[00:00:00] Rani: Hi everyone. Welcome. This is Rani here with Helen. We had a few technical issues, but , hopefully it’s got resolved now. So, please feel free to say, who’s here and where are you joining us from, but it’s very exciting to be here. Thank you so much for your time today. So I will let Helen go first.

[00:00:23] And Helen, do you want to introduce yourself?

[00:00:26] Helen: Hi, my name’s Helen Kini. I’m an NHS GP up on the Wirral. I’m also got a real passion for women’s health. I’ve been doing further studying and education for the last 20 years and over the last few years after also discovering lifestyle medicine.

[00:00:42] I’ve set up a lifestyle medicine clinic on the world and, I’ve been able to pursue the women’s health aspect specialising, looking after, supporting women through the menopause, having a sort of holistic approach with both looking at the hormonal health as well as lifestyle.

[00:00:57] Rani: This is brilliant, Helen, because this was just I remember you we, we made contact.

[00:01:02] We had a conversation and you said, Hey, Rani, do you know it is well, menopause day? I said, No I didn’t. And then this conversation was that many people are struggling. And would it not be nice to just give, share some ideas, share something that we know might be of help because we are both interested in lifestyle medicine.

[00:01:20] I think the few things in common, isn’t it Helen? We you are a lifestyle medicine physician. I am studying to be a lifestyle medicine physician, but I’m already doing that. And we are both interested in the holistic, holistic approach to health and wellbeing. We are both, we are women.

[00:01:34] We are going towards that stage. I def definitely in perimenopause and I know I’m going slowly creeping towards menopause and. Sometimes, I guess if you don’t understand, there’s an apprehension and, you hear all the stories of things going wrong and being a psychiatrist I have seen things go wrong for people and they might be misdiagnosed with something else when actually all that’s happening is that they are, know, going through some severe, per menopausal symptoms, which mimic something else.

[00:02:01] And if is some kind of mental health issue. So if we do, if you’re not even aware, some, know, some of the symptoms and how we can minimise that, how we can support our health I think that you could go down that sort of That rabbit hole where you don’t even know what’s happening and then you think that, okay, maybe something else is wrong with you, or something is seriously wrong with you.

[00:02:20] So we thought, let’s have a conversation and very honest conversation about menopause. Something that we all go through the transition from, one chapter of the life to another and how can we make it more smooth sailing rather than a bumpy ride. And so that’s the conversation I want to have.

[00:02:37] I’m no expert in menopause, but I do have understanding of mental health issues in menopause. So this is what we are talking about weren’t we, Helen, right at the beginning? But tell me, I know that this is your special, you are specialising in women’s mental health, especially in menopause.

[00:02:54] What are the key things that people need to be aware?

[00:02:57] Helen: I think the important thing is exactly as you described is about understanding and it’s about understanding what’s happening to yourself during this period in your life. So obviously before premenopausal when we’ve got our normal cycle, and for lots of women that can be different, we’ve got a constant fluctuation of our hormones.

[00:03:15] But during the perimenopause that can occur seven to 10 years before the actual menopause, which is the stopping of the period, or a year after the periods have stopped, you see quite a fluctuation and a steady decline of the hormones. And because we’ve got estrogen receptors in every cell of our body, we start noticing quite a significant number of symptoms, both psychologically psychological symptoms and physical symptoms.

[00:03:37] And up to date, there’s up to 50 symptoms that have been mentioned and if not more, I think someone mentioned last week up to 63. So these can range from all sorts and I think. From my experience from supporting women during this transition, as you described, Ronnie is actually, life is really super busy at this stage.

[00:03:55] So you can be juggling children, juggling relative elderly relatives, obviously working and all those things like fatigue, joint pain, aches even skin changes, anxiety, all those type of things we can put down to life events we can put down to stress. And actually the peri menopausal symptoms can be quite insidious.

[00:04:16] They can creep in and people notice sometimes worsening migraines and obviously like you said, they can start wondering if something more physical is wrong with them. I think unless you actually aware yourself that this might be occurring sometimes when you go and see a gp, we are as gps obviously we can, we work with having a conversation with you and and when I was studying, I’m not sure about yourself, but we weren’t trained as fully about menopause actually itself and the treatments for it.

[00:04:43] So it depends on who you see, whether or not they bring it up as a potential differential. And sometimes, as you said, we can go down rabbit warrens. I’ve got patients who’ve been to see cardiologists or probably seen yourself Rani, from a psychiatry point of view. And actually, if you look at the whole picture and you talk to the women, it actually, it is this menopause transition, which.

[00:05:04] Obviously we need to look at it from an individual point of view about how we help support that, that woman through that. Is that your experience? Have you had experience of people being unwell from a mental health point of

[00:05:14] Rani: view? Yeah I have also like that extreme, obviously because we are in secondary care, we get to hear of the extreme cases.

[00:05:23] I, I know people who have been doing super well and they have been in some sort of carrier and everything and they have no history of mental health issues. And then all of a sudden, they might even present with very stressing due psychosis, for example. And I know I’m talking about extreme cases because, being a psychiatrist, I do get exposed to extreme cases, but I also know that.

[00:05:44] When they say that it’s interesting when you take the history, they said, Yeah, it was just like when my, my, my periods were, about to stop and then I said this, clearly there is something else going on here. Like, otherwise you could be just diagnosed with something else.

[00:05:58] Like, the psychosis stressing your psychosis and you don’t even pay attention to the hormonal aspect. And I think now, people, sometimes people are aware of it, sometimes they are not. And when it comes to women in our age, know, over the age of over the age of 40 or even in the late thirties, isn’t it?

[00:06:15] Sometimes it can be perimenopausal symptom can start quite early for some people, and I know of someone who’s so young, but there’s a family history that her mother had menopause when she was like in her like late thirties. Can you can imagine that. And she was having all the symptoms and no one was even considering menopause or perimenopause.

[00:06:34] Cause she’s too young. And so clearly, I have seen cases like this. If you, it’s not in your radar, and if you’re not even aware, it would be so easy to have the piecemeal of piecemeal treatment, or I’m having too much of migraine. Okay, take this anti migraine tablet. Or I’m having like an anxiety and, anxiety and, low mood.

[00:06:52] Okay, take this antidepressant. So it could be very piecemeal rather than really look and, what is the underlying cause of all this? What is the source of all this? So I think this conversation, and I think on in one hour we can only cover so much, can’t we, Helen? But I, what I’m hoping is people who are attending will just be more mindful.

[00:07:14] I say, Oh, this interesting. No one even thought about it. But can I, can this be a possibility? Because I don’t understand why suddenly I’m starting. Brain fog, for example. And my concentration is dimming and I can’t seem to recall things. And by the way, for people if you don’t know, so if anyone doesn’t know here, the theme for this World Menopause Day is about cognition and mood.

[00:07:39] So, and they I went to the website and then they have this review paper on brain fog In menopause, a healthcare professionals guide for decision making and counseling on cognition. And I think. Most people were to read this and they could then at least they would say, Oh wow, okay. I can explore that.

[00:07:58] Some of this might, might be to do with menopause. And they were also trying to reassure people that, it is unlikely that, just because you have this brain fault that it will proceed to having something serious like dementia, for example. But Helen over to.

[00:08:12] Helen: Exactly as you described.

[00:08:13] But then, I think it’s about thinking menopause, isn’t it, for yourself. And obviously when health professionals, chat to you as well, we’ve gotta be thinking about it as a potential, as a, as a diagnosis. So you mentioned early menopause. I think that’s really important to talk about.

[00:08:27] One in hundred women under the age of 40 will have what we call premature ovarian insufficiency and one in a thousand under 30. So, this is happening and and I think, for women going from say 40 to 45, and obviously it’s all individual, but your periods can start changing and that obviously.

[00:08:46] Historically was a sort of a sign that things were changing and that is the case. But for some women, their periods remain quite regular. So these other symptoms that start coming, people discount, para menopause as an option, but it can be the case. And I think it’s just about being mindful and of course, making sure that you see your GP or your, your practice nurse and make sure there’s nothing else going on, cause that’s important to exclude at this time in life as well.

[00:09:09] But I think from my experience of seeing a lot of ladies, it’s about actually bringing up that conversation. It’s having that chat and I think this is where we get to the diagnosis and , it is a clinical diagnosis essentially under the age of 45. It is reasonable to do blood tests and for some women that is helpful and we have to repeat them occasionally.

[00:09:27] For women over the age of 45, there is actually no regarding nice guidance. There’s no indication to check bloods and it’s based on a clinical diagnosis. So, we use different scales. We use we, chat to the patients about their symptoms and actually, you it is about talking about a management plan.

[00:09:45] Then, obviously prioritizing lifestyle and thinking about what aspects of that could help. And also considering hormone replacement if indicated, if patient’s able and having that chat about giving a woman all her options and then coming to a shared.

[00:10:00] Rani: Yeah. Yeah. Let’s talk about the test, First of all, so did I hear you say that if someone is more than 45 years, there’s no point of doing blood tests then?

[00:10:09] It’s more of a diagnostic, like clinical. But if someone is less than 45 years old because people are not even considering menopause, So what kind of, so if someone is listening here and they say they’re from the uk where we have got, access to, its, so what could they tell their gp? Like, what kind of blood tests should they be asking?

[00:10:28] Helen: Okay, so usually obviously it’s still based on a clinical diagnosis as well, so it’s about having a chat about the number of symptoms. There are quite a few and we can share these, after this event, there are quite a few trackers that people use apps or form, forms that you can fill out with number of the different symptoms that you might be experiencing.

[00:10:46] So that allows you to gather it altogether and take that with you to the gp. And then if you are under the age of 45, obviously your GP will be thinking. Are there any other reasons why you may be experiencing this? Thinking about things like thyroid and, other symptoms that can present with similar symptoms, but.

[00:11:03] But the blood test itself, we use follicle stimulating hormone, FSH. And that gives us an idea whether or not the the brain that, part of the brain, the, the, within the hypothalamus and the pitu clan is trying to stimulate those ovaries to produce X. And if that’s the, they’re stimulating them and it’s not happening,

[00:11:20] the feedback session makes the FSH go up. So sometimes for women, we see that climbing and we see it above a certain level, and we can know that’s more likely to be the menopause. But hormones keep fluctuating. So it could be that by next month it’s down again. So we do for the early menopause, so under the age of 45, ask for two separate blood tests, at least six weeks apart with the FSH, just to see again, and two normal blood tests

[00:11:44] doesn’t discount the perimenopause. And I think that’s really important cuz a lot of women do go and I’ve heard many stories of being told they’ve had a one blood test. It’s normal. So perimenopause is being discounted and I think working with your GP or your health professional and actually, using the trackers and explaining that you have these number of symptoms and actually you, you do want to talk about possible treatment options, I think’s really important.

[00:12:08] Rani: Oh, brilliant. Emma says, I found a balance app useful to track symptoms. So is it one kind of app, the balance

[00:12:15] Helen: app? Yeah, so, Dr. Louis Newton who’s obviously done an awful lot of campaigning around menopause, they’ve developed a balance app. They’ve got a great library of resources on their website, Balance Menopause and the Balance app is

[00:12:28] a very good example of fem tech tracking, where you can actually pop down all your symptoms daily. I think it gives you a lot of good information and advice and sign posts to you, and you can actually download a health report from that and take that to your health professional. So that really helps the conversation.

[00:12:44] It is a quite complex conversation, and it can’t necessarily be done in one consultation and we need to, gather that information and work with you. So I think it’s really helpful. Yes, and I signed post patients to that as well. Is it free app?

[00:12:56] Rani: It is. Oh, brilliant. So yeah, I would say if the lady thinking, Oh, I’m not sure whether to, how to go about it. Definitely. One quick action you can take as a result of this webinar is definitely have a look at the Balance app and if it appeals to you, then you can download it. So, can you take a question?

[00:13:14] I know that we had in mind that maybe we’ll talk for a, half an hour or so and then we’ll get a question, but I think, as, let’s go with the flow and there’s a question and it might just make sense to answer it now. Hello Kavita So Kavita is a colleague of mine, she is an NHS consultant psychiatrist listening in.

[00:13:31] My question, is there any link between age onset of menstruation and age of onset of menopause?

[00:13:38] Helen: Great question. So ultimately as a woman, we have a finite number of eggs, so within our ovaries. So ultimately, once those eggs are have been used or for want of a better word, your eggs supplies depleted, you’ll, we’ll, your eostrogen levels will deteriorate and you’ll go into menopause.

[00:13:55] So, I believe that there is a, an association with that. But again, it’s very individual cause it depends on that woman and her egg

[00:14:02] Rani: level. Okay, excellent. Unfortunately in the UK not all GPs are performing blood tests when menopause is established. Do you think having tests is important?

[00:14:13] You already said that, didn’t you? Yeah,

[00:14:14] Helen: I mean I think once you go past the age of 45 or certainly you have stopped your periods then there are no indications really to require blood tests. And I think it, that is quite important, but also quite a confusing time for women. Cuz I think, especially if you’re still having irregular bleeding.

[00:14:31] I mean we described, didn’t we, that peri-menopausal time, you I think as a woman, and I’ve chatted to a lot of women saying they just want to know, I just wanna know, what does, can I, can we just have the test And I’ve had a lot of conversations and it doesn’t actually change our management.

[00:14:44] So it can feel, I think, frustrating for women not having a test, but actually it is an opportunity to have a conversation around that holistic approach to menopause. There’s lots of new exciting research out there. There’s some talk about I was down. British Society of Lifestyle Medicine Conference recently, and I’ve work working alongside a company called a science company called Agile, who are actually looking at the vaginal microbiome.

[00:15:06] So the bugs within our vagina that actually can actually demonstrate possibly we’re in the, they’re in the pilot stage at the moment where we are in the transition for menopause. So, there, there are new, there’s new research coming out all the time and hopefully we’ll be able to utilise that alongside the clinical approach on blood tests if you’re young to help support, diagnosis at this stage.

[00:15:27] Rani: Darlene is asking, I’m 53 and still having regular. Are tests still a moot point?

[00:15:34] Helen: I think that’s fantastic. So Darlene, that means that, obviously you’re having a regular cycle. We know that the whilst you’re still having your regular cycle, you’re quite protected from a, from the estrogen point of view.

[00:15:43] So thinking about your long term health, and we haven’t moved to that, but the obviously after the menopause, we are at increased risk of long-term conditions such as chronic cardiovascular disease, diabetes, osteoporosis, obviously from our bone health point of view. So, if you’re having regular cycles, that’s a really good sign for health then, but it doesn’t mean that you’re not perimenopausal.

[00:16:02] But yes, from a blood test point of view, I wouldn’t be worried about that. And if you were starting to show symptoms alongside your your regular cycle, which were giving, troublesome symptoms that you wanted to talk about treatment regardless of that from a lifestyle point of view which we’ll move on to, we would encourage that.

[00:16:17] But no, I wouldn’t do any

[00:16:18] Rani: blood tests. Yeah, but that’s a, so, so I guess what I’m also hearing here and contemplating is like okay. For people who are already in menopause that, we can look at how to alleviate those symptoms, but people who are in the perimenopause and we know that our, we, our biological age is going that way, where you know it’s going to, our estrogen is getting more and more in lower and lower, and rather than weight and for the inevitable, is there anything we could do in terms of a lifestyle that could also support us?

[00:16:48] It’s not like, jumping from a cliff. So, we do a more slow coming down the cliff, .

[00:16:53] Helen: Absolutely. There’s a lot of research going on out there and there’s been some more published today around estrogen actually having an anti-inflammatory effect for a lot of women.

[00:17:03] So as our eastern levels do do fluctuate and diminish, we are going to get potentially more of an inflammatory response. And as we know Rani, it can affect so many different areas. So it can affect obviously your ability to digest effectively, it can affect your way, you manage sugar and all those other things that obviously then have an impact on your long term health conditions.

[00:17:24] Like we mentioned before. So from a lifestyle point of view, there’s absolutely loads we could do and there’s lots of evidence around that. By making lifestyle changes, we can actually really improve symptoms. So reducing alcohol and caffeine can make a huge difference to hot flushes and obviously any urinary symptoms that patients might be experiencing.

[00:17:43] We know that there’s a, there’s some research around the Mediterranean diet and improving menopausal symptoms and there are increasing Evidence around diet dietary changes which, looking at the whole food, plant-based type diets and reducing processed food can really improve symptoms for patients, which I’ve seen patients do in isolation.

[00:18:02] And I can see one of the questions saying about patients who can’t take hrt. And that’s absolutely key, for us to say there’s lots that we can do to help increasing physical activity. Obviously we know how beneficial that is for our long term health and our bone health, but that can really improve symptoms by increasing our muscular mass and, things like that.

[00:18:20] So, yeah. And moving on to the psychological symptoms, Ronnie and I know this is your area of expertise, but, managing our mind during this time and managing energy is absolutely key. And, a lot of women come to us and it’s that fatigue that lack of energy, the dips, the brain fog, the, and actually by being self-aware that this is happening and putting in Different personal to you about different ways to manage that I think are really key.

[00:18:45] You might want to give us some advice on that as well.

[00:18:48] Rani: Yeah. I’m just taking, thinking of taking a back, I know there’s some more questions, but I want to pose the questions just for now and just to, so that we are doing it like a sequential order because I like to just think simple and say, okay let’s two step by step in a way.

[00:19:03] And definitely, we definitely will come to your questions. So maybe this is a good idea so that you don’t go away and you stay until the end of this this webinar because we are going to talk about those. What I’m thinking is you, I’m just thinking more about. Preparation and, we talked about some symptoms and so I’m thinking of like, say for example, someone is in their forties and they’re starting to notice and maybe meet food least forties and starting to notice that okay, they’re they are in the para menopausal symptoms.

[00:19:33] It’s not un, it’s not bothersome at the moment. And so clearly, so when we talk about lifestyle, in lifestyle changes, lifestyle medicine approaches, I guess the best time to implement those would be even before we are, rather than waiting for symptoms to, for us to experience symptoms when we know that, okay, I can see my per menopausal belly.

[00:19:55] I guess for me it was like the, okay, where’s this come from? from nowhere. So, Okay, there’s a sign that, okay, I’m I’m going that direction. I guess I, I’m just thinking about, the lifestyle practice and obviously stress is a big thing, isn’t it? I’m just, again, I’m, The reason I’m slowing down here is I’m thinking, I’m just allowing, this is an invitation actually to all the other women in in in this webinar.

[00:20:18] I’m assuming there’s all, all women, but there might be also some men, but I’m just in, in invitation for us to just slow down a little bit because I think most of us by this time, we are in a peak carrier, isn’t it? Like we have been junior doctors or, junior in the professionals, and then we are setting up a family and we are working hard.

[00:20:38] And like in a mid forties, like we have, we are in that like, wow, we are going to get the next promotion or we are doing the next listing thing and we are super, super busy and there’s so many different things and. One of the things that I know from the coaching aspect is most of us are not paying so much attention to our own needs.

[00:20:58] We are just giving, we are being imam and we are being this professional and we are a bang, let’s do this and doing thing. And we are like driven. And and that’s something that I want to say from our own life that I can be so driven and then I can, I say, Oh yes, I can experience that, but you know, let’s ignore that.

[00:21:13] But in this conversation I’m hoping that, it’ll make all of us pause a little bit and no matter where we are in the perimenopause or whether you perimenopausal or menopausal of post-menopausal, we can, you know this, there’s still time to slow down and just consider like the key areas of our life in which we call lifestyle a key lifestyle medicine.

[00:21:35] Areas There are four. In total there are six, but four of them are the ones that you know, that keeps coming back again and very, it’s very simple to remember. And I use an acronym Helen called Meds, m e d s. I say, your meds not working or normal meds not working. Try this new meds.

[00:21:53] So can all that’s not working through this new meds. But basically, It’s about m is poor, the mindful activities, it’s about slowing down. It’s about looking at as stress levels and saying, Okay, what is contributing do to my stress? And how can I like look at this? How can I reduce it so that I have an optimum, stress level.

[00:22:13] Obviously we all, we can’t do without stress, but, how can I function at the optimal level? So that’s a really good, one of the. Key lifestyle area that we can still implement no matter where we are in this in in, in this timeline of or its range of being a woman in transition.

[00:22:30] The second one is E, which is about exercise and movement. Again you talked about it and we really come back with come back about it. So exercise and movement, how key it is for us. And especially because as we grow older, we lose our muscle mass, don’t we? And so like, Some sort of weightbearing exercise is so key for us, including some just, normal walking and that kind of thing.

[00:22:51] D is the diet you talked about and, just keeping it very simple. And the whole food plant-based diet, Mediterranean diet is something that, like you said you can check it out because it’s quite, very doable. The Mediterranean diet, it doesn’t feel like a diet at all.

[00:23:06] Basically. You just know, oh, this is quite healthy. Then I can continue this way rather than thinking I have to cut off everything. So Mediterranean diet is a really good one and not, Restrictive in my view. And the s sense for sleep. Sleep is something we’ll come back to because I know that at least in mental health, the, one of the key foundations of all the, the pillars that we are gonna talk about is sleep.

[00:23:27] And if the sleep, if we can, if the sleep goes wrong, or if we can at least do something with the sleep, then we can, most of the symptoms can, can get better. And the other two two ones of li lifestyle, medicine areas about reducing or abstaining from use of addictive substances and less caffeine drug, alcohol, we obviously have to mention drugs as well and as, as well as nicotine.

[00:23:51] And the final sixth area is about those connections that reach connections and support from one another. But when I say connections, One for me and talking about how we can help ourselves and slow down and everything. It’s a connection with ourself. Yeah. Something that we don’t pay attention to. We think, Oh, it’s all, have to go and reach out to friends and that’s great, but it’s also about being comfortable.

[00:24:16] On our own and being our, have a good, having a good relationship with ourselves. I think that’s another key one. So, so that can be done in any time, isn’t it? But mostly when you know, you are not having those symptoms yet, But you could have those, you might not have those. But when you have a good lifestyle and are, you are approaching it from that, from that mindset, so to speak, chances are that you won’t have such a hard problem, Hard time is it right

[00:24:42] Helen: Helen?

[00:24:43] I think it is, and I think, we know lifestyle medicine is for everybody, isn’t it? We all need lifestyle medicine for all, from. All aspects of our lives. And I think you’re right. I think if you can approach it in that holistic approach from your lifestyle, thinking about all those different pillars, it’s really key from all the women that I’ve looked after.

[00:24:59] I think actually, going back to the connection is absolutely key. A lot of women actually can feel that they lose that connection with themselves a bit at this stage of life. You can start feeling like you’re just not yourself. And actually, although we talked about all those multitude, different symptoms, I think that’s probably the biggest tell.

[00:25:15] When I’ve speaking to people, they just sound, I just don’t feel like me. And I think that’s so important. And I think sometimes we do use ourselves a bit this time of life, don’t we? Both through physician in the family around work and it can all just be so busy we can lose ourselves and what nourishes us really.

[00:25:31] So I think that’s really important and I so many times when we’ve chatted and we’ve within the lifestyle medicine clinic flourish that I work in we try and put a lifestyle prescription, around a patient. And so often with women during this transition, it’s about prioritizing yourself, putting yourself a bit higher.

[00:25:46] Self care is absolutely key. There’s a brilliant self care leaflet around menopause that’s just been released, which is brilliant. Talking about all the different pillars and how relevant to menopause. So that’s worth looking up as well. Just thinking out loud, that would

[00:26:00] Rani: be the, where can people find,

[00:26:02] Helen: So if you just put self care, the self care forum and menopause, that will come up.

[00:26:06] And that’s got some brilliant advice. That’s just been one of the supporting resources come out from the women’s health strategy when the, that we are looking at trying to help women across, across the country. So I think that’s useful and I think self care is so key, isn’t it, in everything we do.

[00:26:20] And it’s the first thing that goes when we’re really busy. .

[00:26:22] Rani: Yeah. And I think maybe I. I’m wondering whether we can see this this transition, menopause transition as a, as an invitation from life for us to slow down. Like slow down intentionally. Like, I’m not saying, Oh, don’t do anything and just sit and do nothing.

[00:26:40] , you wish you could just slow there. You do nothing and you don’t have to look up to the kids and the dogs and that kind of thing. But I genuinely think this is an invitation for us to slow down enough and prioritize and say what is it my life about? I could just chase, I could just keep doing and I could just keep chasing things.

[00:26:57] The next goal or, say everyone else is important, but what, is there a message for me? Again, this, again, this is about the coaching element. It’s like if I were to use this phase, this menopause transition as an important chapter in my life where I can like again, reconsider my, my, what my priorities are and you know what my values are, what my, why am I doing what I’m doing?

[00:27:21] And that, that way when we are allowing ourselves to slow down, then we have those answers like, maybe I need to speak to someone. Maybe I need to. Reconsider, my that I wanted to do the yoga, wanted to do this thing, and I was drawn to do this, but I said, Oh, I don’t have any time now because I have to do all these sort of things.

[00:27:40] And maybe its a, something which I really need to consider bringing into my, in busy schedule. But as a meantime, and it doesn’t have to be doing, it could just be being I just choose to like that one hour. I’m not going to do anything else, but I’m intentionally going to slow down with my cup of, tea and have my favorite book in front of me and give myself that permission.

[00:28:01] And you’d be surprised, like in my coaching conversations, how many people don’t do that? How many people but I’m not, I’m too busy, Ronnie, I’m too busy to do that. I don’t

[00:28:09] Helen: do that. Ronnie . I I, if there’s any pillar that I need to work on, it’s that active mind there.

[00:28:13] You’re okay. I’m busy. I feel like I’m achieving. And actually, as you get, and if the sleep goes or anything like that, it’s really difficult, isn’t it? And I suppose that’s, from a personal conversation, that’s when I notice the sleep, the migraines starting to affect and, and just rather.

[00:28:29] Address it. It’s just busy. Tick that tasks. And I think it’s, you’re completely right, it’s about being really honest with yourself and thinking, actually, no, this isn’t right. And I need to have a think about how to do things differently. And that’s actually okay. Yeah. Cause I think sometimes women feel that if they are having to change things and everything that’s a failing in some way.

[00:28:46] And it’s just definitely not. If anything, it’s a superpower I think. And it’s an opportunity to to really thrive. Cause I’ve met a few women that have actually seen it as an opportunity to pivot in careers, Right. Who actually step out, do that thing they want to do. And I spoke to a patient this morning and I asked if I could use their analogy, but she said since starting the self care, she said, I feel like I’m doing what I need to do.

[00:29:09] Like put my own oxygen mask on before looking after others. And I thought, That’s so true, isn’t it? And she was saying that since. More for herself, which she thought initially was quite a selfish thing. And I could completely empathize because if I, you do things, you almost needing permission from others to, to put that self care in place.

[00:29:25] She said she felt she was more patient, she was more able to perform, she more productive at work. And I think we all know how much better we feel when we go for that walk in nature or we do go for that bath and then have a better sleep. But it’s doing it, isn’t it? It’s that doing.

[00:29:41] Rani: And I that’s really interesting.

[00:29:43] And the other thing I wonder, because I turned 50 in September last month, and part of me was, crikey, I’m all, I’m already 50. Oh my goodness. So those that are coming to me and I just wonder whether we, we think that, okay, after 50 we can just like, Looks, going to disappear at some point.

[00:30:01] And, we are getting older and I just wonder, there are two, two options, isn’t it? We either say, Okay, maybe this is fate, my certain levels are going to go down anyway, I’m going to have some, all these hot flushes and that kind of thing. We either say that, always say, Hey, that might happen, but what could I choose?

[00:30:17] And maybe this is an invitation again, having passed 50 or going towards 50 is like, how can I pivot, like you said, and how can I embrace this transition so that actually I get the best, the best days I yet to come. I have had this 50 years of my life and I was some, sometimes I did things that I was not, I’m very pleased about.

[00:30:37] And we all have done that kind of thing. I have done for sure. But that that, I guess for me and what I’m seeing is people, for people to thrive, we need to be. And let’s be authentic. Let’s be very honest about some of the, stuff that’s not going right and not feel judgmental about, but say I’m human.

[00:30:56] And I I know I messed it up because we are, no one’s perfect and how do I want to show up now? What do I want my life to be about now? And this is so much more of a like, , I am, I am creating, I can create and design my life from this phase. And it can be quite nice. It can be based on what I want to see happen in my life.

[00:31:19] And that’s a such an empowering state for us women to be in rather than, Oh God, I’m 50 already, I’m feeling old. Look at my skin, look at my wrinkles. Can I say that? So I guess that’s the conversation I love having with people in my coaching sessions about how do we step into our own power?

[00:31:35] How do we create that life in a, in in as we go through this transition and have fun. Come on ladies. We need to have fun. Even when we are saying thinking, Oh goodness me, my time is over, let’s have some fun . That’s came to me, Ellen .

[00:31:51] Helen: Absolutely. And I think that leads on nicely to treatment, doesn’t it?

[00:31:54] Because I think actually we’ve talked a lot about, people’s experiences and I think this is we’ve talked a lot about the lifestyle and I lifestyle change is quite challenging and quite hard, And I think that’s when obviously, Thinking about the whole picture and thinking about the hormone hormones we described as dropping that, we do need to have a conversation about hormone replacement.

[00:32:12] It’s really key for a lot of women. So one in four women won’t have any symptoms. Throughout the menopause, two in four women will have quite significant symptoms and one in four will have really severe symptoms. So I think it’s important to realize that for every woman they’re different.

[00:32:25] And it could be that, it might be that they’re psychological or the vasomotor symptoms like we described, like the hot flushes and things, and they will respond really well to hormone replacement. So, we can talk a bit about that in, in a bit if we like. But there’s also women that just have, especially postmenopausal ladies.

[00:32:41] We have a lot of, obviously as our issue levels drop right down, we’ve gotta think of those vaginal symptoms. So, vaginal soreness, dryness, difficulty with intercourse, uncomfortable even wearing trousers and things. And, we’re not talking about that’s enough. So I think 70% of women postmenopausally have symptoms of vaginal discomfort or sores, and only 7% of women get help.

[00:33:02] Rani: Yeah.

[00:33:03] Helen: Wow. We need to get, we need to talk about that, don’t we? Don’t you think?

[00:33:06] Rani: Yes. Yes. And today I had another stats, which is one in four people. I even considering leav them jobs because of menopausal. Now how horrible is that if we don’t talk about this, if we are not even like thinking, Oh, I can’t, there’s no help then obviously then we are making a major, going to make a major decision thinking there’s no help at all.

[00:33:26] So yes. Let’s talk about each and in that note, can I just say that some people that two things here, one thing is some people are saying that, okay, they’re worried about the risk of cancer and so they’re worried about going and having hrt. And also that some people, I understand that some people have been given antidepressants because, they felt that HRT might be risky.

[00:33:52] So I just want to know your view about it.

[00:33:55] Helen: So obviously there’s been. Quite a lot of controversy around hormone replacement. So, it was prescribed quite regularly and frequently for women. And then the, there was a big study that was reported on in 2002, the Women’s health study and the Million Williams million women’s study.

[00:34:12] And that actually was the conclusions from those studies were quite over generalized and misinterpreted and it created a huge scare. And overnight so many women put their HRT in the bin. Professionals across the board were, became very frightened about prescribing it with the potential risks.

[00:34:27] Ever since then, there’s been more research done and actually it’s shown that actually body identical hormone replacement, so that’s based on yams, which is what we prescribe as per the nice guidance in the British Menopause Society. That’s actually got a. A very safe profile. Obviously any hormone, so any estrogen hormone, there is a slight increased risk of breast cancer.

[00:34:47] And I think for some women, obviously, that risk is absolutely too much of a risk, especially if they’ve either, had breast cancer or a strong family history. So that’s a slightly different conversation. But for the majority of women they will find a benefit and it’s safe to take hormone replacement.

[00:35:02] To put the risk in perspective, which I think’s really important is actually the risk of an increased risk of breast cancer with hormone replacement is it’s a greater risk of breast cancer if you have two glasses of wine at night or if you are overweight.

[00:35:17] Rani: And we don’t think that, do we? Yeah, we

[00:35:19] Helen: don’t think that, and I think we forget that actually you.

[00:35:23] Alcohol and weight are actually in, they are significant risk factors for cancer and we, I think we, that gets missed a little bit, as well. So I think it’s about perspective. It is a small risk. There isn’t, like many things aren’t without risk, but it is a small risk and I think it’s about understanding what the hormone replacement is.

[00:35:40] So the idea is that we are just replacing your normal level of hormone. So we are not giving you huge doses. It’s just about giving you back your hormone level and that obviously is an individual level depending on your, on your symptoms. So some of my ladies in para menopause all the time actually need quite high levels cuz you are actually used to having quite high levels in your system.

[00:36:01] So it’s about titrating the hormone up to your level. And obviously we can talk about the ins and outs of hormones, but that’s quite a complex subject. But how to give it, to, for women it’s the safest way is transdermally. So through a patch gel or spray. And then we obviously have to give you hormones to protect your wound cause estrogen can build up the lining of the womb.

[00:36:18] So that could be done with either tablets or with the coil. And obviously we also can touch on testosterone as well. Cause obviously there’s the brain impact but we know that hormone reduces with age anyway. But we can see a an impact during the menopause as well. So as that de as that hormone decreases cause that can have quite a significant impact on nebido and hormones and and.

[00:36:39] Some women find actually, the brain fog and things are quite affected by that. So, but from a nice guidance point of view we replace your estrogen and we then monitor that and, chat to you about how your symptoms are and then we can titrate it. And just linking that with the lifestyle side, which I think is really key.

[00:36:57] Is it? Lifestyle change can be hard. And I think, we all know what we should be doing and eating and doing and exercising, but actually if your hormones are in your boots, then it’s actually really hard to motivate yourself to be able to do any of that. And some women describe actually feeling so in so much pain cause they’re joint pain and aching that they’re not able to do the exercise, but they previously absolutely loved.

[00:37:18] So I think it’s important for us to have that conversation, including all the options if you’re able. But also there are non-hormonal methods as well of, of, non-hormonal treatments that we can think about for specific symptoms of the menopause. But a lot of the times replacing the estrogen is is very helpful for.

[00:37:36] Rani: Okay. We have many questions and I know we only have 15 minutes. Okay. So we’ll, we will take take the ones that we stopped. So, few is high. I work with young women with a medical menopause as part of their cancer treatment. Certain is not an option. Can you advise any lifestyle approaches, especially for their mental health symptom?

[00:37:55] Helen: So, that’s really important, isn’t it? And I think, like we said before, that’s why lifestyle medicine is so key. And for younger women, I think there are lots of different complexities with that conversation. Obviously around how they’re approaching. But bone health all we want to think about how can we help them.

[00:38:11] Feel as well as they can do. And obviously if you are going through the menopause at a younger age, you are, there are increased risks with regards to bone and cardiovascular disease and the other. So, really optimizing their diet and nutrition. Exercise movement is key, both the mind and body.

[00:38:25] But you know, especially as we touched on before, strength exercising and weight bearing exercise to help protect bones is super important. And from the mental health point of view, all those aspects of lifestyle will actually help their mental health. But obviously actually addressing the challenges that those girls are experiencing and, again, having a connections with, obviously with supportive talking therapy and actually support around that cognitive behavioral therapy.

[00:38:50] There’s a huge amount of evidence around that with managing menopausal symptoms as well. So that might be really helpful as well to get some of those techniques and strategies to help. Okay.

[00:39:01] Rani: I will add something when it makes sense for me to add, so I’m at the moment I’m quickly wishing through.

[00:39:06] So, Sue says, What recommendations to treat managed symptoms of menopause such as anxiety and brain fog?

[00:39:15] Helen: So, obviously replacing hormones can be very helpful for some women. One in three women do get prescribed antidepressants and actually, four symptoms at this stage and actually, Nice guidance suggests that hormone replacement is the first line treatment for women with psychological symptoms of menopause at this stage of life.

[00:39:33] So obviously it’s complex, isn’t it? For every individual woman, we’ve got to think about, their situation. And it might be that there’s previous mental health issues that have exacerbated, but I think addressing the hormones alongside that or, is really key. Brain fogs really challenging, it makes patients it’s real.

[00:39:49] There’s been some really interesting research from Lisa Moscony, and you can see her on a TED Talk and she does, she’s, they’ve scanned women’s brains and they can see the changes through the menopause and they do recover, that they will recover even. But that word finding that brain fog can be very distressing, especially as we described women in work, trying to on, in the boardroom, trying to get names and, trying to work.

[00:40:10] It’s, it can be really hard. So, it’s about, also sharing. So exactly as you described before, Ronnie, it’s saying, actually I’m struggling a bit. Talking is your, I hope now there are menopause workplace policies. You can talk to a trusted colleague, you can chat. That’s really key. Just to start talking and get some help.

[00:40:27] Go and see the gp. Go and see your nurse and if you don’t meet someone who’s got a special interest in women’s health and menopause, ask to see if someone is more and more people are being trained up. And I’d be hopeful that actually people are received in a much more positive way than maybe in the.

[00:40:42] Rani: Thank you. And to add to that, I would say that okay, the interesting, I was talking to someone who has gone through menopause and they might be here listening in. So here’s the thing. They talked about how there is our just like we talked about the relationship with ourselves, we also have relationship with the symptoms we are having.

[00:41:00] For example. The more we are, say for example we have hot flashes or feeling anxiety or low mood or so on, there’s that for sure. That’s one. I call it level one sort of discomfort. But there is a level two and level three discomfort, which is the level two is our thinking about it.

[00:41:17] Like how we do, Oh my goodness I can’t believe I’m having this again, or, I’m feeling jittery about that. So our thoughts play a lot of role in, how we experience that and then we have more thinking like, Oh, I can’t believe I just said that because I’m a professional. I should know better.

[00:41:32] So that this kind of. That mind chatter going on can also really affect the symptoms and make them worse. So this is, this is why things like, if you are, some people do meditation and mindfulness. I know it’s not everyone’s thing and I, it’s not my thing for sure, but I do know that when my mind is quite, that even if I, so for example, I have mild osteoarthritis that t my family and so I’m doing.

[00:41:55] Lifestyle medicine changes for it, and it doesn’t bother me at all, but I know that when I have a dip, like when I get that sort of, Oh, I can’t be bothered and I have something sugary, then I know that it plays up. But what I’m trying to say here is that, we start noticing that, we have a lot of conditioning going on, like chatter.

[00:42:13] And the more we are aware of how the mind works, and that is something I do a lot in my in my coaching, I call it mental wealth coaching. The more we understand how the mind works, the more we are at peace with some of the experiences we are having in the moment. Because, think about it, even if someone has a panic attack for example, because that’s something I see or anxiety, the more we try to resist it and say, Oh, I shouldn’t be have this panic attack.

[00:42:35] We get what the symptoms worsen. So it’s the same with other, symptoms. Like whatever. Even if it break brain fog or it’s, I don’t know, hot flushes, the more we think about it, the more we say, I don’t need it right now. Are we are trying to push it away, the more intense it can be. So there is this practice of, acceptance of what is like being in the present moment.

[00:42:56] And what helps really is like, Understanding that these experiences do come and go and you are not going to have hot flashes 24 7. There will be period. You do have it worsen and worse. And the more you understand that there’s nothing to be so scared of, frightened of that also gives you another, like a you, you feel more in, more grounded despite your, mental your menopausal symptoms.

[00:43:19] So that’s certainly a way I would. And dealing with a brain fog or Exactly. Or anything. But very quickly. Another thing about antidepressants, now I know that most people who are prescribed antidepressant, they don’t even, think much about asking the doctor about, very simple things that we call informed consent.

[00:43:37] For if they, someone has depression and they have tried everything else, like they have tried lifestyle medicine and everything, and it is getting to a point that they have tried everything. And obviously we know that antidepressants can may help people. We are not going to go into how they work and that kind of thing.

[00:43:52] But if someone is being given antidepressants purely for menopausal symptoms, again, it’s the same thing. We need to say asking like, how is this meant to be working? How long am I supposed to take it for? What are the benefits? What other risks. How easy it is going to come off medication because I, we know now there’s more literature coming out about people experience withdrawal symptoms, which can be worse than when they, why they were started or the antidepressant in the first place.

[00:44:17] So all I’m saying here is that, know, you might have to go, you might want to go for it, but be a very well informed consumer. And then you might realize that before I go into that antidepressants, have I really tried a lifestyle thing that I know that I can adjust and then if I do go on antidepressants, I really need to be clear on how long I’m going to be in four.

[00:44:36] Because otherwise, if you continue for, say six months, one year, not everyone, but some people definitely have about 50 people, 50% people can have difficulty in coming off it. So that’s a very quick educational tip here about when you are looking at your choices.

[00:44:52] Helen: I think that’s really important cuz I sometimes meet women who have been put on antidepressants and actually it was possibly related to hormone deficiency, but I think it’s understanding about actually u you know, possibly utilizing the both feeling a lot better.

[00:45:06] Putting that lifestyle medicine approach in, in place and then working with the GP or, with regards to coming off the antidepressant if necessary. But that’s, you’ll be able to talk about that more maybe at another time, Riley. But that’s really important not to just hop off, just to stop things,

[00:45:19] Rani: isn’t it?

[00:45:20] Oh, you can’t. And this is where things go wrong. And then I, trust me, I have seen many cases like that. This is why I want to make sure that people are really understanding about education aspect about informed constant bit. Moving on. I will catch up very soon. So Becky says hello to your both.

[00:45:35] I was wondering, could you talk me a little more about the link between menopause and severe headaches?

[00:45:41] Helen: Okay, so obviously we talked about before that the para menopause is est symptoms that are fluctuating and when, if you have got a tendency towards migraines or headaches, you, some women really notice worsening during this period of time.

[00:45:56] So that can be that your headaches are becoming more severe, they’re becoming erratic. And that can be incredibly challenging for some women. And again, talking about lots of different aspects of change in your life if it affects your sleep. And so if your sleep’s affected by the menopause or the fluctuating hormones, then we can, your migraines may get worse.

[00:46:15] So it’s quite a complex time. And again, lifetime medicine, looking at replacing the hormones just steadily. So we’re very low level of hormone. And building that up gradually can be really helpful for both headache and migraine sufferers. So yeah, actually someone tells me they get worsening headaches.

[00:46:32] That to me straight away makes me think, what are your hormones doing? How are your periods? How are you otherwise? And usually other symptoms come out and we realize it’s a sign that the para menopause is possibly happening.

[00:46:43] Rani: Yeah. And food does contribute, doesn’t it? Because there are some food, if we have like high sugar content food or have processed food, again, that’s going to worsen the headaches

[00:46:51] Helen: for sure.

[00:46:51] Yeah. And the trouble is all these symptoms we’re talking about that, and I think we’ve touched on it before, but it’s really it’s sometimes we do end up self-medicating with things like caffeine with alcohol and things. Cause we just wanna go to sleep, we just wanna be able to sleep.

[00:47:05] We just want the headache to go away. We want to feel a bit calmer. And I think you mentioned it before about being self-aware, but actually it can feel so difficult this time that and sugar. And you just get that quick, just feel a little bit better to keep going. So I think it’s about being kind to yourself really and saying, actually, yeah, I know I’m doing this.

[00:47:22] I know what I need to do. How can I go a little bit? How can I make some of those little changes just to make it make myself feel a little bit better? And I suppose it’s about caring for yourself, isn’t it? And nourishing yourself rather than I suppose creating these fluctuations even more with the life.

[00:47:37] Rani: Yeah. And I would say that if you are, you have tried to do it and you think you need help, there are lifestyle medi, medicine practitioners, there are coaches, health coaches, there are life coaches such as myself. And I know that you are very, you are definitely the go to and it comes to menopause, aren’t you, Helen?

[00:47:54] So there are lots of help and yeah,

[00:47:57] Helen: we have health coaches in general practice now, in nhs, gps and, any support over the practical aspects, social prescribers, things like that. So there’s, there is a lot of help out there and there’s a lot of really sensible resources and things out there, which obviously we can share as well.

[00:48:10] Yeah.

[00:48:10] Rani: Okay. Moving on. Darlene says I’m not having any symptoms besides mild anxiety and fatigue, no hot flush flushes, et cetera. The fact that I’m still having a cycle at 53 is about to send me over the edge .

[00:48:23] Helen: As I mentioned before, it’s a really good sign of healthiness, but obviously I can understand it’s probably a lot of other people may have stopped their periods at that stage.

[00:48:30] So I would say I would celebrate it cause it’s a good sign of, wellbeing. But I think obviously you’ve mentioned the anxiety and the fatigue. Obviously we talked about lifestyle approaches to help with some of those milder symptoms, which you might want to do. And obviously, if you haven’t got any contraindications you might want to consider talking to your GP about a trial of hormone replacement.

[00:48:48] It may help, but again, it’s about looking at the whole picture and thinking about yourself

[00:48:52] Rani: as an in. Yes. And Kavita has given some excellent tips there, so I’m not going to read it out because we are running out of time, But thank you Kavita. Gabriela’s asking how long should patients stay on HRT?

[00:49:04] Helen: So, that’s, again, it’s a very individual conversation with their patients. So a, the. Evidence suggests that you should be on you. You can, You offered HRT and it’s a choice to be on hormone replacement, to re, to treat symptoms, but depending on how long you want to be on it, that’s very much down to you as an individual.

[00:49:21] So for women, that’s why it’s important to reevaluate and to assess your hormone replacement every year or certainly. Earlier than that. If you are, when you’re starting on it and for, a lot of women as they go through the menopause, into the menopause and postmenopause, your actual needs for the estrogen may go down.

[00:49:37] So we may reduce your hormone replacement down, like we mentioned before, topical estrogen. So estrogen via pessary or cream or gel or ring. If a ring vaginally, that’s usually very important into the longer term postmenopausally. I’ve got a lot of ladies that actually continue hormone replacement and with a shared decision about risks and benefits, then that’s their choice, that is up to them.

[00:49:58] And, but for topical HRT, so the localised HRT for the bladder and vaginal symptoms, I think for majority of women, that’s a long term issue and that. That should be for forever really, because we’re always gonna be in this eostrogen deficient state. One thing we didn’t mention just during the hormone replacement was about this window of opportunity.

[00:50:15] So when you, there is obviously up to the menopause, there’s no issue with regards to starting hormone replacement, but after that it’s, we look at 10 years from into the postmenopause that’s a safe time to start hormone replacement. After that, there are some slight increased risks that we have to talk about on an individual basis, but within the 10 years it’s been shown to

[00:50:33] Rani: be safe.

[00:50:35] Very quickly moving on. And you can see that my speed has gone up . We also ask yeah, we’ll keep, try to keep the answers short. Michelle is saying, Hi, I suffer from fibromyalgia, chronic fatigue syndrome, other amongst other conditions. Majority of the symptoms of menopause is also the same as this medical condition.

[00:50:53] How will I know which is

[00:50:54] Helen: which? It’s difficult, it’s challenging, and I think it’s about knowing yourself and knowing if things are slightly different. So it’s that self-awareness. If you have got symptoms of menopause alongside it with change in periods or obviously of an age or bloods, depending on your age, I can’t tell from this, then maybe a trial of hormone replacement may be beneficial alongside all the treatment for your other.

[00:51:14] Rani: Yes. Okay. Pauline says, Is HRT suitable if you have breast cancer? I think you have already answered this, haven’t you. Amanda says reflexology has helped. Thank you. Amanda. Kavita is asking, you mentioned about sexual difficulties, especially the vaginal dryness, et cetera. Can you advise anything topical or is HRT the treatment?

[00:51:33] Helen: So you can use non-hormonal, sort of vaginal moisturisers or lubricants. So we recommend products like yes or silk, very useful adjuncts. But, really the skin in the vagina and the bladder tissues and everything are missing the estrogen. So if you are able, and even, it’s a very safe treatment replacing the hormones topically vaginally.

[00:51:53] So again, it creates a lot of fear and concern, but actually the evidence is that it’s a very low amount that gets absorbed systemically. And for the majority of women, it’s a safe treatment

[00:52:02] Rani: and GPS can

[00:52:03] Helen: prescribed that? Absolutely. And actually just recently you can actually buy vaginal estrogen over the counter.

[00:52:08] It’s called Gina. It’s a product over the counter. But again I would encourage everybody to go and see if you have got symptoms of what we call genito-urinary symptoms of the menopause. Go and speak to your GP. It’s something that’s easily treated. Too many women are suffering and needlessly because it’s, we can treat.

[00:52:24] Rani: I think we have done an incredible job. We have covered as much as we can. Thank you everyone for coming here and asking us the questions. You might have more questions, but then we can always contact us.

[00:52:36] So because you are on the email list, I will send an email. Should you have any questions about coaching, lifestyle medicine or hormone replacement,, anything.

[00:52:44] So you will know who to turn to. And Helen, I really enjoyed the time with you interacting and having this

[00:52:51] Helen: conversation. Always lovely chatting. So yeah. And thank you ever so much for everyone coming. No, it’s been brilliant.

[00:52:57] Rani: Thank you everyone.