[Music] something that affects over half of the world's population and leaves one in four women experiencing severe and debilitating symptoms from migraines to suicidal thoughts so here at this morning we're making it our mission to start an open and frank conversation about the menopause well we're pleased to welcome gp and menopause specialist dr louise newson who says it's far more than just hot flushes and who wants to end the stigma around hrt alongside lisa snowden who wants to highlight the physical and mental impact the menopause has had on her thanks lisa for being here well done you and also welcome i think this is a really important conversation that we're just going to begin today and we are absolutely going to continue already the response to this has been huge so there is a lot of women out there that are have questions that they want to put to you and it's something that affects half the population and yet not many people know enough about it so in its most simplistic form will you just explain what menopause is and also perimenopause yeah of course but actually it affects the other half of the population indirectly as well yeah everyone knows someone who's menopausal so if you think of the word menopause meno is is menstrual cycle so are periods pauses obviously stop so it is actually when our periods stop and officially you have to be a year after your last period so it's a very weird diagnosis you can't go to a doctor and have a blood test you're still having your periods then actually what's going to happen is you'll often become and perry means around the time of the menopause so a lot of women find that they have menopausal symptoms still having periods but they're changing in nature or frequency and this can occur for a decade or so before periods stop most women that menopause is at the age of 51 in the uk it is but it means that in their 40s they're often perimenopausal but 1 in 100 women under the age of 40 have an early menopause and so that means there are a lot of women in their 20s 30s who are either menopausal or perimenopausal and the symptoms can affect us but also it's when our ovaries stop working so we have low hormones so it can cause symptoms but it also can have health risks so much more and we were talking to you in the break and you know we're going to get everything out that you just said ben because it's extraordinary so much more than hot flashes because it affects memory concentration uh depression causes depression and anxiety some women think that they've actually got dementia because it is so severe how is it so misunderstood because you were saying you go through med school and it's just brushed across quickly yeah i think it's because people sometimes haven't taken a step back and looked at the bigger picture and um a lot of people have thought well it's just a natural process so we all have to go through it like we go through aging or whatever else but actually we're not designed to live without our bodies if you think estrogen is so important for every cell function in our body from the way our white cells fight infection from the way our heart works our brain works as you say so when we don't have these hormones it can affect us in so many ways and increases our risk of heart disease osteoporosis diabetes dementia it's more important because we live for so much longer as well and also we're more aware of all the impact of these diseases not just economically but individually as well you know women are giving up their jobs as you said a lot of people have very low moods i speak to so many women who are in real crisis actually with their mental health and a lot of these women have been misdiagnosed with other symptoms because as healthcare professionals we often haven't had the right training so if someone comes and says i've got palpitations you'll think about their heart you won't necessarily think well what was your periods like have they changed has something happened and so it's really important that every single woman whatever age who's seen by a healthcare professional almost one of the first questions is are you still having your periods do you think any of your symptoms could be due to your hormones and the more us as women understand our bodies the more we can make the diagnosis ourselves and that's really important and so hrt then let's talk about that because there's a lot of misinformation around hrt there's a lot of fear around hrt yeah hrt because people have spoken about this link to breast cancer so yeah let's clear that up yeah that's really important so hrt's three letters hormone replacement therapy when it's given to perimenopausal it's not replacing it's just topping up the missing hormones we're very lucky now in that we have body identical hormones exactly the same structure as the hormones we produce ourselves and so they're given in the nhs and they just replace the missing hormones estrogen is the most important hormone and actually we know that women who have estrogen actually have a lower risk of developing breast cancer which is everyone thinks breast cancer breast cancer the older type of progestogen that is given with estrogen if women still have their womb may be associated with a small increased risk of breast cancer but that risk is lower than the risk a woman has if she's overweight or drinks a couple of glasses of wine just to highlight how low that risk is the newer body identical types of progesterone have never been shown to be associated with a risk of breast cancer any type is associated with a lower risk of dying from breast cancer and more importantly a lower risk of developing heart disease and and dementia which is what causes most of us to die as women so we have to look at the bigger picture and we also have to think about choice for women you know if a woman wants to have her own hormones back then she should be allowed them because of all the health benefits as well um the the department of health in december uh said they've released their vision for women's health aims to address decades of gender health inequality reset the dial on women's health i mean they're great words but right down to prescription levels yeah there's still an issue there yeah of course there is and so a lot of times we prescribe the hormones separately we prescribe estrogen progesterone separately a lot of women need vaginal estrogen as well which works locally for symptoms of vaginal dryness and urinary symptoms each one clocks off a pro a prescription charge so carolyn harris the mp as you know has done the most amazing work to to change it so people can have one prescription charge and they also can have a year which is really important they don't want a month and not just for the financial cost but actually going back and forth yeah not just for the the individual patient but also for the health care professional the pharmacist it's increasing workloads so so that's it hasn't come into play yet but there's a lot of work so hopefully by spring that will happen and that will make a difference but you know it should be more it should be free yeah some preparations actually especially vaginal estrogen should be available over the counter it's safer than viagra you know we can buy viagra over the counter it's mad so it is lisa let's bring you in here now because you it's your 50th birthday on the 23rd yeah this month yeah happy birthday but you were looking back i think you're about 42 were you when you first started about eight years ago about eight years ago so i'm sitting here like a sponge like this is my next phase of life this is coming to me and i want to go into this without being fearful and i think the best way of doing that is to listen to other women hear the stories educate myself and learn so i want to hear your story and what your symptoms were then yeah i mean because like you i was 42 i had no idea i didn't even know what the perimenopause was i knew about the menopause ish but at school you learn about you know your periods puberty pregnancy never was perimenopause or menopause ever mentioned so i was completely in the dark so and i thought it would happen perhaps many many years in the future so i was 42 and i think that when looking back the first symptoms were this um depression and anxiety this feeling of being completely out of control and things that i'd usually do every day i couldn't do it was just it just felt very strange i couldn't process things and then it's a bit of a moving target so then your menstrual cycle starts changing and it becomes really erratic so some months you just don't have a period the next few months you don't stop bleeding and it's so heavy and so debilitating that you cannot leave the house you can't go to work for fear of just bleeding everywhere i mean just awful um and the pain that goes with it and then you've got the anxiety the depression the cycle and i went to a gynecologist it was never mentioned that is this your is could you be premenopausal so when i was 42 the doctor prescribed antidepressants but and i took them for about six months but i just knew it wasn't what i needed and i was also getting these rages out of nowhere this uncontrollable over-emotional rages and my poor partner george i mean he was just like what is going on um this is where um louise said because um obviously this is centers around the woman in the menopause but the partner is involved as well because we we've got lots of calls today you're going to take some calls later on um lots of calls from people saying from guys saying how do i support how do i support because for you you've mentioned um the sort of physical aspects there of which there are so many invariant things but what about the mental aspect for you because you you said you know you couldn't ever see a point where it would end no and it was it was absolutely hideous and a lot of women do want to not be here anymore and that's what breaks my heart like women just suffering and not knowing and not recognizing yourself you've got the weight gain you've got the insecurity you've got confidence issues you start you know second guessing whether you're going to be competent enough to go into work is your brain going to fail you the brain fog the sweats that come on that are really embarrassing of course they are physical as well those symptoms but you just feel so lost so low and you just you just don't know what's going on so when you got your um diagnosis when you were when you actually went in and finally you were told perimenopausal how did that feel then because you started this by saying i thought this was something that happened a lot later yeah i was quite shocked where are you i was really shocked i literally had the biggest lump in my throat and i was just confused and it was almost like a punch in the stomach because i didn't quite know what that meant but i knew that it was a big change and that you know fertility perhaps was off the you know lots of things came into my mind at that moment and it's just a real wake-up call and i just wish i would have known more about it because now you know i feel fantastic and i am on hrt you know it's been an absolute game changer quickly did that help and what what effect well it's a little bit of a moving target and you do have to kind of tweak it don't you louise it's um you know you sort of you get your prescription and you have to just you know up it a little bit and start slowly but it takes about everybody's different it depends on how depleted your hormones are for me it took about a month to kick in um and then you think you've got it under control and then the symptoms come back and the night sweats because i didn't mention that you're sweating all through the night you're up every hour peeing you're shivering after you've sweated so you're just not sleeping at all the next morning you feel wretched then you've got the hot flushes it's literally a yo-yo of just craziness so i'm like spritzing my hormones on and now i'm on testosterone as well and it is it's it's a good balance now but it does hasn't changed it has changed it's been a game-changer i've lost weight i've got my energy back i don't ache anymore in the joints the anxiety's gone the brain fog i can talk to you and have a conversation i remember your names you know i'd be like holly holly it was just like silly things like that and you just you just don't recognize yourself and that's what's so scary um but yes i'm back to feeling brilliant well that is amazing and it is hr how hard is it to get that help like if somebody is watching this today and they're thinking she's just everything lisa said then is me and my i've been going back and forth to the gp about other things maybe this is what it is is it better to go with a list and go look yeah i've got all of these symptoms well how do you do it absolutely the best thing is to fill out a questionnaire and there's menopause questionnaires on the menopause charity website the balance app and then you can actually download that and give it to your healthcare professional and it might not be your gp it might be a nurse it might be a pharmacist it might be a gynecologist like you say and actually say look i've got these symptoms and they're new to me there's nothing else in my life that might be causing them can i explore hormones first and you know all the work i do as a clinical doctor is out of the nice the national institute of health and care excellence menopause guidance they came out six years ago now and they show that the majority of women benefit from hrt for symptoms but also for future health sadly in the uk about 14 of women take hrt that is not the majority but we hear all the time and we're already hearing from some of the calls that women are being turned down or they've been given antidepressants now antidepressants there's no evidence that they help with the low mood associated with the perimenopause or menopause of course they have a role with proper clinical depression but if a woman has clinical depression and is menopausal then she can have both antidepressants and hrt because the menopause is a hormone deficiency with long-term health risks any other hormone deficiencies such as diabetes or hypothyroidism you give the the missing hormone we need to really wake up and think why are women not being given or offered hrt rather than why do they have to beg and plead for it and why do they well i think there's a big injustice it's absolutely horrendous because it's women i don't mean to be rude but if it happened to men if you said to men well you might you will definitely 100 reach an age where your hormone testosterone will go you'll probably have to give up work if you do have sex which is unlikely it will be very painful you won't be able to remember anything and you'll put on weight and feel dreadful but there's a treatment but we'll only give it to a minority of you it just wouldn't happen would it happen what time what made you want to talk about this i just hate the thought of women suffering in silence i hate the thought of women not recognizing themselves giving up work breaking up with their partners having just just not wanting to be here anymore because it is just miserable and so that's why i just this is amazing what you're doing you know just we have to talk about this you said it affects like you said 51 of the global population but the men in our lives get affected too relationships break down families become you know it's it's so important the younger generation need to know the men need to know people at work need to know it needs to be talked about it can't be taboo anymore and people need to know like hrt was demonized for so long it is safe to take is is hrt the silver bullet then for everybody yeah the majority of women there's some women who choose not to take it there are some women who've had for example an estrogen receptor positive cancer who wouldn't take it in the first instance but actually all the evidence or the majority of evidence is that even for those women it can be safe and again it boils down to choice you know a lot of it is individualized and that's really important for anything we do in medicine but actually if women know about any potential risk they know about any potential benefits and also they know about uncertainty so for example breast cancer we haven't got really robust data but then it's up to them to take a decision you know we decide what when we're going to cross the road we just decide if we do any high-risk activities but actually hrt is very very low risk because it is just replacing but also i think you probably suggest that you go to the go to the specialists go to the charities go to the proper websites because there is an enormous amount of unhelpful misinformation absolutely it's really important if anyone's looking at information that it's evidence-based because there is really good quality evidence and sadly the menopause is now a marketing opportunity for a lot of companies because it affects half the population so there's some horrific stories horrific facts about the menopause out there so it's very important that women and men everyone has the right knowledge but it it it isn't just about hot flushes you know if you google menopause it will be a grey-head woman running down the beach actually none of us can not you know we can't hide behind it it's going to happen my youngest patient is 15 she had one natural period and then they stopped my oldest patient is 93. you will be menopausal until the day you die so replacing your hormones you do forever you don't stop at a certain length of time or a certain age because of of how important it is for future health and you know i sometimes wonder what would the world be like if women were given their own hormones back how different would it be it would be incredible wouldn't it um thank you you will be back we will be here with our phone here later answering some of your questions you