Empowering women unheard during menopause

In this week’s podcast, food writer, author and award-winning entrepreneur Freda Shafi talks about her work raising awareness of menopause and recording the experiences in the Pakistani community in West Yorkshire.

Freda shares her own menopause story, and she and Dr Louise discuss key barriers women face accessing care, and ways to improve knowledge to empower women to advocate for themselves.

‘I’m a South Asian woman, I’m a Pakistani, I’m a British Pakistani woman, and I know I represent a certain demographic,’ says Freda.

‘I feel as though I can reach many women through the fact that I am from the community. That may be platforms for women like myself who are able to cascade that information and let that reverberate across those communities.’

Freda’s top three tips: 

1. Help represent your community to spread awareness of menopause symptoms, treatments and services and help tackle the stigma that still surrounds this area.

2. Get a second opinion if you don’t feel your healthcare professional has given you the right diagnosis. Explore the materials that are out there, including the balance app, so that you’re informed when you see your doctor. 

3. Boost training in the menopause for community leaders so that they can signpost women to local services that can help support them.

Follow Freda on Instagram @fredishafi_spiceitup

Transcript

Dr Louise Newson: [00:00:11] Hello, I’m Dr. Louise Newson. I’m a GP and menopause specialist and I’m also the founder of the Newson Health Menopause and Wellbeing Centre here in Stratford-upon-Avon. I’m also the founder of the free balance app. Each week on my podcast, join me and my special guests where we discuss all things perimenopause and menopause. We talk about the latest research, bust myths on menopause symptoms and treatments, and often share moving and always inspirational personal stories. This podcast is brought to you by the Newson Health Group, which has clinics across the UK dedicated to providing individualised perimenopause and menopause care for all women. So very excited for today’s podcast. I’ve got with me in the studio someone called Freda who approached me, like lots of people do, and told me about the incredible work that she’s doing. And for those of you that might know, I spend a lot of my time trying to work out how to reach people who have really been unheard, have been sort of vanished from society with their perimenopause and menopause. And the more work I do, the more I realise, sadly, there’s lots of those women. And it’s actually, I think the majority of women who are not able to access really good quality care, advice and treatment. So Freda has been doing some really great work. So I’m very privileged to have you here today at my studio. So welcome today. [00:01:44]

Freda Shafi: [00:01:44] Thank you. Is it’s a privilege to be here, actually. [00:01:46]

Dr Louise Newson: [00:01:47] Oh, thank you. So just tell me a bit about you first and your background and why you’re doing what you’re doing, if that’s okay. [00:01:53]

Freda Shafi: [00:01:55] As you may have gathered from some of my background information, I am a creative person who works across the cultural sector and at the moment I’m working in the culinary world. So everything to do with food, health, wellbeing and being equipped to understanding our bodies and how we can make really the best of our our health through food, through nutrition, through lifestyle. And in the current world that we’re living in, we need to be fully aware of how our longevity impacts our family and our communities. So just making sure that we are, I suppose, making the best choices when it comes to food, nutrition and even lifestyle. And that extends to, as I said, the creative sector, the creative industries. I came across the work that you are doing obviously through my own journey and wanting to know more. And I equipped myself with a lot of knowledge, a lot of background, and being in a perimenopausal state myself, I felt I needed to reach out and talk to you about some of the, I suppose, the inequities that still exist, even though there are some brilliant services out there and some great research and work. Sadly, there are still pockets of communities that are not accessing the right care and the right treatment, especially when women of my age bracket approach menopause and perimenopause. [00:03:26]

Dr Louise Newson: [00:03:27] Hmm. Absolutely. It’s an interesting one. I trained in Manchester many years ago now, there is a huge ethnic minority population, and when I was working in casualty, lots of women would come in with total body pain and they would be almost dismissed to say, well, they’re on antidepressants. There’s nothing wrong with them. We’ve checked their thyroid. There’s probably other issues at home. It’s very difficult to get a history because they’re not speaking English. They haven’t got an interpreter with them. You know, what can we do? And I look back in horror because I know a lot of these women were either menopausal or perimenopausal because they were the right age. And I don’t know how much of their symptoms were related to their hormones, but no one even gave them opportunity to have any education or even to talk about it. [00:04:15]

Freda Shafi: [00:04:16] I think that’s very sad. And I think that pertains to a lot of the cultural taboos and stigmas associated with perimenopause and menopause, especially when you think that a woman’s currency in many communities, not just Pakistani and Asian community or ethnic communities, but across the whole spectrum, I would imagine, a woman’s currency is linked to fertility, to use, to abundance, and sadly, it is overlooked and not actually talked about, not even overlooked. That’s probably the wrong word. It’s not even addressed because it is considered almost like a failure on the part of a matriarch, on the part of a woman and part of a family, which is very, very sad. [00:05:00]

Dr Louise Newson: [00:05:01] It’s the same as so many people, because when we’ve looked at the menopause for so many years, it’s been about periods which is associated with fertility, like you quite rightly say. And because we know a lot of women are younger when they’re menopausal as well, at an age where perhaps they would be expected to conceive. It’s a double whammy for those people that are young when they’re menopausal. But actually, even when people are older, you want to cling on to your youth, if you see what I mean. But our youth should not be defined as whether we’re fertile or not, but there is this identity for women. And like you say, in some cultures it’s more than others. But actually the menopause isn’t about losing fertility. And there are some women actually who have an early menopause who are still fertile. Their fertility isn’t as good, but they are still fertile, yet they’ve got this shame that they don’t want to talk. And we see a lot of women who’ve been to fertility clinics and they have reduced fertility and everyone’s been blaming their anxiety, their mental health issues, their poor sleep on their worry about whether they can get pregnant or not. But actually it’s because they’ve got a hormonal deficiency due to their perimenopause or early menopause. So there’s been this misinterpretation of what the menopause actually means and some people refer to the time after menopause as post reproductive health, well it’s not actually. And that’s really confusing for a lot of people. But like you say when you’ve got this added burden actually of being a woman who has to be fertile, it adds a whole new dimension, doesn’t it? [00:06:36]

Freda Shafi: [00:06:36] Absolutely. And as I said before, I’m not dismissing some brilliant work that’s going on in terms of outreach and engaging more representation. There are some brilliant doctors out there like Nighat Arif reaching out to the ethnic minority communities through her social media platforms. But what worries me is that there are still pockets of ignorance within communities. And again, ignorance is not used as a derogatory word here. It’s ignorance, because a lot of the women I have been exposed to sadly have been misdiagnosed, and many of them are on anti-depressants. And as a result of that, they are being labelled as mentally ill. And that’s what probably perturbs me more than anything, is the fact that they are not being, first of all, diagnosed properly or even aware of their local amenities and resources. Even in West Yorkshire there are some brilliant resources that exist like Livve UK run by Melissa Sookia and she is doing some great work. I spoke to her and she said if they approach me, that’s the only way I can help them, Freda. And she absolutely would go in and do some voluntary work. But the fact is they are not even in a position to access those services because they are not aware. And just looking at the actual statistics, 78% of women from ethnic minority communities are actually still very much unaware of their menopausal symptoms. And given that there isn’t a definitive word for it, there is a very broad spectrum word which is very similar to the menopause. You know, the Greek word meno pausis, which is literally everything’s shuts down, which isn’t a very glamorous word either, but it pertains to shut down, which again, is not a word that makes women feel good about their bodies and their health and their sexual health, which again, should not be a taboo subject. But sadly, it is and it has a cascading effect onto their families, onto their husbands and across the community. And it resonates. And that’s one of the reasons why I feel it needs to be addressed. Even though there are some great resources out there are still women not accessing them. [00:08:49]

Dr Louise Newson: [00:08:50] Yeah, it’s very interesting and it’s so frustrating actually, isn’t it, when this is something that happens to 100% of women at different ages, of course, yet we still don’t understand what’s happening. And in fact, seven years ago I used to work with West Midlands Police and we did a survey then to try and understand what women understood by the menopause and about their symptoms, and it’s a very similar figure. It was about 75% of women didn’t realise that their symptoms that they were having were related to their menopause, and the commonest symptoms affecting them at work were anxiety, mood problems, fatigue, memory problems. And they’d been signed off work with depression, headaches, with migraines. And a lot of them were just telling me that they were retiring early because they couldn’t carry on. And this was seven years ago. So hardly anyone was talking about the menopause then. And I remember sitting in this room with these lovely officers and police staff and just saying, but you’re only 50. You can’t give up your job now. And they said, well, we can’t even go to the playground and lift our grandchildren to put them on the swing because we’ve got such bad muscle and joint pains. We’re on antidepressants and they’re not helping. And so you don’t seem depressed, why are you on antidepressants? Oh, well, because that’s all I could be given. And it was then that I really had this sort of almost lightbulb moment thinking, goodness me, this is to me, very obvious, but people aren’t accessing it and obviously developing then the website and then the app. Isn’t it great? It’s got a wonderful reach and everyone says, oh, isn’t it amazing, Louise, you’ve had over a million downloads of balance app. And I think, no, it’s not. It’s 1.2 billion women worldwide. How do we access them and how do we enable them to find out information? Because I think women are very good, lots of communities of women are very close, but they’ve got to know how to start the conversation, how to open up the conversation, isn’t it? And I know you’ve been working really hard in some areas haven’t you to really start that going. [00:10:48]

Freda Shafi: [00:10:50] I feel really passionate about it because I feel if you fail one woman, you are failing a whole entire community. And within the South Asian community there are lots of different demographics. You have a Bangladeshi community, you have an Indian community, have a Pakistani community. So it’s a whole demographic there. And it can take one person’s mindset changing for that to cascade and reverberate through an entire community. And it can be as simple as that, Louise. And I’m on a mission, actually, I’m on a mission because I’ve seen generations before me. I actually have an older family. I’m the youngest of quite an older family, so I have sisters in their 60s and I know I’ve actually interviewed women of different age groups and I’ve interviewed women in their 60s and asked them if they would have done anything differently. And it’s very sad to hear them saying, had I known about this, I would have done things very differently. And now they are on a whole spectrum of medications ranging from thyroid right through to blood pressure and antidepressants. I was offered antidepressants when I approached my GP, but thankfully, Louise, I’d already found you. I’d already found you, and I knew exactly what the protocol would be. And as an articulate Pakistani woman, British Pakistani woman, I was capable of knocking on the GP’s door three times. And in fact, that’s how we met, because it took me three knocks on the door to get my HRT. And can you imagine a woman whose language is not English? Who’s not very confident, who trusts completely and implicitly what the GP is saying, which we should actually, I’m not undermining that. But sadly, even somebody like myself who is articulate and adept at getting through to my GP and armed with a whole arsenal of research and statistics, even then I was refused three times. So I think therein also lies a problem because it’s still happening. And I think if we enable and empower one woman to knock on that door however many times it takes, and if it means me going in and making sure this is happening at a pedestrian level, I’m not a clinician and I don’t profess to be anybody from a medical background. But as a person who can give women a voice and enable them and maybe empower them to just keep pushing and not accept the first port of call, which sadly is always antidepressants. From what I’ve learned from the communities I’m working with. And like I said, the system is still failing many women. [00:13:33]

Dr Louise Newson: [00:13:34] It is. And I don’t quite know why. One day maybe I’ll find out. But I really don’t understand why. And I am, I’m a fellow of the Royal College of GPs and I did speak to some people quite high up, I won’t mention any names, recently and asked them where the antagonism is for my work and for menopause and why is it the women are being underserved. And one of the responses was, well, Louise, your media attention to the menopause is quite difficult because it means so many women now are coming asking for hormones to the detriment of other patients. And I feel really sad about that because I think if we can invest time-wise, but also economically in women in their first or second consultation, sometimes it can take more than one consultation to go through everything. But then these women will then often be liberated and not come back into the general practice or to other healthcare systems, because many women and we know that from just doing some research in our clinic, once they are better and have the right treatment and looking at treatment, when I say holistic treatment, looking at changing, improving their nutrition, exercise, sleep, wellbeing and hormones, if they want them, then actually they don’t then go back to their GP in the short term because they don’t have symptoms. But in the longer term we know they’re less likely to have cardiovascular disease, diabetes, osteoporosis and so forth. And we know that women from certain ethnic minorities have a higher risk of obesity, type two diabetes, cardiovascular disease. Many of these women have a younger menopause. We know women who are younger when they’re menopausal have a higher risk of these diseases as well. We wouldn’t allow women to be walking the streets with raised untreated blood pressure or raised untreated type 2 diabetes. Yet we’re allowing them to have very low hormone levels with risks and symptoms affecting the quality of their life and almost being annoyed that they’re coming to ask for treatment. I don’t really understand that. And the more work we do, empowering people, this side of the stories are that I hear of people being turned away and I can’t quite understand, and I wish someone could tell me in a very reasonable way why it’s so awful. But I haven’t had a reason yet. [00:15:51]

Freda Shafi: [00:15:51] Well, therein for me lies the injustice, Louise. And I think you hit the nail on the head. If a woman is misdiagnosed, then it does sadly lead to many of the conditions which you have shown to be linked to the menopause, dementia, osteoporosis. All of these conditions could quite easily have been, I’m not saying remedied, but you know, HRT isn’t always the answer, but an awareness of just something as simple as diet and, you know, changes to a woman’s diet when certain hormones go out of kilter. I specialise in food, whilst I’m not a nutritionist, I understand what foods work and it’s pretty common sense for me. I’ve been cooking for many, many years where things were cooked from scratch in most instances. And I know that fresh unprocessed foods help certain menopause conditions, and it’s as simple as just awareness and information in many instances, which that in itself doesn’t necessarily involve a medical intervention. That isn’t something that a woman necessarily needs to reach for the antidepressants. It’s just on the first port of call it should be have you accessed this service that is available to you in your community? That’s something I really want to do. If that’s a bridge that I represent, then I would be happy to do that, to signpost women from my community. And I suppose I have a special interest in my own community. I can’t speak for the wider community, but having worked and being from that community myself, I understand the cultural sensitivities, the taboos and everything else I’ve mentioned, but I certainly can support women and signpost them to accessing the right healthcare before they go down a slippery slope of once they are on something, sadly, there are side effects and those side effects can lead to more and more medication. I’ve seen it happen. I’ve seen it happen in the older generations of, say, for example, of my mother’s generation, when a lot of the women in her generation were bedridden at the age of 50 plus. Thankfully, my mum’s very, very well in her 80s, but she had a very different approach to it and it was more about mindset, health, wellbeing and food actually, which is probably where I took my inspiration from food and do what I do. But there are a lot of women who did even at that time, and we’re talking about the 80s and 90s, well before you came on the scene Louisel, even less knowledge and understanding of menopause, many women became bedridden and I often used to wonder why. And I know now and I know lots of it, you know, a certain percentage of that would have been definitively linked to menopause. [00:18:46]

Dr Louise Newson: [00:18:48] So tell us about some of the work that you’ve been doing, some of the research you’re doing. I know you’ve been speaking to a lot of people, and I’m really keen to hear a bit more about that, if that’s possible Freda. [00:18:58]

Freda Shafi: [00:18:59] Well, I’ve interviewed over 20 women. I have case studies of 20 women written down, the ones that I found quite interesting and as I said before, quite definitive in terms of some of the really interesting points that came out. And it’s a very broad demographic from very highly adept and articulate, educated women right through to and again, I’m not using this as a way to undermine women who have come from South Asia, who are housewives and just as adept but in a different way. So women who are articulate enough to access services. I interviewed them and I interviewed housewives from certain communities who are not necessarily medically literate enough to access services. My findings are very interesting, Louise, because even within the more capable, as in able to approach their GP confidently, even those women are not necessarily accessing the right treatment. And the women in the community centres they have been offered certain treatments but are refusing. And I also interviewed daughters of some of the women I interviewed to see what effect it was having in a more family environment and men as well. And looking at the way men approach or don’t approach or even want to engage in the conversation. So my findings are interesting. Some of the older participants sadly said that they felt that they’ve been let down by the system. Had they known about it they would have accessed treatment because now they’re on a spectrum of medications which they are certain in themselves that they probably wouldn’t have had to because of some of the joint pains that they’re suffering, some of the cardiovascular symptoms that some of them have suffered. Had they accessed treatment maybe 10 or 15 years ago, they wouldn’t have done that. So it’s almost like it’s a little bit too late for them. They think, even though I’m trying to push them to have a look and see if there are still options available to them. I’m not pushing for HRT. I’m not pushing them to go down any road other than to be more aware. But like I said, my findings are a lot of stories and anecdotes about the effect it had on their lifestyle, their marriages, their family life, right through to, as you’ve mentioned, some of them stopping work and feeling as though they couldn’t carry on in the workplace. Their brains weren’t functioning. There was the classic symptoms, brain fog, anxiety, and their husbands sadly not being very amenable or supportive to that. And the words like psychosis were being used to describe how they were being labelled by the community, by close family members. And that resulted in many of these women taking alternative treatments, which again, I’m not a clinician, but I know that it just didn’t seem to fit very well with what I was hearing. So it’s quite alarming that the system has failed a generation before us. But looking at some of the younger women, thankfully they are more aware of what’s going on, even though they’re not in a perimenopausal, menopausal age bracket. They know from their mothers. They know from the experiences of what their mothers are going through and are more adept and probably will be more adept at accessing the services. But even then, many of them, because they’re not in that age bracket or even thinking about perimenopause, they’re still very, very much unaware of what’s to come. Some of them even use the word frightened and scared. You know, the idea of the menopause fills them with dread. And again, one of my roles, I feel, is to advocate that it shouldn’t have to be like that for a woman who is perimenopausal. And I feel it’s a game changer. And I feel that there are so many things and opportunities available. If all I can do is reassure a lot of the younger women, then I feel as though there is an awful lot of value in that. I also interviewed some of the people who were running some of the community centres. They too recognise there is a problem. Their hands are tied. It’s a very political situation. As I’m sure you’re aware of when it comes to medicine. But my job is to make them aware of services outside of the GPs that exist, such as I’ve already mentioned in West Yorkshire, we have some great resources like Livve and other things, and high profile doctors like Nighat Arif are doing brilliant things and just seeing if they can be woven into some of the sessions, some of the workshops, some of the coffee mornings. But these gatherings usually are about lifestyle and accessing healthcare and make it a point of menopause being a very targeted thing that they talk about once a month. I’ve gone in and spoken about it and some of the perceptions that came out were very, very interesting. We did posters, we did some notes and some of the quotes that came from that. I wrote them down and some of them were quite discouraging, but some of them were very positive in the sense of that women felt empowered enough to feel like there was an opportunity for them to come back. And one of the quotes was, I’m going to start driving again. I can’t believe I’ve stopped driving. You know that in itself. Right now, it’s sad because it means that a lifestyle, something that’s so relevant to somebody’s lifestyle, driving somewhere, somebody stopped because of the debilitating anxiety. If there is an opportunity to reverse that or address that and, you know, get that woman back. There’s a bit of work to be done. So that’s what my findings have revealed across a range of demographic, as I’ve mentioned. [00:25:23]

Dr Louise Newson: [00:25:24] Which is no surprise from me, because I hear stories all the time from people from all backgrounds saying similar things. But it is absolutely shocking that we’re talking like this in 2023. You know, I speak to a lot of women who are too scared to go out the house, they’re too scared to use public transport. They’ve stopped driving. Like you say, they’ve given up their jobs, but also their role in society. And, you know, older women often have a really pivotal place and role in society, even within families and communities, to really educate and learn and be part of something. And if they can’t do it they’re losing out, but other generations are losing out. So there’s so much that we need to do because there’s the older generation that you say have been lost out and they went on all these other medications. They’re not too old to consider the right treatment that’s individualised for them. But really crucially, and I clearly think about this a lot, having three daughters, the new generation coming in need to be educated really early so they can make choices when they haven’t become this shadow of a person that has withdrawn from society because it’s too hard when you’re riddled with anxiety and you’re a shell of yourself and you’ve knocked on that door too many times to try and get help or you’ve received the wrong help. So it’s empowering women. And the work you’re doing is incredible. It’s really making a dent and a start. And we’re making lots of dents in the work we do. Every day I feel inadequate about the work I do, but actually, it can be amplified by us all working together. And I think that’s where it’s absolutely crucial that we all work together to help as many people as possible, because if each of us just helping a few, if there’s enough of us, then it really gets amplified and resonates. And that seems to be what’s happening. But we certainly have to do so much more work to get to certain communities. So I think your work is incredible and any of you that follow you on Instagram will see how amazingly talented you are, not just, you know, with the work that you’re doing beyond home and everything else, but the way that you design and cook food. I just feel incredibly inadequate looking at some of the things that, you know, it’s wonderful and it’s actually a very, very calming Instagram page just to look at actually with all the craziness of everything that’s going on. So there’s so much you’re contributing to. Before we finish, are you able to give three take home tips for those women who may have listened to this and are struggling, or those women who think, yes, I might be able to help people in my community just by talking and how do I start or what do I do? Are you able to help at all with three tips? [00:28:11]

Freda Shafi: [00:28:12] I think my three tips would definitely start with representation in terms of possibly seeing something that’s culturally relevant. And I don’t want to duplicate what’s already going on because I know that, you know, there are some materials that have been transcribed into South Asian languages, but just to reinforce that, you know, through marketing, videos, posters. I’m a South Asian woman, I’m a Pakistani, I’m a British Pakistani woman, and I know I represent a certain demographic. I feel as though I can reach many women through the fact that I am from the community. That may be platforms for women like myself who are able to cascade that information and let that, as you said, reverberate across those communities. Because if you’re amenable and you’re relatable, I think you will get through. If there is something that is accessible about a woman of colour speaking sense and taking away the taboo and the fear and a lot of the flawed research that as a clinician, you know, you know, just dispelling all of that, that representation I think is really important that Pakistani women of all demographics can relate to somebody from their community that is in the same space as them. I think the other important thing, is diagnosis being more considered. So when that first port of call, may be getting a second opinion. So if the first port of call to the GP based on symptoms and that first diagnosis is sadly or is antidepressants, I would urge many women to get a second opinion and explore the materials. I recommended the balance app. I’m trying to introduce the balance app into various community centers so women can chart their experiences and go to their GPs like myself, fully armed with an arsenal of research stats, even charting their day-to-day symptoms. So the doctors and the GPs, who are much more aware now, more capable at proper diagnosis and then maybe finally training not necessarily for clinicians, but training for gatekeepers such as leaders within the community. And they often are the community centres who look after the wellbeing and the lifestyle of these women who are approaching are in the menopause or even post menopausal, those women displaying classic symptoms of menopause. Those community leaders should be more aware of what they are and able to signpost them to resources outside of GP services. So to summarise, representation, diagnosis, and more training, I would say. [00:31:03]

Dr Louise Newson: [00:31:03] Very good. And keep going with the work that you’re doing and look forward to doing more together in some way as well. So I’m very grateful for your time Freda. Thanks ever so much for coming today. [00:31:12]

Freda Shafi: [00:31:13] You’re very welcome. Louise. Thank you for your time. [00:31:15]

Dr Louise Newson: [00:31:20] You can find out more about Newson Health Group by visiting www.newsonhealth.co.uk and you can download the free balance app on the App Store or Google Play. [00:31:20]

END