Mental health and the perimenopause

Content advisory: this podcast contains themes of mental health and suicide.

Joining Dr Louise on the podcast this week are Lynsey and her husband Kieran. Lynsey movingly describes a rapid deterioration in her mental health during the perimenopause which saw her sectioned under the Mental Health Act.

‘I just felt desperate that this was a new version of me and I couldn’t work out why,’ she recalls.

Lynsey and Kieran, who is a GP, speak to Dr Louise about the need for greater understanding of how hormonal changes during the perimenopause and menopause can impact on mental health, coupled with improved access to HRT.

Contact the Samaritans for 24-hour, confidential support by calling 116 123 or email jo@samaritans.org

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 today on the podcast, I’m actually interviewing two guests together, a husband and wife, who I’ve only met a few seconds ago, actually. I was introduced to Lynsey through someone else on social media. Social media has many pitfalls, but it also has many benefits. And there is a bit of a warning before the podcast starts because it is a difficult story, but Lynsey is very determined to share it and I’m very determined to talk about it because as many of you know, the mental health aspect of the menopause and perimenopause is actually very neglected and not thought about enough. And when we look at the definition of the menopause, it’s always about periods and it’s about fertility. And it’s as if our hormones don’t travel anywhere else other than in our pelvic organs. And of course they do. Our female hormones, estrogen and progesterone and testosterone, are neurotransmitters. They work in many, many areas of our brains as well as elsewhere in our body. So welcome, Lynsey and Kieran to the podcast today. [00:01:58][107.9]

Lynsey: [00:01:59] Thank you very much. It’s lovely to be here. [00:02:01][1.2]

Kieran: [00:02:01] Thank you. [00:02:02][0.2]

Dr Louise Newson: [00:02:02] So let’s introduce you both and then we’ll start talking about things. So Kieran, you’re a GP, it’s always very nice to have a fellow medic on the podcast. So do you specialise in anything or, I would never say you’re just a GP, but are you a general GP or… [00:02:17][14.9]

Kieran: [00:02:19] Yeah, so obviously yeah, GP so as you say a generalist, but I’m also a GP trainer, I also do minor ops. I’m also a clinical director as well for our primary care network, I do a few things. [00:02:28][9.7]

Dr Louise Newson: [00:02:32] So that makes you very busy. [00:02:33][0.7]

Kieran: [00:02:34] Just a bit, yeah, it’s certainly been the busiest three years of my career so far. I used to be in the military before that. [00:02:39][5.0]

Dr Louise Newson: [00:02:39] So okay. Yeah. So some of you might know I’ve pivoted into general practice after doing hospital medicine and I still look back with my year of training with great fondness, actually, but also frustration because actually in that year I was never taught about the menopause, and before that I’d done enough an obs and gynae job and I wasn’t taught about the menopause then and then in medicine I clearly wasn’t. So I don’t know about you, whether it’s been on your radar until recently so much. [00:03:07][27.7]

Kieran: [00:03:08] And I think it has because we’ve got quite big practice and we’ve got seven female GPs. So you know, they are all very sort of up on current HRT guidance. But again, where that guidance comes from is I think some of the issues. Yeah, the direction of it and I’m sure you know, you get that all the time. [00:03:25][17.1]

Dr Louise Newson: [00:03:26] Yeah indeed. And Lynsey you’re not medical are you? [00:03:29][3.1]

Lynsey: [00:03:29] No. I used to be in the Navy and I was a medical assistant and for a short period I did work in operating theatres. But certainly it was more technical and specialised in surgery. So when it came to hormones and female health, that wasn’t particularly on my radar. [00:03:45][15.5]

Dr Louise Newson: [00:03:46] No. Okay. And do you mind me asking how old you are Lynsey? [00:03:48][2.7]

Lynsey: [00:03:51] I’m 45, nearly 46. [00:03:51][0.0]

Dr Louise Newson: [00:03:52] Nearly 46. Okay. So do you mind just giving us a little bit about your story because you’ve otherwise been very fit and well, haven’t you? Not had any medical problems or psychiatric illnesses or anything? [00:04:02][10.2]

Lynsey: [00:04:03] Not at all. I had two children. I didn’t really have any issues following my two children. I did have a very small problem after having a Mirena coil fitted where I suffered some low moods, but it was very concentrated into that time and there was no follow ups afterwards, it sorted itself out. And I was about 35 back then. But then in May of 2022, out of nowhere I suddenly started suffering with anxiety. And I’m not normally an anxious person at all, but this anxiety was around the most simple things like, what am I going to wear in the morning? What am I going to cook for dinner? What’s going on the online shop? Just things that shouldn’t be things that I would worry about became really big hurdles, and that seemed to be the catalyst that started all of this journey off. [00:04:57][53.7]

Dr Louise Newson: [00:04:57] So did you go and talk to anyone about it when you were starting to feel this anxiety? [00:05:01][3.4]

Lynsey: [00:05:02] Yeah, I did. I spoke to my GP practice and I was phoned by their mental health nurse and a low dose of antidepressants was started. Again it was very much was looking like an anxiety disorder, it appeared that way. And I myself wasn’t looking at anything other than, ok that this must be something going on. However, in the following weeks it was literally we are talking from the May of starting feeling like this, going into the June I was getting so anxious and palpitations had started and by July I was in a depression and beginning of really mean strong suicidal thoughts. And then by the end, well Kieran will remember more, I think it was mid-July to end of July, I was in crisis and needed to have crisis mental health involved. And following that I was sectioned under the Mental Health Act. [00:05:57][55.0]

Dr Louise Newson: [00:05:58] Gosh, so that must have been very scary for you, Kieran, with some medical knowledge and watching your wife go from being very fit and well to mentally very disabled. [00:06:06][8.4]

Kieran: [00:06:08] Yeah, extremely. You know, obviously with my background and with the head on, but at the same time trying to be a husband and a father and trying to access the services was let’s just say difficult and interesting. And I know the system inside out, because it’s my local system. And it did seem like what Lynsey just said, it seems you know like a mild anxiety, very simple symptoms to start with, but it was the speed in which it deteriorated and that she was over a matter of 10 to 14 days from start to finish of going from just some suicidal thoughts to attempts. You know, and that’s where it got to the point where she had to then go into hospital as an emergency, that we had to get admitted as an inpatient. And that was the last thing that I wanted to do as a husband but even as a doctor I don’t like doing that because I don’t feel it’s the best place for most people anyway. But that’s where we were sort at because of the level of risk she was having at that point in time. [00:07:09][61.7]

Dr Louise Newson: [00:07:10] Yeah, and that’s the thing, just to be clear, for people listening, people are sectioned usually because they’re at risk of harm either to themselves or others. And it’s a decision that’s not made lightly. It’s done in a very professional way. And I’ve done it several times when I was doing psychiatry, but also as a GP you get involved and it’s…I have actually found it harder as a GP because they were patients that I knew. It was easier almost when you’re a psychiatrist because you come in cold. But when you see this person who isn’t the person that you’ve known maybe for many years and in your case for a long time, it’s really difficult. But you’ve got to be really clear that you’re doing it with the best interest of that person to keep them safe, isn’t it? [00:07:50][40.3]

Kieran: [00:07:51] Yeah, definitely. [00:07:51][0.6]

Dr Louise Newson: [00:07:52] So then what happened when you were admitted, Lynsey, when you were in hospital, Can you remember? [00:07:56][3.7]

Lynsey: [00:07:57] I can and this is it. I have such clear insight and memory about everything that went on, even though I was like a completely different version of myself and my thought processes, I felt the scariest symptom for me was I couldn’t feel any love for anyone, not my children, my husband, my parents. I’m a big animal lover. I couldn’t bear my pets near me, it was such the complete opposite of who I am. So that’s the person who got admitted. And I just felt desperate that this was a new version of me and I couldn’t work out why. And I did say, over and over, this feels so biochemically. It doesn’t feel, you know, there’s nothing that’s happened in my life. My life is in such a good place that I knew that there was no trigger event, no trauma. I did have professionals trying to unpick my my life a little bit. I think to almost see this happens, maybe that attachment and I 100% knew nothing had happened. But I almost then started thinking I need to look within myself. Is something causing this? Because it was such a different transformation but such a negative one. And whilst I wasn’t inpatient, they were switching to simple medication and also electroshock therapy [electroconvulsive therapy, or ECT]. [00:09:17][79.4]

Dr Louise Newson: [00:09:18] Gosh, so you had ECT. And how many rounds of that did you have? [00:09:22][4.0]

Lynsey: [00:09:22] I ended up having nine. And after nine sessions you would hope to see some form of change. And there wasn’t any change. I mean, I was happy to go along with this. Even though I kept saying nothing is changing. I feel exactly the same. And I know Kieran had a lot of frustration on the outside because obviously because he was going to visit me and could see nothing was changing, but it was at some points it had been discussed, oh, maybe it’s her hormones. Or could it be. And this was more from maybe some of the nurses. But there was never oh it could be your hormones, therefore, maybe there’s a different treatment route. It was purely it was just said as a background conversation, and that’s as far as it ever went. [00:10:07][44.7]

Dr Louise Newson: [00:10:08] And can I ask, had your periods changed at all over this time? [00:10:11][3.5]

Lynsey: [00:10:12] This is the thing. They had been slightly erratic, but not much over the last, when I look back with hindsight, years previously they had started to get less regular. However, during this time they just stopped, just completely went and my weight had dropped so much. And I did mention the periods had stopped and I was told they stop because you’ve lost so much weight and you’re depressed. So that was the only conversation I had about my periods. [00:10:39][27.3]

Dr Louise Newson: [00:10:40] Okay. Which obviously it is important, even if this hadn’t been causing your symptoms, because when people lose weight, obviously the brain can stop producing those hormones and the sort of feedback happens. So it is very common when people lose weight because the body actually is very clever, it protects itself. You don’t want to be pregnant if you’re very underweight because you haven’t got the same reserves. But also some of the psychiatric drugs, obviously, I’m not sure what you were on, but there’s quite a few psychiatric drugs that affect another hormone called prolactin in the brain. And when you have raised prolactin, it switches off your FSH and LH, your follicle-stimulating hormone and your luteinizing hormone. So when they’re low, it switches off your estrogen and testosterone from your ovaries as well. You know, all our hormones work in these big loops. And a lot of times when I was doing psychiatry, and it still happens now, when people are on certain drugs, they check prolactin levels, but they don’t actually think about the sex hormones. And, you know, it makes sense really often a lot of people in psychiatric hospitals are on heavy duty drugs, which will be giving people a chemical menopause. So if they didn’t go in being perimenopausal or menopausal, they would certainly go out. And often it’s temporary while the drugs are on. But actually, if you’re switching off important hormones that have effects in the brain and the body, then it’s really important to consider replacing them, if appropriate. So it’s it was probably a double whammy for you, really, that you in your early mid-40s with some change in periods. That is the definition of the perimenopause and then having some, you know, a big insult to your body with what was going on. Certainly you were having some hormonal changes that sadly weren’t picked up were they? [00:12:24][104.1]

Lynsey: [00:12:25] No, not at all. I think, you know, my bloods were taken whilst in there. And looking at my FSH levels, again I was just told they were normal. But again, we were looking for anything because it didn’t feel,.. it was definitely presenting as a mental health disorder. And at one point they suggested I could possibly be bipolar, even though I’d not had a mental health issue prior to this. And in the state of mind I was in. I started thinking, okay, well, maybe that’s it. You know, maybe something is going on like that, because I just wasn’t, I just didn’t feel that. Well, we weren’t getting an answer. [00:13:02][36.8]

Dr Louise Newson: [00:13:04] So you were in hospital for how many weeks? [00:13:05][1.4]

Lynsey: [00:13:06] I was in for six weeks and I could see nothing was changing and I felt that this was going to be me forever. So again, my mindset was so clear. I thought, I’m going to have to get out of here. So I went home on weekend leave and I felt as I got in the house, no connection with the children, no connection with Kieran. And I just, that was it to me. All I could think that’s my life forever. I’m never, ever going to be the person I was.

Dr Louise Newson: [00:13:43] Gosh. And then, you’re still here. So that’s good. [00:13:47][3.7]

Lynsey: [00:13:47] Yes. Yeah, absolutely. The plan thankfully didn’t go quite to plan and I sustained some nasty injuries. I broke my spine, my pelvis in a few places, shattered my heel and several bones in my foot. So I was very unlucky in what’s happened, but I’m very lucky that my plan didn’t go as it should have done. And obviously Kieran is the one who’s then got to deal with the fallout of that and my children and my family and thankfully they got me to a trauma hospital and everything was fine. Well, they stabilised me and I then spent the next month on a trauma ward receiving zero mental health support. There were mental health workers in the hospital, but they visited very sporadically. And I was just, I felt like I’ve been given an even worse punishment because I couldn’t walk, I couldn’t move. I was completely then bedbound in the same state of mind because nothing had changed.

Dr Louise Newson: [00:15:05] So you were trapped in your body, really? [00:15:06][1.3]

Lynsey: [00:15:06] Yeah, absolutely. [00:15:07][0.5]

Dr Louise Newson: [00:15:08] Mhm. Oh, gosh. So what happened after that? [00:15:11][3.2]

Lynsey: [00:15:12] It was more, I’ll say that I’ll pass on to Kieran then because I guess he’s the one who was then in the background thinking this is just not what’s supposed to be happening. She’s not getting any treatment now. We’re treating her injuries but nothing’s happening for her mental health and yeah. So it was over to Kieran now thankfully for what happened next. [00:15:31][19.9]

Dr Louise Newson: [00:15:32] So go then Kieran, what happened? [00:15:33][0.9]

Kieran: [00:15:35] So…that happened was I had to get her admitted and obviously found her. And then once we got her stabilised physically, it was just. You know, I start to rethink things and try and analyse and use my brain as a GP to think, what are we missing here? You know, it hasn’t played the way it should have gone. With everything we’ve done so far for the sort of diagnosis we were thinking it was. And it just didn’t sit right with me because her insight throughout considering how severely mentally unwell she was, just didn’t add up to me. And I’ve been doing this 20 years and it was something that just didn’t sit right with me and the fact she was completely herself, 12 weeks earlier and this has just happened so rapidly, you know, and for her to do what she did and knowing who she is as a person and how much her kids, you know, our kids mean, you know, her love of animals, her life was great. And it was like, well, there’s no trick, this is not normal mental health reaction. It was completely out of character. And I could see in her eyes. And that was the thing throughout the entire time she was an inpatient in the mental health hospital, and I kind of had an argument while the psychiatrist basically, because he came around four weeks in and then said, ah, you mean she’s improving? And I went, sorry, what? And I went, no, she’s not, but she’s still having the same thoughts. And he went, oh is she? And Lynsey at the time when he left the room, went absolutely ballistic at me, which is not her as a character, but because I’d betrayed her trust. Obviously she can see that now and look back with hindsight and reality. But she was livid and we’d never argue and it’s just who we are as a couple. But she was, you know, the most angry I’ve ever seen anyone in my life. And when we were in the trauma hospital, it was just the same. It was just she was in absolute pain with all the injuries. She was on high levels of morphine to keep the pain under control. But she actually got better care from the normal nurses, the NHS nurses on an orthopaedic ward than she did when she was in a mental health hospital, which is a bit of an irony in itself considering they’re there to look after her physical wellbeing and they got to the point where I just said we need to try something different. And I finally got hold of another consultant psychiatrist who was part of the liaison team within the hospital. Again, only because I know people and I know the system and it’s my area. You know, I work across this entire area and being a clinical director has given me avenues into people in more senior positions, but it shouldn’t be that way. And the initial consultant who saw her was a male psychiatrist. And I’m a man, I’ve got nothing against men, but I have quite an issue with the way the perception is and the lack of thought into other options. But maybe that’s my GP head on. Thinking of every single option is always on the table. And so I just said, we need to try something different. I said she has had umpteen medications in a short space of time. She’s had ECT. None of it has made a difference. She just tried to kill herself with an extremely serious attempt. You know, this was not a cry for help. But I then said, let’s just give it a go. And then it was the logistical shenanigans between an orthopaedic team going, well, we can’t prescribe HRT because obviously they are orthopaedics, they deal with bones, which is fair enough. I get that. And then they then contacted obviously obs and gynae, the gynaecology team. They went, I’ll speak to the GP. So you’ve got the specialists supposedly because, and I know I get letters back from them all the time, they don’t start HRT hardly ever nowadays, the gynaecologists. And to be honest, there’s no point in them being involved in the conversation. You know, why they’re on the national panels is bonkers because you probably, and I’m sure you get the same frustration. But this is me seeing it on the ground every single day, both inpatient, and in general practice, my own patients, we see the entire pathway. We see them from start to finish. And this was me seeing it personally on the inside as a husband, but with my other head there going, we need to try this. This is not working. They’re not listening. And this is me from a reasonably educated standpoint, you know, knowing quite a lot about what’s going on. And in the end, this lovely American SHO who was working with orthopaedics went to see Lynsey. And went your husband’s a GP isn’t he? And Lynsey was like like yes. Would he mind if I ring him about HRT? So in the end they rang me to speak to me about it. I tell them what to prescribe. They then couldn’t get hold of it. The hospital pharmacy, obviously, because they don’t really start it there often. So it was like it’s going to be three, four or five days. So in the end, I ended up prescribing it, which goes against what I would normally do, even though I’m allowed to in the GMC guidance. But it wasn’t something I preferred to do. So I ended up prescribing it and took it into the hospital to give it to the junior doctor, who then took another five hours to then put it on the drug chart because they weren’t really sure what they were doing. And so it’s only because I took it in and this was three, four days before she was about to be discharged, and she was still having the same thoughts and everything else. And it was like, I want this started so we can at least see if it makes a difference. It’s not going to harm. And they were so worried because of a lack of mobility and blood clot risk and all of that. But at least we got it on. And so at least just before she was discharged, she actually had a patch of HRT on and it was like, well, let’s just see. [00:21:18][343.2]

Dr Louise Newson: [00:21:19] And as you know, the patches don’t increase clot risk anyway. So they’re actually, no risks and potential benefits. And so did it make any difference? [00:21:28][9.1]

Lynsey: [00:21:29] Initially when it was put on, I couldn’t see anything, any difference. I was still getting those intrusive thoughts, but I had them some psychology sessions provided by crisis mental health, and I was keeping a diary as a result of that. And I worked out in the first 21 days, I’d actually only had the intrusive thoughts ten out of 21 days. Now, prior to that, it had been 21 out of 21 days. It had been every day for as long as I could remember. So I could see things were starting to change. I mean, Kieran said that he could see something had changed in my eyes very, very early on, but I was still in a bad place. But literally on day, I had 28 days, on day 29, I woke up and said, I’m going to phone my friends. And it was like ping. It was like a 28 day cycle. It can’t be a coincidence. [00:22:24][55.2]

Dr Louise Newson: [00:22:25] Gosh. [00:22:25][0.0]

Lynsey: [00:22:26] I was me again. And it was really was like waking up from a nightmare. But it all happened and it was just terrifying. But at the same time, I was just so thankful that I wasn’t in that place. [00:22:38][12.1]

Dr Louise Newson: [00:22:39] It’s very powerful, isn’t it? And, you know, I mean I’m obviously was a female GP for many years and I didn’t understand the biochemical effects of hormones in our brains because like I said, nobody taught me and I’d always prescribed HRT to those women who wanted it, who actively came and asked, but I never would sort of go any deeper. And then I started to see people in my, when I started my dedicated menopause clinic, who had come from psychiatrists with not as extreme stories as you, but very similar. I’ve seen a lot who have had ECT but I’ve seen a lot. Most people that we see are already on antidepressants and they say, I know I’m not depressed, but quite a few are on drugs such as quetiapine, lithium, pregabalin. I’ve seen a few patients now that are on ketamine. They give ketamine infusions for treatment resistant depression. I’ve been talking to the Royal Marsden Hospital because they have nothing in their big handbook about hormonal changes, you know, postnatal depression, PMS and, you know, depression that occurs through the perimenopause and menopause. But a lot of the women I see, they come to my clinic because they’re also menopausal. They’ve sought the clinic out themselves. And I remember the first time I saw a lady who was really in crisis, it was awful. And she’d had a similar story, but actually she’d been housebound for eight years and I hadn’t known at the time she’d written her suicide note. And I was her last sort of port of call, really. But I said to her, you’re 56, you know, it was almost easier than for you. You are definitely menopausal. You’re getting some other symptoms. And I know that for your future brain and heart and bone health, HRT is likely to be helpful as well. So I’m going to give it to you, but I’m not going to give you false hope because her story was so extreme and had gone on for so long, I thought, well, hormones probably won’t help. And about two and a half weeks later, she emailed me to say, I just want to thank you. It’s the first time I’ve managed to sleep and I feel this cloud is lifting. And I thought, my goodness me, but it makes sense. You know, you can put all the sticking plasters you like on, but if you’re not treating the underlying cause and there’s something about medicine, and I think it’s because it’s women’s health that people don’t want to believe women, they don’t want to listen. They don’t want to understand the basic pathophysiology. We’re writing up a paper with a pre-clinical scientist from America looking at the role of testosterone in female brains, and he’s been working on animal models for many, many years. And the behaviour the animals have, the mice, is exactly the same as women, but we can believe the animals. And he’s had amazing papers written in Nature and everything else. I try and write anything about the role of testosterone in women, and it just gets shot down. And it’s, it’s very frustrating in medicine when we can’t move forwards. And you know, there’s lots of, like you say Kieran, this pattern recognition in medicine. You learn and you learn from your patients all the time. And the first time something happens, you think maybe it’s a coincidence and then when it’s the hundredth time or the thousandth time or the 10,000th time, it’s not just a coincidence at all. People don’t make things up. People don’t try and be ill. You know, there’s no psychological advantage of being in a mental hospital or having these thoughts. And, you know, it’s one of the reasons that we’re funding a PhD student looking at suicide risk in perimenopause and in menopausal women. And one of the things that I’ve learned quite quickly from patients is this insight that’s quite hard to describe unless maybe you’ve done psychiatry before. But a lot of people who are that severely depressed who are really thinking about suicide, they actually don’t care. They have no insight or very low insight. And often the drugs. sort of blunt effect a bit as well. But the women that I see who tell me about the thoughts that they’re having or the you know, they’ve even planned what they’re going to do. And they’re telling me in a very sort of clear way, you know, and they they often have very good eye contact. They’ve got their makeup on. They look very presentable. It’s a very different to the way that we see people who are probably clinically depressed. I don’t know if that resonates with either of you at all. [00:26:47][248.0]

Lynsey: [00:26:48] Yeah, absolutely. With me, because it felt almost like a compulsion, an intrusive thought that I needed to act on, not as a result of something else that happened externally. It was just some internal battle. But at the same time, I was very honest with Kieran and with professionals to say, this is how I feel. I don’t understand why I want to kill myself, but something is driving me to kill myself. It wasn’t that I felt everyone would be better off without me. I didn’t even have that going on. It was as if it was something driving me. That’s all I can describe it as. And it felt I needed to make a plan. It was, just completely took over my whole thought process all day long. [00:27:34][45.4]

Dr Louise Newson: [00:27:36] And the other thing that I find incredibly sad and frustrating is the, like you say, the lack of joined up care, but the inability for people to be able to prescribe HRT. Now, HRT is one of the safest things I’ve ever prescribed as a doctor, especially the body identical hormones. They really don’t have risk. This whole breast cancer risk has been overstated and with the body identical hormones, then there isn’t thought to be a risk of breast cancer. As we’ve said, there’s no risk of clot, and that’s fully reversible as well. You know, if I take my patch off, then tomorrow I won’t have any hormones in my body. So they’re not long lasting either. But when we’ve done a lot of training with psychiatrists and speak to psychiatrists, but also people in other specialties like cardiologists or neurologists, when they see people with memory problems and headaches, they all say, well, I can’t prescribe HRT, and I understand you’re absolutely right Kieran, in secondary care, often they can’t start medication. It goes back to the GP. Now this is to me nonsensical because actually it’s using the GPs as puppets and you’re not puppets. You are highly trained individuals who are busy enough anyway. I get a lot of pushback from very high up people because they’re saying that the work I’m doing is creating work for them in general practice. And now there’s so many women asking for HRT and yes, I feel bad that I’m creating work, but actually in the longer term it will be better. And also if we can give people hormones, which means they’re not taking psychiatric drugs, they’re not being sectioned, they’re not having… you know, I don’t really understand the harm. And I’ve have said to psychiatrists when I’ve spoken to them, if you had someone who was an inpatient or outpatient who had hypothyroidism, because that can lower mood and make people feel depressed if you have an underactive thyroid, would you not prescribe thyroxine? Well, of course we would, they say. Or if you had somebody who had a headache, would you give them paracetamol? Well, yes, of course I would. But I’m too scared to prescribe HRT. And this is a hangover of the WHI from 20 years ago. And I just feel it’s really sad. But it’s not just the psychiatrist, you’re just describing in a hospital where, you know, you can access morphine, you can have all sorts of drugs, but a little patch of HRT is too complicated. I just don’t know. I don’t know what you think as a clinical director Kieran. I mean, how can we change the system because it’s just doing women such a disservice and it’s actually having a ripple effect on other health care professionals as well, unnecessarily, I think. [00:30:06][150.6]

Kieran: [00:30:08] Completely agree. And I think there are ways to change it. It requires those who are part of the problem to move out of the way. And I find that a lot with not just this, but with lots of issues during COVID there were so many issues just alone in that period that highlighted how poor NHS England are and how lack of knowledge of reality of what’s on the ground. And that’s what’s important, is the patients that they don’t seem to grasp that we see every single day. And you know, general practice saw 360 million patients last year in some form or other. So the idea that we’re never really truly at the table and I agree with you when it comes to the RCGP at times I don’t know I struggle with the people on those panels at times and their thought processes rather than the reality of what’s required. And as you say, a simple aide-memoire. A medical student, if they had the ability to describe with an aide-memoire, could do HRT. So the idea that we have consultants who struggle to issue a medication that is very simple, if you make it simple for yourself and get just a bit of online learning, if they’re really that struggling, it’s the easy way. [00:31:18][69.6]

Dr Louise Newson: [00:31:19] Yeah, I totally agree. And you know, as you said before, a lot of the time it’s gynaecologists as well that have sort of have always owned the menopause and I suppose I’ve sort of broken the mould a bit because I’m not a gynaecologist, I’m a physician with a pathology degree who’s interested in basic science. But actually I don’t feel that it should be, if I was a gynaecologist, I’m interested in diseases of the pelvic organs, and menopause is usually not a disease of organs. It’s something, you know, it’s a hormone deficiency. It should be an endocrinologist if you’re going to go to a specialty. But some endocrinologists are very good, but quite a few we see in the clinic have already been seen by endocrinologists and they haven’t thought about sex hormones. And I find it’s really frustrating as well because a lot of the pushback I get is because my clinic’s private and they’re saying, well, you’re forcing women to go on HRT because you’re making money out of these patients. And, you know, there’s not many private clinics that see 4,000 women a month and are swamped. And, you know, even that free balance app that I created has nearly got a million users. Well, I’m not making any financial gain out of that. In fact, it’s cost me nearly one million pounds to do the app. But actually, where else in medicine are people scrambling so hard to get help? And, you know, when I look at our patients, we’ve got people from all socioeconomic classes. Who come to the clinic, people that really can’t afford, they don’t want to pay, but where else do they go? And it’s not that they are waiting a referral for a specialist. They’ve just been told, no, they can’t have it, they can’t have HRT. And so this sort of inequality also between sort of private and NHS is actually not helpful either because, you know, we do a lot. We try and encourage people to go and see their GP. Most weeks I get complaints from GP’s to say, how dare you ask this lady to come to us? You know, I’ve even had MPs that have been involved or senior clinical directors in hospitals complaining about me, but these women haven’t got a job. Their partners are really struggling and HRT is free for them because they have free prescriptions. So there’s, I just feel it’s women are just being blocked wherever they go. And there’s a lot obviously, of women that are getting help and it’s brilliant and it’s wonderful, but we still know it’s a minority. And, you know, even when we increase prescribing, there’s a shortage, which then doesn’t help because then that puts more work on people. But I think I think the most important take home lesson from this amazing, very emotional podcast is that hormones do get everywhere and they are safe. And whether it’s a mental health aspect or physical aspect or there’s something else and there’s certainly no harm trying. And, you know, a lot of time, even in psychiatric medicine, it’s a trial of drugs. This is just a trial of something else, which is actually a lot safer than a lot of the drugs. So I’m very grateful for your time. Just to put you on the spot, though, I always do three take home tips and it’s a bit hard to ask for one and a half each. So I’m going to ask you for two tips each. So I’m going to ask you, Lynsey, first, just for two tips for people who have listened and hopefully won’t be in as extreme as you were, but people who have this anxiety or low mood or intrusive thoughts that have come on without any obvious trigger and think it might be related to hormones, what two things would you recommend for them to do? [00:34:52][213.1]

Lynsey: [00:34:53] For me, I would definitely say, listen to your body. Try to investigate what’s going on. With hindsight, it’s a great thing. I can look back, can actually I can see I had joint pain, I had some night sweats. But again, these are things that had been missed completely. So I guess listening to your body. Something has changed, so maybe look at has anything else changed? Have you been logging your periods? Just getting to know your body. And then my second one would be, in this situation, knowledge is purely power because perimenopause wasn’t even on my vocabulary at the time. It wasn’t something I was looking for either. Thankfully Kieran knew about it a lot more than me as a woman. So to be to be arming ourselves as women, to actually find out about these things and the information is definitely getting out there. But only if you’re then looking for it. [00:35:50][57.5]

Dr Louise Newson: [00:35:51] Yes, absolutely. So education is key and also education to share with others as well, isn’t it? So sometimes when you’re in a state, it’s too hard to find information. But if others are, or you recognise it in your friends or your work colleagues don’t just say, oh, that will be the menopause. Think about what can be done to help, because that will often make a difference. So, Kieran, I’d really like to ask you two things. As a healthcare professional, as a GP, what two things do you now look out for that perhaps you hadn’t before? [00:36:22][30.9]

Kieran: [00:36:23] I think it’s the low level anxiety. That’s the big one and it’s really simple stuff, is what Lynsey highlighted during this podcast of they’re struggling with the job, they’re struggling with day to day life, things that any woman wouldn’t give a second thought about. You know, they’re used to multitasking, looking after their kids and the family and working. And I’ve had a couple recently in the last three or four months where early 40s, periods are still there, you know, but just things aren’t right. They’ve been doing their job 10, 15 years and they’re just struggling. So I think if you’re starting to get those low level symptoms and the rest of your life seems normal, then it’s really important to think about that. And the second one I would say is, you know, if you’re getting angry more than you used to, you know, and again, you know, that’s the one that I see a lot where they’re saying, you know, I like my husband, but he’s really annoying me. He’s really irritating me. And it’s like normally he wouldn’t. And I had a really good colleague who’s also a GP and they told me a story when Lynsey was ill, I was talking to them and they gave us a really good story about they’d come home after a really busy day as a GP and they’ve gone home. The husband was cooking dinner and their teenage children were there helping and she just went sod this and walked out, went to the pub. You know and then she thought, I think there’s a problem and, you know, it’s just something that you would think that’s really weird. But it suddenly makes people think the fact it takes that for a woman to think I’ve got a problem that I need to go and think maybe HRT might be the answer to this. I think it’s getting people to understand. Speak out, say your piece and get someone to listen. [00:38:03][99.3]

Dr Louise Newson: [00:38:04] Absolutely. Gosh brilliant advice from both of you. And thank you so much for being so open and sharing this because I know it will help many people and make people really think differently about the perimenopause and menopause. So thanks ever so much for your time today. [00:38:18][14.3]

Kieran: [00:38:19] Thank you. [00:38:19][0.2]

Lynsey: [00:38:19] Thank you. [00:38:19][0.3]

Dr Louise Newson: [00:38:24] 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. [00:38:24][0.0]

END