What is lifestyle medicine and how it can help your menopause?

Joining Dr Louise this week are Dr Tash Mirando and Dr June Tan Sheren, who are GPs based at Osler Health International in Singapore.

Dr Tash and Dr June explain the pillars of lifestyle medicine, including sleep, nutrition and exercise, and talk about longevity and the importance of taking a holistic approach to menopause care.

They also discuss menopause care in Singapore, bust myths on how menopause can affect women of different ethnicities and highlight the importance of knowledge and empowerment in making informed decisions about your health.

You can find out more about Osler Health International on Instagram @oslerhealth.sg and Facebook at oslerhealthsingapore.

For more information on Newson Health, click here.

Dr Louise Newson’s first-ever live theatre tour, Hormones and Menopause – The Great Debate, runs until 12 November. For more information and tickets, click here.

Transcript

Dr Louise Newson: [00:00:00] 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. On the podcast today. I’ve got two lovely GPs with me who both work in Singapore. So Tash and June work together. I went to Singapore last year but didn’t know them then, unfortunately. So it means we’re going to have to reconnect and go back to Singapore. But when I was in Singapore, for those of you that know it, so it’s a great city. Everything works. It’s easy, it’s clean, it’s organised. But Rebecca Lewis and I, who I was with, kept looking around and seeing all these menopausal women. We were seeing people and we were seeing less women out in the streets in their 40s, 50, 60, certainly some. We went to Little India, we went to Chinatown. It was really apparent that there is a difference over there. And so I was really delighted when I spoke to Tash, who comes over to the UK and still works over here as a GP. So very excited to have you both on the podcast to hear more about your work in Singapore. So welcome. [00:01:46][106.2]

Tash Mirando: [00:01:48] Thank you so much Louise. [00:01:49][1.2]

Dr Louise Newson: [00:01:50] So Tash do you want to go first, just say little bit about what’s taken you to Singapore because I know you’re not from Singapore initially. [00:01:55][5.7]

Dr Tash Mirando: [00:01:58] So I’m actually a London NHS doctor, a GP, and I moved to Singapore a couple of years ago, really from a family point of view, to be closer to family who’ve now retired and moved to Sri Lanka, which is where I was born and then grew up in the in the UK. And really finding, finding my feet in Singapore has been fantastic, especially because of the clinic I was able to join, which is called Osler Health International and working alongside June to really improve the quality of life of our patients, especially women, because we we co-head menopause in women’s health here at Osler. As you mentioned, I still I do keep up with my NHS work. I do my best, but it’s just really nice to have that hat on as well and keep up to date with all the latest research guidelines. [00:02:46][48.8]

Dr Louise Newson: [00:02:47] Absolutely. And June, what about you? [00:02:49][2.0]

Dr June Tan Sheren: [00:02:51] Right, Louise, first, I just want to say that a lot of women in Singapore know you, they follow you and, you know, they they are going to be absolutely delighted morning when they wake up to this episode of the podcast. So thank you. Thank you for having us. I’m Singaporean, I’m from Singapore, I’m third generation Singapore and in fact did most of my medical training education here in Singapore. I graduated from the National University of Singapore in 1997 and went into family medicine and in my years of residency I spent about ten years in the public sector here. In the earlier years of residency in family medicine, menopause was a routine part of primary care. You get menopause treatments, you get HRT prescribed to you in the public sector in government clinics that are known as polyclinics here. And it was routine for me to be prescribing, you know, back in those days, Premarin, Premaks, Prempak-C, yeah, back in those days, and I was there when it all came to a halt. But I’m really I’m really happy that I am still in practice 20 years down the road and, and see how women’s care has evolved, how menopause care has evolved and really right now just appreciating how things are coming full circle. [00:04:23][91.8]

Dr Louise Newson: [00:04:24] Yes. And it is. So we’re talking about 2002 when the Women’s Health Initiative study came out, which was the biggest car crash to women’s health, actually. And at the time, people were really worried that the ripple effects, the long term effects it will have and it is still having 22 years later on women’s health because people are scared of taking HRT. And and you’re right, actually, I feel very strongly as a clinician that menopause care should usually be undertaken in primary care because as GPs we’re used to very holistic care. We’re used to making different diagnoses, often more than one diagnoses in patients. We don’t just look at the heart or the lungs or the bladder, we look at everything and we’re often giving two or three different treatments, sometimes in the same consultation, because we… And we also know our patients. And that’s the beauty of, I think, being a clinician, when you know what will work for them, what they won’t, what they’ll understand and what they might not understand. And also when we’re talking the bigger picture about what they can do themselves, because I think in medicine it can be very dictatorial. You must do this, you must do that and fit everyone in the same box. But we don’t live our lives like that, so how can we function, you know, do medicine like that. So when we’re looking at menopause care, there’s lots of things we do, aren’t there? It’s not just one treatment. And one of the things that I’m very interested in, I know you are is is a whole lifestyle and lifestyle medicine has become really topical. And it’s something I was not really taught much about, nutrition. It wasn’t really taught much about, I was taught a lot about physiology of exercise, but not what it means and what it does to people. And we now talk more about preventative medicine, reducing diseases rather than treating diseases. And lifestyle medicine comes up a lot. And there’s lots of lifestyle gurus out there. But there’s quite a lot of noise. And sometimes it’s easier to ignore all the noise and just say, I’ll carry on in my own little space. So what, what is Tash, what actually is lifestyle medicine? How would you define it? [00:06:44][139.9]

Dr Tash Mirando: [00:06:46] So lifestyle medicine is actually evidence based, scientifically backed approach to prevention of chronic disease and actually looking at reversal. But I would say before anybody talks about medication, even going along the lines of hormones, it’s we need to optimise our baseline health because we can throw medication at people to them during the face. It may not matter until we really focus on the basics. So what we break it down into is the six pillars of lifestyle medicine. So me personally, sleep is number one. We’ve got to optimise our sleep. Looking at adult point of view, it’s 7 to 9 hours of sleep each night. Easier said than done. Especially young families, work, balancing so many things out. But getting that step in order can then help set everything else in place. Second is nutrition. Protein, fibre, fats. Focus on the protein, focus on the fibre. And it’s having that balance because then comes exercise. This isn’t about just going for walks or doing your full cardio workouts. It’s actually looking at strength training. Got to strength training, lift heavy weights. It’s not just about, I know you love your yoga and you’re very good at it, but you’ve got to lift heavy weights. And that’s really, really important. And especially in this part of the world, sometimes it’s not, especially the older generations, it’s not something that is considered as important, but we know it is, osteoporosis risk. Looking at osteosarcoma, it’s so important. Moving on to mental health and well-being. Looking at your social network, looking at social connectedness. And then if you smoke, stop smoking. Sorry. And if you drink, cut back or stop. And so it’s really basing it from a science led approach to those six pillars, because once we look at optimising each one of them and building it up, even if, say, some a stressful situation comes up, you already have your sleep in order. You’ve got your nutrition, you’ve got your exercises back up. So you can balance it for that short period of time, which means anything else you do on top of that works a lot better. And I find that a lot in menopause consults is that women who actually really focus on those lifestyle measures and optimising to help do a lot better on hormone therapy. [00:09:18][152.1]

Dr Louise Newson: [00:09:19] Absolutely. And our body likes homeostasis. Our brain does. But our bodies, as we like, we all like routine and we like the same. But if we’ve got into the wrong routines, it’s this sort of can be a downward spiral as well. And you throw low or change your hormones into the mix, as you say, when you’re stressed, where you haven’t slept, you go for maybe a comfort food or you go for something. And if your habits aren’t great, you’re it’s going to compound the worse and bad habits anyway. Often isn’t it. And and so when we talk about you talk quite clearly, obviously, about prevention, which is wonderful, which is what we should be doing, of course. [00:09:58][39.2]

Dr Tash Mirando: [00:09:59] Absolutely. [00:09:59][0.0]

Dr Louise Newson: [00:10:00] What would you say to these people who don’t really think about doctors preventing disease? It’s more about we’re treating illnesses. What would you say is so important for preventing disease? [00:10:10][9.9]

Dr June Tan Sheren: [00:10:11] So so, you know, in all the talks, the educational talks that that we give, that Tash and I do individually as well to raise awareness on menopause and in consultation at the micro level as well. You know we emphasise so much on preventive measures that include lifestyle measures that really form the cornerstones, the foundation of health and wellbeing. And I like to say to my patients that during this menopause transition this is a really good opportunity for you to relook your state of health and wellbeing at the moment and see what lifestyle measures, what aspects, sleep your nutrition, your activity level, your mental wellbeing, what that can be further optimised at a sustainable level, something that will set yourself up for the longer term, for better, for really good health and wellbeing, for the longer term. So I know many people might might like, but to your question Louise ask why are we, are we as doctors giving advice on preventive care? Well, I would say that that’s very natural to us as GP and family, family physicians, that that has always been one of the core pillars of family medicine. It’s not just curative, it is, preventive care is a huge part of what we do. And I, I like to be able to, to provide that, reinforce that with patients. [00:11:54][102.9]

Dr Louise Newson: [00:11:55] And it’s interesting. So I did a lot of hospital medicine before I went into general practice. And, and when I did my obstetrics and gynaecology job, it was probably the first time I thought about preventative medicine because I was thinking about pre-conception counselling. So if people are organised enough and thinking further ahead and planning a pregnancy, I know it doesn’t always happen for everybody, we spend quite a lot of time, don’t we, especially as GPs, in preparing for the pregnancy, making sure the women is as healthy as possible. So it’s a great time doing the pillars, as you exactly say, thinking about nutrition, thinking about smoking, everything, because then it’s gives the mother the best chance and the developing foetus when it happens too. So it was then that I thought, Gosh, actually that’s really good investment of time. Whereas before in hospital medicine it’s very reactive, you know. Bed six is a heart attack, bed seven is an asthma attack and you’re just literally playing ping pong when you’re just literally going from one thing to another to another and you’re maybe speaking to the person that had an oesteoporotic fracture, perhaps you should have the vitamin D, but that’s still the treatment you’re not really preventing. So I remember thinking, oh that’s good. Yes. Wow. And then just asking every consultant, every consultation, I’ve always done it. Do you exercise? What’s your diet like? Do you smoke? Do you drink? What’s your sleep like? And it takes minutes. And actually, some patients then have said to me, you know what, just you asking that question made me feel really guilty. And so I don’t buy, you know, fast food, or I started exercising a bit and it’s not like I’ve lectured them I’ve not even said like, it’s just that question and I think you didn’t know what you think. But often you don’t expect your doctor to be interested in you somehow. And does that resonate with you? [00:13:48][113.0]

Dr June Tan Sheren: [00:13:49] Yeah, absolutely. I think you just need to ask the question and not say any more. And that turns on a switch that makes patients start to think about, yes, you know what what other aspects of of their lives can they can they work at? [00:14:03][13.2]

Dr Tash Mirando: [00:14:03] And it also helps to build the rapport and that relationship because as GP’s that is fundamental. As family physicians is the for me it’s special. You really get to know your patient, you get to know the families and that so you have all the information, you can work things out before they even work walking through the door. Something’s not right today. What is going on. [00:14:25][22.2]

Dr Louise Newson: [00:14:26] And you don’t realise the impact. So I had a patient when I was in general practice, this lovely, lovely lady, and she was in her late 70s and she was morbidly obese and she cared for her husband who sadly died from cancer. And I knew him very well as well. And then about 15 years ago, I had pancreatitis and I was really ill. And when I got better, had time off work and she saw me and she said see Dr Newson, all these seeds and these food that you eat aren’t helping. And I don’t even remember talking about seeds, I must have said something like sprinkle some seeds… and she was really funny. But then I said I said, Well, ok, I get what you’re saying, but actually, nutriton’s really important, we had a little chat, talked a lot about her poor husband. And and I’d stopped talking about her weight because she knew she was really overweight. And the last thing you want is someone shaming you when you’ve not come in for that problem. So I’m very respectful as I know you are to your patients and then she lost, I kid you not four stone in weight and I and it was just before I left general practice, it took a year or so and I said, What was the shift? How did you do it? She well I just, we had that joke about seeds. And then I thought, Actually, now I’m going to prove her wrong. So I’ve thrown away all the cakes. I don’t nibble, and her arthritis in her knees was so much better. She honestly was a different person. And actually. I said, Gosh, you know, so many people say oh I’ve left it too late. I can’t change my life. I can’t lose weight. [00:15:54][88.5]

Dr Tash Mirando: [00:15:55] No such thing. [00:15:56][1.2]

Dr Louise Newson: [00:15:56] And there isn’t. And she really and I thought, well, a little throwaway comment, but I could tease her a little bit because I’d known her for like 15 years. I thought, that’s incredible, the the sort of when you have that mutual respect. But if I’d gone into her and said, Right, let’s look at your kitchen cupboard, let’s reduce your food, it would have been detrimental for our relationship. [00:16:17][20.9]

Dr Tash Mirando: [00:16:19] It’s also picking and choosing. You can’t do everything all at the same time. So a lot of the work we do is about a very 360 degree view. They may come in with one thing, but she’s actually let’s start with this. Which is completely different to what they came in with. And let’s break it down and work on it, because if you go home with four or five things, you have to suddenly change. It’s really difficult. [00:16:44][24.8]

Dr Louise Newson: [00:16:45] Bit overwhelming isn’t that. [00:16:46][1.2]

Dr Tash Mirando: [00:16:47] It is completely overwhelming. So it’s finding that one or two things and breaking it down and working on that and then building on it. And we’re lucky because we have the privilege of time. [00:16:58][11.5]

Dr June Tan Sheren: [00:17:00] Just helping patients to prioritise steps involved. [00:17:02][2.3]

Dr Louise Newson: [00:17:03] Yeah. And what’s the feedback been night with your work? [00:17:05][2.2]

Dr Tash Mirando: [00:17:08] It’s fantastic. Really satisfying. We’re busy. [00:17:11][2.9]

Dr Louise Newson: [00:17:14] Yeah. And it’s it, but it’s so rewarding. I mean, having a rewarding job is amazing. It’s. It’s very humbling, but it’s very enjoyable, of course. But actually knowing that you’re helping future health, I think is incredible, isn’t it? [00:17:30][15.8]

Dr Tash Mirando: [00:17:33] Especially looking at it. You mentioned future health. There’s a lot of, a lot on social media, also about longevity and breaking that down into health span and life span. We’ve set up the first public sector longevity clinic here in Singapore at Alexandra Hospital, and it’s about looking at that gap between health span, which is the age until you’re healthy and lifespan, which is when you die. And unfortunately, that gap can be ten years. So being unhealthy for ten years is really not that great from a quality of life point of view. So what you need to now… [00:18:11][37.9]

Dr Louise Newson: [00:18:12] And that is really important, especially when you look at areas of deprivation and certain ethnicities as well, because that think that ten years actually can expand even longer, and especially in women. And if we say I’m going to mention menopause because of the podcast, but we know that menopause extends that, too. So there’s good works, especially women, as you know, who have an early menopause at a younger age, the longer they are without hormones, the worse their future health is. And that’s just a fact. And that’s because of the anti-inflammatory nature of our hormones. And so looking at all these pillars is crucial. But when you talk, I’ve gone to so many longevity talks because I’m so interested in it. But they always miss hormones. And it’s not just even in women. Men have testosterone, which is very anti-inflammatory. And also men have oestrogen and progesterone, but there’s no research done into that. But I do feel like with patients who take HRT and feel better, it’s then so much easier for them to do their lifestyle things and their sleep often improves and everything else. I mean do you find the same? [00:19:21][68.7]

Dr Tash Mirando: [00:19:22] Yeah, we do. And it’s a lot of the times it’s finding that balance, getting the women on the right hormones for them in the safest way and then building on the rest of it as well. It all goes hand in hand, but doing it in a, in a way that’s not overwhelming as well. [00:19:40][18.0]

Dr June Tan Sheren: [00:19:41] So there’s a lot of interest in Singapore these days into lifes pan and health span. And because Singapore’s life expectancies are one of the highest in the world and we also have one of those rapidly ageing populations, the statistics are that one in four by 2030 would be over the age of 65, and that becomes closer to one in almost two by 2050. Yes, I know. Gosh. So there there are a number of very important initiatives that the government has put into place now to address this this issue of the rapidly ageing population. Osteoporosis has always been a major public health concern. But back when, you know, 20 years ago when I mentioned how menopause was part of routine practice, it was primarily to address the issue of osteoporosis. Yeah. Yeah. One in three women over the age of 50 in Singapore have osteoporosis. Yeah. Isn’t that just ridiculous. And the rates of hip fractures in Singapore are the highest in all of Asia. So I do think that right now, with the priorities going into resources and channelling interests in looking at the rapidly ageing population, I do think that that there will be interest in menopause and enhancing women’s health in this transitional period. Yeah. [00:21:35][113.8]

Dr Louise Newson: [00:21:35] Yeah. And it’s interesting because you spoke about osteoporosis, which is so important, but so many people still don’t know what it is or they don’t realise the impact of fragility, osteoporotic fractures, especially the hip, but even the wrist can be really disabling for lots of people, as we’ve seen, but especially the pain from osteoporotic fractures in the in the spine as well, you know, really, really affect people. And we know that HRT can reduce osteoporosis, but we also know that it can treat osteoporosis because it can build strength. And it’s often forgotten that as well, isn’t it, how important the hormones are for bones? And it’s interesting because so many times I go to lectures by menopause specialists and they talk about giving HRT for symptoms and it’s usually for flushes and sweats. And we know there’s a myriad of other symptoms, but people seem to forget about disease prevention. And even if we only look at osteoporosis, there is still really good evidence. And if I had a choice between a bisphosphonates or hormones for treating osteoporosis or preventing osteoporosis, I know I would take to see because it’s got better safety data for a start. And do people use HRT for osteoporosis treatment or prevention in Singapore? [00:23:00][84.6]

Dr June Tan Sheren: [00:23:02] In the past, yes. Yeah. But currently currently the guidelines on osteoporosis prevention and treatment still have, yes lifestyle measures, the bisphosphonates and a little mention about HRT right at the bottom. So yeah that that bit of evidence hasn’t quite caught up yet. [00:23:24][22.2]

Dr Louise Newson: [00:23:25] No, but it’s interesting when you look at how common osteoporosis is, especially in Asian women and how that’s forgotten. And a lot of people, well I’ve been taught, and I’m keen to know if it’s the same for you, because of maybe that diet might be have more soy in their diet that they have less symptoms. So then there’s a lot of people say, well, menopause isn’t really a thing in certain ethnicities or certain countries because they’re not having the same hot flushes and sweats. [00:23:51][26.5]

Dr June Tan Sheren: [00:23:54] That’s that’s so great that you brought that up because that is what some patients have come to to to to say to us, because their own doctors have told them, oh Asian women don’t suffer from menopause, which is which is just ludicrous. Right. I think what fed into that was that 20 years ago, there was a smallish study here in Singapore that looked at the types of symptoms that Asian, that women in Singapore suffered, and they found that vasomotor symptoms, hot flashes and night sweats were not so not as common as muscle aches and joint pains. And so I don’t know, but people took that to mean, oh Asian women don’t suffer through menopause. But the truth is, interestingly, this finding has been validated more recently in a couple of studies that the National University of Singapore published just a few months ago that found that muscle aches and joint pains were the number one symptom across the major ethnic groups. Yeah, the Chinese Malays and Indians, followed by sleep disturbances, I think. And vaginal symptoms, and then physical and mental exhaustion followed by flushes, night sweats. And to me, I think that, you know, it’s a whole process. It’s one mechanism of osteosarcopenia we have such high rates of osteoporosis, we cannot ignore this top symptom of menopause in Singapore, which is myalgia and arthralgia. I think this all goes together and really needs to be looked into. [00:25:37][103.2]

Dr Tash Mirando: [00:25:38] So as you mentioned about the earlier one goes through menopause and it’s looking at from an average age, we always talk about 51, but here in Singapore, it’s 49. And in South Asian women, could be 47. If you think of timelines of the perimenopause, this whole concept of you’re too young to be in the perimenopause. I’m not saying everyone should just assume they are. We rule things out. We examine, we check on other organic causes. But there shouldn’t be such a thing as you’re too young to go through menopause. And as you said, especially at a young age, it’s making sure that women get the care they need. [00:26:20][41.5]

Dr Louise Newson: [00:26:21] Yeah, And that is so important because we don’t know. Often it’s retrospectively we can see the age someone started being perimenopausal and someone was lecturing, something I went to recently and they were saying there’s an early perimenopause and a late perimenopause stage. And they were saying one’s at age 47 and one’s age 49. And I thought, How do you know? Because you don’t know when you become menopausal. So it’s only like looking back in time. But then we know that for most people you want to start treatment in the perimenopause anyway. So most of us don’t know the date of our menopause and it doesn’t matter. But we don’t want to be missing out on those preventative health measures, especially even just carry on talking about osteoporosis. We don’t want to wait until people in menopausal and then start thinking about what can we do to improve your brain density because it’s dropping in the perimenopause, isn’t it? [00:27:16][55.1]

Dr Tash Mirando: [00:27:18] I think one of the other sort of things we deal with is blood tests. Hormone blood test requests. And having that conversation about when it’s appropriate, when it’s not, you know, but it’s a lot of tests being done. And it’s when you have that conversation and explain things, it really makes a big difference. So that’s a lot of the times sort of the talks and the education work June and I do. A lot of questions come up with, but why aren’t you testing my hormones? [00:27:45][26.9]

Dr Louise Newson: [00:27:46] Yes. And it’s really interesting, isn’t it? So we we do we do do blood tests, but we often are looking at vitamin D levels and ferritin and thyroid. And obviously, you can’t treat unless, often in medicine, unless you have some test result. But it’s different in perimenopause and menopause, and that makes people feel really uncomfortable sometimes. But then I often say to people, look, I have migraines. No one’s done a brain scan on me. No one’s done a blood test to diagnose my migraines. It’s gone on my history. And also, when I have tried different treatments for my migraine, I have what’s called a therapeutic trial. Someone gives me a treatment and says this might work. And then, like the triptans, you go through different ones and some have awful side effects, so I say, I can’t take that again. Okay, we’ll try this one. And that is very much the same with hormonal treatment, isn’t it? [00:28:39][53.2]

Dr Tash Mirando: [00:28:41] And it’s a concept of a therapeutic trial and the fact that if you want to have a therapeutic trial on or off, that’s a choice. And as long as that choice is educated, you’ve been educated on the choice. You understand that this benefits. At the end of the day women know themselves better than anyone else. [00:29:00][19.9]

Dr June Tan Sheren: [00:29:01] And as you can as you can tell, many women do come to us with all these blood tests already done and they’ve been told, oh they’re not menopausal. Go find another solution for for your issues. Yeah. And yeah, we we take the opportunity to then educate them and let them know what we can do. [00:29:23][21.8]

Dr Tash Mirando: [00:29:23] And what the choice are as well. [00:29:24][0.7]

Dr June Tan Sheren: [00:29:24] Regardless of the blood test results. [00:29:26][1.3]

Dr Louise Newson: [00:29:26] Yeah. Really important, isn’t it? And then, you know, we choose what exercise we do. We choose what we eat. And I think treatment for a condition or preventing a condition is no different. Actually it is choice. And and I think his GP is we’re used to sharing choices and working with our patients. So it is, as I said before, a great privilege to be in this position. But we’re working with our patients and it’s not a one way sort of transaction when we see patients and it’s constantly evolving. And like you say, the relationship we have is weaved into into those consultations, which is so important. So I’m very grateful for your time. I’m, there’s so much more we can talk about, but I’ll have to come over to Singapore or you’ll have to come over here, and Tash when you’re next in the UK, you’ll have to come and visit us. So before we finish, we always ask for three take home tips, which is really hard when there’s two of you. So I’m going to extend to four. So you could do two each. So I’m very keen on two things each that you think for lifestyle that people can achieve that’s reasonable whether they’re perimenopausal menopausal or just listening for pleasure. Because I don’t think lifestyle should be that different, regardless of your hormonal status or not or gender or not. I think we should always having similar lifestyles if we can. Yes. So. So two things each, I’ll go with you Tash first that you would recommend. [00:31:01][94.3]

Dr Tash Mirando: [00:31:02] Certainly. For me it’s go for gold when it comes to your quality of life. Get that protein in, get that fibre and ladies please strength train and I’m talking lift some heavy weights safely. My second is don’t be afraid of hormones. What we have now are body identical hormones using the safest way. So have a conversation with the right person and see what works for you. Just don’t be afraid. [00:31:31][28.4]

Dr Louise Newson: [00:31:32] Thank you. Over to you. [00:31:33][1.3]

Dr June Tan Sheren: [00:31:35] I’m a big picture sort of person, so I want to say that menopause presents a wonderful opportunity for all of us to set ourselves up for health and wellbeing for the longer term. And it might mean resetting, relooking life goals, rebuilding, regrouping, maybe even reinventing ourselves in order to put ourselves on the right track for the next stretch of our lives. And secondly, knowledge empowers. Do not be afraid to ask questions. Yeah. Do not be afraid to question what you think is common knowledge and has been enshrined into into our health beliefs. Do not be afraid to seek out knowledge so that you can make informed decisions for yourself and can therefore take charge of your own health and wellbeing. [00:32:36][61.5]

Dr Louise Newson: [00:32:38] I love that. It’s really good. It’s all about being in control. And knowledge totally is power. And I like the way we can challenge others. We can challenge ourselves. We can change our minds. We can change direction. It’s. It’s all achievable. But starting is sometimes the hardest part of any job, isn’t it? So I know people have started by listening, and I hope people have got lot out of this podcast. I’ve really enjoyed it. So thank you ever so much for your time. [00:33:05][27.1]

Dr June Tan Sheren: [00:33:06] Thank you so much for having us. [00:33:08][1.4]

Dr Tash Mirando: [00:33:08] Thank you very much for having us. [00:33:09][1.3]

Dr Louise Newson: [00:33:10] 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. [00:33:10][0.0]

ENDS