as inferior because of our biology, not just different, there's not been the same input into women's health as there should have been. And as a result our healthcare is second class. Yeah. And women are just expected to shut up. Should we go out and demonstrate together? Yes, absolutely. I can hear you're really passionate about it. I am. I mean, I find it really frustrating, especially when I get countless women coming to me who've been to so many other healthcare professionals and just kind of been fobbed off. Yeah. But now with the increased awareness around menopause, there's a bit of a backlash in some of the medical professional communities where it's like, oh my God, it's a Davina effect. And what does she know? And why do you want HRT? Because it's going to give you breast cancer. Yeah, I know, I know. Angry. Yeah. Well, you know what? Davina did bring it out there, whether she knows anything about it or not. She, she brought it out there. Her, her show was like what really kind of kickstarted Absolutely. Oh, it's important that women like Davina, Mariella Frostrop, and Penny Lancaster and all the rest of them, yeah, come out, are open about what they've been through. Yeah, because that's what's taking it out to the wider public. Yeah, no, I agree. I think it's amazing what they've done. I think it's been really brave of them to address it as well. But it's, it's still not enough because the message still isn't getting out there to the people it needs to get out to. What do you think? More treatments on the NHS and more training, like in the early— I think first of all training, and not just for medical, like future doctors. I think every single person in healthcare, whether they're a physiotherapist or a nurse or a healthcare assistant or whoever needs to be educated on the symptoms and signs of menopause. Yeah. So that they recognize it because a lot of the problem we have is our sex hormones. So estrogen, progesterone, testosterone have an impact all over the body, not just on the reproductive system. Yes. So there's receptors in the brain, there's receptors in the heart, receptors in bone. The effects of the hormones on the body are so widespread that when you get fluctuations, the symptoms are widespread. And a lot of women go to their doctor and they get treatment for the anxiety or they get treatment for the joint pain. And nobody ever really puts it together that actually this is menopause. Yeah. And all you need is to balance hormones again. Yeah. I know. I do. I do know that. But I do think like there's not— there's more people like you around now. There are a few more people like you that do really understand it. Whereas 10 years ago I was— I basically had to do my own research, if I'm honest. I did. And I completely— and I never— when I started in this arena, prescribing HRT wasn't what I planned to do. I wanted to do the treatments that went alongside it, but because my ladies couldn't get the HRT from their NHS doctors and even struggled to find private doctors to get it, I ended up having to provide that service as well. So why, why couldn't they get it, and why were they struggling to get it? Um, lack of knowledge, lack of access. Yeah, as well. So I mean, back then before the pandemic, it was easier to get a GP appointment. Yeah. And it's not the fault on that side. The NHS is severely underfunded in the right way. Yeah. And there aren't enough doctors, there aren't enough appointments for the population, and trying to get in to see your GP is virtually impossible now because there is so much backlog. Yeah. And then even when you did get in to see them, the education around menopause isn't there. Yeah. So you'd go in and like I said, you'd get anti-anxiety medication or you get painkillers or— and nobody would put it together that actually all the symptoms that you're having is down to menopause, especially if you're still having periods, like you said, because of the old guidance and things, and the old way people have been trained where HRT is bad for you, you should only use it for the minimum amount of time if at all. Yeah. And after you've been on it for 5 years, you have to come off it. Um, it's not the case anymore. A lot of GPs are still trained in that way. Yeah, yeah. So it just, it got too frustrating for me and my patients, so ended up being easier for me to put in a menopause HRT service as well. That's good. That's excellent. Yes. So even yesterday, I mean, I, I know I'm one of these people that's in several Facebook groups, but they are about menopause and things. A young girl had been to her GP and said, oh no, she was in for a health check and apparently she was shouted at and said because she'd gone private. To get HRT. And she said, what are you doing on these? You know, you can give yourself breast cancer. And this was like a couple of days ago and made her feel terrible. She said she actually felt like she was back at school being told off. And so you're right, so many doctors as well are not educated about it, are they? No. I mean, I had an argument with the GP in a bar once. It's just a chance meeting. I was at a conference and they were out with their work and we were just talking about what I do, what they do, and the women's health thing came up and he proudly said to me, oh, I prescribed one of my patients oestrogen because they'd had a hysterectomy. Oh, on its own? On its own. I was like, well done you. I was like, what about the progesterone and the testosterone? Oh no, that's not on the NHS. And if I give her progesterone, I'm going to give her breast cancer. Yeah, you could give her womb cancer just giving her oestrogen on their own, on your own, can't you? She's had a hysterectomy, so that's why it was oestrogen. Okay. But we've got progesterone receptors all over our body. Yeah. And the old-fashioned progestins, which were the synthetic ones, they're the ones that carried the risks. The micronised progesterone actually crosses the blood-brain barrier. So Utrogestan, which is the only licensed micronized progesterone. Okay. Um, that has benefits over just protecting the uterine lining. Yeah. So I understand the old progestins not being given, but when you've got progesterone that works all over the body, then a lot of women need that to balance their oestrogen, even if they don't have a womb. Yeah. And that's not common knowledge either, unless you go to someone who's really done their homework on menopause and hormones. I kind of knew that. Don't they call progesterone the happy hormone? Because it's good for your everything, your brain as well. Yes, sleep. And if you have estrogen without progesterone, yeah, then you end up getting symptoms of estrogen imbalance. And some of the women I've seen in my clinic are women who've been given estradiol only HRT on the NHS because they've had a hysterectomy. Okay. And I give them their progesterone because they need it. Yeah. Yeah. So, you know, just because when we get to a certain age and it doesn't mean that we don't need our hormones anymore, does it? No. So we're living a lot longer than our ancestors did, and that's just because of improvement in sanitation, improvement in healthcare, etc. If you look at subsequent generations, everyone lives a little bit longer, and they are now saying that people of my children's generation will routinely live into past 100. Really? But our bodies haven't quite caught up with that. No. Whereas— and that's why there's more dementia, don't you think? Because people are living longer. And also because, I mean, if you look at dementia, it's twice as common in women as men. Yeah. There are a lot of theories that that's down to the fact that we lose our oestrogen so suddenly at menopause. Okay. And that contributes to it? That can possibly contribute to it. There is a lot more research needed on it. Yeah. But there are thoughts that actually women have more dementia because an 80-year-old man has more estrogen than an 80-year-old woman. Yeah, because women's plummet at menopause, whereas men, when they go through andropause, get a gradual slow decline in their hormones. I'd say throughout history, men have given their bodies more importance than women. Yeah. And if you look at the way the women's, um, bodies have been described, it's We've basically been seen as a receptacle to bear children. Yeah. And once you've done that and raise your children, there's no need for you. That's right. You look at all the studies on heart disease and diabetes and all of that, it's all done on men. Yeah. And it's taken with respect to their physiology, but it's well known that women experience heart attacks differently to men. Right. Okay. The same symptoms that men do traditionally. It's, it's different. Our physiology is different and things happen to us at different times, and there's not been enough research done on women's health. I mean, until the 1900s, we were locked up in asylums when we had menopause. This is something else I spoke about the other day, about how, um, you know, some time ago that, uh, suicide was was much higher in women around, you know, the menopausal age and that it was probably the menopause that was turning them to commit suicide. Absolutely. I didn't have any help then, or I didn't know what was going on. No. So, I mean, for whatever reason, we're living a lot longer beyond our reproductive usefulness. For whatever reason. I think we are living longer. And I mean, there are theories behind that as well. There's the grandmother theory, which is why humans are one of the few mammals that live beyond their menopausal age, because there's an advantage to having a grandmother help look after the children. I've never heard that one before. Oh, it's out there. I need to make that a sound clip. That's excellent. I mean, there's theories as to why humans live beyond their menopause that are floating around. Obviously no one really knows the reason. No, but that's funny what you just said. I love that. Sorry, that's all right. Um, lost my train of thought. Um, but yeah, so once upon a time you'd have menopause, you'd live for a few more years, and then you die. Now we're spending half of our lives with menopause. Yeah. And we need our hormones to function effectively. Yeah. So this is, for example, another age-related hormonal condition is hypothyroidism. It's much more common as you age. Okay. We don't turn around and say, no, we're not replacing your thyroid hormone, do we? No. We give patients thyroid hormones to replace what they're producing. When patients don't produce insulin when they're diabetic, we give them insulin. Yeah. So why is there such resistance to replacing sex hormones? Because God was a man, that's why. But there is, there is more resistance to replacing female sex hormones than male sex hormones, because actually a lot of my men, as they get older, start to get erectile dysfunction and other symptoms of low testosterone can go get their testosterone checked by their doctor. Yeah, without too much of a fuss. Yeah, they don't get told, oh, you're going to get prostate cancer or testicular cancer because you're taking testosterone. No. Yeah, no, you're absolutely right. Um, wow. Um, I really love you, Dr. Shirin. Thank you. I can go on forever and ever about it. It's good. I think you're the most passionate person I've ever had on. It's excellent. I love it. So, so what? Just tell me a little bit more about you. So how did you— why did you decide to become a doctor then? Was it in your family or something? I am the only doctor in my family, but I think my mum always wanted me to be a doctor, so she told me that I was going to be a doctor. Right. She was told. I was told. But actually, I think I wanted to be one from 6, and I used to play doctors and nurses with my brother, and I always made him be the nurse because I was the doctor. Did you give him injections? Pretend ones? Yeah, I used to do that. I always had the doctor's kit, and I'd always give him the nurse's kit. I bet he was pleased about that. Oh, it's It's fine, the dynamics of our relationship haven't changed yet, so. So you were going to be a doctor? And then I toyed with the idea of not doing it when I was in my teens because my dad kept telling me that I'd have to work really hard for no money and no sleep and it's not the kind of life he wanted for me. Told me that being a doctor wasn't the kind of lifestyle he would envisage for me me because of the sleepless nights, the low pay compared to the hours you worked and things like that. So I looked at other things, but then I thought, actually, no, I really do want to be a doctor, and I don't care about the money. I care more about being able to help people. Yeah. So I went to medical school, and every year I thought I was going to fail and get kicked out, and miraculously passed every year. And at the end of it, you get management consultancy firms trying to poach you straight out of medical school because you've got the skills they want. Yeah. But even— nope, I want to be a doctor. My focus is I want to help people. I want to save lives, and that's what I want to do. So that's how I got into it. Wow, that's amazing. And where do you live in— oh no, I won't talk about where you live on the— but your clinic's in Kent, isn't it? Yes, so my clinic is in Greenhithe. It's in a development called Ingress Park, which is around the corner from Bluewater. Oh, okay. Um, we've actually got the only commercial unit in the development because they're supposed to build more, but they haven't yet. So I'm heading for shops and bars and restaurants and things, but at the moment we're the only commercial unit. Oh, I'm sure it will, will probably, um, get bigger. Everything seems to, doesn't it? It does, yes. Yeah, so but anyway, people can come and see you and then they can go to Bluewater and do shopping. Yeah, so it's a really expensive visit then. Yeah, expensive. Yeah, um, so were you— are you from Kent though, or was you from somewhere else? Um, I was actually born in Pakistan, but my parents moved to the UK when I was 2. Born in Pakistan, but my parents moved to the UK when I was almost 2. Okay. Kind of Northwest London, so originally Harrow, and then we moved to Rickmansworth, and then I lived in Barnet for a little while as well, so it was all Northwest London. And then I went to university at Guy's and Thomas, and with the rotations, I ended up being more Southeast. And I actually found my house on a shopping trip to Bluewater, so when I say when I say don't, Bluewater is expensive, I really mean it. What, did you actually see it as you was driving along or something? We saw the signs to, um, new builds as we were driving along, so we went and had a nosy, and I absolutely just fell in love with Ingress Park and ended up moving there. Um, I lived there for 17 years. We've moved out now, um, slightly further into the countryside. Right. It was just moving. Having been in central London for university and living in that area afterwards as well, it was just nice to be out somewhere quiet. And at the time I was thinking about where I wanted to have children. Yeah. So we just kept moving further and further into the suburbs. Yeah, no, I totally agree. I used to be in London like every day of my life, in what, for one way or another, and I actually can't bear to go there now. It's like I just need green fields and streams and things. I'm the same. I think when you're in a role where you're communicating with people all the time, it's nice to have that space and peace of mind as well. Yeah. Oh, so, so how far do you have to go to get to your clinic? Is it, is it far from your house or? A 25-minute drive. It's not actually that far in mileage, but because I live down country lanes, it takes a long time to get through them. Yeah, but at least it's a nice drive though. You're not on a bus, not on the M25. No, I do have to do a little stint on the A2, but it's not too bad. Okay, so how many children have you got? A daughter? I have two girls. Oh, 17-year-old, 14-year-old. Yeah, I think that's another reason why I'm so passionate about changing Yeah, yeah, yeah, no, I agree. My husband— I've got two stepdaughters, um, and one of them kind of about 6 months ago decided to take herself to a hormone clinic, um, even though she's 29, because she gets really bad, like PMT and moodiness and, you know, and she's checking out her cycle at the moment with the Dutch test. Yeah. So I've done that for some of my patients as well. So although the majority of my patients are older, I do have younger patients. I've treated women with hormonal migraines and things as well with just balancing their hormones a little bit. Yeah, exactly. So that was quite unusual for me to to learn that she'd gone down that route at such a young age. But I think that that is the future. I think, I think we need to understand our bodies better. And there is a real reluctance for testing in the UK for some reason. And one of my colleagues said, well, I wouldn't drive my car blindfolded, so why would I steer my body without knowing what's going on? Yeah, yeah. Because of the NHS and the fact that we're used to not having to pay for things, and a lot of these tests are expensive, they are. Don't realize that actually when you're having a blood test on the NHS, that's what the NHS is paying to process blood test. Yeah, just because you're not physically paying for it at that point doesn't mean somewhere, someone somewhere down the line isn't paying for for it. Yeah, I think you're right about, you know, we're used to getting everything free or reasonably free on the NHS because, you know, I do get ladies that come to see me or talk to me and I think they say they're not feeling good and they don't, you know, they have no energy and I say, why don't you get a test? And they'll say, well, no, I can't, I've got to pay for my holiday. And I think, what's more important? Your health is more important, and then you're going to feel so much better. But I think that is because you're right, we're used to, used to having to— we're used to not paying for things, whereas in countries like America you pay for everything, don't you? Or you have to. Yeah, and they get guide checks once a year in America. My cousin, he's not even a year older than me, she goes for annual visits to her OB/GYN, as they call them, and has a smear test and has her hormones checked and all the rest of it. And that's just part of their normal life. Whereas we get an NHS check every 5 years if we're lucky past 40. I don't get— I've been told I don't need any more smear tests because I'm, I'm 60, I'm over 60. So does that mean that I— there's no possibility that I could get, you know— There is still a possibility, there is always a possibility. But the smear test here is an NHS screening program, so they're screening the women that they can make the highest impact on if they pick up cervical cancer earlier. What do you mean? It's not a diagnostic test, it's just a population screening test. Right. Basically what they do is they screen the population that they can make most impact on, and that they're likely to pick up the disease in at an early stage. But if you get any sort of symptoms of abnormal bleeding or things like that, then you're still meant to go and see your doctor and get referred on a 2-week wait for diagnosis. Yeah, but I also think that some people think when they, when they're G, when they get told they don't have to go and have a smear test anymore. That they think they're outside the risk area. Yeah, exactly. I do, I do think that, and I think they, I do think they should be made aware that there's still a risk. It might be smaller, but there's still a risk, and to keep your eye on. Absolutely, and if there's still, if there's anything abnormal, you need to see your doctor and be referred for diagnosis. So an example of that is if you're a younger woman that's having smears test and you've had your smear test and it's not due for another 3 years, if you've got abnormal bleeding, say after intercourse, you wouldn't be— wait for a smear test. Yeah. To see what's going on. You're expected to go and they wouldn't do a smear test at that stage. They do other tests to actually see what's going on. So the smear test is just— it's like a screening thing. It's not a diagnostic test. Yeah. So just because you're outside of the screening program doesn't mean you need to stop being vigilant. Yeah, that's really good advice. So, so, um, just tell me, um, what is your, uh, website and your details for your, your clinic? Okay, so my clinic's called Elite Aesthetics. Yeah, the website is elite-aesthetics.com. Aesthetics.co.uk. Yeah, uh, and we're in Greenhithe in Kent, um, and it's literally 5 minutes away from Bluewater. Okay. And, uh, also Google me, Dr. Shirin Lokani. I come up on Google, only good things, I hope. I hope so too. The last time I checked, it's mainly the articles I've been involved in because I try and do a lot of work to highlight menopause and women's health. So I've done quite a few features in the press with that. Yeah, so, um, well, that's excellent. So people can not, not only come to you for aesthetics, but you do have a very big, um, interest and offer lots of treatments for, for women's health and anything to do with those kind of issues, and men's health as well. We haven't talked about men's health because it's a women's radio station, but I do a lot with men. We can talk about men, we're not completely allergic to them on here. No, so I treat andropause, I treat erectile dysfunction, um, Peyronie's disease and other men's health issues as well. Did you say Peyronie's disease? What is that? Yeah, um, it's when men have a curve in their penis. Oh, sorry. Is it? Oh, okay, I didn't know that. I've learned something today. Peroni, like the beer, but, um, E-Y-R-O-N-I. E-Y, okay, good. Yeah, I know, you know, I know you say that, um, men, you know, are looked after better and that sort of thing, but I do think these days that men have quite a raw deal as well because, um, with their mental health. Like, this, this, um, station was started because of men's mental health, um, because there's a men's radio station as well because they apparently, you know, the suicide rate is so high in men, they decided to do this station so that people people could talk and listen and hopefully, you know, because men don't really talk about things, do they, to their friends. They're expected to be stoic and carry on, aren't they? That's the way. And we're told to man up, aren't we? Yeah, men are told to man up and not talk about their emotions, and that's not healthy for anyone. No, it's quite sad really. So we don't hate men and we know they have problems as well, but we're just jealous that they get looked after better. That's a good way to put it. Okay, so is there anything else you'd like to tell me? We've got about 5 minutes left here. Um, I'm not sure. Is there anything else you think we've not covered? Um, I'm, um, um, no, I think you've covered everything. You know, it isn't just about the physical, uh, things that happen to us in menopause or perimenopause. Um, it's about, um, our mental health as well, because I know some women do really suffer from depression and anxiety when, um, yeah. So when women go through perimenopause, one of the first symptoms they tend to get is depression or anxiety. Yeah. And if you look at antidepressant use in that age group, so early 40s to mid-40s, there's a big surge in the amount of antidepressants that are prescribed to women in that age group because they go in and it's put down to them being busy and stressed. Because when we go through menopause now, you're looking at women who've got children generally who are younger and are demanding, and then you've got the other side where you've got older parents that need you more. Yeah. And your own needs and work and things like that. It's a really turbulent time to have to go through fluctuations in your hormones. And there is an effect of the sex hormones on your brain, and it does affect your mental health anyway, having imbalances in your hormones. And I find that a lot of people tend to talk about hot flashes when it comes to menopause. That does annoy me. It does annoy me. It's like That's all people seem to talk about, isn't it? Yeah, exactly. You're only menopausal if you're having hot flashes. And it's actually, no, my patients that come to me, their number one complaints: depression, anxiety, loss of confidence, and brain fog. Yeah, yeah, yeah. That's why people want to seek help, because actually they say, oh, if I have a hot flash, I can cope with that, I can manage that. Yeah. The fact that I can't function as me anymore. Yeah. And I can't do the meetings and I can't sort out the children and parents and everything else. So I think that side, the neurological and the mental health side of menopause, is more debilitating for women than the physical symptoms like hot flashes. So what, I mean, what would you advise rather than be, you know, ask for antidepressants if you feel in that way or anti-anxiety? Medication, have, have, get your hormones checked. It's difficult because in perimenopause, having your hormones checked may not tell you anything. Yeah, because they fluctuate so much, and it depends on at which point they're tested, and it's different one month to the next. So, so what do you suggest then? I suggest keeping a record of your symptoms. So there are a lot of apps out there now that allow you to track your symptoms, right? And it's important to remember that anxiety and depression still coexist with menopause as well. So just because you've got those symptoms, it's not necessarily menopause. It can be your mental health as well. So it's a real minefield. Yeah. But I think it's important that you talk to someone about how you're feeling. Yeah. Keep a track of your symptoms. If you've got other symptoms like insomnia you know, brain fog, joint pain, irregular periods, it's easier to put the puzzle together if you've kept track of things. Yeah. So what if someone was having anxiety and depression because of their hormone imbalance and you don't want to put them on antidepressants? What would you suggest remedy-wise? If they're amenable to HRT, I'm a big advocate of HRT for everyone who's perimenopausal and can have it because that's the gold standard. You do things like CBT to improve your mood. Yeah. Yoga, other forms of exercise, lifestyle changes. There's all sorts of different things you can do if you don't want to go down the HRT route. Yeah. Okay. Well, it's, it's been really lovely to talk to you, Shirin, and I'm sure that I'm going to see you probably as an MP in the government at some point. Um, I'll leave that to my daughter. I'm too old for that. No, because I, you know, you're very passionate about women and everything, so that they're shouting at them. But yeah, it's been really lovely to talk to you and very inspiring, and thank you very much for your time. So I'm gonna say goodbye now. Thank you so much for having me on. It's been my absolute pleasure. I really enjoyed it. Thank you, Shirin. So, so this is my show, The Menopause Show, on Women's Radio Station. And remember to look us up on social media, Women's Radio Station, abbreviated to STN. And that's on Instagram, YouTube, and Facebook. And just get in touch with me if you've got any questions. Um, get me on Instagram or Facebook, Sue Moxley. Okay, thank you very much. Thank you. Bye. Bye-bye.