Motor neurone disease and perimenopause: Nicola’s story

This week, Dr Louise is joined by Nicola McFarlane, who was diagnosed with motor neurone disease (MND) in 2023.

Nicola shares the story of her MND diagnosis, as well as the barriers she faced in accessing treatment for perimenopause symptoms – including low mood, anxiety and recurrent UTIs – to improve her quality of life.

Nicola talks about how health professionals often put her perimenopause symptoms (which pre-dated her MND diagnosis) down to her MND, and why she is sharing her own experiences to help other women living with MND and facing hormonal changes.

For more information on Newson Health, click here.

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. Today on my podcast, I’m going to introduce to you a very inspirational person called Nicola, who I met six months ago, and she has motor neurone disease. And she’s also got hormonal deficiencies, so she takes HRT for that and she’s got a really interesting story. And the more I think about hormones being biologically active throughout a body, the more I’m really concerned about our brains and our nervous system because that’s been ignored for so long. So I’m hoping in the next half hour we can really tease out and unpick some of the reasons why our hormones are so important for all of our nervous system and brains. But especially when you think about people that have neurodegenerative disorders as well. So welcome, Nicola. Thank you so much for joining me. I’m in a different location today, so some of you might have seen I’ve got some of my daughter’s artwork behind me. So before we logged on, we were talking about art because you’ve gone from being a sportsperson to now thinking about painting, haven’t you? [00:02:05][114.5]

Nicola McFarlane: [00:02:06] That is true. I think MND is all about adaptation and focusing on what you can do. And I can’t ride horses anymore or go for a run. So yeah, I’ve been getting into my artwork, trying anyway, but rubbish at the moment, but I’m sticking with it. [00:02:21][15.5]

Dr Louise Newson: [00:02:22] Everybody has to start somewhere. [00:02:23][1.5]

Nicola McFarlane: [00:02:24] Exactly. [00:02:24][0.0]

Dr Louise Newson: [00:02:25] So before we start too much, MND, three letters, motor neurone disease, people often don’t know what it is, and even actually doctors can be quite confused because there are different types. It’s not the same prognosis. Everyone’s different as well. So do you mind just explaining what motor neurone disease is and how it can affect people? Yeah. [00:02:47][21.9]

Nicola McFarlane: [00:02:47] The way I explain it to my friends is your muscles and brains have to communicate. And because my motor neurones are dying, my muscles and brains can’t talk to each other anymore. So your muscles eventually, if they’re not being used, they atrophy, they give up. So with motor neurone disease, it affects everyone totally differently and at different rates of progression. It’s my hands and arms and slightly my speech that’s affected at the moment. But my body will become weaker and weaker over time. And you know, your diaphragm is also a muscle, so your breathing can be affected. It’s a terminal prognosis. It always progresses and the average life expectancy when you’re diagnosed is between two and five years. So obviously a horrendous diagnosis for anyone to be given. And there are no effective treatments at this time. [00:03:51][63.5]

Dr Louise Newson: [00:03:52] So when were you diagnosed? [00:03:53][0.6]

Nicola McFarlane: [00:03:54] May last year. So May 2023. So just over two years ago. [00:03:58][4.2]

Dr Louise Newson: [00:03:59] And how was the diagnosis made? Did you have symptoms for a while or what happened? [00:04:03][3.9]

Nicola McFarlane: [00:04:04] Yeah, I was very I mean, I use the term lucky loosely. I was diagnosed very quickly and that’s not always the case with the majority of people. I had to horse. I was often outdoors and cold. And when my hands got cold they seized up and didn’t work very well. I also would notice round about November the year before that I had a tiny, tiny lisp. But to be honest, I didn’t put those symptoms together and I also had muscle twitches, which is something called fasciculations. Yeah, it’s the muscle kind of calling out the brain going, Where are you? So I was quite fortunate. I was referred quite quickly to a neurologist. And if I’m honest, I’d Googled it and I’d seen motor neurone disease, but obviously I desperately hoped that I wouldn’t have that disease. 90% of cases are what’s called sporadic. So that means they don’t know what causes it. And there’s no family history. Now, I when I was in the process of being diagnosed, I had three months previously, I think had my first appointment with your clinic. And I had been aware for the previous two years that I wasn’t quite right. I mean, I’d say from the age of 40 I hadn’t been quite right. So I knew that I was having problems with perimenopause. But then I was diagnosed with MND and I kind of thought perimenopause. That’s the least of my worries. But after the dust settled and I came to terms with my diagnosis, I realised I could still be alive for another five, 10 years and I would like quality of life. Thank you very much. So I restarted my appointments with the clinic. And I’m happy to say at the moment, I believe my hormones are balanced and I am better for it. [00:06:08][124.3]

Dr Louise Newson: [00:06:09] That’s really interesting, isn’t it? So did you have time when you had been diagnosed with MND but you weren’t taking hormones? [00:06:15][6.9]

Nicola McFarlane: [00:06:16] Yeah. So I think I’d been on I was taking the gel just like one pump for about three months when I was diagnosed. And yeah, I mean, I carried on, but obviously I was, you know, not mentally in a great state. And I kind of, like I say, I just thought menopause is the least of my worries. But I remember having a conversation with my lovely pharmacist one day and she said, Nicola, your perimenopause is impacting your life more now than the MND. And that’s not to make light of MND but I was very early stages when I was diagnosed, but I would say I’m 48, but from the age of 40 I’ve had just crippling anxiety, low mood, recurrent UTIs and nobody, no GP ever said to me this could be perimenopause. They, I would say between the ages of 40 and 44, I was on five different antidepressants that didn’t work. And the stress of starting a new antidepressant, withdrawing, changing was horrendous. I’d stopped drinking, I stopped caffeine, and I was running 10k, 5k three times a week. I was meditating. I did a yoga teacher training course. I was doing all the right things and I knew that I wasn’t right. And then, I would say, since having MND, even though it’s life changing and it’s so difficult, my anxiety levels are better now than they were in my early 40s because of HRT. [00:08:06][109.9]

Dr Louise Newson: [00:08:08] Gosh. And that’s really, it’s so interesting because in medicine you can have so many different diagnoses and you can have more than one thing going on, of course we can. But somehow when it comes to perimenopause or menopause, it’s sort of it’s either you have treatment or you don’t, and there’s nothing in between. And then the whole narrative gets lost quite a lot. And we see a lot of women in the clinic who have other disorders and diseases, but they almost like trivialise the perimenopause of menopause or think well it’s just something that’s going to happen. And we don’t need to worry about that because we’ve got this other condition going on. But actually, like I said at the beginning, the impact of hormones oestradiol, progesterone, testosterone in our brain and our central nervous system, ut also our peripheral nervous system, is really important. And we know the commonest symptoms certainly in the perimenopause are brain fog, memory problems, but also anxiety, low mood. And it can be quite catastrophic anxiety. People can really ruminate and worry and worry about small things, like worry about whether I’m going to leave the house in time to catch my train to go to work. But then suddenly if you have a diagnosis like you had of MND, it could be so awful because you’ve got this anxiety anyway. And as you know, no one knows what your life expectancy is really going to be. Yeah, there are so many other things that can affect us anyway. You know, day to day, we could get run over crossing the road. So it’s living for the moment and being the best version of yourself every day, but also thinking about these hormones, they’re neurotransmitters, so they affect the level of other neurotransmitters in our brain. But also when you think about the peripheral nervous system. So every time we move a muscle, as you say, our brain has to tell us that there’s these signals that go down to every single muscle and coordinate the movement. Now we’ve got this synapses, these connections between each muscle fibre and the signals go between. But those signals are helped with having hormones. But the way the nerve fibres conduct, it’s a bit like electricity, isn’t it? The way that they conduct those messengers again, is helped by hormones and the myelin sheath which conducts everything really fast. So if you put your hand on a hot flame, hopefully your brain will tell you very quickly it’s hot. The myelin sheath gets built by progesterone, oestrogen and testosterone as well, which so many people don’t realise. And so it’s crucially important that your central nervous system and your peripheral nervous system is as good as it can be with everything else going on with the motor neurone disease. And so even if you had no other symptoms related to your perimenopause, I would still say that there are more benefits of taking hormones or three hormones for your peripheral nervous system and your central nervous system as well. [00:11:15][186.8]

Nicola McFarlane: [00:11:16] Yeah, I couldn’t agree more. And I think all the research that I did myself on to perimenopause and it actually brought me and a lot of my school friends closer together because we were all having these similar struggles. And I remember when I was diagnosed with MND, I spoke to a GP and they said, yes, as you have a mood disorder, you will definitely struggle with this diagnosis. I didn’t have a mood disorder. I was going through hormonal changes and I needed help and support. And I find it frustrating that I’ve had to go private for that help and that there doesn’t seem to be joined up approaches and an interest in women’s health. And as you say, I want quality of life. I have a lot to deal with with my health and if I can improve other areas of my life, have more mood stability, have more motivation, have more periods of calm, then of course I’m going to take that. But I do feel like the medical community in some regards just wrote me off, oh she’s got MND, so why bother? [00:12:28][72.7]

Dr Louise Newson: [00:12:30] Yeah, which is absolutely wrong. You know, one of the first things really that I learned in medicine was to not be judgemental and to do the best for every single patient, of course. But we shouldn’t be just labelling people and putting them in a box because everybody who’s perimenopausal is different. Everybody’s who has got motor neurone disease is different. But also you’re such a positive person. You don’t want to be defined by your condition either. You know you want to be defined as the person that you are, that just so happens to have motor neurone disease. But the other thing is, is we know that our hormones oestradiol, progesterone, testosterone help build our muscles and bones as well. And so if you’ve got a condition that is impairing the way your muscles work, which you’ve already said, motor neurone disease does have a negative effect, anything that’s going to help you build muscle strength, keep your bones strong. The last thing you want to do is tumble and fall and have an oesteoporotic hip fracture, and that would be catastrophic for anyone with motor neurone disease or not have the strength when your muscles are becoming less strong anyway. But you don’t want anything else, that’s going to make them weaker. And we know that perimenopausal and menopausal women are at risk of osteosarcopenia, which basically means the bones and the muscles get weaker. And as we get older, they do as well. So, you know, we know keeping active is really important and you know that too. But we know that our hormones have a very beneficial effect. And so that’s very important when we’re thinking about your immediate health as well as your future health. [00:14:10][100.6]

Nicola McFarlane: [00:14:11] Yeah, absolutely. And even the UTIs, I mean, I have suffered so badly in my 40s from UTIs and I actually had a male GP tell me that even if I was really busy I had to be very careful to wipe myself properly. And I was having to get antibiotics all the time. Rightly or wrongly, I was lying to pharmacists and saying I hadn’t had a UTI, you know, previously because I so desperately needed the antibiotics. Nobody ever mentioned perimenopause. The first appointment I had with the Newson clinic, the doctor told me that UTIs are a very common symptom of perimenopause and that when my hormones were balanced, they would stop. And they did. And again, when you are disabled and you have the difficulties with MND, and I think any woman that’s had a UTI and cystitis knows it’s agony. [00:15:12][61.0]

Dr Louise Newson: [00:15:14] Absolutely. And cystitis is very, very common. I was recently lecturing to a predominently female audience and asked, Is there anyone in the audience that hasn’t had a urinary tract infection? Rather than saying who has because I knew there would be a real show of hands. And literally there were three people in the audience that hadn’t and most of us that have had them. It’s not just a bit of discomfort and going slightly more often. It can be awful. I mean, I have sat on the toilet before crying thinking I just can’t. It’s horrendous. It’s absolutely awful. But we also know that, you know, 30% of sepsis is due to urosepsis, so due to urinary tract infections, especially with older people, it’s far more common and it’s so easy to treat. And also, you know, the way the bladder works is determined by our nerves as well. So if our nerves aren’t working as well, our bladder might not empty as well, or pelvic floor muscles might not work so well, we might have more urinary incontinence as well. The last thing you want when you well, any woman, but certainly if you’ve got motor neurone disease as well, if your mobility is… you do’t want to be dribbling urine, you don’t want to be coughing, sneezing… I mean there’s so much as well with any urinary symptoms that are so easy to be treated as well with hormones. [00:16:29][74.8]

Nicola McFarlane: [00:16:30] Yeah, absolutely. And you know, as I say to my friends, the two things that I’m passionate about is sort of advocacy for MND, but also anything to do with menopause. And, you know, I’ll admit when I was in my sort of late 20s, early 30s, I was very ambitious, very dynamic in my career. And I would look at these older women and think, you know, what’s going on and pull yourself together. And I didn’t even know until I was sort of mid-forties that there was such a thing as perimenopause. And I certainly didn’t know about the impact that it could have on me. And I just strongly feel women should be talking more about it. We’re 51% of the population. It should be an open discussion at work and there should be actually support and understanding, because I would say it’s turned, I mean, obviously the MND’s turned my life upside down. But I look back at the time and the opportunities I lost because I was struggling so much with my mood, with anxiety, with motivation, and you just feel like you’re going mad a lot of the time. [00:17:44][74.0]

Dr Louise Newson: [00:17:45] It’s very difficult. And I also very strongly feel that every doctor from every speciality should know about perimenopause, menopause. And be confident in prescribing hormones as well. I did a really amazing neurology job in 1995, a long time ago, and then when I was part of becoming a member of the Royal College of Physicians, I did a neurology course and we spent hours, literally hours trying to make these amazing diagnoses. So, as you say, that fasciculaton with muscle twitches, spending a long time looking at people’s arms and their legs, getting almost excited when see it because you know the diagnosis. But I was never thinking about was hormones or even what that person’s feeling. Because so much in medicine is about making the diagnosis, then getting the treatment without thinking, well, what does that diagnosis mean to that patient? How are they going to change, like for you going from horse riding to painting and drawing? But also, there were so many women in my neurology job, I saw a lot of women who came in for steroid treatment because they had multiple sclerosis. Never once did I ask them about their periods. Never once did I think, Do they have any other symptoms? And any anxiety was because they’ve got a diagnosis of MS. That was what I was told. So often they were given antidepressants because, of course, they’re going to be anxious because they’ve got MS, same with motor neurone disease, you know it’s a life-limiting condition. So oh these poor people are going to be anxious. Yes. Okay. But they don’t all need to be given antidepressants. We should be thinking, are there any other reasons why they could be anxious? What else is going on? What about their hormones? And I feel the same with men, actually. How many men with motor neurone disease are also low in testosterone? But we don’t know. And I’ve never once met yet a neurologist who prescribes hormone replacement therapy or testosterone. And I don’t quite understand why. Because they’re a lot safer than steroids or the biologic agents. [00:19:44][118.8]

Nicola McFarlane: [00:19:44] Yeah. And I actually, I was talking to a neurologist about the journey I’d had and trying to get on HRT and I said, it’s my understanding that our hormones are really important for brain health. And this neurologist said they’re one of the most important things. And I thought, well, if that’s the case, why is there no joined up approach for my health? And, you know, like you say, people say to me, well, of course you’re anxious. Of course you have low mood, you have MND. But I had it long before and it was worse. And the analogy I use is it’s like grief. Grief is very painful, it’s very overwhelming. It can be very confusing and is very difficult. But you are not in it all the time. It comes in waves. And I would say life with this diagnosis is the same. But way before I had MND I was stuck in just this anxious state from the moment I woke up until I went for a run at lunchtime was the only thing that eased it. And it just leads to burnout. And the more I learned, the more I learned that oestrogen can control your cortisol levels, that the way I felt in my life the week before my period, I would be so depressed and then I’d get my period and I would feel better. And as I got older, it just got worse to the point where I just felt like that all the time. [00:21:17][92.9]

Dr Louise Newson: [00:21:19] And it’s so scary. I spoke to somebody two days ago in my clinic who has had very, very dark thoughts and it was horrible to do the consultation, mainly because it was online and I couldn’t even give her a box of tissues when she was crying, but she’d become so scared of her thoughts and she absolutely didn’t want to continue as she was. But she didn’t want to harm herself. But it was horrendous and she couldn’t see any other reason why she was like this. But her periods were still regular, so she was told it couldn’t be her hormones. But of course, her hormones can still change and have this impact on her brain. And it’s horrible because when you’re told different things, you don’t know where else to go, and then you can almost convince yourself that there’s something else going on or that it’s your personality or you can’t cope with, with life which isn’t right. You’re clearly one of the strongest people I think I’ve met. Like psychologically. Well, you are, but, but you wouldn’t have thought that, I didn’t meet you when you were full of anxiety, but you wouldn’t have been that same person, would you, at all? [00:22:27][68.0]

Nicola McFarlane: [00:22:28] No. I felt like a complete failure and I felt like I was going mad and I felt like I should be enjoying my life. People say life begins at 40, and I just felt very isolated. And yeah, I didn’t know where to turn, to be honest. And it was my friend Emily who we just got talking one day and she told me about what she’d been going through. And she told me about your clinic and how it changed her life. And that’s when my journey with it started. And she sent me loads, your podcasts and other podcasts, and I just knew that the way I was feeling was not all down to the MND and especially I’m on testosterone, I have way less anxiety. If I find myself starting to spiral, I can address it. I can go actually, live in the moment. Don’t think too far ahead. I can rationalise it. I can cope. I couldn’t cope before. It was mass overwhelm. [00:23:36][67.7]

Dr Louise Newson: [00:23:37] And I hear that so much and I’ve experienced it myself. This ‘overwhelmingness’. Not that that’s probably really a word, but it’s very hard to rationalise and most of us are busy. I’m very busy. But here and now I’m talking to you so it doesn’t matter what I’m cooking for supper or if I’m going to be late for the next meeting or whatever. It doesn’t matter because I’m here. And somehow hormones give you this ability to rationalise and also compartmentalise so that you can deal with one thing at a time without catastrophising about the future. And that is something that I hear a lot in women, that they just have this constant worry and this constant sort of chatter really in their brain. This noise. That then makes it very difficult to do things that perhaps would have been so easy in the past. And especially when you think about work or, you know, running a home or looking after various relatives, Of course things are going to be so much more difficult and then it will affect your mental health more because you think you’re not coping as well as you did before. [00:24:39][61.4]

Nicola McFarlane: [00:24:39] Yeah, exactly. And I think, like you said before, is about perception. And people just go, you’ve got MND and your life must be terrible. You know, the thing that people say to me the most is I wouldn’t get out of bed if I was you. And I say I could be here another ten years. And in that time, there might be some treatment. It would be a very long time to lie in bed. But, you know, I want quality of life. I want to have the tools I need to help me cope as well as I can. Because when you’re dead, you’re dead forever. If this is the last five or ten years of my life, I would like to try and enjoy it. But the way that I was before, before the HRT, I just couldn’t. I mean, I remember my boyfriend saying to me a few years ago, Do you want to go for a coffee? And I thought I was going have a panic attack. And the thought, No, I travelled to Thailand on my own in my 20s. I lived in the Greek islands. You know, I went with a Lonely Planet and a couple of hundred pound. I turned into this person that was terrified at that the thought of going for a coffee, you know, and all my female friends, the women I talk to at work, the friends I’ve made through MND, they’ve had similar problems and they think, where have I gone, where’s my identity? Who am I now? [00:26:06][86.6]

Dr Louise Newson: [00:26:07] Yeah. And that is so common this whole who is I become. And I remember years ago when I started my clinic, somebody said to me, I don’t like who I’ve become. And I thought, oh I wonder what she’s meaning but I totally get it. That whole joyless, zest for life is gone. You know, you’ve turned into someone that you never wanted to be, but you can’t go back. You can’t control it. And again, it just shows this power of hormones in our brain. And as you said at the beginning, motor neurone disease affects the peripheral nervous system. It affects the nerves that control the muscles, but it doesn’t affect the central nervous system. So it shouldn’t affect your personality or memory or anything else at all. So again, it’s another reason, I think, to be thinking what else is going on? If someone with motor neurone disease has some mental health issues and psychological issues, then it’s unlikely to be due to the MND, isn’t it? [00:27:04][56.6]

Nicola McFarlane: [00:27:05] Well, yeah. And I think my anxiety was so bad that when I was diagnosed I said, could the MMD have caused this, the anxiety? And they said no. And like I say, I kind of shelved my sort of quest to get HRT because I couldn’t get IT through my GP. They wouldn’t prescribe it. So, you know, it did take me a long time, but I absolutely wouldn’t be without it now. And I’m so vocal, especially MND, it does absolutely affect young people and young women, but there’s loads of women with it that are in middle age. So yeah, I always try and speak about it. Any chance I get to make sure that they’re getting what they need and deserve. Nobody should be written off because they have a horrible prognosis. [00:27:52][47.2]

Dr Louise Newson: [00:27:53] Totally agree. And actually, I have spoken to people with motor neurone disease who are younger, still having periods, but some of their symptoms get worse before their periods, so their muscle strength gets worse. They might get urinary tract infections. And they’ve been told, that’s just the way MND is. Or the same with MS, oh it’s just the way it can change. But if you take that history really carefully and you find that it’s just before periods, that’s when hormone levels are at their lowest. And so often people with PMS or PMDD, we can give a low dose of hormones and top up just before their periods and then any other symptoms related to another condition I can then deal, multiple sclerosis can actually really improve. And also we know that no one’s too young to be menopausal. No one’s too young to have low testosterone. So I think anybody with a progressive neurological disorder, we should really be on hyper alert for hormones because we’ve known for decades that our hormones are neuro steroids they’re produced in our brain. They reduce inflammation. They improve the way our nerve cells all work. And they also, if we have them they’ll delay any degenerative diseases as well. So the sooner people are on them the better and they’re so safe. You know I spoke to a lady the other day and I said, look, if it doesn’t help, you don’t have to continue with the hormones. But we can try it and see because it’s so hard to get a proper blood test because what is in your bloodstream is not the same as what’s in your brain. And your need for testosterone is going to be different from my need. And if your brain is working in a different way because of your motor neurone disease, who knows? No one’s done research. Maybe you need a higher dose or a different dose. We just don’t know. But because we don’t know, it doesn’t mean we can’t try something and see if it helps. And that’s what sometimes happens in medicine. People say, we don’t have the evidence, therefore we can’t do it. We don’t have evidence in lots of things we do, but we can still try and see if it does make a difference. [00:29:54][120.5]

Nicola McFarlane: [00:29:54] Well, exactly. And it’s safe. And I just think there’s so much misinformation out there. And a lot of women, I know they’re too scared to try it. And you think it is such a shame that women for years have been told that this can cause cancer and other mistruths, really. What I struggle with is if neurologists know the importance of hormones on the brain and the neurological system, then why isn’t there this joined up approach? Why aren’t these conversations happening with women and like you say men that might have lower testosterone? [00:30:30][36.0]

Dr Louise Newson: [00:30:32] And I wish I could answer. I really do. And one day, hopefully, things will change. But I’m so grateful for your time today and your honesty, because I know it’s going to help so many people just listening to this podcast. I really do. And hopefully people who are listening who know people with MND and or have MND, hopefully it will allow them to think differently maybe as well about hormones. So before we finish, I am going to ask for three take home tips, but three tips for people who have any neurological condition. What three things do you think you should be doing to help thinking about hormones and your future health? [00:31:11][39.7]

Nicola McFarlane: [00:31:12] So in terms of like taking hormones? [00:31:14][1.9]

Dr Louise Newson: [00:31:15] Just making a diagnosis yourself, if you’re not being listened to. [00:31:18][3.0]

Nicola McFarlane: [00:31:19] I would say don’t give up. Trust yourself. You know your body and your brain better than anyone. Don’t allow yourself to be gaslit. Don’t allow any doctor to put a label on you like they did me with my mood disorder. So believe in yourself. Trust yourself. And maybe most importantly, have hope. Just because you’re going through a hard time now and your mental health maybe isn’t good and you feel hopeless, you will come through this. But don’t give up. And if it means changing doctor, just keep on going. [00:31:56][36.9]

Dr Louise Newson: [00:31:57] Yeah. I think that’s so important. And talking to others, knowing that there are solutions and ways that you can feel better and also just improve how you’re feeling. Because like you say, every day is important. We can’t be investing for what we’re doing in the future without thinking about the present. [00:32:14][17.6]

Nicola McFarlane: [00:32:15] Tomorrow isn’t guaranteed for anyone, and it is so important just to live each day, one day at a time. The future, who knows what it will bring. But again it’s very difficult when you’re suffering anxiety because you have every worry in the world. But just know that help is out there. And there’s… I’ve met so many amazing women through work and my community just by starting those conversations and mentioning menopause, which leaves me vulnerable. And it is a risk. But the conversations and the connections I’ve had, and we help each other. [00:32:50][34.9]

Dr Louise Newson: [00:32:51] Fantastic. So thank you so much for your time. Great. [00:32:53][2.5]

Nicola McFarlane: [00:32:54] Thank you. No, thank you. Really appreciate it. Thanks, Louise. [00:32:57][2.9]

Dr Louise Newson: [00:33:02] 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. [00:33:02][0.0]

ENDS