When night sweats are not the menopause with Dr Susanna Crowe

Susie Crowe is a consultant obstetrician and gynaecologist who is passionate about advocating for and empowering women to understand their bodies and supporting them to make choices about their medical care and their lifestyle.

In the midst of the pandemic, Susie noticed fatigue creeping in and put it down to burnout from her busy job. When she began having night sweats and saw her doctor, the menopause was the initial diagnosis suspected but there were no other symptoms of perimenopause occurring. Susie became more unwell and after months of having normal blood tests, further investigations revealed that she had non-Hodgkin lymphoma – a type of blood cancer. In this episode, the experts discuss women’s experiences of sudden onset menopause after treatments for cancer and the benefits and safety of HRT.

Susie’s advice to healthcare professionals:

1. Listen to your patients as they know their bodies best
2. Have empathy for a women’s menopausal symptoms (as they may be worse than those from the cancer or side effects from treatments) and she may feel very vulnerable
3. Prioritise personalisation and choice by providing the right information and encouraging your patient to make their own decision based on what’s important to them and their life.

Follow Susie on social media on Twitter and Instagram

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 balance. On the podcast, I will be joined each week by an exciting guest to help provide evidence-based information and advice about both the perimenopause and the menopause.

Dr Louise Newson [00:00:46] Today on the podcast, I’ve got a patient and a healthcare professional. So it’s really, really interesting because I’m going to listen to two perspectives, actually. So I’ve got with me Susie, who has recently reached out to me and has a very interesting story that we will go through. So thanks Susie, for joining me today.

Dr Susie Crowe [00:01:02] Thank you so much it’s really nice to be here.

Dr Louise Newson [00:01:04] So you were very complimentary in your email to me, which is very nice, but that’s not why I invited you to the podcast. I have all sorts of emails and some are not as complimentary, but that doesn’t matter. I think the important thing is about listening to women, actually, and we’ve all got different journeys, we all have different backgrounds, we have different lives, we have different experiences, but we also have different health as well. And I don’t… we’ll tease this out, but I know from my own personal experience, being a medical professional and a patient is just awful actually, because you think you have more knowledge than you have. And the first time when I was ill with sepsis, after my first daughter, I thought I knew everything and actually I didn’t because I was ill, and I needed someone to take control. But the junior doctors were too scared because I was a doctor. So then I got Consultant led care, which they never wrote in the notes, and there were all sorts of things that really quite scared me about being a patient because I don’t think you get always the best care. People are a bit apprehensive, so there’s lots of things going on. So if you wouldn’t mind Susie just explaining, because you are a gynaecologist aren’t you, so just explain a bit about what you do and then about how you became a patient, if that’s okay.

Dr Susie Crowe [00:02:14] That’s fine. So yes, I’m a consultant obstetrician, gynaecologist. I’ve been doing it for 20 years this year actually, and I love my job, so I’m a general obstetrician, gynaecologist so I do intra partum care really, is my specialty around high-risk pregnancies but also managing risk, managing the labour wards, etc. And on the gynaecology side, I’m a benign gynaecologist and I’m really passionate about advocacy for women and that’s why I went into the job. And one of the things I love about being a gynaecologist in particular, is around informing women about their bodies so that they have the same amount of knowledge I have, and then helping them to make the right choices. On the obstetric side, I run a Birth Options clinic, or ran a Birth Options clinic, that really was around supporting women’s choice and personalisation. So in particular, women who want to birth outside guidelines, for example. So yeah, that’s who I am professionally.

Dr Louise Newson [00:03:08] Great. And so important. I think being an advocate for our patients is really important actually. And I don’t know about you, but I didn’t really learn much about that at a medical school. I had some great training actually with – quite unusual then actually – a psychiatrist that specialised in oncology. And I always wanted to do oncology cancer medicine. I did a lot of training towards it and then changed my job really just for lifestyle and getting married and everything else. But he taught a lot about involving the patient right from the outset and sharing any concerns, and also not just the patient but anyone close to them as well. And also knowing that there’s not a rush in medicine, you know, there are some things don’t get me wrong, if someone was having a heart attack, then time is of the essence. But a lot of things even more serious diagnoses like cancer, we’ve got a bit of time to make sure we’re really on board with our patients and we explore every concern and it might not be apparent initially. So I think being an advocate is really important part of a job, isn’t it?

Dr Susie Crowe [00:04:13] Again, I agree. But it’s also I think, you know, I think I really hope that I provide really holistic care as well. So I’m a really massive believer in looking at the whole picture, but also thinking about advising women from the whole picture’s perspective. You know, I’m a big advocate of diet and lifestyle and kind of weaving that into my practice as well. So it’s about thinking about how we can help ourselves whilst also helping women to understand their bodies and the potential treatment options. Because often things will go hand in hand won’t they, where we’ll need conventional medical treatment. But actually that, you know, we all know that there are things that we can do to boost our own health. And I think particularly with women’s health, I think we have massive opportunities particularly through pregnancy, but then as a life course to actually really pick up and be promoting optimal health for women. And I really see my job as being a big part of that.

Dr Louise Newson [00:05:04] And pregnancy is a massive time because I don’t think there’s any other time in certainly, a woman’s life that she has that much involvement with healthcare professionals, not just doctors, but also other healthcare professionals who can drip feed information, actually. And certainly, when you’re pregnant, you want the best outcomes for you, but also for your unborn baby as well. So it is.. if you can’t get as healthy as you can or get as much knowledge then, then it’s really hard. But to have months of time actually, and even postpartum, you’ve still got time. Most of us never go and see a healthcare professional at all, do we? And we want to avoid it. So actually it’s a really prime time to get as much information. And like you say, holistically is really important and certainly as a general practitioner, it’s really important that we’re not just focusing on one symptom or one disease it’s looking more and preventative medicine has got to include holistic lifestyle, education and information, hasn’t it?

Dr Susie Crowe [00:06:01] Yeah, I absolutely agree. Yeah.

Dr Louise Newson [00:06:02] So then moving forward, as I said at the beginning, you’ve been a patient, not one of my patients, I hasten to add. But what happened for you to become a patient?

Dr Susie Crowe [00:06:10] Yeah. So it goes back a couple of years now. So I think I was reflecting on it this morning. I turned 40 in 2018 and just oh, I was so happy to turn 40. I felt like I was in the prime of my life. I’ve got three children. I got my consultant job that I absolutely love and we have to acknowledge the effects of having pregnancies and children and the effects on your career and, you know, you’re stopping and starting. And I finally felt like I was in just such a great place. I was really fit. I was really healthy. And with hindsight, it was probably in the latter half of 2019 that I started becoming unwell but didn’t realise it. And obviously beginning of 2020, we all know what happened in 2020. So the pandemic hit and at the time I was clinical director of women’s services in the large teaching hospital in which I work. So changing and delivering the care that we needed to was just huge. Maternity care had to keep going throughout the pandemic, but we also had to completely change the way we worked. We had to make new guidelines, we had to work so hard and we also had to really sadly, and really awfully, pause all the gynaecology which we had to deal with as well. So I think in the midst of that context, where I was working all the time, which I really was and was also… had lost – as we all did – the normality of our lives at the beginning of the pandemic. So those things that help us to feel well, we couldn’t do anymore, you know, I’d have these big sessions where I’d go to the gym on these two days a week and do what I did, which I absolutely loved. I love going out to gigs. I couldn’t do that anymore. And so in that context, I was becoming more unwell but not really recognising it and obviously thought it was burnout. I think there may have been a degree of that as well, being completely honest, because trying to work at that level, given the NHS, that much pressure, can be quite challenging. By the autumn of 2020 my night sweats started, so essentially I was getting fatigued but without really recognising it, still managed to do lots of exercise, still managing to work. And then my night sweats started at that point, interestingly, that I went first went to the GP probably in about the autumn and really interestingly, everybody said that it was menopause. So this is the interesting thing about my story and I remember saying ‘It’s not, I know it’s not menopause because I am a gynaecologist, but also I’ve breastfed three babies and when you breastfeed, you have lower estrogen levels’. I know what it’s like to have low estrogen…

Dr Louise Newson [00:08:37] Was it a different sort of sweat?

Dr Susie Crowe [00:08:39] Yeah, it is so different. It’s so different to the sweats you get with menopause. It was just completely drenching. They just come on out of the blue. So, you know, they weren’t every night, obviously, because they kind of start quite slowly. But I would be in a really deep sleep and I would wake up initially like, say a bowl of water being thrown over me. I suppose towards the end it was like a bucket had been thrown over me.

Dr Louise Newson [00:09:01] Did you feel any warmth at all?

Dr Susie Crowe [00:09:03] No, no. No, no. And so I felt really strongly that actually if it had been menopause, and I had that bad night sweats, I’d have other symptoms that were associated with low estrogen levels. So I couldn’t have night sweats that bad without having hot flushes as well.

Dr Louise Newson [00:09:19] And it’s interesting. I mean I had night sweats and never had a hot flush at all, but I did have other symptoms as well. And I did feel this sort of warmth. But also when I woke up, I felt that I was then become more anxious, you know, very common isn’t it, in the early hours when your hormone levels are low. My sleep was very interrupted. I got quite a lot of muscle and joint pain. I sort of.. these early morning symptoms were, so I did have this sort of variation with the day. So there are little things that.. but the other thing is what’s really interesting is that you as a woman felt that, you know, and we learn so much from our patients, don’t we? And I think certainly in women’s health issues, not just in menopause, but endometriosis and PMS, women actually often know don’t they, whether it’s their hormones or not. I know that sounds a bit weird, but they do, don’t they?

Dr Susie Crowe [00:10:05] They do. I think this is it, you know, women understand their bodies. I think because of our hormonal fluctuations, we see it all the time. You know, I see it all the time in my gynae clinic, I see it with my pregnant patients as well. But actually, women know. They know their bodies. We become quite attuned to them. And I knew as well, that I had had no perimenopausal symptoms, none whatsoever. I’d felt completely well up until the point at which I was starting to get tired, essentially, and then these night sweats started. So, yes, initially the first set was done in terms of blood tests and they obviously came back completely normal. And so we were kind of said we’ll watch and wait because all my blood were completely normal. And then we did another set of blood tests. And they were still completely normal. And by this point, actually, I was just getting more and more unwell. So it was the fatigue. And I think if people haven’t experienced fatigue, you can’t… it’s quite difficult to describe it actually. It’s just this absolute exhaustion I felt. I literally felt exhausted to my bones and I would wake up in the morning having had a full night’s sleep and just I would want to cry because I was just so tired. In the midst of it all I’d self-referred into the Practitioner Health Programme. Practitioner Health is it’s name, which is for doctors with burnout, mental health problems. I’d been seeing just the most amazing woman through that who is a GP by background, who I’d been talking to a bit about this who was saying ‘actually you need to go back. I’m a bit worried about your physical health’ but also recognised actually, that I was becoming really unwell and kind of really advocated for me to go off sick, which actually we know what doctors are like, you know, and we’ll be completely honest. I felt terrible about it. I felt terrible about letting my patients down, my colleagues down, but actually went off sick around the Christmas which was around the second wave of COVID hitting. And it was during that time, that having that space, made me realise just how unwell I was. And in that time, that’s when I started getting other symptoms. So the other symptoms I felt: getting abdominal pain and bloating, feeling sick most of the time and just not being able to eat properly. So by the early part of the next year I went back to the GP again because it was really difficult to get, you know, face to face appointment because that was the nature of it, but saw a really wonderful, and amazing GP who did a battery of tests, you know, this poor doctor sitting with a doctor sitting in front of her going ‘I feel genuinely a bit unwell’, you know. But at the same time, I was still really active, I’d cycle there and it was quite a long way, you know, it must’ve been quite difficult for her. It’s hard, I think, treating doctors. But anyway, she did a battery of tests and ultimately what then ended up happening was it came back that I had non-Hodgkin’s lymphoma, basically.

Dr Louise Newson [00:12:43] Right. So that’s a type of – well if you just explain what it is, some listeners might not know, if that’s okay.

Dr Susie Crowe [00:12:47] Exactly. So it’s a type of blood cancer, essentially, and it came completely out of the blue. I think one of my interesting things to learn about was that I had obviously thought about it. I know that night sweats are a symptom of lymphoma. What I didn’t realise was that you could have completely normal blood tests and still have lymphoma which is obviously you know my education.

Dr Louise Newson [00:13:11] Yeah. And that’s really hard, isn’t it. So I mean, when I..my first symptoms where fatigue and night sweats and I felt like I’d been drugged and it was just this most horrible…. but I did have these other subtle symptoms, but I did a haematology job as part of my medical training, and I worked with a haematologist who was an oncologist. And we did a lot of especially leukaemia, but some lymphoma patients came through the unit in Manchester as well. And so I kept saying to my husband, ‘I think I’ve got lymphoma, I absolutely do’. And he said, ‘Oh gosh, Louise, oh, come on, you’ve just got over pancreatitis, you know, there can’t be something else going on’. And so I was convinced, but I knew that my blood test would be normal because I’d done enough training, if you see what I mean. And for those of you listening, obviously blood tests for menopause and perimenopause are a waste of time usually, so we can’t do it. So how do you know the difference? And some of you might be listening, thinking, ‘oh, my goodness me, have I got a lymphoma?’ And how do you know? And a lot of times with patients, we don’t know. And I could have been right or wrong… you didn’t know. And actually often within the clinic we will give HRT. But if we’re worried then we would carry on with the referral to a haematologist and have investigations and also night sweats often improve very quickly with estrogen. So if, for example, someone had, you know, given you some HRT to try, it wouldn’t have harmed the lymphoma. But also, if you were still having symptoms a few weeks later, then you would have known it definitely wasn’t. So it’s just to reassure people that are listening because I don’t want everyone to then go to their GP, over night sweats to think that it could be. But.. and that’s why actually – no disrespect to gynaecologists – I really feel like as general practitioners, we’re in a really good place to help menopause because we’re used to seeing people with unexplained symptoms or symptoms that could be due to other diseases. You know, how do we make sure that someone who’s got brain fog, memory problems and headaches doesn’t have a brain tumour, and palpitations doesn’t have a, you know, a difficult heart arrhythmia? And that’s what we have to do. But we’re used to that. So sorry to interrupt, but I wanted to just reassure people.

Dr Susie Crowe [00:15:18] And I agree, and I think I did have an unknown diagnosis at the time. You know, nobody knew what it was. You know, I think people thought that it was likely to be a cancer diagnosis. But I think we have to be really clear about the fact that I was really unwell. This wasn’t like… I’ve been through menopausal symptoms now, which is why I’m here. But, you know, this is very different and that kind of lassitude and just being so unwell but also other symptoms can start creeping in as well. But at the time it was unknown, you know it was query ovarian cancer, query bowel cancer, query lymphoma, query other you know, there were other endocrine things. We did a battery of tests and in the end, I had an MRI scan and that’s where my lymphoma was picked up. So I was diagnosed with something called follicular lymphoma, which is a low grade lymphoma. Thankfully it’s very easily treated, which is great. Technically it’s incurable, so you’re always in long term remission. But actually, the likelihood is I will be in remission for a long time. And I know that’s life for you.

Dr Louise Newson [00:16:18] But one of the treatments is chemotherapy, isn’t it?

Dr Susie Crowe [00:16:20] It is. And so interestingly my haematologist who’s been amazing, we’re talking about personalised care, has been brilliant and he’s so good at listening to me and he really, really listened to me. He really emphasised that also based on my history in the scan findings so far, stating that this is what I think it is. It had all started in my mesentery, which is this piece of tissue that kind of holds your bowel together. So that’s why it was all hidden as well. I didn’t have any obvious lymph nodes because it was all contained in my abdomen and pelvis. And interestingly, he kind of said to me at the time, ‘Look, I’ve seen this pattern before really interestingly, I’ve seen it in younger men. I was in my early forties with a very similar lifestyle to you’. Interestingly kind of kept talking about the impact of stress on disease, which I didn’t really understand. Talked a bit about you know ‘I’ve seen these men with this particular pattern of follicular lymphoma and you know, you’re going to be fine. We’re going to offer you chemotherapy’. And it was said to me at the time, you know ‘I’ve got these male patients that I’ve seen who’ve got back to their normal functionality, they were all running ten kilometres a day. You’re going to be great very soon’. And obviously recommended chemotherapy to me and my instinct again because I’m a gynaecologist and I thought, oh my goodness, I’m going to have chemotherapy. I’m in my early forties. This might affect my ovaries. So interestingly, one of the first things I actually did because I knew I was due to have a Mirena coil change anyway, was going to get my Mirena changed just in case I went through the menopause, just in case I needed that part of my HRT, basically. So essentially – because in my head I knew it was a risk but at the time the quoted risk is about 4% of cancer. It’s quite low, actually.

Dr Louise Newson [00:17:56] I wonder how they get these levels, though, because it’s very difficult to know because so many symptoms especially even post chemo are attributed to ‘chemo brain’ or.. and because there’s no diagnostic criteria other than symptoms, I think it’s probably a lot higher. I don’t know what you think about that. I think it probably is.

Dr Susie Crowe [00:18:14] I think so. I mean, subsequently I then read every paper I could because that’s the kind of person I am and don’t get me wrong, I trust my haematologist absolutely implicitly. He’s been so brilliant at walking that line between treating me as both a doctor and a patient. But he’s also brilliant because he’ll say, ‘This is what I recommend, this is the evidence base’. But he’ll also tell me the randomised controlled trial which it’s based on so that I understand where that’s come from. I’m not here to challenge him. I’m not, you know, I trust him, but it’s around that understanding that absolutely I had done all the reading. I think it’s a lot higher than that. Absolutely. Yeah. So I went through, I had six cycles of chemotherapy last summer, which finished probably about a year ago, something like that. And I was coming out the other side of it interestingly, because my B symptoms were being so severe, and interestingly the other things I had by this point were weight loss as well. So I was very unwell. But interestingly, because for me my lymphoma symptoms were quite predominated by night sweats, one of our concerns initially was are we missing menopause as well, actually.

Dr Louise Newson [00:19:17] Yeah.

Dr Susie Crowe [00:19:17] So my haematologist had done some extra blood tests and actually my hormones, my ovarian profile, for what it’s worth, was completely normal and still was undergoing chemotherapy last year, again, I didn’t have any menopausal symptoms then. And I think again the interesting thing – and I think this is where we will have to appreciate that as doctors we don’t know everything even when it’s about ourselves and people make mistakes even when it’s about ourselves – what I didn’t realise was that my ovaries could stop working several months afterwards. I think I thought if it was going to happen it’s going to happen at the time. I’m an optimist and so I was kind of coming out to the other side of it, was starting to feel better. So my lymphomas symptoms had started picking up, probably mid-chemotherapy. And then the cumulative effects of chemotherapy meant that the chemotherapy symptoms then started. And then probably by around the autumn of last year, that’s when I started feeling quite a lot better and we started to think about phasing back into work, although that needed to be different because I’m still being treated with a monoclonal antibody that lessens my immune system, so I can’t work clinically. So there’s a lot going on. But overall, you know, I carried on exercising throughout the whole thing. I’ve done loads of yoga. I’ve worked a lot on acceptance and balance, you know nutrition and diets and all of those things. And actually I felt quite well. And then in probably about September time, my first symptom was anxiety.

Dr Louise Newson [00:20:39] Interesting.

Dr Susie Crowe [00:20:39] I got to feel really anxious and really anxious about little things, which just isn’t me at all, I’m an obstetrician. I deal with.

Dr Louise Newson [00:20:50] Lots of anxiety.

Dr Susie Crowe [00:20:51] Exactly. You know, I deal with adrenaline. And that’s what I love, you know? So at first, the anxiety, then a little bit of hot flushes, not huge actually. I was applying for new jobs at the time. We kind of came off a couple of kind of pre-interview meetings, Teams meetings and thinking, I feel a bit hot!

Dr Louise Newson [00:21:07] Yeah.

Dr Susie Crowe [00:21:08] And then interestingly, woke up in the middle of the night one night, with the night sweats. But interestingly, I just didn’t think it was lymphona I just knew it was menopause. And it’s because I was hot.

Dr Louise Newson [00:21:18] Yeah, isn’t that interesting? So quite different experience to before.

Dr Susie Crowe [00:21:22] Completely different experiences. So I basically woke up fanning myself in that very typical kind of way, was fanning myself, I’m really hot and I kind of sat on the side of the bed and thought, ‘Oh my goodness, this is menopause, I’m a gynaecologist. I’ve only just realised it’. So I think the other thing about it is that – and this is where I think it’s different for the women who’ve been through chemotherapy – is it’s not gradual. You don’t go through the perimenopause, it hits you really hard. And that was it. I got hit really, really, really hard by it. So it kind of ramped up very quickly from kind of these mild symptoms to quite severe anxiety and insomnia. And I couldn’t sleep. So I went to the GP to say, and I have to point out I was with a big conglomerate GP practice at the time which isn’t necessarily set up for chronic disease and I’ve changed since then. I’ve got really wonderful GP practice that I’m with now. So they said, ‘Well, no, because you’ve got night sweats again, you’ve got to go back to haematologist’, which is also this whole thing about, you know, I suppose what I want to say is it’s just about listening to patients really. But I can see why people are anxious about these things.

Dr Louise Newson [00:22:33] Yeah.

Dr Susie Crowe [00:22:33] So I went back to my haematologist who said ‘I think it’s menopause, your scans, we just scanned you, we couldn’t find’. I said ‘No, I was in remission’. So went back to the GP and said, ‘No, we’re happy for me to have HRT’. And essentially, they weren’t happy to prescribe it because they said that I needed to be counselled on the risks because I’ve already had one type of cancer. And this isn’t …obviously this is my story, but this is one of the reasons I reached out to you is because actually this is very universal for women with blood cancers actually.

Dr Louise Newson [00:23:04] Yeah. And we see it with all types of cancer actually. So just to be clear, we’re not talking about breast cancer. We’ve talked about this in other podcasts, but there are so many other cancers and people then seem to think that HRT is bad. And when I do training for healthcare professionals, because I was never taught any of this stuff at all and actually I feel really embarrassed now saying that I worked for six months in a leukaemia and lymphoma unit and we didn’t even ask them, we didn’t give them any information, didn’t tell them they could become menopausal. Anyway, I can’t go back, but it’s not on a lot of people’s radars. And so I often, maybe it’s very simplistic of me, but I love this when I teach healthcare professionals. I’ll say ‘would this lady have a type of cancer if she was young and would part of that treatment be to remove her ovaries?’ So if you, as you were menstruating when you had your lymphoma diagnosed, did any of the cancer specialist haematologists ever offer you ovaries to be removed as part of your treatment? Well, of course not, because your own hormonal function, estrogen and progesterone, testosterone, are not interfering with the cancer. And in fact, they were helping you to function. And we also know that estrodial and testosterone are actually very anti-inflammatory. And that’s probably one of the reasons that women probably have less cancers actually when they’re younger. And this is the really key work that we’re doing with some really big team of people. So actually that it makes it very easy. And then it’s not just with cancers, actually, if someone has, you know, a clotting disorder or if they have migraines or anything, I’ll often say to medical students and nurses and doctors and pharmacists, ‘well, would you advocate taking her ovaries out then? No? Why would you do that? Okay. Well, then HRT is just replacing that’. And also, you know, you’re young, so it’s important that you do have the replacement hormones, as we know for many reasons, for your future health. So in that way, I think it’s almost easier to conceptualise, isn’t it? But there’s still this myth and we see it sometimes in medicine when we’re out of our comfort zone. And I’m sure you’re very aware when we’ve got pregnant women – and goodness only knows pregnant women can still have other diseases and symptoms – but it’s very much… when I was working on labour ward I’d often get phoned up ‘Oh, this lady’s got a migraine. Can she come into labour ward because she’s 36 weeks pregnant?’ ‘No, you can treat her migraines’. And I think you get clouded because people get scared.

Dr Susie Crowe [00:25:28] Absolutely. Again, we see this all the time, as you said, with pregnancy as well. We see this all the time. Where actually we have these gender biases. We’ve seen it with COVID. You know, the data with COVID showed, yes, pregnant women, unfortunately, had worse outcomes because people were scared to treat them with the appropriate medicines. Now, I’ll say just because they’re pregnant. You know, we’ve seen the same around things like heart attacks in pregnancy, etc. And that’s one of the reasons that, you know, again, to reassure people this is getting much better. This is how we just you know, this is all about how we’re improving medicine, improving our understanding. You know, on that side, we got these massive maternal medicine networks that are making a big difference, I suppose kind of going back to the ovarian issue, which is exactly as you described. If I as a gynaecologist, took out women’s ovaries, which sometimes I’ve had to and I’ve had to remove both ovaries, I would give them HRT straight away and that would be our practice. And I suppose I also understand the history of HRT was, I suppose I was at medical school in the late nineties when it was the wonder drug, and I remember sitting in a lecture with this lecturer saying, ‘You have to tell your mother to take it because it’s the best thing ever’. And I was an obstetrician, gynaecologist in the early noughties when those big studies came out. But actually interestingly, I was working in the menopause centre that was one of the big research centres for menopause where we were already saying, ‘Actually we don’t think this data is right’. You know, we were getting into it all the time. That’s been a part of our teaching. And so I suppose again, just thinking about my own personalised care, I completely understand that there are all sorts of ways you can treat menopause and there are all sorts of ways that women want to deal with it and everybody’s individual. But for me as a gynaecologist, I’d always looked at the risks and benefit profile of HRT. I’ve looked at the risks of breast cancer associated with drinking or obesity. And, you know, we can’t modify all risk factors that present as cancerous, as I have found, because, you know, I suppose I’d always I’ve made the decision many years ago that I was going to have transdermal estrogen when I went through the menopause. So for me, it was just like well there’s no difference. But also I didn’t feel as though it was a gradual transition. I didn’t feel like it was traditional menopause. I felt like I say somebody had taken my ovaries out. It was so sudden. And having looked after women who had their ovaries taken out, I feel like I kind of knew what that was like. And so I felt that actually this was a hormone deficiency that I just needed replaced. And if it be my thyroid gland, there wouldn’t have been a problem over it essentially. But it’s that fear, isn’t it? There is that huge fear around HRT that had crept in 20 years ago that I think is still just hopefully starting to eb away a bit now.

Dr Louise Newson [00:28:09] Well, only a bit, unfortunately, because it’s 20 years. Earlier in July 2022, it was 20 years, and the 9th July is 20 years since the publication went out. And we’re still trying to reassure. And I think it’s a great way to end, isn’t it? Because the most important thing for me actually isn’t the evidence. It’s about patient choice, and it’s about understanding and allowing women to make the decision. When she’s been given the right information, she’s had the right time. She’s not pressurised. She’s just deciding for herself and also knowing that any decision for treatment can change at any time. Everything we do is reversible in medicine. Well, not everything, but certainly prescribing HRT is definitely reversible. Having a baby is not reversible! And I think knowing that we’re there at every stage of the journey with our patients is really important. So we can help with doubt, we can help with uncertainty. We can also reassure and educate those around them. So it might be their relatives that are more scared than the actual patient. So, you know, the experience you’ve had and very kindly have shared so openly. So thanks, Susie, because that’s I’m sure will help a lot of people. So just before we finish, Susie, I’m going to try three take home tips on you. And I’d really like you to try and help really answer three ways that you think women could be more listened to by the healthcare professionals to have this united journey together.

Dr Susie Crowe [00:29:31] Absolutely. I think the bottom line is, is that we just have to listen. It’s about listening to people and understanding their experiences. And so I think the first thing is about listening. The second is about empathy. And what I have found on this journey is that actually my experiences of my menopausal symptoms, actually in many ways were worse than many of the other symptoms that I had through other things. And as I said, I’ve got the advocacy to have got the treatment I needed, but not everybody else has. But despite that, actually what I found dealing with people is that when you’re unwell, you’ll feel very, very vulnerable and just empathy goes a really, really long way. And the other thing is just around personalisation and choice. So kind of having that really solid understanding of what makes a difference to people and giving people a really open choice that’s not paternalistic and actually is ‘this is the information I have, you make the right choice for you and for your life’.

Dr Louise Newson [00:30:26] Yeah, really sad because we’re all individuals, aren’t we? We choose every day what we’re going to wear or how we’re going to spend the day, and that needs to continue in the conversations with health as well. So thank you so much for your time. And just to finally tell everyone that Susie’s going to work with my team to produce more literature actually for women who’ve had cancer, but especially haematological cancers such as lymphomas to help educate them more so thanks in advance for your help with this and thanks for your time today. It’s been great.

Dr Susie Crowe [00:30:54] Thank you so much. Thank you for having me.

Dr Louise Newson [00:30:58] 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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