Nursing and the menopause: International Nurses Day special episode
In a special episode on the eve of International Nurses Day, this week’s guest is Sue Thomas, an advanced nurse practitioner with an interest in menopause who works alongside Dr Louise at Newson Health Menopause and Wellbeing Centre.
They discuss Sue’s 30-year nursing career, including her work in cardiovascular disease prevention, and talk about the vital role nurses play in raising awareness and treating women during the perimenopause and menopause.
And with figures showing nine out of ten UK nurses are women, and more than half aged over 41, Sue and Dr Louise discuss the impact of the perimenopause and menopause on the nursing profession, with Sue sharing her own menopause experience and the barriers she faced when trying to access HRT.
Sue’s three take home tips for fellow nurses and healthcare professionals are:
1. Look for more education about the menopause, such as the free Confidence in the Menopause course
2. If you are struggling with menopause yourself, be open with colleagues and line managers – we need to look after each other
3. Let’s make the menopause a positive thing.
Click here to read an advice article by Sue for healthcare professionals on coping with menopause in the workplace.
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. On this week’s podcast, I’ve got with me a nurse who I’ve known for quite a few years now and ensnared her into the Newson Health community more recently. So someone called Sue Thomas, who I met quite a few years ago Sue didn’t I? Did you come to my clinic first, or was it a conference that you came to?
Sue Thomas: [00:01:04] Yeah, I sat in on your clinic. You very kindly let me do that because of course, when I’d been through the British Menopause Society course for nurses, there’s no mentorship unfortunately, nationally there’s shortage. So in order to get the experience, the clinical experience, I asked, could I come and sit in? And you very kindly let me and I sat signed with Rebecca [Dr Rebecca Lewis], actually. And I think that was after we’ve done a little presentation on group consultations many moons ago.
Dr Louise Newson: [00:01:29] Yeah, that’s exactly right. And I think, like me, you were sort of quite astounded with the stories and the need from women and I know when I did some theory training many years ago, I read lots of articles, went on a few courses, but I just thought, hmm, when a patient sitting is in front of me, I don’t quite know what to say or what to do, and you want to see people do it in action. And it’s like anything in medicine, isn’t it? You learn on the job. You obviously need to have theory. Of course you do, whether you’re a doctor, nurse, pharmacist or whatever. But you actually you learn so much more from your patients. And the way that we deal with patients, obviously every consultation is different, isn’t it, and every menopause and perimenopausal story is different. So how we approach is quite different as well. And I think, you know, there’s a lot of people who come and sit in my clinic or our clinic and really quite surprised actually, with the amount of suffering often that women have, which I don’t really think there are many other areas of medicine where people are left to suffer and be ignored for so long. I don’t know what you think.
Sue Thomas: [00:02:37] Well, I remember the first patient actually, that I saw with Rebecca, and I’ve been nursing a long time and I’ve seen a lot in my time, and I always remember that patient. She’ll stay with me, actually. And it had been a 15 year journey for this lady to finally get the care that she needed. And I think at that point she’d actually given up a job and she was quite high, quite senior, but she’d been to see, I think, several doctors along the way and just was struggling really badly that of course her work mustn’t have been so supportive and she ended up leaving her job and coming into clinic. And I heard the story and I sat at the back of the room listening to this and I just couldn’t believe it. And I remember Rebecca saying, Sue, there are a lot of ladies that you’re going to be dealing with as a nurse in the menopause clinics that have similar stories. I’ll never forget that lady, you know, and I’ve seen and heard, you know, quite a few sad stories along the way as well. I mean, it’s getting better, isn’t it, Louise? But with a fair way to go, I think. [00:03:46][69.4]
Dr Louise Newson: [00:03:47] Yeah, I think it is and it isn’t. I think some of the problem is that there’s more awareness, which is not a problem. Of course that’s really good. There’s more knowledge, which again is really good, but actually there still seems to be this imbalance between the amount of knowledge that women have and the amounts of knowledge that some, not all, all healthcare professionals have. And I spoke to a lady this morning actually who’s had symptoms for about seven years now, and she’s on Pregabalin, a type of medication because she gets really bad pins and needles and she’s also on some drug, it’s codeine and paracetamol and something else in it. And I said, what is that for? And she said, I’m really embarrassed to tell you. And I said, well, tell me. I said, is it for pain? And she said, no, not really. It’s actually to help me sleep. Without it, I can’t sleep. But she said, I know I’m a bit addicted to it now. So she’s been given this medication. And I said, what about your menopause? Do you think any of your symptoms are due to menopause? Oh yeah, she said. But I was just told I just need to get through it. It’s just one of those things. It’s just part of being a woman. And I think this is where it’s sad that women are not offered evidence-based treatment for many reasons, and it’s been medicalised in the wrong way. And I know your your background is obviously very evidence-based and your sort of speciality really before you came into menopause was cardiovascular medicine, wasn’t it?
Sue Thomas: [00:05:09] Yeah, cardiovascular disease prevention primarily. So within practice, I did a lot of work with a national education charity called Education for Health, and we went around the country training doctors and nurses to look after patients who were at high risk of cardiovascular disease and those who had cardiovascular disease. And of course, you know, I didn’t realise actually until fairly recently, I have to admit, we have to remember that a lot of ladies are very frightened of breast cancer, particularly in relation to hormone replacement therapy. But you have to remember, Louise, that, you know, it’s not breast cancer that kills women. It’s heart disease, it’s cardiovascular disease. And we’ve got really good evidence that hormone replacement therapy reduces that risk. And so, you know, to my mind and I’m hoping that in the not too distant future that actually hormone replacement therapy is, you know, a big part of the cardiovascular disease prevention strategy, really. I don’t see why it shouldn’t be. I know it’s not for primary prevention at the moment, but I can see that happening because we’ve got really good evidence, it’s coming through thick and fast now, isn’t it? That it does protect.
Dr Louise Newson: [00:06:21] Well it is there and isn’t it interesting because the USA Preventative Services Task Force have just announced there’s not enough evidence for primary prevention. And as you know, some of us wrote a letter to the journal and others did as well to say, well, there is evidence. And sometimes I think about it and think because HRT is so cheap and there’s not big pharma involved, actually, there’s a lot of big pharma that want statins to be prescribed. They want blood pressure lowering treatment to be prescribed and maybe antidepressants as well, and painkillers and and and… especially in America, actually. But also I think there is that in the UK as well. And just for transparency, those who are listening, none of us who worked with Newson Health do any paid work with pharma. So we’re not talking about this from a vested interest. But I think because pharma for HRT is not really there, there are pharmaceutical companies, but they haven’t got the same presence and money behind them. I wonder whether that has a difference because there’s more evidence that HRT can reduce future risk of a heart attack than there is for statins in women. Yet we prescribe statins and a lot of people are encouraged to prescribe statins for primary prevention of heart disease for women aren’t they?
Sue Thomas: [00:07:36] Yeah, absolutely. And I think if you look at Framingham, the big study that’s ongoing, we didn’t have a lot of women in that study as well. But we know that heart attacks go up as women go through the menopause and we know that estrogen replacement, we know that that that is an anti-inflammatory effect, isn’t it, on vessels. So I’m just hoping at some point alongside of course lifestyle management that we start looking a little bit more seriously really at how we can incorporate good menopause care as part of primary prevention for cardiovascular disease.
Dr Louise Newson: [00:08:09] Well, absolutely, because like if like you say it’s the biggest killer killer and increasingly we know that women who have a heart attack actually often present with different symptoms to men, and they have a worse prognosis actually after heart attack. And that can be harder to diagnose because of their atypical symptoms. So even having heart disease as a woman puts you on a wrong foot almost compared to men. But also, we want to prevent disease. You know, we’ve come into medicine, me as a doctor, you as a nurse, obviously to treat disease, but also to prevent disease.
Sue Thomas: [00:08:43] To prevent.
Dr Louise Newson: [00:08:43] As well. Yeah. And you know, there’s been amazing work with prevention of cardiovascular disease with everything else as well. You know, I often think in my mind about hypertension, raised blood pressure, because that doesn’t usually cause symptoms. And I think is it a disease or not? Well, it doesn’t actually matter whether it’s a disease or not. The reason that we treat raised blood pressure is to reduce risk of cardiovascular disease, isn’t it? And absolutely, there is good evidence that lowering blood pressure can reduce incidence of heart attacks and strokes.
Sue Thomas: [00:09:17] Absolutely. Modifiable risks are the biggest.
Dr Louise Newson: [00:09:20] Absolutely.
Sue Thomas: [00:09:21] Area, really. So it’s a lot is lifestyle choice, Louise, you know, You’ve got your family history and your genetics and all the rest of it. But actually the biggest risk factors are in that modifiable category. So if we can educate, which we do as part of our management of women going through the menopause, certainly lifestyles are really big. And that’s the same with hypertension management, you know, prevention of cardiovascular disease, the majority of it is lifestyle. So exercise and I don’t like to use the word exercise, actually, I like to use the word activity.
Dr Louise Newson: [00:09:51] Yes. Yes. Activity or movement. [00:09:53][1.5]
Sue Thomas: [00:09:54] Or movement, yeah. Because we know that reduces blood pressure. We know that has a really good benefit for mental health as well as reducing cardiovascular disease risk.
Dr Louise Newson: [00:10:03] Absolutely. So anything for prevention is really, really key. But we know actually that to try and ask many menopausal women to exercise more, to eat better, to reduce alcohol, to stop smoking can be really difficult can’t it?
Sue Thomas: [00:10:21] Especially when you’re not feeling very well.
Dr Louise Newson: [00:10:23] This is the thing, isn’t it? You know, I had someone, a doctor, sat in my clinic a few years ago and she said, ooh Louise you seem to be prescribing HRT in the first consultation. What I do is I encourage women to change their lifestyle first, and I won’t give them HRT unless they’ve shown me that they’re committed with losing weight, doing exercise and sleeping better and everything else. And I said to her I understand you saying that, but actually, as a perimenopausal woman myself, it was impossible for me to improve my exercise, to sleep better, to eat better, because actually I had so many symptoms, I couldn’t be bothered to do anything and I didn’t feel I exercising. I had so much muscle and joint pain and headaches and reduced motivation and I was putting on weight despite eating relatively healthily. So actually I’m setting myself up to fail. And the last thing I wanted when I saw a doctor was for them to tell me to improve my lifestyle. For some women, absolutely, it might be the right thing to consider first line. But usually we do it in conjunction don’t we? And I think that’s the same you know, when I used to run diabetes clinics and, you know, the recommendations are lifestyle first aren’t they, before starting a diabetes…
Sue Thomas: [00:11:33] That’s probably where your colleague was coming from.
Dr Louise Newson: [00:11:35] Yeah, probably. But actually when I was in general practice, I knew a lot of my patients really well and I knew that I could sit there till I was blue in the face, telling them that I needed to change their lifestyle. I knew they wouldn’t, but actually, if they started a drug that then helped them to feel better and help their sugars to come down, then often the rest would fall into place. And so I often didn’t adhere to the guidelines in such a strict way. I’d give them the choice and say, look, the guidelines say three months before, but actually I know what you’re like and I know you’ve sort of tried with lifestyle before, so how about having some medication and then we can review. And then sometimes, and I had quite a few patients who then their lifestyle became so much better that they would lose their weight and everything else. So then they would reduce some of their medication afterwards. Which is good.
Sue Thomas: [00:12:25] That’s not unusual.
Dr Louise Newson: [00:12:26] It’s not, is it? And I think that’s the same with heart drugs as well. Actually, if we can optimise our diet and exercise and sleep and everything else, a lot of people come off antihypertensive don’t they?
Sue Thomas: [00:12:36] Yes, definitely.
Dr Louise Newson: [00:12:38] And I think in medicine we sometimes forget that we everything we prescribe can be stopped as well. And a lot of women we see in the clinic, they come on all these medications, like this lady I said today with her Pregabalin and her painkillers. But I know in three months time she’ll be able to come off those, or I’m pretty sure. And we do that a lot. And I think it’s really important, isn’t it, to remember that any medicine is not, you don’t sign up for life, do you, for a medication. It has to be reviewed and the dose might need changing, the type might need changing. And that’s the same with HRT. Although most people take it for life, the dose often does need changing, doesn’t it?
Sue Thomas: [00:13:18] Yeah, absolutely. And it’s that holistic assessment, isn’t it? And that shared decision making. And I think it’s tailoring things to the individual as well. What one person can do or wants to do, the next person doesn’t. And I think exposure to different activities because as I say, I don’t like to use the word exercise because the minute you say exercise, you know, people, it’s all they can see is a Lycra clad lady on some sort of treadmill in a sweaty gym or whatever. But it doesn’t have to be, it could be ballroom dancing, Latin American dance if you fancy dancing, that’s exercise, yoga, golf, tennis, anything that gets you moving gets, you know, walking. They’ve got really good evidence for walking groups now, where it can improve mental health, you are getting out with other people, you’re having a conversation and there’s some good evidence that it improves brain function as well, as well as get the weight down. So once the weight comes down, then the blood pressure starts to come down, then everything. So, you know, so like a domino effect. But you’ve got to feel well in the first place, haven’t you Louise, to be able to do all those things, like you say. I do remember that when I had my hysterectomy back in 2020, and I remember postoperatively walking down the stairs, it was about six or eight weeks later and thinking I don’t have to walk down the stairs after I’d recovered, of course, one step at a time. And the only difference was Louise, I was on HRT, I was on estrogen. So the wound…it was, you know, tender where the incision was and so on. But the actual joint pains… and I have never… I’d been suffering with joint pains for years and brain fog and a bit of anxiety. I never thought I was going through the menopause. I didn’t assimilate those, you know, symptoms. But I’ve been suffering with perimenopause, must have been for years, and the only thing that changed after my hysterectomy was estrogen replacement. And I was able to come down the stairs. And it was only that I twigged and thought, oh my goodness, I’ve not been able to do it for years. Interesting isn’t it?
Dr Louise Newson: [00:15:12] Yeah, and actually we’re just presenting some results of a questionnaire that we did recently about surprising symptoms of the menopause and muscle and joint pains is one of the things that affects over 15% of women. But they were surprised about it. And often people say how hard it is, especially in the morning when you’re usually at their lowest, when people are perimenopausal, coming down the stairs, holding the banister, taking time. And sometimes people say even the soles of their feet feel very uncomfortable, you know, like walking on pebbles, very uncomfortable. And it’s one of those things that because all we talk about is flushes and so many years that’s what it’s been done. But there’s physical symptoms, but also the psychological symptoms that are affecting people in the workplace. And you know, I’ve said it before and I say it again that about 40% of NHS employees are menopausal. But when we look at nurses, it’s probably even more than that, isn’t it Sue?
Sue Thomas: [00:16:12] So yeah, I mean, I think we’re all in very difficult jobs and we care for others and we’re less likely to care for ourselves, aren’t we, and our teams around us as well? I don’t think we’re the best at doing that because we’re just so busy and demanding jobs as doctors and nurses. But I think we do need to look after ourselves because there’s not that many of us. Let’s face it. I mean, we’re in a crisis at the minute. Got our colleagues on strike with no doctors, nurses coming into certainly primary care. I work in general practice and a third of our workforce is going to be retiring anytime soon. And there’s no one really to re-fill those places. So we have to look after ourselves and sometimes we have to work differently with patients and we have to think about different ways of caring for patients. And because the demand is ever increasing and we don’t always have the staff and the resources to deal with that demand, we’re doing the best that we can, but we do need to look after ourselves. And I think because, as you know, Louise, it’s a huge amount of perimenopausal and menopausal age that are in most senior jobs, often within the NHS. We’ve got to keep hold of them. We can’t afford to lose any.
Dr Louise Newson: [00:17:20] And it’s very hard. In fact, my husband was sent something through from his NHS Trust about Menopause support, a menopause group, and he said, oh, Louise do you want to have a look at this? And I said, no, because I think I’ll just get too upset because it’s about support. It’s not about treatment, it’s about support. It’s like we need our hands held when we’re menopausal. I didn’t need my hand held at all. I just needed some hormones and I didn’t know how to get hold of them. And this is a problem I hear time and time again I see so many women who are nurses and they’re unable to carry on working. They’re unable to get treatment that they want. That’s, you know, based on NICE guidance. So they’re reducing their hours or leaving. They’re not leaving because they want to, you know, lots of them have had some amazing careers and they’re made of steel. Nurses are really hard workers. I think, you know, a lot of nurses I speak to and they do 13 hour shifts. It’s full on, you know, really hard. They’re really committed to the organisation yet put menopause or perimenopause into the mix it’s just too hard for them. And it makes me really sad, actually, and actually very angry to think that we have something that’s very cheap, that cost effective, that’s evidence based. It’s mentioned in NICE guidance, yet we’re refusing our own profession so that we’re letting them down to the extent that they have to leave in a time when every single nurse counts.
Sue Thomas: [00:18:46] Absolutely. And from personal experience, I mean, it was only, as I say, three years ago, I had my hysterectomy. I was in a women’s hospital leaving and having already talked to the surgeon prior to having known a bit more knowledge about the menopause and all the rest of it, I was going to be plunged into this surgical menopause. So I wanted to be prepared. And actually I’d spoken about HRT and I asked could I have it on my discharge? And when it was being discharged Louise, there was no HRT, there was no mention of HRT, and I was told to go away, recover, and if I got symptoms in six months to go and speak to my GP, that’s what I was told. And this is a women’s specialist hospital and so of course I didn’t do that, Louise, I asked, please may I have some estrogen? And at that point the TTOs [to take out] had been done. So it was an add-on, so they had to go back and get the final okay and I was offered an oral estrogen. There was no choice. But of course having that bit more knowledge I said no, please may I some gel? And it was, do you remember the scene in Oliver when he asked for more porridge? That’s how I felt. Really, that’s how I felt. And then after that it was then, you know, there’s no follow up particularly. You get a six week remote check and all that. But then that was going back to the GP and saying, can I please have some more gel, you know, and it’s never on a repeat, you know, and it’s a continual, you’re having to bother people and it needs to be, it could be so much more efficient. We’ve got increased demand because sometimes systems aren’t that good. Why couldn’t I have had it on repeat so I don’t have to keep ringing in and I don’t have to keep bothering?
Dr Louise Newson: [00:20:23] No. And it could be so easy. And I know there’s a lot of people out there who are very rude about the work that I do and someone I know met somebody quite senior in the NHS recently and she said that she knew me and the person rolled their eyes and said, oh, not Dr Louise Newson. And she said, oh, can I just ask why you’re saying that? What is it about her? Do you not agree with what she’s doing or…what is it? She said no, she’s just creating so much work for us because every other patient we see is a woman who’s perimenopausal or menopausal and wants HRT, and then this person I know said to this other person, do you think that’s Louise’s fault? And then she went, no, I suppose you’re right. It’s not. And it’s this perception, isn’t it, that it’s a short term problem for longer term gains. And of course, it’s demanding and having more women. But actually, the number of women we see in the clinic who have been going back and forth for investigations, for palpitations, they’ve gone back and forth for investigations, for their urinary symptoms. They’ve had brain scans for their memory problems. They’ve been seen by psychiatrists, they’ve been back and forth to their GP with all these weird and wonderful symptoms. So actually they are creating a lot of work, but they’re going under the radar. And, you know, I think back as a GP, most of the people I saw were women and most of the people I saw were in their 40s and 50s. And never, well, unless they said to me I’m menopausal or like you, I’ve had a hysterectomy that it’s so obvious they’re menopausal. I didn’t think about it and I would be one of those doctors that would send people off for tests. And, you know, we could nip it in the bud. And I think that’s what we need to do, really, like we’ve done with cardiovascular disease prevention. You know, I used to see quite a few people, mainly men, who actually were having a heart attack, they’d come into the surgery and we’d have aspirin all ready, we’d have the GTN and we’d call the ambulance. That doesn’t happen anymore because awareness is huge about what is a heart attack, if you have this chest pain, you dial 999 and then you go in and you in and you have a primary angioplasty. It’s incredible what happens. You know, over the last 30 years of me being a doctor, it’s been transformational for heart disease. Hasn’t it?
Sue Thomas: [00:22:35] Oh, absolutely.
Dr Louise Newson: [00:22:37] It’s been incredible. And even for stroke as well, it’s now seen as an emergency. Whereas in my day, ‘oh bed four in the corner has had a stroke just put them to bed and we’ll do a scan and see whether they need aspirin or not’. It’s so different. And absolutely isn’t that right? But menopausal women is just still oh no, we don’t want to manage them.
Sue Thomas: [00:22:57] Yeah, I think there’s possibly a lack of confidence and I know that the knowledge base hasn’t been that great. I know as a nurse, going through all my career and I’ve been in nursing for 30 years, I mean, we were never offered menopause training, certainly not in my training and not as a nurse practitioner. I can’t remember being offered menopause training. It was only when, you know, I remember seeing ladies and thinking, oh gosh, something up, and signposting these ladies to GPs for more help. And certainly smears are a great opportunity for nurses to identify and it’s asking the right questions at the right time isn’t it, and getting patients who, for example, are having some GSM symptoms to get them on vaginal estrogen because precious few ladies can’t have vaginal estrogen. And it makes the cervical cytology so much more comfortable. But it’s identifying them and there’s certain practices and certainly we’ve done this and it was only through your FourteenFish training and it’s fabulous. It’s free training for everybody to access. I mean, I did the British Menopause Society course, which was great. And your training as well with the case studies and like you say, the case studies for me, I think and for a lot of nurses we like case studies because that’s that’s how you learn through real life stories.
Dr Louise Newson: [00:24:09] Of course you do, it brings it to life.
Sue Thomas: [00:24:11] It brings it to life. And so I remember coming out of that and thinking, we’ve got to identify these patients better. And so what we’ve done is in reception, because I work in a general practice, we’ve put a little poster up for the reception team, we did a little educational thing and just said if you get ladies between the ages, say, of 45 and 55 with these symptoms, hot flushes, low mood, palpitations I put about six or seven symptoms, we know there’s a lot more than that, but the key ones, then please signpost them through to the doctors and nurses who have more of a specialist interest in the menopause. So we’re hopefully going to identify them a bit better doing that as well. And that’s easily done, isn’t it?
Dr Louise Newson: [00:24:52] Yeah, but so important, the number of people who avoid going for smears because they’re uncomfortable or painful or a lot of people have said to me my last one was so unpleasant, I’m never going again. I say did anyone talk to you about vaginal hormones, not at all and vaginal hormones, as you know, are very different to systemic hormones. And about a fifth of people who take HRT still need to use vaginal hormones as well.
Sue Thomas: [00:25:16] And a lot don’t realise that, they don’t appreciate that.
Dr Louise Newson: [00:25:19] No, I was at an event talking recently and a woman in the audience said, I’m not allowed to have vaginal hormones because I’m on HRT, but I’m really having a lot of discomfort. And you know, the dose is very low, they’re very safe. And even for women who’ve had breast cancer, they can usually very safely use vaginal estrogen. So there’s a huge amount that we need to do. And I know you’re doing a large amount educating fellow nurses as well, which is wonderful. And I think nurses are understanding, you know, whenever I lecture and teach nurses, it’s overwhelming the response I get. And they have a bit of a personal interest because if they’re menopausal as well. But nurses are great at giving information in very easy to understand chunks of information, sometimes have longer consultations than doctors as well, actually. And I certainly feel going forwards in menopause care, more nurses and pharmacists should be involved actually, because they really do it very well, I’m not saying that, doctors don’t, I can’t say that because I’m a doctor, can I?
Sue Thomas: [00:26:24] Know. But I think you are right Louise. Patients do often open up to nurses more, you know.
Dr Louise Newson: [00:26:29] They do. They absolutely do. They’ll tell you more than they often tell us. And I think that’s really, really important. But I think, you know, joined up way using all clinicians, working together for the common goal of improving health and reducing diseases has got to be the way forward. So the work you’re doing is amazing. I’m very grateful for you coming and talking about it today Sue and opening up a bit about your personal experience. Before we end, I’ve got to ask you three take home tips, of course, but I would like to ask you three things that you think nurses could do now to make a difference. So I know there’s quite a few healthcare professionals that listen to the podcast. So if there are nurses or any healthcare professionals listening and they feel that they need a bit more education about the menopause or they’re not really sure, what are three things that you would recommend for them?
Sue Thomas: [00:27:22] Well, I would definitely recommend getting some more education. And of course, now we’ve got access to FourteenFish, which is free, and its fabulous menopause training. So I definitely do that. I would also say to nurses to talk more to each other and to line managers and to say if you are struggling a little bit on the wards or in practice, then you know, you need to let people know. And you know, I’m sure in larger organisations there are protocols and policies for menopause. Unfortunately, I don’t think it’s that common in general practice to have those policies. But I think talking and asking for support and don’t be frightened of doing that. As I say, we do need to look after each other so that we can provide the best care for our patients as well. And the third, I want to say, let’s make it positive. Let’s make the menopause positive, because I hear so many times it’s negative terms that we use. I mean, recently we’ve set up a local support group because there really isn’t anything in my kind of area, Warwickshire, NHS-wise. So I’ve set up a little support group and we did a focus group and asked the ladies what one word that summed up to them their menopause. There were 22 ladies there and we had something like 136 years of menopause between us, so some were six months in and some were at the other side. There wasn’t one positive word. There was isolation, loneliness, struggle. Everything was negative. And it shouldn’t be like that. We have to make it more positive, don’t we? And I think if we stand together, we support each other. We talk more, we can make it more positive, get on the right treatment, speak to people who know what they’re doing and they’re specialising in the menopause. And if you don’t see somebody in the practice, perhaps as a GP practice is normally the first port of call, then go and see somebody else. And if not, if you need to go privately, then do go private because there’s fabulous clinics, like Newson Health that are scattered throughout the country. But we shouldn’t be battling for good, standardised, basic menopause care. It should be free at point of access Louise, shouldn’t it?
Dr Louise Newson: [00:29:26] Absolutely, totally agree. So great tips and hopefully that’s been useful for many people to listen to and feel more empowered with more knowledge so then everybody can hopefully receive the right care, attention, treatment that they deserve. So thanks again for your time today Sue, it’s been really good.
Sue Thomas: [00:29:46] Oh, thanks, Louise. Thank you.
Dr Louise Newson: [00:29:50] For more information about the perimenopause and menopause, please visit my website, www.balance-menopause.com. Or you can download the free balance app, which is available to download from the App Store or from Google Play.