Menopause in overlooked communities

This week Dr Louise is joined by Dr Ruth Beesley, a GP who works in central Peterborough and who specialises in working with the homeless, those with alcohol or drug addictions and vulnerable women who engage in sex work.

Dr Ruth talks about the challenges vulnerable groups of women face ­and how their trauma can act as a barrier to accessing the healthcare they need, both in general and for the menopause. Passionate about reducing health inequalities, Dr Ruth tells us about her outreach clinic and a new mobile bus clinic, both of which allow her to reach more women.

Finally, Dr Ruth shares her learnings on working with hard-to-reach groups and reflects on the three things that have made her job so rewarding:

1. Giving women the confidence to believe that they and their health really matters.
2. Listening and seeing people’s story – people are more than just a set of symptoms, they are a whole person.
3. Being part of someone’s life at some of their most vulnerable times, and they share some of that vulnerability with you, is a huge privilege as a doctor.

Click here to find out more about Newson Health Group

Transcript

Dr Louise Newson: [00:00:11] Hello, I’m Dr Louise Newson. I’m a GP and menopause specialist and I’m also the founder of the Newson Health Menopause and Wellbeing Centre here in Stratford-upon-Avon. I’m also the founder of the free balance app. Each week on my podcast, join me and my special guests where we discuss all things perimenopause and menopause. We talk about the latest research, bust myths on menopause, symptoms and treatments, and often share moving and always inspirational personal stories. This podcast is brought to you by the Newson Health Group, which has clinics across the UK dedicated to providing individualised perimenopause and menopause care for all women. So in this week’s podcast, I’ve got someone called Dr. Ruth Beesley with me, who I spoke to a few weeks ago now. She’s a fellow GP and has a really, really fascinating and interesting and I think very rewarding job as well. So she’s kindly agreed to come and talk about everything today. So welcome Ruth, thanks for joining me on the podcast. [00:01:20][69.9]

Dr Ruth Beesley: [00:01:21] Hello Louise, nice to be here. [00:01:22][1.0]

Dr Louise Newson: [00:01:23] So I spend a lot of my time thinking about how to help people that will never come to my clinic, that they’ll never probably go anywhere and get the right help, treatment, advice that they really need and deserve. And many years ago, some people might know I worked in a prison for a week and I’ve still got my notes actually from that week. It was one of the most harrowing, hardest weeks I’ve done as a doctor, listening to these stories and thinking about women and as a GP, it was a real privilege. I worked in quite a deprived area, going into people’s homes that I’d never meet socially, you know, seeing how people live, listening to stories and realising how lucky I’ve been in my life, that I’ve never been abused. I’ve had warmth, I’ve had love. I’ve had attention by not just my family, but my friends. And I’ve had a good education as well. And I’ve got a lot to be grateful for. But people aren’t as fortunate, but they all deserve to have the same advice, support, treatment, for whatever condition. And so you’ve spent a lot of your time, and you still do, reaching a lot more people than I’ve ever reached. And so I’m really keen to hear more about your work if that’s okay, Ruth. [00:02:31][68.3]

Dr Ruth Beesley: [00:02:31] Yes. So I work in a busy city centre general practice, and a few years ago we realised that actually there was a lot of people out there that just weren’t coming in to the doctor’s surgery. And they were living with awful symptoms, illnesses, but for so many reasons there was just barriers to them accessing the service. And we kind of, you know, I came to realise that actually often the services we design, we develop, they work for us, and they don’t necessarily work for some of our patients. Particularly, you know, thinking of people who are very busy, who work long hours, who don’t have access to smartphones, who maybe don’t speak English, can’t read and write, have literacy issues, women who are in abusive relationships, dealing with addictions, mental health problems, all these huge numbers of factors that can make actually trying to get an appointment with your doctor even more difficult than it already can be for some people. And so they just don’t prioritise it. They don’t prioritise their health. They live with symptoms that are gradually getting worse and worse. And we know that often they they get sicker, they end up in hospital more and they die younger. So at the practice I work at and myself we decided to try and do something about that. So we initially started doing an outreach clinic, particularly for the homeless population, those in temporary accommodation, and from that grew a specialist women’s clinic, which we called Wildflowers Clinic, and that is particularly aimed at women who are struggling with mental health problems, with addictions, particularly drug and alcohol addictions, who are facing homelessness, or living in bed and breakfast accommodation, who are often victims of domestic violence or sexual exploitation, and they are just extremely vulnerable women. So we set up a specialist clinic to try and meet them where they’re at, to meet their needs, and particularly looking at things like their sexual health. It’s like smear testing and issues such as menopause, which they know very little about and are very unaware of often. [00:04:38][127.0]

Dr Louise Newson: [00:04:40] It’s so interesting because so much of this is actually interwoven and it’s all together and in medicine we can be very compartmentalised, really, and think about mental health or physical health or think about, like you say, drug addiction or if people have been abused and you often don’t always think together. And even when I did psychiatry, actually, I did a project about abuse and eating disorders. And a lot of it can be really linked. And it was only actually when somebody spoke to me and because as a medical student, I had an an hour with somebody and, you know, you really get to know them don’t you when you have a long, long period of time? And it was this lady who’d had an eating disorder and she had bulimia. And then actually she said, well, of course, it’s because I’ve been abused, right at the end, like 57 minutes into the… And I was so young and naive. And I was like, what? And she said, well, yes, there is evidence that people who – and she was telling me, you know – there’s a lot of people that have been abused actually have an eating disorder. And it’s a cycle. And I was thinking, oh, my goodness, there’s more. I was just concentrating on, you know, how many meals do you eat and how many times do you make yourself sick and, you know, what’s your body image? Because they were the questions I had been taught to learn. Suddenly I’m asking about her mother’s ex-partner and the things that he used to do to her and how it… And then it’s then that you think, goodness me, actually, no wonder this poor lady has developed and all these things and it can often have such a bigger impact, like you say, not just on her immediate family, but the community around her and how then she tries to develop and lead her life and then her knowledge as well. And actually the project that I wrote ended up being a lot longer and it made me realise the power of time actually with people. And I was there as a very young medical student. She knew I had no power to treat her in any way, but she had never spoken to anybody at any length who she could trust. And I thought, wow, actually, what what an incredible job I’m going into where you can have that time, where, and I’m sure you hear it a lot, people will tell you things that they probably haven’t told others. [00:06:53][132.4]

Dr Ruth Beesley: [00:06:53] Yeah, definitely. I think one of the things that I’ve certainly learned when I’m talking with patients, particularly when they’re in these kind of situations, is rather than the kind of very traditional doctor approach of, you know, what’s the matter with you? What’s wrong with you? To try and think actually what’s happened to you? And what’s your story? And then you get, like you say, you get to so much more and so much then starts to make sense and you can understand then where some of their fears come from, some of their anxieties around authority, around filling in forms, around giving details, all these kind of things that can be really quite traumatic for some people. [00:07:30][36.8]

Dr Louise Newson: [00:07:30] Yes. And it’s very revealing, isn’t it? And I, I was reading a really interesting book, actually, from the seventies last weekend, and it was actually about PMS, premenstrual syndrome. And there was a lot of debate about whether it should be a disease, whether it should be an illness. The ethical and the moral side behind it as well. And they were saying about labelling of all these different areas for the same condition and how it can really change patients’ and people’s perceptions. And then they were comparing things like drug addiction, which fits lots of almost criteria. That, is drug addiction and illness, is it a disease? Is it illegal because a lot of people are taking illegal drugs. And then, of… Some people obviously do end up in prison. And how did society define those people? Do they feel sorry for people who are drug addicts, for example, or do they blame them or do they, are they cross because they are committing a crime? And what about the psychological and the mental health issues of these people? What about… And it’s like you say it’s so interesting, but for that person, they didn’t give a flying monkeys, whether they’ve got a disease, whether they’re committing a crime, whatever. And so much of it is situational as well, isn’t it? They didn’t choose to have that life. But so many people, it’s sort of almost repetitive behavior that parents or grandparents, they’re aunties or whatever, and it’s not being able to escape and move away, isn’t it? There’s a lot of people that don’t want to have the life that they have and they really, really want to be healthier don’t they or maybe change, but how do they start when there’s so much going on? I think a lot of people I’ve dealt with have been so much stronger and have the most amazing personalities that have just been undervalued. [00:09:20][110.0]

Dr Ruth Beesley: [00:09:22] Yeah, see, that’s definitely my experience is that actually the women I work with who struggle with addictions, there is nearly always significant childhood trauma, significant mental health, significant abuse, and they are such incredibly strong women to actually get through every day and try and fight and try and get help is really, you know, they’re really strong, incredible women who are just having to deal with this chaos and this, you know, trauma. And, you know, they do sometimes feel judged when they go into various environments and settings. You know, and I think, you know, when I speak to them and spend time with them, what they tell me is they already feel bad enough themselves. They’re already angry and frustrated with themselves and you know desperate for help but actually, help is pretty hard to come by. So, you know, it’s it’s really good when they do come to the clinic. And we run the clinic in a really relaxed way. So it’s a bit like a kind of a coffee afternoon, really. We do tea, coffee, cake. We kind of have like, you know, sanitary products that are kind of donated and things and create that environment where there is some peer support. They can support each other, they can talk to each other. We have drugs and alcohol workers there. You can chat to them and try and support them to get the help they need. And then we kind of get them into the room and get the medical bits done but actually those bits are actually quite a small bit, sometimes, of what a positive experience that can be, particularly around building trust and building relationships and hearing their story and then understanding them better. [00:10:59][97.9]

Dr Louise Newson: [00:11:00] Absolutely and I think a lot of people don’t realise, as doctors, I certainly feel very strongly that I’m not here to judge anybody. You know, we’ve all dealt, as healthcare professionals, with people with, with addictions, with all sorts of lifestyle behaviours that we would never want ourselves. I never will judge someone or undermine them or not value them or not treat them in the same way as I would somebody else, because there’s always a reason. And I think also as healthcare professionals, we’re not shy at asking questions. And also people know that what they tell us is confidential. And I think that’s really pivotal, isn’t it, as well, that we do have this sort of art, skill, of being able to tease out information that maybe others haven’t asked before. And certainly even in the clinic, just something as basic, really, asking about libido and sex, all sorts of things come out, actually, and people have not even, they often say, no one’s ever asked me before. And it’s quite straightforward if someone’s in a heterosexual relationship with one partner, then it’s really just talking in that way. But then I’ve asked other people and it’s unearthed all sorts of abuse stories or all sorts of things that you just think, goodness me, if I hadn’t asked a simple question, you know, things don’t develop do they? [00:12:21][80.4]

Dr Ruth Beesley: [00:12:21] And my experience with these women is they like to be asked, they like to tell their story. They like to feel somebody is actually interested. And I think people often feel quite anxious or nervous about talking to people who have experienced trauma, talking to people who are going through very difficult situations with, you know, domestic violence or addiction problems. But actually, these women, they like to feel heard. It’s important they feel heard. And valued. [00:12:47][25.6]

Dr Louise Newson: [00:12:47] Yes, absolutely. I think being valued and not being judged are really important. I spoke to someone on Sunday, actually, who was actually had messaged me with some awful thoughts that she was having in her head and she said all sorts of things that happened in the past, that she had been sexually abused by her father, even after she was married. And he only died two years ago. And she’s 53 and the sexual abuse had carried on. But she was very matter of fact about it, because that’s what… she knew it was wrong and it was a real relief when he died. But obviously, on the menopause podcast, we need to talk about female hormones. And I do feel the impact of our hormones on our brains for a lot of women can be really huge. And very common symptoms that I hear in our clinic are this low self-esteem, this feeling of reduced self-worth. You know, I deserve to feel like this. I really am just a shell of myself and I have no confidence anymore. And for some women who, you know, are CEOs of a massive organisation, obviously that really can affect them at work. But for women who have been subject to abuse or do have an alcohol or a drug addiction, they’re going to feel even more worse, aren’t they? And how do you diagnose that and how do you recognise it? And how do they recognise that there may be a hormonal element? And also, a lot of these women, if they do abuse drugs or alcohol, often their periods will stop or they’ll have an eating disorder and their periods will stop or they’re on drugs. Some of the anti-psychotic or antidepressants or contraceptives will block hormones working. And it’s this whole chicken and egg. How do we as healthcare professionals pick up those ones? And I’m not just talking about menopause. It was easy, this lady in her fifties, she was clearly menopausal. But what about women in their twenties and thirties who may have PMS or PMDD or be perimenopausal or have an early menopause or POI? How do you think Ruth we should be picking these women up? Because I really worry about them. [00:14:54][126.6]

Dr Ruth Beesley: [00:14:54] I think it is it is difficult. I had a lady in my clinic recently and kind of she’s she’s in her sort of early forties now, kind of reviewing her notes, chatting to her. She had actually had gone through her menopause in her twenties and had never had any treatment and was actually her life had become actually increasingly more broken from that point on and that she had developed some more mental health problems and ended up sleeping in a tent. Her husband had passed away. So life had got extremely difficult. But actually she’d never been really spoken to about her early menopause, about the effect of hormones on her mental health and how she was feeling, and also obviously the sort of physical risks of not having had any hormones for that period of time. So we know it’s out there, we know it goes on. But as you say, there’s a whole group of women I work with who don’t experience the classical menopause symptoms because of the other factors affecting them in terms of mental health, side effects of drugs, effects of medication, side effects of poverty, of malnutrition, of all these other things that they’re dealing with. So I think as healthcare professionals, we need to be much, much more alert to acknowledging that, recognising it. And also, I think from the point of view of education, these are women who, you know, don’t know very much about menopause. And I think it’s actually brilliant that we have a society now where menopause is much more spoken about. There’s a lot more media coverage, a lot more information available on all sorts of different formats. But actually, for these women, there’s still very little knowledge. And I kind of I think… [00:16:26][91.4]

Dr Louise Newson: [00:16:26] Absolutely. [00:16:26][0.0]

Dr Ruth Beesley: [00:16:27] When Covid first happened, we were kind of, you know, you couldn’t not know about Covid except my homeless patients didn’t know about Covid because they weren’t watching the news every day. They didn’t have a smartphone. So we were having to educate them. And I think it’s similar with menopause, actually. We assume that basic knowledge, that it’s actually sometimes not there, it was they they had no issue with their mother, they don’t have siblings they have a relationship with. [00:16:48][21.3]

Dr Louise Newson: [00:16:49] I was doing some training a few years ago now and it was some doctors there who work in inner city Manchester, in areas of deprivation. I said, well, what about menopause? Louise, it’s not a priority for us. The menopause. We are dealing with chronic mental health, we’re dealing with hypertension, obesity, diabetes. We cannot deal with the menopause. And I just thought, oh, oh, really? Actually, we need to be thinking more of how it is associated with these chronic diseases. And we know the longer the woman is without her hormones, the greater the risk of all those chronic diseases and the diseases of deprivation are the chronic diseases, they’re the inflammatory diseases, aren’t they? They’re the heart disease, the you know, diabetes, you know, even osteoporosis. But certainly mental health issues. And we know that for so many women, their mental health is worse when their hormones dip. And, you know, I’m not just interested in the menopause and perimenopause, this PMS, this change that occurs. And, you know, I was reading some papers even as early as in the fifties, showing that women are more likely to undertake a crime or be admitted to a prison and be arrested in the days before their periods. And Katharina Dalton did some amazing work looking at this. But why aren’t we looking at it? Why aren’t we addressing it? And I’m really obviously not saying that everybody’s issues will be solved by hormones. That would be completely naive and wrong of me. But in the same way, if these women were hypertensive, we would give them medication to lower their blood pressure. Can we not consider giving them oestrogen, but also testosterone? Our audit data of more than a thousand women show that their mental health improvements are more statistically significant than their libido improvements. My clinical practice every day sees women who are mentally and also physically, they’re sharper, they’re more active, you know, on testosterone. And how many women are not having, you know, we don’t know because no one’s done any studies but I would much prefer as a woman to take hormones than I would to take a psychiatric medication. [00:18:53][123.6]

Dr Ruth Beesley: [00:18:55] I think the women that I’m working with, particularly the effect on their mental health, has a magnified impact on their ability to cope with what’s already a really difficult life. You know, already trying to sort out finances, trying to sort out food, trying to sort out housing, dealing with all those constant hurdles when you haven’t got access to a phone, you maybe have poor literacy, all those things I mentioned, and then you get another whammy of your hormones being you know, very low, feeling even less motivated, feeling even more anxious, feeling even more that you want to just bury your head and shut the door and not engage with the world that was already scary. It just magnifies all those problems. Yep, because people get… [00:19:39][44.1]

Dr Louise Newson: [00:19:40] Absolutely, and also we we know things like memory can be affected and cognition. If you’re having to fill out a form or go and speak to someone about your housing and you can’t string a sentence together, you can’t remember words, you can’t remember your date of birth, you know, that actually has a really big impact as well. But I remember a lady many years ago who had become housebound with her crippling anxiety because of her menopause and she had access to the internet, but she had ordered lots of things over the internet. So when I said what medication are you on and she said oh, no, nothing, I said, well, are you on any supplements, anything you buy, and she said, oh, yes. And she had brought two carrier bags with her to the clinic and she tipped them out. I’ve never seen so many supplements. Some of them were labelled menopause, but a lot of them were just all sorts of other things. And she was just desperate for help. And then when we put all those in the bin, she actually took her own hormones back. She came back and she said, I want to thank you because I’ve left my husband. I said, I’m sorry, I don’t know why you’re thanking me for, she said, I have been in an abusive relationship for 25 years. And she said, I’ve just been so submissive. I’ve just done everything that he wanted and more. I’m basically, all I am is a paid cleaner and prostitute for him. And it’s been horrendous, but I’ve not been able to do anything. But she said, now I’ve got the confidence, I’ve got the knowledge that I can live on my own and I’ve got the independence now and I’ve just stood up to him for the first time and confronted him with all this abuse, physical and sexual, that I’ve had for so long. I just want to thank you because now, and now she actually lives a bit in Spain. She’s been doing all sorts and it’s been so rewarding watching her, seeing how she’s changed and improved. But it’s also been so incredibly frustrating for me, thinking about how many other women are in those situations and don’t realise and how easy it was for me to just give her some hormones so she can do it from within. And obviously, so much in medicine is multifactorial. It’s not just a treatment or not, but actually I was able to listen to her, I was able to support her and everything just pieced together. And her whole life has really changed over the last seven years and it could have been very different. And I spend a lot of my time worrying, but I think it’s necessary worrying because there are so many neglected people out there aren’t there. [00:21:58][138.1]

Dr Ruth Beesley: [00:21:58] Yeah, there are. And their lives just get increasingly difficult and they feel more and more disempowered to change things. And I think recognising the hormonal component in that is hugely important, but it means thinking about it, asking the questions, continuing with that kind of health promotion and understanding and education around menopause, to reach the different groups like, you know, I was talking about at the beginning, about going out to these populations that we know don’t come in. And actually recognising there are, you know, pockets of women out there that really don’t know anything about the menopause at all. [00:22:35][36.8]

Dr Louise Newson: [00:22:35] Absolutely. And so before we started recording, you were telling me about a new project. So I’m really keen to talk to you about it on a podcast. And I’m actually very jealous, Ruth, because when I started the clinic five years ago, my poor finance director who struggles because I, we give so much as an organisation away, the free balance app, to our education, to our research. And I said, I’ve got this idea, Katrina. And she said oh what now? I said, I really want to have a menopause bus. I want to have a Newson Health bus that can go into areas of deprivation. It might not be a clinic, but we can kit it out for a clinic so we can do blood tests, we can examine people if we need to, but it can be an awareness and we can rock up outside Asda, in to areas of deprivation. She said, Louise, you’ve only just opened the clinic, I really just think we need to put this on a backburner. And you’ve just told me that you’ve got a bus and I’m now very jealous. I’m not a jealous person, but I am jealous of this bus. So tell me a bit about it. [00:23:31][55.3]

Dr Ruth Beesley: [00:23:31] We’ve got a fabulous new bus that arrived last week. It’s a mobile clinic. It’s a clinic room on the back of a bus that can go out to where populations are, and it’s primarily aimed at outreaching to the homeless population, to those living in hostels, bed and breakfast accommodations. And we know there’s lots of people out there, there’s lots of families out there, there’s lots of women out there that aren’t accessing services, don’t come in to doctor surgeries, don’t come into day centres, things like that. So this is about actually taking a clinical room and a doctor, a nurse. We’re also going to look at having things like podiatrists and physiotherapists on the bus and going out to where people are. But one of the things that I said when the bus was being designed that we absolutely had to have was an examination couch so I could do smear tests on. So we can do smear tests on the bus, which I think is really really important. [00:24:17][46.1]

Dr Louise Newson: [00:24:18] Yeah. No, I’ve still got pictures of mine. It’s all been branded and we can see because it’s done as a clinic. And, you know, I really, with our education program, we’re putting it under a not for profit, which will soon be a charity. So all our money will be recirculated. And for me, this is an area that if we’ve got some money, I would love to do it because it’s reaching people. People won’t always come to the clinic and they won’t always come to see their GP. They won’t go to see, you know, a healthcare professional, but if they’re there and they’re stumbling over them, then they will and they’ll go with others..People learn from their own a lot more, don’t they, as well? And I think that’s really important. [00:25:53][95.0]

Dr Ruth Beesley: [00:25:54] Absolutely. And I found that with a couple of women who I’ve spoken to about menopause who’ve actually started on hormones, they’re very keen to, you know, talk to other women, women who were in the hostels or out on the street and show them the patch that they’ve got and talk about it and talk about how accessible it is and how easy it is for them to use even with quite chaotic lives. We can tailor their hormone treatment to meet the needs and to meet how their lives are, you know, to make it as easy as possible for them to manage their treatment. Yeah, women talking to other women about their experiences, particularly women who share their experiences, share their background stories, understand where they’re coming from, I think is really powerful. [00:26:36][42.2]

Dr Louise Newson: [00:26:37] Absolutely. I think we do have an edge on men in lots of ways, but one of it is we’re very good at talking and sharing and allowing people to learn from each other. And a lot of, in my bus that I eventually will get, it doesn’t all have to be healthcare professionals there as well. So, you know, sharing knowledge with those that have firsthand experience is often, like you say, really, really powerful. And I know the work you’re doing is incredible. And wouldn’t it be great if we can maximise and do even more? Because obviously you’re only working in a small geographical area. But I’m very grateful for your time, Ruth, because just in this half an hour, I’m hoping people have listened, will be thinking in a different way about people. Absolutely not judging people, but thinking in even small ways how we can all help in society to really help because there’s a huge amount we can do. And hopefully people have just maybe thought about things in a slightly different way and we can take this conversation further. So I’m really interested in going forward and seeing how things are in the future. So but before we end, I’m very keen obviously for three take home tips so three things that you think have made the biggest difference to the largest group of people with the effort that you’ve done and the work that you’ve done, the sort of the most rewarding things really, that you’ve you’ve done reaching these women? [00:27:56][79.5]

Dr Ruth Beesley: [00:27:57] Oh, it’s tricky. It is definitely, it is the most rewarding part of my career, without a doubt. And I think that certainly giving women the confidence to believe that they matter, to believe that their health matters, is really important. I think listening and seeing people’s story, not just a set of symptoms that are in front of you or a drug addiction or a, you know, another issue. But actually seeing that as part of a whole person, and a whole person that has come from childhood. And I think oh the third one, I think I guess personally, it’s just really exciting to do a job where you get the privilege of being part of someone’s life at some of their most vulnerable times, and they share some of that vulnerability with you. And that’s just a huge privilege as a doctor. [00:28:50][52.6]

Dr Louise Newson: [00:28:51] Absolutely. I totally agree. And I think it’s so interesting. Someone said to me a while ago, which is so true, that medicine is a science and an art and the art is individualising care and care means a lot, but it’s also about listening and it’s really looking after that person, thinking of them as a person, not a patient for a lot of the time, which sometimes gets lost in medicine, actually. So I think stripping it back to the basics and remembering, which I do every day, what a privilege it is to be a healthcare professional is really good, so don’t lose the work that you’re doing. Keep going and look forward to talking to you again. But thanks ever so much for today Ruth it’s been really interesting. [00:29:32][41.3]

Dr Ruth Beesley: [00:29:33] Thank you. It’s been great. And I’ll let you know how the bus goes. [00:29:34][1.2]

Dr Louise Newson: [00:29:35] Oh, yes. Thank you. [00:29:36][1.0]

Dr Ruth Beesley: [00:29:36] Thank you. [00:29:37][0.3]

Dr Louise Newson: [00:29:41] You can find out more about Newson Health Group by visiting www.newsonhealth.co.uk. And you can download the free balance app on the App Store or Google Play. [00:29:41][0.0]

END