How pharmacists can improve menopause care in your GP practice and community with Rupa Lyall

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

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

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

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

Episode Transcript:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Rupa Lyall [00:08:07] Yeah.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

END.

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