My experience of long COVID and changing hormones with Dr Marianne Tinkler
Dr Marianne Tinkler is a respiratory consultant from Swindon. In March 2020, Marianne contracted Covid-19 and had to take a month off work with a severe cough and extreme fatigue. She returned to frontline work on the wards at the height of the pandemic but found it difficult due to ongoing symptoms of tiredness, breathlessness, a racing heart rate and significant brain fog. Later that year, when long COVID became more recognised and Marianne was continuing to experience severe symptoms, she was encouraged to take an extended break from work, and this gave her time to reflect on her hormonal journey as well as learning how to navigate life with long COVID.
In this episode, the experts discuss the relationship between long COVID and the perimenopause/ menopause, the barriers to accessing treatment and some of the benefits of diet, movement and HRT for those suffering with long COVID.
Marianne’s advice if you have long COVID:
- Pace yourself carefully and don’t ‘push through’.
- Track your symptoms on the balance app and consider HRT if you think some of your symptoms may be due to perimenopause or menopause – even if you think you’re ‘too young’.
- Look at your diet and activity levels and eat foods that are good for your gut microbiome. Try and get outside every day, even if your energy levels will only allow you to sit on a bench.
Dr Louise Newson [00:00:09] Hello. I’m Dr Louise Newson and welcome to my podcast. I’m a GP and menopause specialist and I run the Newson Health Menopause and Wellbeing Centre here in Stratford upon Avon. I’m also the founder of the Menopause Charity and the menopause support app called balance. On the podcast, I will be joined each week by an exciting guest to help provide evidence-based information and advice about both the perimenopause and the menopause. So today on the podcast, I’ve got with me Dr Marianne Tinkler, who I have been hearing about actually for a little while and up until today, never seen her face to face, as it were. So Marianne is a respiratory consultant who also has long COVID and reached out actually because she was very keen to talk about her experience and hopefully allow others to learn from it and maybe resonate with some of what she’s going to say. So thanks, Marianne, for joining me today.
Dr Marianne Tinkler [00:01:15] Thanks for having me, Louise. It’s nice to see you in person and meet you face to face.
Dr Louise Newson [00:01:21] Oh, so respiratory. I was, many people know I was wanting to do oncology when I was a lot younger and so I did my hospital jobs and one of them was working for a respiratory consultant in Manchester. And I really enjoyed it actually. And, you know, our lungs are obviously incredibly important, but there is so many conditions that can really affect our lung function that we often don’t think about and sometimes just think about lungs in isolation, don’t we, rather than how other body processes can be affected with our breathing. So what made you decide to go into respiratory medicine?
Dr Marianne Tinkler [00:01:56] Respiratory was my first job that I did as a doctor in training. I trained in Wales and I was lucky that I had great consultants that I worked with and I really enjoyed my job and I think there’s just a wealth of diseases, as we talked about, from asthma, from lung cancer. It is the whole spectrum of young people to old people, diseases that we can cure and you can get better from, to the diseases that we can’t cure and the end of life and that’s really what I enjoy about it. So that’s why I went into respiratory medicine. I think medicine is much more than just prescribing a drug. You know, it’s all about their lifestyle. It’s all about their diet, their exercise, you know, what conditions do they live in? Are they in mouldy houses, in damp houses? And that’s so important in respiratory medicine, the air that we breathe in, is it polluted, is it damp, is it mouldy? And that’s why I really enjoy respiratory medicine. It is not just the drugs that we prescribe, it’s our lifestyles.
Dr Louise Newson [00:03:00] Oh, it’s totally, and actually can be very rewarding. I remember as a junior doctor in Manchester, there was a patient, he had a lung cancer that had been diagnosed and he kept coughing up blood. And I then saw him one night when I was on call at three in the morning, I’d gone to another bed to see another patient and he was there across the ward and I went up to him and he was so scared actually, because coughing up blood is horrendous actually, and very scary for relatives as well. And no one had actually talked to him about ways that he could help his breathing and the pain that he was in. And everyone was just focused on the blood. And what happens if he coughed up a lot of blood? And that’s a very catastrophic way to die, understandably. But no one had really sat down and given him time just to talk and because I’d recognised him and his family had recognised me, I went over and I remember at three in the morning having this long conversation actually about how there are lots of things that can be done and knowing that there were ways for the family to look out to, you know, when they need to ask for help as well. And actually then I thought, really communication is key because everyone in the ward, when I spoke to the team that would look after him the next day, they said, “Oh, we’re just worried about his bleeding and the coughing up blood” and I said “but he’s not worried about that. He’s worried about the way he’s going to die. And if he can’t breathe properly.” And I just thought, goodness, sometimes we could be scared of asking questions but they’re the questions that people want to have answers for aren’t they?
Dr Marianne Tinkler [00:04:26] And I imagine that was the thing that he was worrying about the most, and he was just waiting or hoping that somebody would raise that. And it was that elephant in the room that he didn’t want to raise with anyone because he would have thought that it was too big or too scary to talk about. And if the doctors weren’t talking about it or the nurses weren’t talking about it, it must have been too big a thing.
Dr Louise Newson [00:04:48] So I also said at the beginning that you’re not just a respiratory consultant, you’re a respiratory consultant with long COVID, and no one wants to be labelled by a disease or thought as something with a disease. But you very bravely want to talk about your experience. So to have long COVID, by definition you will have had COVID infections so do you mind talking a little bit about it.
Dr Marianne Tinkler [00:05:08] Yeah, I do feel a bit vulnerable telling my story, but I feel now that I’ve got to a point of my recovery where I feel brave enough and I think it’s that vulnerability isn’t it, of being brave. But yeah, I got COVID right at the start – being a respiratory consultant before COVID was technically recognised as being in the country but it was – right at the start of March 2020, obviously being a respiratory consultant whilst working on the wards. So, you know, typical cough, fever, tiredness, loss of smell in March and I got it pretty badly, well I did get it very badly. So I was off work for a month and at the time, you know, I got a very bad cough, chest pain and looking back when I had a CT scan, six weeks later, my severe chest pain with the acute infection was explained with bilateral broken ribs at the time, which is blamed why I was very sore, coughing at the time. And you know, at the time we thought it was just a viral infection and that it would get better, we would recover. And so I just thought it was that. So I went back to work on the frontline when COVID was hitting and, you know, I wasn’t too bad, but I was noticing that I was getting very breathless just walking the kids on to school. My heart rate would go up to 140, which, you know, I was mid to late thirties and this wasn’t normal to me. I was fit and active. I had three young boys and it was sort of in the summer of 2020 when it was starting to come around in the social media that actually this was a post-viral syndrome, that ‘long COVID’ was starting to get mentioned. And this syndrome of POTS and actually I’ve never heard of POTS, you know, through medical school, this Persistent Orthostatic Tachycardia Syndrome was getting mentioned in the sort of Facebook forums. And so I diagnosed myself, I guess, with POTS doing the NASA Lean test. That’s when you sit down, you measure your heart rate and then you stand up leaning against a wall and you measure your heart rate over a 15 minute period. And my heart rate went from 60 sitting down, which was normal for me to 120. And the criteria for POTS is a raise of 30. And that sort of explained why I was feeling pretty rubbish. So I had – long COVID has got about 200 symptoms and I had the typical features of long COVID. I was tired all the time and long COVID, it’s not just fatigue, you know, it’s not just tiredness. It is an overwhelming fatigue. I had muscle aches. I felt like I’d been in the gym sort of doing weights all the time. I would wake up feeling like I was hungover all the time. So I was managing through the summer and was sort of feeling okay, going to work and not doing too bad. And then I think it started getting worse when I had a period of a severe headache, and my immunologist feels that that was a reactivation of possible herpes simplex – so the cold sore virus – and for me that’s when my long COVID really kicked off. And at that point the typical symptoms of long COVID for me got worse. I would wake up feeling like I had the worst hangover ever, feeling constantly jetlagged. It wasn’t just like a normal sort of tiredness, you know? I couldn’t really think, I had brain fog. So, you know, a better term is ‘cognitive dysfunction’. You know, I struggled to do simple tasks. I couldn’t add up, you know, 4 times 6.
Dr Louise Newson [00:08:52] Very scary.
Dr Marianne Tinkler [00:08:55] Yeah really scary. You know, I’d put things in the oven to cook, cakes, and completely forget about them, come back and they were burning. You know, I’m a constantly juggling mum of three boys. I can multitask and I would just forget to do things. Too much physical or cognitive exertion would flare my symptoms, which is a real key feature of long COVID or post exertional malaise. And that’s a real sign that your body needs to rest. But I’m a typical busy working mum. I ignored that and I, my response was just to push through. So I was still working at this point and being a mum of three boys, and I would be at work and then on my days not working, when my kids were at school or at nursery, I would just be sleeping all day. And so I was in this typical ‘boom and bust’ cycle. And at this point I spoke with sort of occupational health. And this was the point where occupational health said “you are really not coping”. And they said you need time off work, which I was really, really thankful actually. You know, I think doctors are some of the worst people to look after our own health and you’ll probably agree with this won’t you.
Dr Louise Newson [00:10:15] Yes, totally!
Dr Marianne Tinkler [00:10:15] So I think I needed someone to look after my health. And so I was told you need to stop work. And for me, that was a really dark time actually, because actually being given the permission to stop was then a point where I totally sank down and I fell apart in a heap, to be honest. And, you know, I think I was completely holding it together and then it fell apart. And so I was off work, pretty much not able to do anything for about three months.
Dr Louise Newson [00:10:49] Gosh. And were you having your period? Sorry to ask a weird question!
Dr Marianne Tinkler [00:10:53] No no!
Dr Louise Newson [00:10:53] You’re talking about long COVID.
Dr Marianne Tinkler [00:10:56] No. So I’ve got three boys. I had IVF for the first two and then number three was a very, very welcome surprise. And I had a Mirena coil with baby number three.
Dr Louise Newson [00:11:07] So that means for those listening, the Mirena coil has got a synthetic progestogen in it and it keeps the lining of the womb thin, a great contraceptive, but it often results in there being no periods. And so that’s very hard then, isn’t it, to monitor your menstrual cycle or your hormones if you’re not having periods. We know hormone blood tests are a waste of time. So then what did you do? What made you think about your hormones?
Dr Marianne Tinkler [00:11:30] So it was basically about three months later, I started noticing that every month I would have a real flare of my symptoms around every four weeks. So it was a 28 day cycle. I could pick it off the diary that I would have a three or four day period where my symptoms would get way worse and it would pretty much take me to my bed. You know, my symptoms would flare off massively, and to me it felt like a complete dip of my estrogen. And then I would feel a bit better. And then a month later it would dip again. So I booked an appointment and had a chat with a really lovely GP who didn’t dismiss me and I just said, it just seems to me that this feels really like a dip of estrogen. I said could I try some – I said, I’m only 38. I’ve got no family history of early menopause, but please, can I try some estrogen? And, you know, we discussed the pros and cons. And she said, I’m happy, she said there’s no point doing a blood test, because actually it won’t really help us. But based on your symptoms, you know, talking through symptoms I had on top of things, I had some tingling in my hands and feet, my sleep – I mean, COVID’s recognised to, and long COVID, disturb your sleep. But I was really struggling to fall to sleep. I would wake every sleep cycle. I’d have really vivid dreams and I was just not waking refreshed from it. And obviously if you can’t sleep properly, you’re not going to heal your body properly are you? It’s not going to help you. And so she said, “Well, why don’t we try on some topical estrogen.” Obviously, I had the Mirena to help from the progesterone side of things and she said “give it a month with one pump of estrogen and if that doesn’t help or if it does help a little bit, we can increase it up to two.” And it did help a bit, so I increased it up to two and it helped a little bit more.
Dr Louise Newson [00:13:29] Interesting.
Dr Marianne Tinkler [00:13:30] Which I thought was really interesting.
Dr Louise Newson [00:13:32] Mmm, and then since then, you don’t mind me saying that you’ve been using some testosterone as well, haven’t you?
Dr Marianne Tinkler [00:13:39] I have. So, you know, I think the other things that I felt, you know, you spend a lot of time reflecting on your symptoms. I just couldn’t exert myself without having this flare of post exertional malaise. I was getting very breathless. My quality of life was rubbish. You know, I couldn’t go out with my kids without, you know, having a flare of my symptoms and having to go to bed essentially. You’d have to plan where you could go because you’d have to make sure you could rest in a park. You couldn’t go out for a whole day trip with them because it would, you know, I didn’t have enough energy to go and do that. We’d have to plan our holidays where we could go because holidays would be too much energy. You know, my quality of life was awful. For me, I had very low motivation and very low mood. I put on a lot of weight, which I was trying to lose, but my normal ways of losing it just weren’t working. So that’s why I reached out to your clinic to try and see, it felt for me that I had low testosterone levels, and I felt quite personally that I wanted to try some testosterone. And the background, I’d also been seeing a cardiologist because I’d been diagnosed with this dysautonomia and POTS and I’d also been doing lots around changing my diet, doing lots of vitamins from the long COVID side of things and lots of other treatments that we can come on to from that side of things. So, yes, so I started on some testosterone and I think that’s really helped me. The blood tests have also shown that I’ve had low testosterone and the testosterone replacement, I feel has helped me over the last six months.
Dr Louise Newson [00:15:28] I think it’s very interesting isn’t it? So, if I’d had this conversation with you ten years ago, I didn’t even know women produced testosterone because I don’t know about you, Marianne, but no one taught me that at medical school.
Dr Marianne Tinkler [00:15:38] No, nobody mentions it do they?
Dr Louise Newson [00:15:41] No and I remember going to a lecture, actually, with a menopause specialist to say women produce more testosterone than estrogen when they are younger. And I was like “What? Testosterone? Women? “What’s happening there?” And then I obviously read about it. Most of the evidence is just looking at libido, because that’s all they’ve done. Because obviously women don’t get me wrong, libido is very important. But actually we are more than just sexual beings and we have a lot of testosterone receptors in our brains in areas where we look at cognition and memory and mood. And then we also have a lot of testosterone receptors in our cardiovascular system and our lungs and our bowels and our skin and our joints and everywhere. So then you think, well, you know, we have been designed as human beings for our bodies to work very well. But we don’t have a testosterone receptor just for fun. It must be there for a physiological reason. And so then you sort of look and put the pieces together and then because NICE guidance say we can prescribe testosterone for women who have reduced sexual desire. Most women I see in the clinic have zero or very little libido despite being on HRT. So then I’ve been prescribing testosterone for reduced sexual desire, finding that women say, well, their mood, their energy, their concentration, their stamina, their ability to sleep, their ability to function and multitask has all returned. And yes, a lot of women find that they improve their lifestyle and their eating habits and their exercise, which, of course, is going to have an effect. But the biggest difference they’ve made in their sort of 3 to 6 months since I last saw them in the clinic is starting testosterone. And I think it’s very interesting when you think of POTS as well, the effect of testosterone on our hearts. I see a lot of women who find very dizzy when they stand up. You might not be diagnosed with POTS, but testosterone can often have this effect as well. And it is just a hormone and we give very low doses as well. So it’s very safe to try compared to some other things. And I’m sure with your job, you’ve prescribed all sorts of drugs that have had side effects.
Dr Marianne Tinkler [00:17:45] Well, I think that’s it. I mean, and I think also, you know, for me, I had a very low sex drive through it all. So that was a definitely had the criteria as well. But actually what was more affecting my quality of life, as you said, was my cognitive dysfunction, my low motivation, my low, you know, just everything, my low quality of life. You know, I’m now able to work. I’m now able to function more as a mum. I’m now able to string words together a bit better. And as you said, the HRT and the testosterone have much lower risks than a lot of other treatments that the long COVID patients are going out and seeking privately. You know, people are going out trying apheresis, which is a blood filtering system, which is costing, you know, 15, 20, £25,000. They’re going out and doing you know, they’re trying anything to try and get back their quality of life. And I think you have to recognise that yes, ideally as doctors we are hoping to get evidence-based treatments. But long COVID is a new disease which, you know, I think the ONS data is that there are 380,000 patients with long COVID symptoms of two years of which I’m one of them. And the UK is getting some trials out and I think they’ve got 50 million worth of funding in the UK now of studies. But I think the quality of studies that the NIHR are funding in the UK at the moment are a bit variable. They’re either observational ones or they’re quite postcode lottery, like the STIMULATE-ICP, which are only recruiting for London, or they’re looking at weight loss meal replacement ones, which you have to question about if your quality of life for long COVID is quite poor, how much better are you going to feel if you’re going to get a meal replacement? You know, I’m not sure just losing weight is going to make you feel better. And I think we have to question, there’s quite a lot of gaslighting still going.
Dr Louise Newson [00:19:59] Totally. But I think this you know, the gaslighting is something I’d not even thought about until recently. But there’s a lot with menopause, and I think there’s a lot with long COVID. I’m a member of a lot of long COVID support groups and listen to the stories and in fact, quite early on with long COVID, I kept saying to my husband, “I’m sure hormones are part of this”. And he said, “look, stop blaming hormones on everything.” And I said, “No, but listen, we know that coronavirus attacks the ACE-2 receptors. We know there are a lot of ACE-2 receptors in our ovaries.” But we also know that any infection can affect the way our ovaries work because our bodies are very well designed to protect us from being pregnant at times of infection or times of illness, so our ovaries won’t work as well when we’ve got an infection. They won’t work as well with the way the coronavirus affects ACE-2 receptors. And also a lot of women are just going to become perimenopausal or menopausal as well as having COVID. So I’m not saying that the long COVID cure is hormones, but I am saying that I think a lot of women are going to have a worse deal of their long COVID because their hormone levels are low. And so in the times when long COVID started to be talked about, I actually reached out to 40 different research teams and spoke about hormones and they all just said, “No, we’re not interested”. “No, we’re not doing any studies.” Nothing, nothing, nothing. And then there was a study, I won’t say where, but somewhere in London. And they were looking at antihistamines, they were looking at colchicine, or they were looking at aspirin or actually it wasn’t aspirin it was a NOAC – a Novel Oral AntiCoagulant. And I said, “Well, could you just have a fourth arm, just looking at hormones?” And they said, “No, we can’t.” And I said, “Right. Why don’t you just do some hormone testing? Because estradiol is not very reliable. But it’s very interesting sometimes to do testosterone levels because testosterone deficiency can occur even if estradiol levels are normal.” And they said, “no, we’re not doing that”. So I found it all very frustrating. And then you just look at the commonest group of people with long COVID are women in their late forties. So then I’ve said to quite a few people who run long COVID clinics, “Why don’t you screen women for the menopause or perimenopause, give them the balance app, allow them to have their hormones rebalanced, because they’ll be perimenopausal or menopausal, and then see what’s left. Because you might find that your clinic isn’t quite as busy as it could be otherwise.” But no one’s had menopause training. A lot of hospital doctors don’t prescribe HRT, so I feel like we haven’t moved the needle forwards and I’m not quite sure how to do it because this is a global health problem, long COVID, isn’t it?
Dr Marianne Tinkler [00:22:36] Exactly. And that’s what I’m seeing in my clinic as well. In my respiratory clinic, I’m seeing some long COVID patients and I haven’t yet done the HRT training. And in respiratory don’t get menopause training, but obviously I’m developing and now an interest in the menopause. And so I try and direct the long COVID patients that I see, I get them to download the balance app. But I’ve directed a few patients to their GP and then I see them back again in four months time. I said, you know, “have you had any luck discussing perhaps getting HRT with your GP?” And some of them have had difficulty despite being in the prime menopausal range of sort of fifties. And they said, “oh no, they said they don’t think I’m menopausal”. And to me they’ve got long COVID, I think they’ve got some menopausal symptoms, you know, they’ve got clear hot flushes, you know, some joint pains, some, you know, but they’re having difficulty discussing perhaps getting HRT from their GPs. And I think it’s this difficulty isn’t it of… there’s a lot of barriers, isn’t there, for patients to access menopausal care? And I know our GPs are… there’s a big crisis isn’t there at the moment and everybody is trying to do their best to do the best care that they can at the moment. But I don’t quite know what the best answer is. You know, last year I was a NHS England patient advocate for long COVID, so, you know, we did try and bring it up and I think a lot of the long COVID clinics now are screening patients for any menopausal symptoms. So I think the landscape is changing and I discussed it at my long COVID clinic recently. So I think the awareness is there and I’m on long COVID groups and do bring up the overlap between perimenopausal symptoms and long COVID symptoms. I don’t think it is just perimenopausal symptoms cause long COVID and long COVID symptoms are perimenopausal. You know, it is little increments. And actually, the HRT hasn’t solved all of my problems. You know, I have a lot of cardiac problems, but it’s those tiny little wins that if you can cause, give a little increment of benefit with some HRT and a little increment of benefit with some cardiac medication and a little increment of benefit with the MCAS treatment with the Famotidine and Fexofenadine for the long COVID and I’ve had some hyperbaric oxygen treatment and that helps and I’ve changed my diet and that helps a little bit. And you get these little incremental gains, then I think you gradually try and improve your quality of life to try and get a bit better.
Dr Louise Newson [00:25:29] I think it’s so important and I think nothing in many walks of medicine actually is 100%. And I think as a patient, we have a responsibility to work out what’s best for us. So even if I had long COVID, you had long COVID, what treatment would work for both of us would probably be different, but it’s a combination of treatments as well, and it might be that HRT makes one person 2% better. Someone else 20% better, someone else 80% better. That’s fine actually. But we need to be able to allow people to have a choice. And what I am hearing from a lot of long COVID people is that they’re like you say, they’re being denied even a trial of HRT, but also they’re only prescribing estrogen. They’re not prescribing testosterone because there’s a lot of reservation about prescribing testosterone, despite it being on NICE guidance.
Dr Marianne Tinkler [00:26:17] I’ve been really lucky now that, you know, obviously the testosterone has been instigated in the private clinic and now my GP has taken over the prescribing of it through the NHS.
Dr Louise Newson [00:26:27] Yes, which is very good.
Dr Marianne Tinkler [00:26:28] And the thing I feel really strongly about, which is why I’ve overcome my vulnerability and why I’m doing the podcast with you now, is I feel really strongly that actually we need to try and break down the barriers of access to patients because I feel really strongly that actually it shouldn’t be the people who can afford to go and pay privately to get access to this treatment. You know, what about… and it’s clear it comes out in the data. You know, some of the research data say that long COVID is predominantly affects women who are in their forties to sixties. Well, actually, no, it doesn’t. It’s just that the data is capturing that. It affects the ethnic minorities just as much but they’re not coming through the long COVID clinics as much because they’re not accessing healthcare as much. And I suspect that actually comes out in the menopause data as well. You know, these patients aren’t able to access the private menopause care as much and probably aren’t able to access the NHS menopause care as much as well. So, you know, these patients probably aren’t able to access the testosterone or HRT as much and so probably aren’t able to get that 1 or 2 or 10% benefit for their long COVID as much. And so we should be reaching out into those communities, into those less access patient groups to try to get them in. And it was even in the Bank of England economic reports that actually there’s a big cohort of previously working people who now aren’t working. And they think that there’s a signal that because of long COVID those people now aren’t working or have gone to working part time because of long COVID. And actually, you know, if there are some treatments and maybe if HRT is going to help people either get back to work or increase their hours because of that, actually that’s going to have a big economic benefit. You know, it’s going to have a massive personal benefit. You know, I’m lucky I’ve got some income protection, but actually there are lots of people and lots of people in the long COVID forums who are now losing their jobs because of the long COVID, you know. Or people who are having to have their Grannies pay their mortgage. You know, it’s a massive personal and economic impact of this and actually if a drug like HRT or if some intervention is going to have an impact for these patients, you know, and these patients are willing to make some informed choices and are happy to take those individual risks whilst they’re waiting for these research trials to come through, and the research trials actually need to be done to decide whether these treatments are going to make a difference with the testosterone and the HRT, which they’re not – doesn’t sound like they are happening at the moment. You know, I think we need to look to see whether they are going to benefit aren’t they?
Dr Louise Newson [00:29:33] Absolutely. I think you’re totally right. And we’re doing a lot of work actually behind the scenes with a clinic that we’ll announce hopefully soon about how to make HRT prescribing, especially testosterone, cheaper, more affordable, because a lot of it is about choice. And if women want something when they’ve got knowledge, then I feel very strongly they shouldn’t be denied it, if it’s coming from the right place and for the right reasons. And I really hope that we can start doing some proper research, especially into the merits of testosterone beyond libido. So I’m really grateful for your time, Marianne, and I think I’m going to have to get you to come back so we can talk even more about other treatments also with long COVID as well, because I know we’ve talked a lot about hormones, but there’s lots of other things and I’m hoping maybe I could invite you to come back next year so we can talk again, because it’s a really important topic that is not going away very quickly and not quick enough, because I think research priorities aren’t quite aligned to what the women want. So before we end though, three take home tips, if that’s okay, say for people who’ve got long COVID and maybe struggling or not receiving the treatment or advice that they are perhaps expecting. What would you recommend?
Dr Marianne Tinkler [00:30:46] Make sure that you pace and don’t push through.
Dr Louise Newson [00:30:49] Yeah.
Dr Marianne Tinkler [00:30:49] Track your symptoms on the balance app and consider HRT if you think that you could have an element of menopausal or perimenopause. Even if you may be younger than you think. And think about the holistic lifestyle changes, such as looking at your diet, exercise. Think about having a balanced diet, a rainbow diet with a range of multicoloured diet, with a probiotic sort of, lots of kimchi, kombucha and cassia. I’ve had smoothies and sort of flaxseeds to help improve your gut microbiome. I think that’s really important to the route of recovery from long COVID and also exercise getting outside if you can, even if it’s just sitting outside on a bench if your long COVID fatigue doesn’t allow you. I think that’s really important for your wellbeing.
Dr Louise Newson [00:31:44] Absolutely. Really good advice. And we’ve got a special booklet actually about long COVID as well. And there’s lots of information with Emma Ellis Flint about the gut microbe as well, because all of this is really important to consider and look at. And the most important thing is just do not suffer in silence. So thank you so much again for your time, Marianne. It’s been great, so thank you.
Dr Louise Newson [00:32:05] Thanks for inviting me, Louise. It’s great that you’re helping and just raise the awareness about the link with long COVID and hormones.
Dr Louise Newson [00:32:13] Thank you. For more information about the perimenopause and menopause, please visit my website: balance-menopause.com or you can download the free balance app which is available to download from the App Store or from Google Play.