Spreading the word about menopause care in the US, and beyond

This week Dr Louise is joined by Aoife O’Sullivan, a family medicine doctor who trained in Dublin before completing a second family medicine residency at the University of Maryland.

After taking some time out to complete extra training in perimenopausal and menopausal care, including Newson Health’s Confidence in the Menopause course, Dr Aoife is passionate about providing more comprehensive and holistic care to women during midlife.

Dr Aoife share the ways clinicians, and all people, can educate themselves in order to improve the health of women in the US, and across the world:

1. Take every opportunity to learn and educate. So join any local healthcare Facebook groups and pass on links to the Confidence in the Menopause website, the balance app, etc. Even if you reach one or two people like that, it will make a difference and they might reach another one or two people.
2. Share small bites of information because it can be a little overwhelming. So when you’re trying to reach somebody, give them small amounts of information at a time.
3. Harness the power of friends. If everyone informs their friends and they all go to their doctors, obstetricians, gynaecologists and urologists, and ask questions, it will fuel discussion and increase knowledge.

You can follow Dr Aoife on Instagram @portlandmenopausedoc

Find out more about the Confidence in the Menopause course and click here for more about Newson Health.

Transcript

Dr Louise: [00:00:11] Hello, I’m Doctor 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’ve got another American guest although she’s not American, she lives in America, she’s Irish and another healthcare professional, another doctor who reached out to me a while ago and just shared some really inspirational words and offered to come on the podcast so we can have a talk about education, about how much we learned when we were younger about the menopause and how much we wish we’d learned and what we’re doing about it really. So Aoife has kindly agreed to come onto the podcast today. So thanks Aoife for joining me. [00:01:34][83.4]

Dr Aoife: [00:01:34] Thanks so much for having me. [00:01:36][1.2]

Dr Louise: [00:01:36] So everyone can hear this in those words that you don’t have an American accent, do you? [00:01:40][3.5]

Dr Aoife: [00:01:42] When I go home to Ireland, people tell me I have an American accent. Yeah. [00:01:45][3.0]

Dr Louise: [00:01:45] Oh really? So you are from Ireland, but where did you do your medical training then Aoife? [00:01:50][5.6]

Dr Aoife: [00:01:51] I did it in Dublin in the Royal College of Surgeons. And then that was back when you could do your own GP scheme after med school. And so I did three years of my own GP scheme and then we moved over here to America, Baltimore, Maryland, first of all. And back then they didn’t accept any schemes done outside America. So my husband and I both had to go back and do residency all over again. [00:02:18][27.1]

Dr Louise: [00:02:18] Gosh. [00:02:18][0.0]

Dr Aoife: [00:02:19] Yes. So I did a second GP scheme there and then have been working since then. [00:02:24][5.8]

Dr Louise: [00:02:25] And whereabouts are you based now? [00:02:26][1.1]

Dr Aoife: [00:02:27] About eight years ago we moved over to the West Coast, to Portland in Oregon. [00:02:31][3.7]

Dr Louise: [00:02:32] Nice. So and you work as a family physician, a GP. [00:02:35][2.7]

Dr Aoife: [00:02:35] Yeah I do, I’m in a clinic with five other working mums and we have our own little clinic just doing our GP thing. [00:02:43][8.1]

Dr Louise: [00:02:44] Great. So I mean healthcare is quite different in America to the UK of course. And every country has its own advantages and disadvantages, doesn’t it? [00:02:52][8.5]

Dr Aoife: [00:02:53] It really does, yeah. The healthcare system is different over here. It’s all insurance based. And so you know there is talk about moving to a healthcare for all system. You know something like the NHS. But there’s always pushback about that as well. There are pros and cons to the government controlling healthcare too. [00:03:13][19.9]

Dr Louise: [00:03:14] Course there is. And you know, actually it’s just five years since we opened our clinic over here, which is a private clinic, which actually causes a lot of aggro, which you picked up quite rightly on, on social media, because there’s something, it’s really, really weird, actually, when I set my clinic up, as I’m sure you know, I wanted to work in the NHS and continue working in the NHS. And then I couldn’t find a job, I couldn’t find a clinic where I could work. And so I started off just one day a week working in a local private hospital. And then we set up a dedicated private menopause clinic. And the amount of flak I get because it’s a private clinic. And actually it’s interesting because if I was still working in the NHS and doing part time NHS, part time private, I think it would be fine. And also if I was an orthopaedic surgeon, earning a lot more than I do doing a lot of private work, it would be fine as well. Or, you know, another specialty. It’s really interesting and I think it’s because it’s probably well it is that I know of the first GP-led menopause clinic that’s private and it’s large. But as many people know, we give a lot of our profit back to education, to balance app, to everything else because we don’t have external funding for any of this. But it doesn’t seem right if people still don’t want to see that it’s a good thing that I’m trying to help as many people as possible with very limited resources. I think it’s harder when you do have this two system, because then it feels like a two-tier system. And I know a lot of people, especially even doctors that come and work with us, are really surprised that actually what we are doing is seeing women from all socioeconomic backgrounds who actually just want choice about their future health. And a lot of people, we see, are very grateful just because they’ve had time. They’ve had someone to listen to, someone who actually understands. But you shouldn’t have to pay for that, really. But it’s difficult, isn’t it? [00:05:07][113.8]

Dr Aoife: [00:05:08] Oh, yes. And it’s absolutely to do with women’s healthcare, because historically, you know, once we’re done having babies, you know, we’re not they’re not very important anymore. Yeah. I came across a meme a while ago, and it was an old lady cleaning out a big bookshelf, and she came across a massive big novel and it said how to incorporate the arms into Irish dance. Because I don’t know if you’ve seen Irish dance, but you keep your arms straight down by your side. And that really made me think about my medical career. I feel like I have been missing this massive volume of information for my whole career. I started med school almost 30 years ago, and I feel like I’ve been working from one volume when it was actually a two-part series and, you know, when I came across you and doctor Heather Hirsch and some other doctors over here who are really kind of fighting the good fight as well. Kelly Casperson, Rachel Ruben and Mary Claire Haver. I mean, this whole other world opened up for me. I just, I thought back over all the women I’ve seen over my career and how I just did not see it was like they were speaking another language and I didn’t know that language. You know and now when I, when I see a patient and I look at their problem list, I’m like, oh, you know, probably six of those things are all to do with lack of oestrogen. It’s really been eye opening and for me life changing. [00:06:44][96.1]

Dr Louise: [00:06:45] It’s quite something actually and I was talking to a big event today and it was for firefighters actually, and for people all across the country that work with the fire service. And when I talk and present and talk about the symptoms, talk about the health risks, talk about the injustice to women not being allowed an evidence-based treatment. There’s a lot of anger actually in the room as well. And I feel quite angry. And I feel like I’ve not been privy, like you say to this information that would have been, made such a difference to patients in the past, and you only know what you’re taught. And so I never knew what the symptoms of oestrogen and testosterone deficiency were. All I was taught about were flushes and sweats and vaginal dryness. And so the number of women I’ve literally sat there and thought, well, they’re not depressed, I’ve done their thyroid function tests, I’ve done their blood count. They’ve been back and forth with palpitations. They’ve been back and forth with urinary tract infections to the hospital. They’ve, you know, it’s awful. And then I remember one of my patients, well, she probably would be about 80 now, but I saw her when she was between 60 and 70 years old, and she was on diazepam, and she was one of the few patients we still had on a sort of almost a repeat prescribing of diazepam. And we were trying to get her off it. And every time we reduced, it was awful for her and she’d have some difficult times. She’d gone through a divorce and various things, and she was having trouble with one of her sons, but never once did I think or say to her, what was your menopause like? What were you like before your periods stopped? It was like she was just that this almost, and I ended up seeing her because everyone was getting annoyed because they said, you’ve got to stop her diazepam. And I said, But I’ve tried and there isn’t any. And she was aware that it was addictive. She’d tried other medications, and so we did carry on in a very low dose of her diazepam. But I just think back, oh my, why didn’t I think, why didn’t I think? And I feel cheated and robbed from that like you say that volume two. But now it’s out there. And as you know, it’s very, very rewarding, transformational medicine. There’s very little in medicine where I can see someone and think, do you know what? I can make you feel even a little bit better. And I know I can improve your future health in a way that no other medicine I can think of that does. We sort of always been told off for it, and sort of every time I go to meetings, I feel like I’m a nuisance because people are now asking for HRT and they’re being prescribed it, and people just say, oh, all she does is prescribe HRT. Well of course I don’t. All I do is listen to women and decide what the right treatment option for them is. And I go by the guidelines that are very clear that it produces more benefits than risks, but it still seems, I don’t know, it’s weird, isn’t it? [00:09:29][164.2]

Dr Aoife: [00:09:29] It is rage inducing. I mean, just I feel so much guilt and horror when I think back over the women that I’ve seen. And I completely missed the diagnosis because I just did not know it existed. You know, all those years in medical school, two residencies and honest to God, I don’t remember one bit of training apart from, like you say, some hot flashes equals menopause. And, you know, even though I didn’t put the pieces together, you know how we say we think our phones listen to us? I honestly think my phone put things together for me because I, you know, went through a period where I was just so exhausted, my hair was falling out, I had no energy. I was worrying about everything. And I went to my GP and I said, what is wrong with me? And she said, you know, I think you’re depressed. And I said, but I treat women with depression every day. I don’t think I’m depressed. I don’t feel sad. Everything in my life is going great, thankfully. I just don’t seem to be able to actually enjoy it. And, you know, I walked out of there with a prescription for Wellbutrin, just like most women do. And it was after that that things started popping up on my Instagram. So your page started popping up, Heather Hirsch’s page started popping up, and that was when I started to see videos. And that was for me, a doctor with nearly 30 years of training behind me, that was how I learned everything I know about menopause. It all started with that. With your little video clips and some other doctors, and it went from there. And I ended up, I finished a previous job and decided I was going to take some time off between that and my next job and just study everything I could about menopause. And so I did your Confidence in the Menopause course, which was incredible. And then Heather Hirsch over here has a course as well for clinicians. And then the International Menopause Society has a free course that clinicians can do, call the IMPART course. And then I have the NAMs exam coming up next month, the North American Menopause Society. So I just I crammed it all into six months and tried to learn everything I could. And I’m now using all of that at work and also trying to, you know, talk to other doctors about it as well and spread the word a little bit because, you know, a year ago, if you’d said to me something about HRT, the first thing that would have come to mind would be, oh, no, isn’t that dangerous? Like, I don’t know anything about that, but I heard some connection between it and breast cancer. And so that is still invariably when it comes up as a topic, when I’m talking to another doctor, it’s invariably what they believe still too. [00:12:15][166.0]

Dr Louise: [00:12:17] It’s really hard to change people’s perceptions, really difficult. And, you know, nothing we do in medicine is without risk actually. Even avoiding medicine is not without risk. And there’s a lot of pushback in the work I do say, well, what about the harm or perceived harm? And what about the breast cancer risk or womb cancer risk? Well women will develop breast cancer who take HRT, they will develop womb cancer when taking HRT. They will have car crashes. They will, you know, forget to clean their teeth. They will have other issues. But that doesn’t mean the HRT has caused it. And I think this is where it’s really difficult.

Of course, we’ve got a handful of women over seven years who have developed breast cancer, while they’ve been taking HRT, and many of those have chosen to carry on because of the improvements in their health, health improvements. But we can’t prove that it’s been caused. And then we have to think about patient choice as well. But I do think you’re absolutely right. The more you read about the benefits of HRT, the more I think we need to turn things on our head a bit and say, well, what are the risks of not taking HRT as opposed to what are the very, very small risks? You know, a colleague phoned me today and she’s had an abnormal mammogram. And the first thing that the doctor said was, oh, you’ve been on HRT for six years. That’s a real worry because it increases risk. And I said, but actually the type of HRT you’re on hasn’t been shown to increase risk. The study he’s quoting isn’t associated. It’s not relevant for your type of HRT. And she needs more tests, they don’t know what’s going on, but it’s just that knee jerk reaction that they’re, let’s blame the HRT prescriber. And this colleague I know drinks quite a lot of alcohol. She doesn’t quite exercise as much as she should do. Her mother had breast cancer. There’s all sorts of things that might happen that could increase her risk of breast cancer. But then the women are made to feel really guilty. And I think that’s a real problem as well, isn’t it? Because, you know, we’ve all seen people who have had lung cancer who smoked. The last thing I’m going to do is say to person well, if you hadn’t smoked, you wouldn’t have got that lung cancer, because I’ve always also seen a lot of people with lung cancer who have never smoked. So even though we know the cause and effect very different than with HRT and breast cancer, cause and effect with lung cancer and smoking is established. But not every lung cancer is caused by smoking. But actually with HRT there isn’t a proven, with the body identical hormones, associated risk. But it still sort of goes on and it’s this undercurrent, isn’t it? That’s happening. I mean, what’s it like in America? Because American doctors tend to be very risk averse, don’t they? [00:15:46][208.8]

Dr Aoife: [00:15:47] It’s exactly the same, if not worse. And so I really feel like you almost have to change people’s minds one by one. You know, like I make phone calls to if I have a minute. I’ll try and catch someone’s specialist who has said to them, oh no, don’t do that because HRT is dangerous and just even try and chat to them. And you know, I remember what I was like as well. If someone had called me and said, well, hey, you know, did you realise that you know, that information is 20 years old? It wasn’t accurate. We have newer information. It’s better and it’s more accurate. I would have been like, oh, OK, I’ll have a look at that. Thanks very much. You know, I have two separate friends over here. So one of them went to their doctor to talk about HRT and was told, no, that’s dangerous. And, you know, were sent away. And the other one went to their gynaecologist and said, you know, can I talk about HRT? And her doctor said, you know what, I really don’t know much about that. And she had come prepared. You know, she had stuff from the balance website and some other articles and gave it to her doctor, and her doctor was really receptive to it and took it home and went through it all and educated herself. And she went back to her and she left with her HRT, you know. So it’s almost like just doing it person by person to try it. But that’s a very slow process. [00:17:13][85.6]

Dr Louise: [00:17:14] Yes, totally and that’s sort of what I’ve done over here. And it’s interesting. So when I opened my clinic obviously five years ago and then it got very busy and I said to one of the directors, Marcus, we’re not doing enough. He said, well, we are Louise and in business you focus on one thing and you get it right. And I said, no, but I can’t bear all the suffering. I can’t bear what’s going on. And I decided to develop balance, obviously, the website, the app and all the information on the website, of course, as well. And then I said to him, well I want to do this education program and I want to do it remotely so anyone can access it. And he said, and he’s a businessman, he’s not a doctor or a clinician. And he said, but the problem is Louise, if you educate all the women and you educate all the healthcare practitioners, you won’t have a clinic. And I said, wouldn’t that be wonderful? Actually, because I can’t bear the stories. And actually what I hopefully will we be meeting then are the more complicated patients who really need my knowledge and experience and so I can really advise them. So women have had breast cancer or have had complicated medical history. But it’s still not happening. And I think what’s happening certainly over here in the UK, but I can see in some other countries is that women are educating themselves at a speed that’s quicker, but also women are helping other women. You know, at this conference today, there were men as well as women from the fire brigade, but they’re all just the volume, as you can imagine over lunch was huge with women just being it’s like they’ve been allowed to talk. Once I can start to talk about vaginal dryness and libido, but also the anxiety, the low mood, the memory problems they know they’re not alone because they’re looking around the room and going, yeah, that’s me, that’s me, that’s me. But actually what we can do as healthcare practitioners is actually say, but there is a treatment. So I think before they’ve been talking themselves around in circles and say, well, how long do your symptoms last for? How long do yours? Oh my goodness, that sounds awful. Well, hopefully mine will go. Well how much more do I have to endure? Whereas actually today it was a real change to other conferences I’ve spoken at because the women were like, it’s quite outrageous for them because they’re hearing about this evidence-based treatment. And then they say, but why haven’t I been offered it? Why wasn’t I given it? Why am I given antidepressants or and so they’re the ones like you say who I know will go and educate the healthcare practitioners, which is great, but then it has a spinoff effect that the healthcare practitioners just think I’m sort of forcing people to take HRT. And of course I’m not. I’m allowing people the choice to be exposed to that information. And it is that thing like you say, once you see it, you can’t unsee it almost. And even today I was doing a book signing and women were coming up, and even before they open their mouth, I could just look at them and think, oh, this poor lady needs HRT, this poor lady. And you know the stories that they tell me. I saw one lady who was very overweight and she’d waited two years to see a gynaecologist in the menopause clinic, and she’d been given a 25 microgram patch, which is a very small dose. She looked quite young. She looked in her 40s, and she said, I’ve been told I can only have this for a short period of time, and if I don’t lose weight, they’re going to stop it. [00:20:21][187.3]

Dr Aoife: [00:20:21] Oh my gosh. [00:20:22][0.4]

Dr Louise: [00:20:22] She’d waited two years for that advice. And I said, does anyone talk to you about different doses or about testosterone? No, that’s all I can have because of my weight. And I said, well, and she knows like I do and you do that, there is no clot risk with through the skin oestrogen. And some people absorb it differently. Some people do need higher doses. 25 micrograms is a quarter of the license dose. It’s a very, very small dose for someone who looked quite young. And I thought, what a shame. Not only has she waited two years, but it’s been affecting her job as well. And there was another lady talking on the stage today who was in her 50s but she had taken an early retirement. And she now knows the symptoms. She knows what’s going on, she knows she’s menopausal. And she actually said, if I knew then what I know now, I wouldn’t have taken early retirement. And I feel like I’ve wasted these three years. Been always sort of fobbed off with, you know, different diagnoses and everything else. And now it’s happened I don’t want other people to make the wrong decisions about their job. It’s very brave of her to talk so openly and candidly, but we shouldn’t be listening to stories like this. [00:21:31][68.7]

Dr Aoife: [00:21:31] You know, I wonder how many women, if we knew the truth, had taken their own lives, had lost their marriages, had left their jobs because of menopause? I would just say the number is extraordinary. And honestly, I know this is like flogging a dead horse, but we would not be having this conversation if this was about men. [00:21:53][21.1]

Dr Louise: [00:21:53] No. You know, absolutely wouldn’t. And it is really sad that we’re even having to have conversations about the menopause in this way. And there was another lady actually today talking on the stage. She was only 32. She had very severe endometriosis that she had for many years, took a long time to be diagnosed and it was quite severe. So she ended up having a hysterectomy and her ovaries removed to try and reduce her symptoms of her endometriosis. She had to wait so long for surgery they’d stopped her hormones working medically with an injection. So she went into a medical menopause, which was horrible. But she said oh, at least it prepared me for what I was going to have to happen to me. And then she had a hysterectomy. She said she had to battle to get some oestrogen, but it took so long to get that she didn’t dare ask about testosterone. And she said, all my friends, a lot of my friends have, are have been pregnancies, they’ve got young children, she’s got two young children. I’ve had to get my head around the thought of never being able to have children again, which is one thing. But I will say, who do I talk to about my vaginal dryness? She said I adore my husband but my libido is gone. Our sexual relationship is really difficult. And she said, and now I’m thinking about all these symptoms that I will have to endure, that I will have now I’m menopausal. And Rebecca Lewis was there with me because she was talking, and we both looked at each other and I knew we were both thinking, but she doesn’t have to endure those symptoms. She doesn’t have to think like that. Because if you get the right dose and type of HRT, you should have minimal or no symptoms and you should just have a healthy life as much as you can. The same way, if someone had an underactive thyroid gland, they shouldn’t have symptoms of their thyroid deficiency, should they? [00:23:36][102.7]

Dr Aoife: [00:23:36] It’s exactly the same. Yeah, I just think of it like that now. That’s what it means to me. I would never check a TSH on a woman and see it’s sky high and do nothing. You know, I mean, that’s malpractice, honestly, or negligence or just unethical and immoral as well to do that to somebody. [00:23:59][22.6]

Dr Louise: [00:24:00] Yes, yes. And that is a problem. I mean Philip Sarrel over in the USA has been looking at the costs, economic costs actually, of women not being given HRT, especially young women who’ve had an early menopause because of surgery. And still it’s still a small number proportion of women who, once they have both their ovaries removed and have a hysterectomy, are given HRT, which is just dreadful actually. You wouldn’t remove anyone else’s organs that was producing hormones and not allow them to have those hormones back. And some of his work goes back as far away as the 80s and 90s, and it still hasn’t moved forward. So how do you think we can change, like in America? What do you think is going to make the biggest difference to improve health of women so that they can have HRT. [00:24:46][46.2]

Dr Aoife: [00:24:47] Women. I think, like you say, I don’t know if there’s ever been an instance like this in medicine before where our patients know more than we do and come in armed with information and knowing the correct way to manage a disease or a condition and their doctor doesn’t. Like, I can’t think of any other instance, apart from rare conditions where a patient will do a deep dive because they or their loved one has something and you know it’s not well known. [00:25:16][29.1]

Dr Louise: [00:25:17] I think one of the other areas of medicine I was thinking about recently was HIV medicine, actually, which is something that we had to learn very, very quickly because HIV came really quite quickly in the 80s with quite a high mortality and morbidity, which thankfully it doesn’t now. So lots of new drugs were coming on the scene, lots of potential side effects weren’t there as well and interactions with other drugs. Quite complicated medicine to learn in a short period of time. And a lot of people living with HIV got to know a lot very quickly. And they really and I’m sure you have I’ve seen people HIV who literally would tell you the drugs and I couldn’t pronounce some of them. They would know exactly, they’d know what they’d interact with, really empowering stuff, actually. And that was in the sort of 80s, 90s when people didn’t really have the internet, they didn’t have this sort of rich appetite for knowledge, as patients do now. And certainly I don’t know if you know our Confidence in the Nenopause course that we’ve just relaunched, we’re making it available to anybody. So it doesn’t matter whether they’re healthcare professional or not, they can have access to exactly the same information and training about the menopause, which I think is going to be really important. I know some healthcare professionals might not like it, but I feel very strongly as a menopausal women who has been a patient and still is a patient for my menopause specialist and also as a doctor, why should I know different information just because I’ve got a different job? It’s really important, and I think the way a lot of medicine should be going really, don’t you? [00:26:42][85.6]

Dr Aoife: [00:26:44] Yes, absolutely. We just need our clinicians to catch up. And, you know, I can see why it’s difficult. I mean, there’s no time. You know, you see your patients all day, you go home, make dinner for your kids, get back on the computer to finish your notes. It’s just constant and nonstop. There’s no time to stop and study something that you’ve never been taught about and know nothing about. [00:27:09][25.3]

Dr Louise: [00:27:09] Absolutely. And then I think there are misconceptions. So, you know, I’ve been to meetings and people say, well Louise, it’s just a lifestyle drug. People take it because they want nice skin and hair. And it’s really frustrating because of course they don’t. And then some people will say, well, Louise, you know, people are coming to the doctors who had never come before, and they’re now demanding a treatment that they think is going to improve their symptoms. And we should be considering other treatments as well. But then I also think, and I know actually from science that women who take HRT have less risk of disease. They have less symptoms. So actually these women are less likely to go to their doctor. So even if you invest a bit of time and money and effort now, it’s going to reap dividends going forwards, isn’t it when we look at future health economics too? [00:27:58][48.6]

Dr Aoife: [00:27:59] Absolutely. And you know, sometimes when I think about this whole situation, it’s really hard to feel that you are not wearing a tinfoil hat. I mean, it just feels like there are so many obstacles in your way and so many fights, you know, why do you need five years of information on testosterone to get something passed for women and six months for men? You know, it’s just it’s very hard to feel like you’re not imagining some conspiracy. [00:28:27][28.2]

Dr Louise: [00:28:30] Well, someone a while ago, a professor who I know quite well, who’s nearly retired, amazing person, said to me about 5 or 6 years ago, actually, when I opened my clinic, oh no it was seven years ago, I opened my, my website, which I used to call Menopause Doctor, and someone had phoned me up and told me to take it down because they had a menopause website. And I was like, what’s going on? We can have loads of websites can’t we on different conditions? And he said to me, Louise, I think there’s a conspiracy theory. I don’t know why, but I think there is. And I was like, really? But surely as a doctor you just want to help people. And I realised more and more there is and I can’t quite understand why it’s happening, but it does. But I think you’re right. Well, I know you’re right, because women know and actually, the truth always wins, doesn’t it? And I think all we can do is sort of work together. And actually with the work I’m doing, I’ve met some really vile people, but I’ve also met some incredible people. And, you know, they’re the people that will carry on with the messaging and carry on understanding the science, understanding the good of the work that’s being done. And so it is this sort of groundswell of people, which is on a positive day, it’s really exciting to watch actually, I think. [00:29:41][71.2]

Dr Aoife: [00:29:42] It is. It really is, yeah. I suppose I surround myself with that now. So I get that feeling a lot. Where, well, we’re getting somewhere. Something’s happening. The ball is moving. So yeah, it’s nice to be surrounded by that. [00:29:56][13.9]

Dr Louise: [00:29:56] Yeah, yeah. Good. Well, we’ve got a long way to go. But before we end, I’m very grateful for your time obviously, but I’m really keen for three take-home tips really. So three things that you think in America would make the biggest difference over the next five years to improve the health of women. [00:30:13][16.5]

Dr Aoife: [00:30:14] So you know my main thing is how do we educate clinicians? So my top three tips would be you know take every opportunity, every time something comes up with a colleague or you know for me I’m part of a couple of Facebook groups over here. One of them is here in Oregon called Oregon Physician Women’s Group. And occasionally it’ll come up, someone will ask a question about HRT, and I jump straight on it and, you know, give links to the Confidence in the Menopause website, the balance app and things. So just trying to reach even if you reach 1 or 2 people like that, it will make a difference and they might reach 1 or 2 people. And then the second tip is to share, I think, small bites of information because it can be a little overwhelming. And I remember even starting your course, listening to the first few videos, and I was like, I couldn’t even figure out the names of the oestrogen and progesterone and Utrogestan. And like, you have to go kind of slowly. So just when you’re trying to reach somebody to give them small amounts of information, give them a link to the Confidence in the Menopause course or the balance website, something small that they can go to and not feel overwhelmed. And then the third thing for me is what I’m trying to do is harnessing the power of my friends. I have some great groups of friends, big group of Irish women over here, and you know, each of them tells a bunch of their friends, we’re all in different friend groups, and they’re all going to their doctors and their obstetricians and gynaecologists and their urologists, and they’re all asking questions. They may not necessarily want to leave with a prescription of HRT, but they want to know what their doctor knows and they want to have discussions about it. And so they’re my top three tips to how we can get there eventually. [00:32:09][114.5]

Dr Louise: [00:32:09] Perfect. And I think that’s the same in all countries actually. Everything that you said should happen in every country. And some countries are doing it quicker than others. But it’s great. And I think the power of social media, the power of being able to reach, even just doing this podcast, a few years ago, it wouldn’t have been quite so conceivable that we could work in this way. So we’ve got to use it in a very positive way and use this positive energy to really help people and try and deflect the negative energy so we can keep going. So thank you ever so much Aoife for your time today. And maybe come back in a few years and we can see where the conversation’s gone to then. But thank you ever so much. [00:32:46][36.8]

Dr Aoife: [00:32:46] That would be great. I’d love that. Thank you. [00:32:48][2.0]

Dr Louise: [00:32:53] 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.

ENDS