Thinking hormones in psychiatric consultations with Dr Devika Patel

Dr Devika Patel joins Dr Louise Newson in this episode of the podcast to share how a chance encounter when overhearing an educational webinar on the menopause was a light bulb moment for her practice as a psychiatrist. Devika takes us through her journey of how this knowledge from learning about menopause has transformed the psychiatric care she now offers to her patients.

Devika’s 3 tips for those with mental health challenges who are in perimenopause/menopause:

1. Don’t forget the important lifestyle changes (healthy diet, exercise, reduce stress, improve sleep and have meaningful connections with others) apply to mental health just as they do with menopause.
2. When seeking help, go with your own data to your healthcare appointment. Track your moods with your cycle and really make any links clear to your clinician.
3. If you don’t feel your healthcare professional is the right match for you, see someone else and advocate for yourself.

Follow Dr Patel on social media:

Instagram @drdevikapatel

Twitter @drdevikapatel

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 [00:00:45] So today with me I’ve got a somebody who reached out to me like a lot of people do, online. And she hadn’t really thought about the menopause for a long time, but she is a medical professional and she’s actually a psychiatrist. And we’re going to talk about how her eyes have been opened to the world of the perimenopause and menopause. So Devika, thanks ever so much for joining us today.

Dr Devika Patel [00:01:08] Thank you for having me on the podcast.

Dr Louise Newson [00:01:10] So I was doing – was it me that was doing a webinar? And your husband is a GP, isn’t he? I think you weren’t really – it wasn’t on your radar, but he was listening to and you started to listen. And you had this lightbulb moment, didn’t you?

Dr Devika Patel [00:01:24] Yeah, yeah. It was an evening webinar that you were doing. It was during COVID lockdown. So we were doing all these kind of online learning sessions in the evening. It was quite the thing then. I was literally eating my dinner. It was there in the background. He was watching and kind of 10 minutes in you were talking about basically patients that were coming with lots of antidepressants and different medication, nothing working, and then thinking about the symptoms in terms of the menopause. And it really clicked for me at that point. I had so many patients that I had seen throughout my training kind of come to mind thinking, ‘Oh my God, did I miss something there? Was it actually the menopause I should have been treating?’. And since then, it has really changed how I practice and how I think about women in a more holistic manner and definitely considering menopause, their hormones, in every single consultation that I do now.

Dr Louise Newson [00:02:10] Which is amazing. I love it. I love hearing stories like this. And, you know, it’s very true because I think for many years, and it still is actually, menopause is thought as a women’s health specialty. And I was actually talking to the organisation of conferences and events for the Royal Society of Medicine, of which I’m a member, and she said, ‘Oh, which category did you tick?’ Because there’s lots of categories, you know, are you interested in heart disease, diabetes, mental health, pharmacology? Actually, I can tick all of them because menopause is of course, every single thing. And I said, ‘well, you’re only allowed to take a maximum of I think it was four or five, so I ended up leaving it blank’. So she is changing that. But she said, ‘Well, we can do a women’s health event’. I said, ‘No, it’s not women’s health actually’. Because women’s health is often gynaecology. So it’s contraception and endometriosis – very, very important. But actually, it was only when I started my clinic where I just dedicated obviously my life to menopause, I’m hearing stories time and time and time again where women say to me, ‘Oh, yes, I have 30 hot flushes a day, but it doesn’t matter I’ve got a bag full of clothes. I just change all the time in the toilets at work. But what really affects me is my mood. I’m not interested in things. I’m just existing. I’m not living. My zest for life is gone. I have no appetite for any enjoyment. I stop going out. I stopped seeing friends. I’m a shell of what I used to be and I don’t know what’s happening to me’. And all these words are really strong. And then I look at how do we diagnose clinical depression and in general practice you know, we fill out these questionnaires, as you know, and every single practically perimenopausal, menopausal women would actually fulfil the criteria for being either mildly or moderately, or some severely, depressed. So I can see why people are being given antidepressants. But then I also have done enough psychiatry to know that there are differences. So a lot of the women have really good eye contact. They often really present themselves very well and they’ve got really good insights. They say, ‘This isn’t me, this is not me. I’m scared of the way I’m feeling. I’m scared of these intrusive thoughts. I don’t want to act on them. I don’t want to harm myself, but I’m just overwhelmed’. And when I was doing psychiatry and you’ll tell me whether I’m right or wrong. But there are a lot of people with severe clinical depression. They really don’t care what they look like. They have no insight at all. So it is quite subtle – on paper it’s exactly the same, isn’t it? But I mean, what’s your experience as a psychiatrist now you’ve picked up on the menopause?

Dr Devika Patel [00:04:38] Yeah. So I’ll kind of take you through a journey of how I thought about using the knowledge I’ve learnt in practice. Of course, the main thing that I was doing was kind of listening to your podcast, accessing your educational material, but it wasn’t anything formal. I wasn’t taught by a psychiatrist how to kind of deal with this. I kind of had to find my own path. So initially I got very excited by it and every patient I saw above the age of 40 that told me they didn’t have periods. I was like, ‘this is the menopause. They don’t need to be seen by me. It’s the menopause’. And actually, when I kind of spoke to them about it in that manner, that was actually very invalidating for them because they had waited so long to be referred to me. And what they wanted from me was a diagnosis and then some medication, they’d already tried some stuff with the GP, hadn’t worked, so I was there to give them the stronger stuff. So I realised that approach was the wrong way and rather than thinking it as it’s either menopause or depression, just understanding, I need to see my patient in a very holistic manner. I need to be open to the idea that there are possibly menopausal symptoms that are impacting on the depression, or it could actually be a depression mimicking menopause. And when I started thinking about it in that way, rather than trying to be too rigid, working out which one it was. I was able to give my patients better care. So what I do now is I’ll start having the conversation about periods, menstrual cycles, try to get their understanding of what they think is happening, try to get an understanding if they’ve heard of the perimenopause or menopause. I’m dealing more with the perimenopause I found, because people when I ask about the periods, then they’ll be like, ‘Oh actually yeah, I have noticed a difference’. But before they’ve been asked, they’ve not really noticed that their changes in mood have also been linked to changes in periods. So I’m trying to get the answers out of them and tease out what’s happening. And then what I’ll do is I’ll, I’ll decide, okay, we’re going to treat it as if it’s depression or anxiety or we’re going to go for this. There’s also going to be a point where we’re going to stop and have to review the diagnosis. But at the same time, I want you to speak to your GP, download the balance app, I give them a leaflet that you’ve also produced which is really, really helpful, which gets them to see that actually brain fog, poor memory, low mood, all these things there’s so many similarities between the depression and the perimenopause or menopause, and that way I’m equipping them with the knowledge, they can go back to their GP and see whether they need to start HRT or optimise their treatment already. And they can also be given the mental health support alongside it. And I found that approach works much better and I’m working.

Dr Louise Newson [00:06:58] And is that helping?

Dr Devika Patel [00:07:00] It definitely is because when I first started with telling patients it was just all the menopause, it was not the right approach, obviously. But now what I have is patients coming back to me saying ‘thank you for that because it has helped how I’m feeling and that’s all I need’. Even if it’s helping just 20%, 30%, it’s not about finding the one cure. In psychiatry we always think about things in a holistic manner, but somewhere along the line, menopause has been forgotten and the impact of hormones on mental health has been totally forgotten.

Dr Louise Newson [00:07:27] It’s amazing, isn’t it? Because certainly a lot of people out there and I probably know have a lot of sort of haters and bullies and they think all I want to do is prescribe HRT and give HRT to everyone. But actually it’s not just HRT. It’s about our mental health, our physical health, our wellbeing, what we eat, how we sleep, how we exercise, how we look after ourselves. And the mental impact of everything we do has a massive, massive effect. I mean, I do yoga regularly and I was saying to my yoga teacher last week, actually, I really wonder what I would be like if I didn’t do yoga and not physically, but mentally, because I know my brain would be scrambled. Yoga gives me a lot of mental power, really, to compartmentalise what I’m doing, to focus on the here and now and to not sensationalise and get too worried about things. And, you know, this is amazing ability, but that’s not the HRT. That’s not what I eat. I know it’s yoga does massive things to me. And – but that’s my choice and that’s fine. I’ve been educated, I can choose and a lot of my friends go running outside. Love it. Great. But actually you’re absolutely right there’s this missing bit and it’s almost like it’s a white elephant and people are scared. And then when I talk to people who say, well, how do you know, you’re missing depression. And well, actually, for me in the clinic, it’s easy because a lot of women have been on three or four or five different antidepressants and tell me they don’t work. But actually, there are also a lot of women that do have clinical depression and are also perimenopausal and menopausal. And it’s quite fine to treat with hormones and with HRT. And when I’ve spoken to other psychiatrists, I said, ‘well, if someone had an underactive thyroid gland and they were feeling very low and flat and not much energy, would you just concentrate on their depression?’ Well, of course we wouldn’t. We would consider thyroxine. And it’s the same, isn’t it?

Dr Devika Patel [00:09:19] It is. And I use the analogy of pain as well. So if someone comes to me because they’re depressed, because they have pain, their pain also needs to be treated. I can’t just throw antidepressants. Yes, I understand they are clinically depressed, but we have to look at what might be causing that. And that kind of interplay between the menopause and mental health is so messy we cannot ever be able to say 100% this is only menopause, 100% this is only depression, because the menopause can cause you to become depressed or you may be just depressed. It could be any combination of those. And we don’t have to come to a certain answer, like you’ve said. And you can always do a trial of HRT, see how the patient gets on. The truth is, that’s what we do with antidepressants. When you look at the guidelines, it says trial of antidepressants. So you are trying to see if there is any impact. And if you don’t see impact, you’re changing. Well, that’s the same way that we should approach HRT alongside our treatment too.

Dr Louise Newson [00:10:12] Yeah, it’s so important isn’t it. When I first qualified as a doctor, we didn’t have the luxury of the newer antidepressants because I’m quite old, I’m older than you clearly. And so a lot of it we gave dothiepin and even amitriptyline and they have quite a lot of side effects. And one of my consultants actually used to prescribe a lot of dothiepin to patients. We did a lot of rheumatology. Thinking back, I cringe actually, because a lot of these people were low in in their mood, they had muscle pains, joint pain. A lot of them had lupus, actually. And he would always prescribe dothiepin and they’d often come back feeling better, but they had these horrendous side effects. And then I remember when Prozac was a big thing. Great, but a lot of people found they were very anxious and became more anxious and hypervigilant. So then we had paroxetine, which we don’t prescribe as much now, but Sertraline. And then we had venlafaxine. So these drugs are getting better with less side effects. So I think that makes them easier to prescribe because they’re better tolerated. And, like you say, people either come back and say, I feel so much better or they don’t. In which case you do sometimes change or reconsider the diagnosis. But then some of the drugs that are used in psychiatry actually switch off hormones as well don’t they. So if they weren’t perimenopausal or menopausal beforehand, they will be after 3 to 6 months of some of your drugs won’t they.

Dr Devika Patel [00:11:32] Yeah, that’s really important to note. So any of the antipsychotics we use can increase the levels of prolactin and that can stop your periods. So we’re inducing that as well. It was really silly that I hadn’t thought about that impact before. Like, I think about it as, okay, we don’t have periods anymore. We’re going to measure prolactin. But I never thought about how that can have a negative impact on mood. I thought about it purely from the physical health point of view.

Dr Louise Newson [00:11:59] Well I didn’t either until literally a few years ago. So I remember working. I worked in Styal Prison, a female prison, and a lot of these women are on antipsychotics, various medication, and a lot of people have such low mood, but they all say they put on weight. A lot of people do their cholesterols because their cholesterol levels can raise and we sort of talk don’t we about burnt out sort of, you know, depression but actually I look at these people, well they must all be menopausal, and we know cholesterol goes up when women are menopausal. We know blood pressure goes up, we know weight goes up, we know addictive behaviour goes up. And a lot of these people smoke a lot and then they smoke even more. And that’s obviously compounding their cardiovascular health. And I think, gosh, I’d never even given them any hormones it didn’t even cross my mind. And a lot of people measure prolactin levels, but then they don’t think about oestrogen, but also testosterone. And it’s a sort of medical castration really that’s happening to women, isn’t it?

Dr Devika Patel [00:12:59] Yeah, yeah. 100%. And just talking about kind of women and thinking about them as different, not just small men, in psychiatry, I still think that we’re behind. So finally, people are thinking about how women may need some extra support or a separate service. So perinatal services have emerged in the last 5 to 8 years, which is brilliant. So it’s looking at actually hormones are going to be massively different during pregnancy. And someone with a pre-existing mental health condition, or may develop something during that time, so we need a specialist service for it. And the more I think about it, I think we need specialist services at the other two transition points, puberty and the menopause, just to make sure that we’re looking at it carefully and think about – there just needs to be more research and more services into that area to think how do we manage this as something separate? Because it is, there’s an extra factor that’s added in not just your male counterpart.

Dr Louise Newson [00:13:47] I totally, totally agree. And I think the whole reproductive depression is a really – John Studd has spoken about this for many years. He’s sadly died now, he’s a professor of gynaecology. And it’s really, really important because like you say, mental health, well even in adolescence, we always blame their hormones. But of course, we probably should because they’re changing all the time. But then postnatal depression, you know, we know women go from having levels of 10, 20,000 of estradiol to nothing overnight. And then it’s never given – hormones are never given back. There’s these great units, like you say, and they’re giving heavy duty drugs, but actually no one’s giving them a bit of hormones. And then I read a paper this morning about treatment of PMS, premenstrual syndrome or PMDD, and they’re saying, ‘oh, just give short amounts of antidepressants for a few days. It worked really well, let’s say for the longer term, you know, every day, antidepressants’. No mention in that paper, nothing about oestrogen. And, you know, we see a lot of women and I don’t know whether it’s PMS or perimenopause because they’re in their mid-late forties, they’re still having periods, but the few days before, they get this dip. It doesn’t matter what the diagnosis is, the cause of their symptoms is usually this dip in hormones. So you can just top it out with some hormones. And it’s much better to treat the underlying cause in medicine, isn’t it, than put a sticking plaster on.

Dr Devika Patel [00:15:06] Exactly. And with psychiatrists, we’re using kind of two medications: antidepressants, antipsychotics, mainly, and then we have our ‘as required’ medication, sleeping tablets, benzodiazepines. But I really think it’s time that we are adding more things to our repertoire. And hormones seems to be something that can help, especially for women’s mental health. Talking about things like PMDD, there’s also – it can get as severe as having psychotic episodes during menstruation. And I’ve seen one case of that in my training so far. It was quite rare. But again, because it’s rare, there’s hardly any research done. There’s one really good professor in Brockington who actually was the leader in getting mother and baby unit set up and really looking into women’s mental health, and that was in the 1980s, 1990s. We’re kind of 30 years on and it doesn’t seem to have really moved anywhere. And I feel the menopause, that’s the biggest change that has happened really for women’s health. If you look at the last two decades.

Dr Louise Newson [00:16:02] But still we’ve got a long way to go as you know. I feel like I’m starting what we’re doing. And in fact, someone came and spoke to my school. So this was in the eighties and she came and spoke about her work and she was a doctor. She’s now sadly died. She retired soon after. So this was in the eighties. She must’ve been about 60 odd then. And she was talking about hormonal variations that occur. She’s talking a lot about progesterone, but she was saying the natural progesterone – so this is the body identical progesterone, so not the synthetic progestogens – have a really good calming effect on the brain and how they should be considered for postnatal depression and also for PMS and the menopause. A bit she mentioned about oestrogen, but I was looking at her Wikipedia recently and it’s all there, but everyone ignored it because she was a bit of a ‘crazy woman’. And why would you believe women in the eighties who were in their field? And I thought, goodness me, I don’t want to go to my grave and not had any, made any advance. She must have been as frustrated as I am. And so – but I think it’s about how we train and educate and help psychiatrists. And I’m very grateful because you invited me to give a presentation didn’t you. Do you want to talk about that?

Dr Devika Patel [00:17:16] Yes. So as soon as I’d connected with you, it was over kind of Instagram. And then you very kindly called me and I had a discussion and I actually until then, I knew that the menopause was impacting mental health. But when you discussed a few cases, I realised kind of how severe that impact was. So then I kind of, my brain switched on. I was like, I need to get Louise in to speak to the rest of the psychiatrists because I was kind of talking to my colleagues, but I was like, the impact needs to be greater than this. So I found my way onto a organising committee for a small conference that we do in the West Midlands, and you were luckily free for that day, so you came to speak to us and there was about just under 200 people that had signed up. And during your talk we had 100 people live and you were the first speaker to open the conference, and it was a virtual conference, but there was so much interaction. The chat was constantly throughout when you were speaking. There was an amazing question and answer session, which not only did people ask about, ‘Well, how do I manage this? How do I treat it? Or ‘Yes, I see this in my practise’. It was psychiatrists talking about their own experiences and sharing tips like, ‘Well, if you want this, you should try this way. I’ve tried this’, and even asking you, ‘Well, I want to get access to this. How do I get around this or is there a loophole through this?’ So I’ll be honest with you, when I – the day before, I was getting a bit worried and I spoke to my husband and I was like, ‘I’m not sure if people are just going to say like, why did you bring this GP to speak to us about mental health? We know what we’re doing’ and I was really worried about how it would be received. But my husband said, ‘Look, if you think that it’s useful, I’m sure even a small percentage of your colleagues will find it useful, and that’s all you need to do to have an impact for your patients’. So I thought, okay, well it’s all organised now, we’ll see how it goes. And it was even better than I had imagined. And actually, it’s been a month since that conference and I still, when I bump into colleagues, they’re telling me how great it was and I’ve had some really good kind of just people telling me about scenarios where they’ve considered the menopause. So one of the most acute assessments that I will do as a psychiatrist, is a Mental Health Act assessment. And in that, we’re considering whether we’re going to section a patient, if they need to come into hospital or we need to do something quite urgently because they are quite unwell. And one of the doctors that came had mentioned in this assessment, which usually happens in A and E, about their periods and their menopause, just showing how important it is that we talk about it at every point of care, whether it’s the first assessments in an emergency, because we don’t know when it’s going to be important to the patient’s care. So it’s just something that we should just get into our kind of usual questioning. So yeah, that was really great, and I think there’s been a lot more appetite for it. People are considering it, and I do hope that we can continue sharing and spreading the message amongst psychiatrists because like you said, education is the first step in awareness.

Dr Louise Newson [00:20:04] It absolutely is. And it was really – I mean, I was equally as nervous as you the day before, thinking well, I’m a crazy menopausal women who’s a GP, why are they going to listen? And, you know, we have spoken to all sorts of academic psychiatrists and haven’t been taken seriously, as you know. And so I loved it because – I didn’t enjoy it because it was through teams; it’s so much nicer to do it in real life – but you could feel the questions and the energy and it wasn’t just about their patients, it was about them. But then I also, afterwards, as I often do with these events, reflect and feel very, very sad and thinking our own profession has been let down. Would it be that there was another condition? The only thing I think about that’s similar-ish is migraine, actually, because that’s really badly managed for so many women, and I suppose I’m more in tune because I have migraines, my daughter has debilitating migraines. But most other things I think people can access, you know, if you’re in pain, like you say, or if you’ve got arthritis or if you’ve got a heart defect or if you’ve got palpitations, if you’ve got bladder problems, there’s somebody somewhere that you generally could get first level advice. Obviously, we always often, if we’re struggling, go and see another specialist or someone at a teaching hospital to get really top of the range advice. But I can’t think of anywhere where healthcare professionals are struggling. You know, I always think the advantage of being a healthcare professional, there’s not many, but one of them is that you always know the best person to get advice from. So if my children have been ill or my husband, or when I had pancreatitis and was struggling, I can pick up the phone and speak to somebody whereas actually even with my own menopause, I only had one person in the country that could help me six years ago and that was a struggle to get to speak to him. So that’s wrong, isn’t it? You know, we’ve got to look after our own.

Dr Devika Patel [00:21:52] And I think for – I’m not being sexist in any way – but for men to be in that webinar and see the comments that women were making, that where their equals help to just bring it home to be like this isn’t a them and us situation like there’s someone that doesn’t know about menopause and that’s why they’re struggling. These are highly educated, professional psychiatrists that know what’s going on and still unable to get the support and help that they need. So it just paints the picture of how difficult it must be for that person that has no idea they are just going to their GP, they getting referred to us and they may not even think about the menopause or perimenopause. And that’s where we come in. We have 30-minute, 60-minute appointments, we have the luxury of time compared to GPs, so we should really use that appointment. I can spend 5 minutes talking about menopause and that is all I need to drop them the information they need. Tell them a lot about it, find out what their understanding is and give them some reading material. And that’s nothing in the grand scheme of things.

Dr Louise Newson [00:22:49] And that’s pivotal actually, because everyone’s pushed for time aren’t they? Healthcare professionals are really pushed for time. But I think actually if we can enable people to just plant the seed, so even rather than doing very technical, detailed questionnaires, I often think if as healthcare professionals, we just say, whatever specialty we’re in, we say to a woman, ‘Could it be your hormones? Do you think it could be your hormones?’ 80% of the time you’ll get the answer from the patient. And then it’s you know, as you know, one of the reasons I’ve developed the app is so that people can just do it in their own time. They’re not taking anybody’s time. You don’t want to be sitting down, going through every single minutial point or giving a questionnaire and filling it out with them – just let them do the homework. And I think when women are empowered, even women that have mental health issues, they’re still able to use their brain because they want to get better. And if they can’t, then they usually have a friend or a carer or you know, you work obviously with nurses and assistants, and anybody would be able to help. And some of the work I’ve done actually since the webinar is some psychiatrists and some other healthcare professionals have reached out and they’ve just realised it’s them as well. And actually I find like myself, I’m more interested because I’ve experienced symptoms and I know how helping getting the right treatment really makes a difference. So if we have likeminded people who are sort of experiencing symptoms, need help themselves or have got help, they’re more likely to help their inpatients and outpatients as well. So it’s this whole ripple effect, but it’s really important to get it through the mental health communities, isn’t it?

Dr Devika Patel [00:24:27] 100%. And I was just thinking because I’m a ‘general adult’ psychiatry trainee – so I treat anyone between the age of 18 and 65. So it’s like, this is really important for me. But actually, when I thought about all the other specialties, forensic psychiatrist, really important because we have patients in that system that are on the wards for three, five, eight years. They’re going to be patients that will be going through the menopause whilst they’re admitted. That’s important. Learning disability population –they may present with things like aggression or irritability, acting out behaviour and the first line is always ruling out a physical cause and usually things like infection or pain are looked at. Are we thinking about the menopause or their cycles?

Dr Louise Newson [00:25:07] We’re doing some work actually, it hasn’t been produced yet, but for learning disability. And it was triggered actually by a patient who can’t communicate very well. Like you say, behaviour became very erratic, just very distressing for everyone. Couldn’t work out the cause, but actually she had really bad vaginal dryness, so sitting down was incredibly uncomfortable for her. She didn’t have any urinary tract infections, so she’d had loads of – because that’s one of the things obviously that’s screened for. But she was getting a lot of urgency, discomfort, everything else and just giving her some localised hormonal treatment, you know, absolutely transformed her behaviour. But you can see I was getting very irritable, very cross. My husband’s breathing was annoying me. Everything was just…I was catastrophising. But if I couldn’t vocalise, you’re scared. You know, it’s a horrible feeling when something is changing in your brain and you’ve got no control. So, you know, women that don’t have English as their first language, difficult to communicate. When we take history through interpreters, we know so much gets lost in translation. But actually, for these women who can’t express themselves because they don’t know and the culture might not allow them to say what they, how they’re really feeling, it’s very difficult then for us as healthcare professionals to make a proper diagnosis often, isn’t it?

Dr Devika Patel [00:26:25] Yeah, of course. So I just think it’s really relevant to every psychiatrist. Maybe not CAMHS. That could be the only one I can think of. But I’ve also heard that you had your youngest patient that’s seen you is age 14. So there’s probably even an indication, but there it becomes, how are we thinking about hormones and mental health screening at any point we should be thinking about the periods. Start with that simple question, then seeing where it takes you and it’s leading with curiosity.

Dr Louise Newson [00:26:49] Yeah, I think so important those initial questions and as you know, I’m talking at the Royal College of Psychiatrists as well, which I will have done by the time this podcast comes out. So we’ll see what happens there. But I feel like we’re at the start of a great journey and I’m very, you know, openly thankful to you Devika for actually well listening over your husband’s shoulder and taking this seriously and let’s see what happens. So it’s very exciting. So thank you ever so much. And before we end, I’d really like three tips really for people who are perimenopausal or menopausal. They think that they might or might not need their antidepressant, but they’ve been told that that’s all they can have is the antidepressant. So it’s really what else can they do and how can they start that conversation either with their own GP or with their mental health team? Because a lot of these people will be under mental health teams. So what can they do and what else, in addition to HRT might be useful for them as well?

Dr Devika Patel [00:27:44] So if I start with the easier things, as with menopause, there’s medication, but there’s also lifestyle changes. Well, the lifestyle changes that I would recommend for the perimenopause and menopause are the same that I would recommend for someone with depression or anxiety. So those are things that you can do without asking any permission, and that’s improving your diet, doing your exercise, making sure that you’re trying to reduce your stress and getting important sleep, and having meaningful connection with people. All those things are going to improve. Then my second thing would be that if you suspect it is perimenopause or menopause, you need to almost go to your appointment as if you’re fighting your case. So go with all the data. So if you’ve tracked your cycles and noticed that they’re reducing, take that. Track your mood to see how it’s kind of playing out with different stages in your cycle if you’re still having periods or just coming to the end of them, because that’s really useful data that we can’t ignore. If someone presents that to me, I’m not going to say ‘it’s all in your head’ or ‘it’s just depression, it’s not linked’. So really spell it out for that practitioner, whether it’s your GP or your mental health professional. And then the other thing is you aren’t always going to find a good match. There are going to be some doctors that haven’t yet learnt about the menopause and perimenopause, and that isn’t the fault of theirs, it’s the medical education system that isn’t yet up to speed with that. So then I would just suggest going to see another doctor, whether that’s asking for another psychiatrist to see or another GP and there is nothing wrong. So I think the main thing is just to be strong and make sure that you advocate for yourself because you might be ahead of the education journey for menopause and perimenopause even more than your healthcare professional. And that’s okay. You’ve put the information so that they can support you, if you’re not getting the help, you need to find someone else.

Dr Louise Newson [00:29:23] Yeah. So that really, really important, isn’t it, is that we as patients are our own advocate, but we also use others as well and actually know that the first opinion is not always the one that’s right for you. I’m not saying it’s not right because a lot of things are right. But if it doesn’t feel right and it’s not what you expected, or if it’s your partner or friend and they come out and you think that doesn’t, then see someone else. And I don’t think any of us as healthcare professionals, I’d never mind if someone, one of my patients sees someone else. I think it’s really important to get what’s right for you. So that’s really great tips and I’m very grateful for your time today and I look forward to maybe coming back in maybe a few months, years, let’s see and see how these conversations change.

Dr Devika Patel [00:30:08] And I hope it’s much more different. And we’re talking about all the new advances that we’ve made and the progress. I definitely think that is going to happen. We’re just starting, like you said. So thank you, Louise, for letting me join you on the journey.

Dr Louise Newson [00:30:20] Yes so beginning of an exciting journey. So thanks ever so much and look forward to speaking again.

Dr Devika Patel [00:30:27] Thank you.

Dr Louise Newson [00:30:30] 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.

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