Mood, mental health and hormones with Dr Clair Crockett

The focus of this year’s World Menopause Day was cognition and mood. In this episode, Dr Louise Newson talks to Dr Clair Crockett, a GP and menopause specialist with an interest in mood, mental health and hormones. Clair’s interest in the topic stems from her own experience of escalating anxiety, low mood and intrusive thoughts in the premenstrual phase of her cycle during her mid-to-late 30s. Through her own research, she looked for ways to help her symptoms including through lifestyle changes, supplements and antidepressants. While these all helped some aspects of her mental health, it wasn’t until she began taking HRT that the premenstrual mental health symptoms eased.

The experts discuss the importance of considering hormones when helping women experiencing mental health problems and outline some of the ways they are working to improve education about menopause and mental health amongst healthcare professionals.

Clair’s tips to women with mental health symptoms in perimenopause and menopause:

1. Track your symptoms and periods, the balance app is a good way to do this. This will make it easier to relay to your healthcare professional when you see them. Ask who has an interest in women’s health in your GP practice so you can see the most appropriate person.
2. Tackling mental health in perimenopause and menopause is multi-faceted, it can take a while to get it right through a combination of taking HRT, your food choices, exercise, and doing work that inspires you.
3. Make peace with your body image and don’t let it stop your progress.

If you’d like to read more about Clair’s personal experience of mental health and hormones, you can read her story here.

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 on my podcast, I’ve got with me Dr Clair Crockett, who’s a doctor that I’ve known for a little while now. But she’s really become very important in my life, like lots of people, because she’s doing a huge amount of work, not just in the clinic, but liaising with lots of people, bringing groups of like-minded people together to really take forward lots of aspects of the menopause, but especially mental health and the menopause, which many of you know is really, really crucial and really important and underserviced and under-researched as well. So welcome, Clair, today.

Dr Clair Crockett [00:01:20] Hi, Louise. Thank you for having me.

Dr Louise Newson [00:01:21] So I’m not sure how long we’ve known each other, but it feels longer than it probably is. You were introduced by another doctor that we both know weren’t you, and then you came and started working in the clinic. But you’re sort of a bit like me, really. It’s taking over your life, thinking about perimenopause and menopause.

Dr Clair Crockett [00:01:39] Yeah, that’s right, I think. Yeah, definitely. I was introduced by another doctor that you knew and that I had worked with as well. And she put us in touch with one another. And as you said, the perimenopause of menopause and mental health in relation to that in particular, is something that I’m really interested and passionate about.

Dr Louise Newson [00:02:00] So if you sort of look back in time, so certainly if I’d met you as a medical student, I wouldn’t have ever heard about the perimenopause. I would have known that the menopause causes a few hot flushes and periods to stop. But I wouldn’t have known anything about the association of mental health and female hormones at all, actually. Were you aware of it at all when you were a medical student?

Dr Clair Crockett [00:02:22] No, not at all. I don’t think. Even the perimenopause and menopause, even though it was probably touched on briefly, it certainly wasn’t something that was a big part of what we were taught or expected to learn or cover. So it’s something that I sort of developed a bit of an interest in and you sort of go out yourself and try and learn more about it.

Dr Louise Newson [00:02:43] Absolutely. I mean, I did a lot of psychiatry actually in Manchester and I really, really enjoyed it. And I remember doing a project actually for a lady that had an eating disorder and she had sadly been abused as well. So there was lots of psychiatry going on, lots of mental health in her past history. But I’m sure looking back, her periods had stopped as well because of her eating disorder. And, you know, I never thought about oh her periods have stopped therefore she wouldn’t have hormones, therefore, that would be impacting on her mental health. And, you know, that was 30 years ago. I wish I could go back in time and just think about that. But if you’re not taught these things, it’s impossible, isn’t it, to know?

Dr Clair Crockett [00:03:21] Yeah, it is. And you just sort of follow the same pattern that you’re taught about these different conditions and how you treat them. And it’s really difficult sort of to step outside the box and take a fresh look at things because you’re sort of in that process of thinking this is a psychiatric problem, this is a medical problem. It’s really difficult.

Dr Louise Newson [00:03:42] Yeah. And I sometimes think in medicine we’re all sort of on a hamster wheel. We just very focused and we do what we think is best, always think what is best, but it’s only what we’ve learnt. And to think beyond the books sometimes really difficult, partly because we haven’t got time, because we’re so busy, but also it’s knowing what to believe, who to believe as well, which can be quite difficult. And certainly, I know with a lot of medicine that I practice, I’ve learnt from my own experience in general practice, you know, certainly even just having a child has made me realise how difficult it is to be a mother and then having various illnesses in the past. I’ve become a lot more aware of my own body, but certainly it was only when my hormones started changing, I realised how difficult it can be for the perimenopause. And, I know you’ve had a bit of experience as well, haven’t you, with your hormones changing. So do you mind just explaining what happened?

Dr Clair Crockett [00:04:37] Yes, I’ve always had a little sort of some background anxiety which has been reasonably manageable, but sort of as I came into my mid-to-late thirties, I really started to notice that there was quite a cyclical element to that. And so in the couple of weeks perhaps before my period – my cycles were still very regular – but in the couple of weeks before my period, I was really starting to notice that I felt more anxious, my mood might dip. And it sort of escalated then over two or three years towards my late thirties, and at times it could become quite distressing. I might get suicidal, intrusive thoughts. It wasn’t anything that I ever felt I would act on, but they were quite distressing to have that repeatedly happening. And then it almost got to a point where I knew it was going to come in that lead up to my period, and I think that’s where I started to think or sort of put two and two together, I think almost and start to think, Oh, perhaps this is hormonal. And I started to look into it a bit more, and I think that’s where my sort of interest in this area really stemmed from then.

Dr Louise Newson [00:05:47] And this is very, very scary, isn’t it? When you’re having those thoughts and you know, it’s not rational and you know that there’s no reason to have these thoughts, but you can’t stop them.

Dr Clair Crockett [00:05:58] Yeah, it is distressing.

Dr Louise Newson [00:06:00] So did you try and get help or did you speak to anyone about it?

Dr Clair Crockett [00:06:04] I sort of spent a bit of time looking into it myself and seeing sort of what the background to it might be and how I might be able to help myself, I guess was the first place that I started. And so I looked to my lifestyle and looked at alternative treatments like supplements and things like that that I could try and introduce that might help. And I had taken Citalopram previously, and I did go to the GP and this was before I sort of realised that there was a cyclical element to it, and I did go back on to the citalopram, but still I was still getting that dip before the period, even when taking that and taking some supplements and things. And it was I think my family noticed that there was a bit of a change as well and encouraged me to perhaps look at getting some more specialist help with things. And so I chose to go to a private menopause clinic to get a bit of time and understanding, perhaps from someone that knew more about it, to see whether they felt that it was significant or not.

Dr Louise Newson [00:07:10] And did they think it was related to your hormones at the time?

Dr Clair Crockett [00:07:13] Yeah, they did. I think I tracked what was happening and sort of gave an explanation of what I was experiencing. And yes, they agreed that it probably was hormonal in nature. And this was, I think, when I was 38 or 9. And so we sort of had a chat through what the options might be and what we might do. And I sort of had in the back of my mind that I’d like to try some HRT to help, because from the reading that I’d done, I’d found out that that perhaps was a good way to approach it. And so the doctor that I had a consultation with agreed. And that’s what we did. We tried some HRT and it was really helpful. It took a little while to sort of tweak it, to get it right for me, but it was definitely quite quickly. I noticed that I wasn’t getting that dip before my period each month, which was amazing. Yeah.

Dr Louise Newson [00:08:14] Gosh. And that must have made a huge difference.

Dr Clair Crockett [00:08:18] Yeah, it did make a massive difference.

Dr Louise Newson [00:08:21] And it’s quite interesting isn’t it because if you knew no medicine and if you just knew a bit about the menstrual cycle and about how our hormones change, it does actually make sense since we have this drop in estrogen levels before our periods and quite a few women just get a bit flat, don’t they, for a day or two before their periods. Some women experience PMS or PMDD, and this can also be related to changes in hormones. But I was always taught, like you I suppose, try different supplements, look at lifestyle. Sometimes we used to give antidepressants, sometimes just for two out of four weeks to see if that helped. And it certainly is a recommended treatment. But I remember sitting in Professor John Studd’s clinic about seven or eight years ago now. He was the first person I’d sat in a menopause clinic. I went up to see him in London and sadly he’s died now. But he was very inspirational. People thought he was a bit of a maverick in his time, but actually he just taught a lot of common sense. And I remember seeing a lady there who described a similar story to you with PMS and he said, “just take this gel my dear and come back in three months and I can tell you you’ll feel better”. And I said to him, “What are you doing? I’ve never done that in my life”. He said, “Louise, I’m just topping up her hormones. She’s still having regular periods, but I’m just topping her up for a few days before to stop this decline”. And I thought, gosh, that’s just common sense medicine. Why didn’t anyone teach me that before? And it is sort of mentioned in some lists and green top guidelines aren’t there, for PMS at the Royal College of Obs and Gynae produced a few years ago now. And the hormones are mentioned, but there’s quite a lot of mention of other treatments as well. So it’s sort of hidden almost, I think, and people just don’t seem to think about hormones for first line treatment, and I’m not really sure why. Because there’s no risk, is there, with having just some estrogen?

Dr Clair Crockett [00:10:13] No. Particularly in younger women before the age of 51, there’s no increased risk. We’re just topping up the hormones that are already there essentially.

Dr Louise Newson [00:10:23] And actually it’s safer than the contraceptive pill is.

Dr Clair Crockett [00:10:28] Yeah, that’s the thing that I think that is silly about it really, isn’t it, that people feel quite nervous about starting HRT and actually it is safer than the contraceptive pill and that’s quite readily prescribed, isn’t it?

Dr Louise Newson [00:10:42] Absolutely. Especially to young women. And I think because when we look at the HRT that we prescribe, it’s body identical. So it’s the same hormone as we produce ourselves in our ovaries and the estrogen is through the skin, so there’s no risk of clot. And some people find that if they take the contraceptive pill or the progestogen-only pill as contraception, the progestogen in it is synthetic and some people have some progesterone intolerance, so therefore their mood can even be worse. So I see – I’m sure you have – women who said, “oh, I don’t want to go on hormones because when I took the contraceptive pill and I felt dreadful, when I had the implants I felt dreadful. My mood was really awful.” But that could be quite different with HRT can’t it?

Dr Clair Crockett [00:11:23] Yes, it can, because we’re using the body identical hormone. So we’re just replacing, we’re giving it back in the same form as our body’s used to, rather than the synthetic forms that are in the contraceptive pills and things. And so often I see that, as you do, that women tolerate it far better and it’s really nice to see what an improvement it can make.

Dr Louise Newson [00:11:46] Yeah, and also we can change the dose can’t we? Because when people start often, when they still get regular periods, they’re still producing their own hormones, of course, because they’re having periods. But with time, as we get older, of course, our hormones are going to decline as well. So that top up can be a bit more can’t it? And then eventually it’s most days and then every day isn’t it? And what I really like about all of this is that women are in control. I think they can see what their symptoms are like. And sometimes I’ve had women who just do it two or three days before their period. And then when I’ve reviewed and they said, “Oh, no, I’ve started to do it five or six days before”, and then it just sort of gradually increases. And it’s difficult to know, isn’t it, whether these women are perimenopausal or it’s PMS and there’s no blood test to know the difference. But actually, I always say to patients, it doesn’t actually really matter because it’s just a label isn’t it? It is a hormonal problem that we’re correcting.

Dr Clair Crockett [00:12:40] Yeah, I explain it in the same way and that because it’s a safe treatment, there’s no harm in trying it. I just say, let’s try it. Let’s see if it helps. And I think, as you said, it’s really nice that sort of something that’s been controlling you, you take the power back over it and you can change the doses around and sort of try to understand your body and get things right for you. I think it can be really empowering when you’ve felt quite debilitated by how you’ve been feeling.

Dr Louise Newson [00:13:11] Absolutely. And I think that’s so important, isn’t it, in everything we do in medicine, for the patient to be in the centre and the patient to be in control as well is really crucial. And I know I’ve been to a lot of meetings with very senior people telling me that it cannot be a hormonal problem if women still have regular periods. And I really push back a lot about that. And often it’s gynaecologists that are saying this and I sort of think, well, maybe gynaecologists don’t see women who have regular periods because of course, why would you go and see a gynaecologist if you have nothing wrong with your periods? So I can understand that they don’t consider it. But when these people are writing guidelines for the whole of the UK, it’s really quite obstructive I think sometimes for them to think like that because certainly in general practice and in real life we see a lot of women who have regular periods and they’re having hormonal changes.

Dr Clair Crockett [00:14:05] Yeah. I think that we do see that a lot, don’t we, and I think that can make it really difficult when the guidelines are so sort of restrictive from that point of view. And so people are reluctant to prescribe outside of that almost.

Dr Louise Newson [00:14:19] Yeah, and that does make it very difficult for a lot of women. And so hormones are so important in our brains, aren’t they? You know, no one thinks just about periods, but actually our hormones work all over our body. So in our skin, even in our nails in our heart in our kidneys, you know, everywhere is really crucial, even for not just ourselves to function, but our brains are so important because we’ve got various areas, haven’t we, in the brain that can really be affected by the lack of estrogen but also testosterone often in the brain too, can’t it?

Dr Clair Crockett [00:14:55] Yeah, it can definitely. And I think we see a lot of women where that’s the case and that they’re troubled by not only depression but suicidal thoughts, as we’ve mentioned, or sort of a fluctuating mood where they might find that they’re diagnosed with bipolar disorder or all sorts of different psychiatric conditions, then that perhaps could in part or in whole be related to the change in their hormones. And the approach to the management is very different, I think. I think that’s a big part of what I’m enjoying doing and why this sort of work is really important to me is just to be able to sort of share that and increase knowledge and understanding to help other healthcare professionals and women.

Dr Louise Newson [00:15:45] And there’s been quite a response hasn’t there? So we’ve been working closely with various psychiatrists and I lectured at the Royal College of Psychiatrists in Edinburgh a few months ago and we’ve had different psychiatrists actually that have reached out, and I know you’re working quite closely with quite a few of them.

Dr Clair Crockett [00:16:01] Yeah, there’s a lot of psychiatrists that are really interested in learning more about it, which is good. They’re starting to see for themselves that this could be a factor in wanting some sort of input to help them improve their understanding so that they can help these patients, which is brilliant. And you mentioned the work that you’ve done with the Royal College of Psychiatrists e-learning modules. And a few of us are putting together a second module, one of the psychiatrists that reached out to the clinic and wanted us to help her do that, which is brilliant. Yeah, it’s great to have everyone sort of coming together and trying to work out what’s the best way to help women.

Dr Louise Newson [00:16:43] Yes. And it’s great because, you know, the psychiatrists are no different to us. They haven’t really had any education or training in the menopause. And it’s like that sort of light bulb moment. Once you see it, you can’t unsee it. And a lot of them are realising that many women that they see either as inpatients or in their clinics, women in their forties or thirties and probably have got some hormonal changes, but they’ve not thought to ask, or the women haven’t thought to realise the association. So it’s really important that we can work together. So we as menopause specialists and GPs can get help if women have got a psychiatric problem, but also the psychiatrists and mental health teams can liaise with us as well and that’s increasing more. And then obviously we’re doing some research aren’t we with Olivia, who’s a PhD student associated with Liverpool University that we’re funding. And that’s going to be really interesting work. I think there’s a lot that’s going to come out of that as well. But tell us a bit about the mental health symptoms that women experience when they and like I say, not every woman has any mental health issues. Some people have none whatsoever. But a lot of people have some sort of low grade anxiety or just feeling a bit flat, don’t they? But what about the sort of other symptoms that really affect people more? Can you explain what they are?

Dr Clair Crockett [00:18:03] I think as you touched on, anxiety is definitely one. Women will mention that they find that that either becomes very exaggerated or they might not have even had any problems with anxiety before and suddenly they’re noticing that they are doing. Irritability is another symptom that women often find quite distressing and low mood, obviously, that we’ve touched upon. Suicidal thoughts and ideation and also with unfortunately, we see some women where it’s escalated to a point where they might attempt suicide or sadly be successful taking their own lives, which is really upsetting. And that’s what we want to be trying to avoid. But often women as well will notice that they’re very emotional. They might cry at very, sort of at the drop of the hat, something that they wouldn’t usually find would make them emotional. They just find that they might be in the aisle in the supermarket and start crying perhaps. And those sort of things can really then affect them in their job as well, because they might be working in a role where they have to stand up. Well, they’re used to standing up in meetings and talking and suddenly they feel that they can’t do that anymore and it can really have a huge impact on their lives then.

Dr Louise Newson [00:19:25] Yeah, certainly. Now I hadn’t realised how many women actually have very intrusive negative thoughts and often haven’t spoken about it before. I’ve had quite a few women who’ve sat in front of me and said, “Look, I’ve never told anyone before, I’m really scared. I have to wake at three or four in the morning and I, you know, really think about not having a future”. But a lot of women are, they have insight. They know they really don’t want to do it. Whereas there’s quite a few people I’ve seen, and I’m sure you have in the past who have been properly clinically depressed and they don’t have this insight, they can’t sort of think it through. So there is a difference and that’s what we’re trying to tease out with the PhD. But it’s very hard and I think a lot of women think that if they tell people, then they’ll be, you know, sectioned or given drugs and not being listened to. And I think that’s a real problem, actually. And the more we can educate psychiatrists and I was reading over the weekend again about these ketamine clinics, and there’s a few over here, there’s 256 ketamine clinics now in the USA. And ketamine, as I’m sure a lot of you heard, is well it’s an anaesthetic drug, but it’s also used as a street drug as well, isn’t it? But it has been shown to lift some people’s mood when they have resistant depression. I’m sure it would lift most of our mood if we took it, but it’s not something that we would want to prescribe. I’ve never prescribed it or give. And I reached out to a professor who runs one of these clinics in the UK this weekend and he said, “Yes, I think you’re right, Louise I think maybe we should be assessing women for perimenopause or menopause before prescribing ketamine”. So, yes, I think you should actually. And, you know, we get a lot of flack for prescribing women their own hormones back by giving them HRT. But these clinics, though, seem to just be popping up and increasing because, you know, women are desperate to feel better. We hear it time and time again. But I strongly feel that we should be looking at the obvious things, i.e. hormones before rushing into something like ketamine.

Dr Clair Crockett [00:21:28] No, I totally agree. And some of these treatments have really nasty side effects as well that can cause a lot of problems for a long time in women’s lives. Not just ketamine, but some antipsychotics and even some antidepressants can have quite negative side effects that can really exacerbate menopausal symptoms.

Dr Louise Newson [00:21:50] Well, that’s right, because certainly some of the antipsychotic drugs and some of the other drugs that are given can actually suppress our own hormones. So if someone’s perimenopausal or got some PMS and then, you know, one of these drugs, actually, it can induce a chemical menopause, it can actually lead to menopause. So it’s making the hormonal changes even worse. And there’s no reason why women can’t have HRT as well as these drugs, is there?

Dr Clair Crockett [00:22:17] No, no, not at all. And often I think it can improve the function of –I think there is some evidence that SSRIs, which is like citalopram, fluoxetine, sertraline antidepressants like that, that having enough estrogen on board if they’re necessary to have the SSRI as well will make them work better.

Dr Louise Newson [00:22:37] And that’s really important. And I wish I had known that before when I was a general practitioner because I sort of now think really every woman who’s in their fifties is likely to be menopausal and sixties and seventies should be considered to have estrogen as well as their antidepressant if they need antidepressants and actually women in their forties are likely to be perimenopausal women in their twenties and thirties, a lot of those will be perimenopausal or menopausal. So everybody who’s a woman who has an antidepressant should be considered for hormones as well if they need it. And it’s likely that would improve the efficacy of antidepressants as well and we know that antidepressant prescribing has really increased, hasn’t it, since prescribing of HRT has reduced?

Dr Clair Crockett [00:23:25] Yeah, it definitely has. I think particularly in the perimenopause, I think because when women still are having regular periods, then, as we’ve already touched on, it’s felt that perhaps HRT isn’t the right thing to be doing if the periods are still regular. And so then if women are presenting with mental health problems or psychological distress, then an antidepressant is an option to try and help that perhaps clinicians feel more comfortable with. And I think it does help to a degree sometimes, but if it’s the hormones that are causing the symptoms, then it’s giving the hormones back that’s going to improve them.

Dr Louise Newson [00:24:03] Yes, because we know it might help. Sometimes it helps with the vasomotor symptoms, but it won’t help with the future health will it? So it won’t help protect bones and heart and brain as well. And like you say, some of the side effects can be really quite distressing, actually, in some of the strongest antipsychotic medication, even some antidepressants like mirtazapine can cause people to put on weight, can cause people to have sleep disturbances, can actually make their mood actually a bit more blunted. And they enjoy things less. They get less sad, but then they enjoy things less as well. And quite a few women we… I’ve spoken before on the podcast about weight gain and lots of people tend to put on weight because of the metabolic changes that occur in the menopause. And then if they’re given medication that will increase their weight, that can be quite a negative cycle as well can’t it?

Dr Clair Crockett [00:24:52] Yeah, I think it can. It can be really difficult. It’s certainly something that I’ve struggled with a bit myself is that trying to maintain a healthy weight and starting to feel better from the HRT, but then it can be quite destructive. Then you’re trying to sort of work on your lifestyle alongside the HRT and other things to get yourself feeling better, knowing that all of those factors together are what’s going to get you to a place where you’re feeling better. And there’s still sort of this pressure on women to have a sort of ideal body shape and body image, and it really can be quite destructive then having a negative body image and feeling that even if you’re feeling better in yourself and you’re exercising regularly and doing all of the things that you know are going to help how you feel, that still you might look at yourself and feel that it just really still affects your self-esteem, even though you are beginning to feel better if that makes sense.

Dr Louise Newson [00:25:52] It makes complete sense. And I think that’s really sad and hard. And society can be really, really quite harsh. And certainly a lot of people are pushing back on the work that I’m doing. And, you know, I get a lot of toxicity and bullying in my work. And recently I was in a meeting and they said, “well, it’s outrageous actually, because all women want to do is look like Davina and that’s why they’re asking for HRT.” The so called ‘Davina Effect’ following the documentary. And I feel really sad about that because, you know, don’t get me wrong Davina’s great, wonderful body. She’s really fit. You know, fitness is her life. But actually I don’t take HRT to look like Davina, and I don’t think anyone should be encouraged because all we need to do is be the best version of ourselves. And that doesn’t mean we have to be a certain dress size or, wear certain clothes or have our hair a certain way. And I also really strongly feel, and I know you do, that HRT is not a lifestyle drug. It’s not to take it to give us a certain look. You know, I take it mainly because I’m scared of osteoporosis, actually, and I’m really worried about dementia. So they’re the reasons. I don’t really care what I look like because I know it’s taken me a long time to realise that, you know, my body shape will not really change. You know, I’m always going to be flat chested, I’m always going to have, you know, bigger thighs. It’s just the way I am. And I think you’ve got this pressure from society, and I think that can be really difficult can’t it and people can really judge you because they might think that you don’t exercise or that, you know, someone doesn’t eat healthily because they’re not the same size as Davina, for example. And then that puts a lot of pressure, doesn’t it, on somebody who is already feeling pressured.

Dr Clair Crockett [00:27:34] Yeah, it does. It does. And I think that’s something that’s really important to recognise is that just by looking at someone, you can’t tell how fit they are or as you said, what their diet is or how much they exercise. You can’t tell that just from their dress size, can you, or how they’ve got their hair. I just think at that time in the perimenopause and menopause where you’re sort of transitioning and there’s a lot of change going on in your body then. Sort of having that negative body image and not feeling comfortable in yourself just makes it even harder.

Dr Louise Newson [00:28:07] Absolutely. I see so many women and it’s that sort of cycle, isn’t it, where you feel really bad about yourself, your mental health is down. You might have put on weight through not changing your diet because the metabolic changes often mean that women put on weight, and then people can comfort eat but then they find it hard to exercise and it takes a long time. And you know, if people have been suffering for three or four years, it’s often going to take three or four years for them to feel better and, you know, get back to how they were before. And it’s not a quick fix. And I think we do spend a lot of time saying to women that, you know, you’re not going to take HRT for three months, six months and then feel amazing. And it’s not, as you quite rightly say, not just HRT. It’s looking at everything else as well. And sometimes, you know what we eat. I look at what my teenage children can get away with eating, and I certainly couldn’t do that. But, you know, metabolism has changed because we age and, you know, choices of food often have to change as we age as well. So it is really important that any of you who are needing help see someone who is very holistic with their approach, because we know that looking at diet and exercise and sleep and wellbeing and even the type of exercise is really important. So there’s a huge amount that needs to be done and all of this obviously can have a negative or positive effect on mental health depending on, you know, what advice and treatments are given. So there’s a lot we need to do and there’s a lot we’re doing. And I’m hoping that maybe Clair can come back and report about some of the other work that we’ve been doing behind the scenes, which I’m really hoping will come to some great projects. So I’m really very grateful for the time that you’re spending and will continue to spend in this area. But before we finish, do you mind just giving three take home tips really. I’m happy for you to choose actually your take home tips because I know you’ve done your homework and prepared. And so what three tips are you going to say.

Dr Clair Crockett [00:30:07] One of the things I was going to say was just about trying to track your symptoms. The balance app is a really good way of doing that to try and sort of get a good picture of what you’re seeing and the symptoms you’re getting when you might perhaps feel more anxious or when you might perhaps feel your mood dipping and tracking that. So then you’ve got something that’s easy to relay then to the clinician that you’re going to talk to and perhaps approaching your GP reception and just saying is there anyone that’s got an interest in women’s health or anyone that might be quite open to listening to what you’ve learnt about yourself by doing this, and just seeing whether you can then come to an agreement about perhaps what might be the best way to approach the symptoms and help manage them for you. And then also just, I think as we’ve touched on, just understanding that it’s quite multifaceted all of this and there’s lots of different pieces that need to come together and it can take a while to get it all right for you. And just being willing to learn more about yourself, I think, and get your HRT right. Think about food choices, exercise and work that inspires you, which is what I’m doing now, which is great. And then also just thinking about going back to the body image and just trying to make some peace with that. So that’s not stopping your progress I think is something that I’ve definitely learnt has been helpful and yeah, I think hopefully all of those things coming together will be helpful from a personal perspective.

Dr Louise Newson [00:31:50] It’s really important. I’m really grateful for you being sort of sharing so much actually, but I think it is. It’s about being confident and feeling at ease with yourself actually. And I think so much of us as women often put ourselves down and we’re always seeking better. And I know my self-esteem is very low many times. And then I think, well, what would I tell an identical twin? How would I try and encourage others? And I think it’s really important, but we’ve got to start with our own haven’t we and sort of realising that none of us are going to be perfect, but we might as well try to be the best version that we can and actually use our skills to help others as well is really important. So great advice and thanks ever so much for your time today, Clair.

Dr Clair Crockett [00:32:33] Oh no, thank you so much for having me.

Dr Louise Newson [00:32:37] 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.