Pushing against social and political constraints on women’s health with Dr Heather Hirsch

Dr Heather Hirsch makes a welcomed return to the podcast this week. Heather is an internal medicine physician, specialising in women’s health and menopause care at the Brigham and Women’s Hospital in Boston Massachusetts, USA. Her clinical work and research centres on inequalities or unanswered questions in the field of women’s health, specifically in menopause education.

In this episode the menopause experts discuss the bigger picture of menopause care as a gender issue, women’s role in society and in the workplace, perceptions of women’s suffering and the menopause as a medical specialty. Louise and Heather share the challenges they each continue to face to educate and inform the public and healthcare professionals on the perimenopause and menopause and the benefits and safety of HRT.

Heather’s 3 tips:

  1. Know what’s going on in your body by keeping a journal and tracking your symptoms. I recommend the free balance app to my patients for this.
  2. List your own priorities and what matters most to you, whether that is your sexual health, your hair or skin, your sleep and so on.
  3. Understand the three strands of menopause management: lifestyle changes, non-hormonal treatments and HRT, and know the pros and cons for all to realise what choices are best for you.

Follow Heather at:

Instagram @heatherhirschmd

Website: heatherhirschmd.com

YouTube: Health by Heather Hirsch

Podcast: Women’s Health by Heather Hirsch

Podcast Transcript:

Dr Louise Newson [00:00:09] Hello. I’m Dr Louise Newson and welcome to my podcast. I’m a GP and menopause specialist and I run the Newson Health Menopause and Wellbeing Centre here in Stratford upon Avon. I’m also the founder of The Menopause Charity and the menopause support app 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.

Dr Louise Newson [00:00:45] So today in the studio, I’m delighted to reintroduce to you Heather Hirsch, who came about a year ago to record a podcast with me. And she’s recently recorded a fabulous podcast for any of you who want to listen for the Newson Health Menopause Society. And now she’s back again. So Heather is a menopause specialist doctor who works in Boston in USA. So welcome, Heather, today.

Dr Heather Hirsch [00:01:11] Oh, thank you so much. I’m so glad to be back.

Dr Louise Newson [00:01:14] Oh, thank you. So you’re doing a huge amount of work, obviously, with your patients, but you’re also doing a lot of education as well, aren’t you, to really get menopause onto the map, like we’re trying to desperately over here and we’ve talked at length and we will continue to talk at length about how hard it is actually to do something that’s actually very easy medicine, isn’t it?

Dr Heather Hirsch [00:01:40] Oh, yes. Actually, this reminds me, I was teaching at Harvard Medical School. That’s the hospital that’s affiliated with my institution. And I was teaching the medical students about menopause and how important it is. And one of the students raised her hand and she said, ‘well, what special certification do you need to prescribe hormone therapy?’ And I said, ‘None’. She said, ‘Well, okay’, you know, these are medical students so she’s like, ‘Why is it so hard?’ ‘What is it about it that makes it that so many doctors are so confused?’ And she just hit the nail right on the head.

Dr Louise Newson [00:02:11] It’s absolutely true isn’t it, because, you know, those of you listening know that the menopause is due to a lack of hormones. And if I said to you, ‘Heather, you’ve got a lack of vitamin D’, you’d say,’ well, give it to me then I’ll have it. Thanks very much’. If you have a lack of iron, you take an iron supplement. It’s just endocrinology. It’s hormone medicine, lack of any other hormones, you just replace. And that’s the beauty of endocrinology, actually. It’s a very nice subject because you get people better very easily. You know, we all know about diabetes. We all know about underactive thyroid glands. And this is just other hormones, isn’t it? There’s three hormones estrogen, progesterone and testosterone, that women need in different doses and different types and not all need all three. Some need 1 some need 2 and some need 3. But that’s as hard as it gets, really, isn’t it?

Dr Heather Hirsch [00:03:00] It is. And whenever I am talking to women as they’re considering hormone therapy, I’ll say just like you kind of also mentioned, ‘look, I bet you know someone who has hypothyroidism, right?’ And they say, ‘oh, yeah’. I say, ‘well, we give them thyroid back, right?’ ‘Yeah’. ‘And what if we only said they had a few years to take their thyroid medicine and then we were going to take it away’ and they’re like, ‘Oh yeah’. And the pieces come together. And it isn’t really rocket science. There is no special certification that you need to be able to prescribe these. And arguably every and any internist, family doctor, OB-GYN, should be able to freely know how to do this. But as we’ve mentioned so many times, the invisibility of women in midlife has been thrust into the medical sphere as well, because no one gets taught this. No one sees their mentors do this. And then, of course, because of the 2002 WHI, that was the last time sort of there was a turning point in terms of menopause care and hormone therapy. And we’re still at a place where the United States about 5 to 10 – let’s just say ten, making it an aggressive estimate – 10% of women take hormone therapy when many, many, many more women would benefit.

Dr Louise Newson [00:04:14] Hmm. And it’s the same. I mean, in the UK, some figures say 14%. But I know areas of low social deprivation, it’s only around 2%, if that. It’s shockingly, shockingly low. And there’s a real resistance. There’s a resistance for people to prescribe. And there’s also a reluctance for women to consider taking it because of this misinformation. But, you know, I spend a lot of time trying to think about what can we do? Because I constantly think I’m not doing enough to really make a difference. I am making a bit of a difference, but it’s not enough and it’s not fast enough as well. The suffering that I hear every day is absolutely traumatising to me, and I know it is to you as well because it’s not necessary.

Dr Heather Hirsch [00:04:57] Mhm.

Dr Louise Newson [00:04:58] So I sometimes think about why is it happening so slowly? And you know, I don’t want to think it is because it’s a female issue but the more I get into this Heather, the more I think it actually is. And I think there’s something about people not wanting women to get as good as they can be. And I find that really quite distressing and uncomfortable even to say. But I’ve been on a lot of meetings. I’ve personally have had a lot of bullying that is continuing, and I’m sure it’s worse because I’m a female. But actually, what is wrong with women asking to have their own hormones back? Why is that seen as such a terrible thing? And it’s not just other men that I’ve heard say,it’s women as well, and women of quite high standing who are physicians. I’ve heard them say ‘it’s outrageous, women are now asking for their hormones back because of all this publicity about HRT’. Why is that?

Dr Heather Hirsch [00:06:01] Well, let’s get into debate mode, because I was a Women’s Studies major. I went to Syracuse University in upstate New York and graduated college in 2004. But I spent a lot of time studying, you know, feminist theory. And I could debate both sides, and I’m happy to. But if we go on the side of women still being considered second-class citizens – or women definitely being second-class citizens after men – women having much less rights, and here in America, much less medical rights. And as we know, those medical rights to early reproductive care are soon going to be flipped upside down. And so, look, that is an obvious fact. We can see Roe versus Wade coming undone. It is a clear fact that women’s health, women’s physical health, emotional and mental health are clearly second tier. And if we want to even extrapolate this debate a little bit further, there’s certainly a fear of the, you know, traditional white male dominated country that if we, maybe if women are feeling well and are thriving and they’re at the peaks of their career, they might outpace men. Now, that’s always going to be hard because women do something men can’t, and that’s childbearing. And then filling those responsibilities for childbearing. We know there’s still huge pay gaps here in the United States. So again, but these are all little clues that point to the fact that women are seen as second-class citizens, at least here in the United States. And I’d love to see if you think that’s similar.

Dr Louise Newson [00:07:33] Yeah. Yeah, absolutely right. And I think there are and, you know, there’s been a lot over the last ten, 20 years looking at gender pay gap. Absolutely, so important, looking at the lack of senior women in boards and everything else. And there’s been a lot of ‘why is this happening, why, why, why?’ And sometimes it’s obviously because women are generally the caregivers if they’ve got children or relatives that they need to look after, absolutely understand. But now we’re realising more and more that a lot of it has to do with menopause. And, you know, 10, maybe 20% of women are giving up their jobs. We know from studies that we’ve done through my not-for-profit, women aren’t going for promotion. They’re not going for the jobs that maybe they should or they’re going more part time or leaving their jobs or changing careers. So we know there’s a reason and we know there’s a treatment, yet there’s still this resistance. And I think you’re right that there are men, but even other women that are scared of this sort of new generation, this new power of women. And, you know, I look at my teenage children and how strong they are. And I was actually reading some of my old school reports. I didn’t even know my mother kept them. Yesterday, she’d given me a bag and they’re all in there. And I think, gosh, I was so naive as a 16, 17 year old, I didn’t have this sort of knowledge that children have got now. And that’s partly because the Internet wasn’t around when I was young, I’m sure, but I wasn’t so aware. And there is this awareness and I’m you know, I have to say to my 17 year old, ‘gosh, I’d be really scared if I was with you at school now’, you know, so, you know, ‘you’re that person that I would just be too scared to be with’. And she’s adorable. But I can see that sort of there is this threat, isn’t there? And I think, you know, women who are top of their game multitask. They go home and they still carry on. They don’t just go into the dark hole because they’ve had a busy day and escape, which is what generally a lot of men do. I can see it can be threatening, but actually shouldn’t it be really exciting as well, that we’re equals and we can challenge and we can do these things? And, you know, there’s a lot of time and energy and effort and money that has been invested for career women, yet they’re just crumbling and they’re haemorrhaging from their workplace and haemorrhaging from life actually and society. And I think we’ve got to acknowledge that women underpin a lot, not just at work, but in general. They’re propping up men and others and other women and children, left, right and centre. But we’re being ignored, we’re not being listened to.

Dr Heather Hirsch [00:10:11] Mmhmm. It is so very true. In fact today, I uploaded a video to YouTube about menopause at work and our good friend and colleague, Dr Phil Sarrel did a lot of studies looking at, you know, the indirect and direct cost to healthcare of women with untreated symptoms and it’s clearly higher. You’re missing work, you’re retiring earlier and you’re seeing more doctors. And so there’s evidence to absolutely back up what we’re both kind of echoing with each other. And then you add on top of that the fact that women have the qualities of emotional intelligence. Not to say all men don’t, but women really have developed so much emotional intelligence, social intelligence, social awareness as they’ve gone up the ladder that to then have their job or their career crumble or their personal life or both, you know, there is such a big problem. And then to the flipside is also, is there at some point where women are hindering their own selves, our own gender, because of, you know, there’s always that theory of upper limit theory. And the upper limit theory is as you get close to the upper limit because you’re either getting excited or you’re scared, you tend to actually retract from that upper limit just when you’re about to burst it. So certainly, we hear several things, friends telling other friends not to take hormone therapy, or friends judging other friends for how they’re going to treat their menopausal symptoms or women telling themselves, ‘oh, no, I just I obviously have to stick it out’. It’s ‘I’m a failure if I need medical treatment’. And those are also messages that women receive. But you put all those together. I mean, it is actually quite glaring how hard the problem is, even though hormone therapy, prescribing hormone therapy isn’t actually it, because that part’s easy. It’s all the things leading up to getting to that visit and making that decision and then from there, training other doctors to continue to do the same.

Dr Louise Newson [00:12:16] Yeah. And I think also women are used to suffering a bit more than men aren’t they I think, you know.

Dr Heather Hirsch [00:12:22] Oh, right every month women have to suffer. Right?! We all know the man cold!

Dr Louise Newson [00:12:27] Yeah. So I think there is that whole thing is that sort of expectation that well, ‘that’s just our lot’. That’s our bag, that’s what we have to put up with. And we do know, obviously, there’s a lot of women who have very severe symptoms, but the majority of people have symptoms which they probably don’t think are severe, but it’s not until they’re better they realise how bad they were. And so – and I hear this so much from women saying, ‘well, I didn’t want to give in and take HRT’. ‘I didn’t think I should come and pester you because I’m really not as bad as my mother was who used to, you know, really struggle’. ‘I’m not so bad as my best friend who has no sleep. I have 2 hours a night. I’m very lucky’ sort of thing. And I’m just like listen to you talk, of course, ‘2 hours of sleep is not normal’ and it’s that whole thing that it’s sort of, well, that’s just what life’s given me and that’s what I need to accept. And it’s how we change that narrative because like you say, you know, we have treatment that is cheap. It’s cheaper for us in the UK than the USA, which should be a lot cheaper for you guys as well. Of course we know that. But it’s safe and it’s being denied time and time and time again. And, you know, it’s also very hard and I know it’s very hard to know how many symptoms are due to low hormones, and I’m sure you’re the same. But in my clinic I say to women, I have no idea how many of your symptoms are related, but I do know that a hormone deficiency is associated with health risks. And so let’s reduce those health risks by replacing, optimising your hormones and then seeing what’s left. And time and time again, these women come back telling me that their brain fog, their joint pains, their headaches, their sleeplessness, their irritability, that everything that they’ve put down to just being a woman at a certain stage of their life and not enjoying their jobs, they suddenly come back and go, ‘Wow, why didn’t I start this before?’ And then they regret, and I’ve had a lot of people crying in my clinic saying, ‘I wish I’d done this sooner, 5/10 years ago’.

Dr Heather Hirsch [00:14:30] ‘Where were you five years ago?’, is what they say.

Dr Louise Newson [00:14:33] Yep. And that’s the first time it happened to me. I felt – well I always feel sad – but I was really shocked because someone came in and I do a questionnaire and I could see the questionnaire, the symptoms were so much better. And then she burst into tears and I said, ‘Gosh, are you okay?’ And she said, ‘No, because I realise the last ten years of my life, I’ve actually wasted because I could have felt like this if I’d come and seeked help earlier’. And I think, gosh, this is such an injustice in so many ways. And, that was six years ago when I opened my clinic and I thought things would have got better. But actually I think they’ve got worse, Heather, because more and more women are understanding what’s going on. So more and more women are now asking for their own hormones to come back or to be replaced. And more and more women are actually still being refused. And it’s not just in the UK, I mean, it’s globally as well, isn’t it? Because I know, you know, you reach lots of people with your lovely work across the globe and I do from all sorts of countries and they’re telling me that they’re refused, they’re refused, they’re not allowed. And it’s like, well, how is there any other medicine where you’re refused treatment?

Dr Heather Hirsch [00:15:40] I never understand how a clinician could say to a patient ‘I don’t believe in that’. They’ll say, ‘I asked my doctor for hormone therapy, but he said, I don’t believe in that’. I said, religion is not really a part of the protocol here. And well, it’s not evidence based, and that shouldn’t be part of the conversation. Not only does that set her up for needing to find another doctor, of course, but she’s going to second guess to if that’s the right thing, because a doctor she’s been seeing for 10, 20 years is saying he doesn’t believe in something, even if she’s read and followed you or me. It’s always just another nail in the coffin, is what it seems to be. And I agree. When you were talking, I thought also, too, if we really want to be, you know, feminist about this, there’s something about the word hormones. You know, everyone always kind of pokes fun at women. ‘Oh, she’s on her period’. ‘She’s PMSing’. ‘Oh, her hormones are all over the place’. Even women say that ‘oh I had a big fight with my partner, it’s just my hormones are all out of whack’. It kind of actually almost minimises what we do. Like we’re just these little hormone doctors that are just playing with these silly female hormones. And I think that there is part of this cultural mythology here that our branch of medicine, preventing chronic diseases, helping women thrive, feeling well, keeping them at work, keeping them happy in their lives, and that it’s just this little silly side thing. And we are really trying to stand up to say, you know, menopause, whether you want to call it a symptom, a syndrome, a disease, it is a part of 100% of women go through this if they live to that age and 80% of women have symptoms that last 5 to 7 years. Why are we continuing to skirt around this? Then you further that with the fact that what we’re replacing is estrogen the female hormone. So it’s just already second class. The women are already second-class citizens, so is estrogen. Not that it should be, but it falls under that realm of, ‘oh, her hormones are just all over the place’. Right? We live in a society where that’s kind of been brushed aside as every woman’s issue when she’s having a bad day, which is just another way to keep women small and to put women down. So I think then when we are talking on social media, we’re raising awareness about menopause and we’re talking about replacing hormones and exactly how to do it and the evidence behind it and what the Women’s Health Study shows, you know, for those who want to continue to make us small, it’s very easy because they just wave their little ‘oh, they’re just talking about hormones’ wand. And this is just a female problem and it’s natural. So there are so many reasons in the book why someone will have to wait 5 to 7 years and then burst into tears because it’s just this battle and it should never have to be.

Dr Louise Newson [00:18:42] Yeah, it’s very interesting. When I – one of my first patients, I remember who I saw when I’d opened my clinic, and she was a nurse and a really lovely, lovely lady. And she’s married to someone who worked in a factory, and he packed boxes for sardines, actually, and they had no money at all. And she was desperate to carry on nursing and she was menopausal. But she had this condition where she was born without a womb, and she knew she could obviously never have children. But it was also the condition that was associated with kidney failure as well. A very unusual genetic condition. So she had had a kidney transplant, which had failed a few years ago. So she was on dialysis waiting for another kidney transplant. And meanwhile, her sister, who had had the same genetic condition but more severe than her, had sadly died. But she had a child that she had adopted. So this patient of mine had inherited, if you like, a two year old boy. And she was waiting kidney transplant and she was menopausal and really, really struggling. And she came to see me and said, ‘my kidney specialist, said I can’t have HRT’ and I said, ‘you need to go and see your GP’. GP said, ‘Oh gosh, no, I don’t know anything. You are on so many drugs you wouldn’t want HRT’. And so she had battled and battled and I was thinking, well, she hasn’t got a womb, so what she needs is a bit of estrogen, maybe a bit of testosterone, but I’ll start with just a bit of estrogen gel. She’s on so many drugs and drugs that stop her rejecting her kidneys. And as you know, some of them will increase the risk of osteoporosis, and kidney disease increases the risk of osteoporosis. So I thought, well, she really needs actually some estrogen. So I gave it to her and I wrote a letter to her doctor and to the patient. And then she came back in floods of tears and she said, I had HRT for a month and I started to feel better. My kidney doctor said, ‘No, no, no, absolutely not’. And then when she read the letter, she said, she laughed and she said, ‘a menopause specialist who on earth does she think she is? That’s not a specialism’. And it really shocked me, actually. And it’s exactly what you’re saying. They just think we’re tinkering around with some lifestyle medicine and they don’t realise the importance of estrogen and how important it is for chronic disease. And I, I do, I know push boundaries, but I often think even if women have no symptoms, there’s some really good evidence that it reduces risk of disease more than giving a statin, for example, for reduction of heart disease. But, you know, people are pushing back about dementia. But of course, it makes sense that estrogen works in our brain, so it reduces risk of dementia and inflammation in the body. And so why can’t it be taken as seriously as other hormones? And in the UK, a lot of endocrinologists, those specialists who specialise in hormones, they actually miss out female hormones so… I don’t know what it’s like in the States, but they’re very good at fiddling with all the other hormones, but not with estrogen and testosterone. And I just don’t know why.

Dr Heather Hirsch [00:21:51] Exactly. Again, it’s part of that invisibility of those don’t really matter or historically they haven’t really had even that argument’s kind of hard because in the eighties and nineties, kind of the golden era when most women got hormone therapy, actually oftentimes without a progesterone because they didn’t even know then that it could increase the risk of uterine cancer. You know, again, endocrinologist here do the same thing. They’re so great with insulin. They’re so great with parathyroid hormone and adrenal insufficiency. But when it comes to a little bit of menopause or even perimenopause, they really feel as though that’s not their area. And so if no one’s owning it, if no one’s doing it, herein lies the problem. And in medicine, at least in the United States, we have become so specialised you could easily argue there should be more, or just as many, menopause specialists as there are cardiologists, right? But there is, I believe, in the United States, I think there’s 100 or so NAMS certified MDs. Now there’s lots of NPs, and physical therapists and pharmacists and they’re wonderful. We need a whole team. But when it comes to prescribing medications, we need those MDs and or those PAs and NPs. And you know, to your last point, I agree and I will say, as the menopause expert who is about to turn 40, I will take hormone therapy for preventative measures and many people might roll over in their grave or that might really irk them. But when you are a clinician who reads this every day, who prescribes and sees patients before your eyes every single day, it is no far stretch to realise how important estrogen is and how. It’s not just a silly thing that we’re replacing just because she’s sweating. It’s more than that.

Dr Louise Newson [00:23:48] Absolutely. And it’s just been so neglected. And actually I was lecturing last week to a whole group of psychiatrists, and I’m doing some work with the Royal College of Psychiatrists over here. And a lot of drugs that are prescribed for quite bad depression and bipolar, as you know, they affect prolactin. So they affect the part of our brain that means that the prolactin levels increase. And when people have high prolactin, it actually can switch off our luteinising hormone and our follicular stimulating hormone, so reduces estrogen and testosterone and it’s very clear pathways. Endocrinology is all about lovely pathways and you can see how the hormones interact. But the psychiatrists usually measure prolactin levels every year on women and men on these drugs. But when I put this slide showing the pathway of how estrogen and testosterone reduces, it was just news to a lot of people. And in fact, a few psychiatrists have emailed me since to say, goodness, your talk really resonated and we’re now looking at our female patients quite differently, but it just hasn’t been thought of before this sort of. And it’s very common. And we know that people on some of these antipsychotic medications have raised cholesterol, they have raised blood pressure, they put on weight. They have this blunted affect. And I’ve known it for years as well. But then I never thought about it when I was doing psychiatry 20 years ago. Well, actually, these women are all menopausal and the men are probably hypergonadal, but we’re just saying, ‘oh, it’s because of their mental illness’, but why aren’t we giving them add-back hormones? It’s crazy, isn’t it?

Dr Heather Hirsch [00:25:30] It really is. It’s absolutely another level of where now we’re going past symptoms into the textbook, and still it’s this medical mystery. It is eye opening and is shocking when we kind of get this time and space to use this episode to kind of think through, you know, what are the social and political things that are keeping women small or not feeling well and not treated equally in the same way as a man would be? One time I put this on Tik Tok. I said, ‘What would happen if men went through menopause?’ And I think the comments were off the chart, you know, tons and tons of comments of ‘this would already be solved by now if this was a male issue’, ‘twice the military budget, three times the military budget’ and NIH funding until it was solved, right? And so it is no secret that I think those women who do realise that there is treatment and they do get treatment and then they say to you, ‘oh my gosh, like, I can’t believe this little patch helped all these things’. Like, why don’t more people know about this Dr. Hirsch and Dr. Newson? And you’re like, ‘I know back to the drawing board’. That’s what I have been doing in my spare time is yelling it from the rooftop and so the cycle continues.

Dr Louise Newson [00:26:53] Yeah, but I think the most important thing for me is educating, obviously educating healthcare professionals, but it is educating women so they are allowed to choose. And I strongly, strongly feel as a physician that patients are allowed to choose. And we’re not here saying that every patient has to have evidence based medicine actually. I remember when I very first learnt about consent and I’m sure you’ve done the same as a student and you learn about informed consent. So this is for any treatment. Patients have to be on board and they have to decide. And I remember learning that if people have all the knowledge, they can refuse treatment, even if that means they going to have harm. So for example, if someone needed a lifesaving operation, but they said, ‘no, I don’t want it’, and they knew the risks of refusing it, they were allowed to say that. And that’s really big stuff. And most people obviously wouldn’t want to refuse lifesaving operations, but we have to respect our patients. And I feel this whole issue of consent and shared decision making is so pivotal when we talk about this, because we’ve been fed all the time about risks, risks, risks of HRT. And we could spend hours discussing the potential risks, but we can spend seconds commenting and discussing about the benefits, but we can spend even less time when we think about each individual patient what they want. And this is where I guess my anger comes in because the patients, i.e. all women, 51% of the population, are not being listened to in this. And this is where I feel our energy has to continue. And I’m sure you agree.

Dr Heather Hirsch [00:28:38] I 100% agree. And I resonate with that story about the nephrologist who said ‘absolutely not’, because why is it that the nephrologist or the oncologist says, why are they the last stop? Why is it that if they say no, the answer’s no? Or where do they even think that they can say no? If a patient has consented, a doctor is prescribed a medication, they can do a quick search to see even with kidney disease, there are no contraindications there that are obvious, especially if you’re using something transdermal. So why is it that patients are overridden when they’ve already consented? And I agree that the idea of consent goes both ways. I was doing a talk to clinicians about hormone therapy and menopause management, and I always say, ‘look, I’m going to spend 80% of this talk talking about hormone therapy because that’s what most of you don’t know about’. So this doctor raises his hand and he stands up and he says, ‘Dr Hirsch, this is great’, you know, ‘but my patients don’t want hormone therapy’. And I said ‘it’s just because they don’t know. No one’s told them about it and they don’t know what they don’t know so they’re not really giving consent because no one has really given them both sides of the coin’. Now, I think what’s happening is that’s what you and I are doing for those people who are lucky enough to stumble upon our stuff, etc., is we’re trying to fill that void. But then when you get someone get into a clinician that says, ‘oh, absolutely not’, that’s where both you and I feel very frustrated and sort of stuck on this issue of, ‘Well, now what do we do?’

Dr Louise Newson [00:30:13] Yeah, so we’ve just got to keep going now.

Dr Heather Hirsch [00:30:16] Yep, yep. And we will.

Dr Louise Newson [00:30:18] Indeed we will. We’re not going to stop. So it’s been absolutely great talking to you again and getting all fired up, which is really good because I know both of us at times feel exhausted and want to stop what we’re doing, but we can support and prop each other up. So before I end Heather, just to have three take home messages, I’d really like to hear from you three ways that women can empower themselves even more to get what they want from their healthcare professional.

Dr Heather Hirsch [00:30:47] Three tips:. I think one thing that you could do that’s a really easy win is just to start journaling and tracking so, you know, when your last period was, what your symptoms are, and maybe what your triggers are. And I’m going to totally plug the balance app because I use it for my patients. And you can use the balance app to start tracking because you can listen to all this information that we’re giving you online. But knowing what’s going on with your body is number 1. Second, then list your priorities. Your priorities may be different from your friends. Maybe your priority is sexual health. Maybe it’s your hair or your skin, and that’s okay. Maybe it’s your sleep. Whatever your priorities are, list your own without asking for others. And then third, I think if you briefly understand what your main options are and they’re going to fall in three buckets: lifestyle changes, non-hormonal medications and hormone therapy, as long as you know those three and you actually really do, especially when talking about the hormone therapy bucket. Know both the pros and the cons. Mostly there are pros. You’re going to feel ready and prepared to realise what you need and what’s best for you. And if you’re listening to this show, it’s likely that you are interested in hormone therapy, have considered a hormone therapy. So as you’re doing that, my three takeaways are know what’s going on with your body and then list your own priorities so that you can get set up to get the best treatment for you.

Dr Louise Newson [00:32:09] Excellent. So being prepared is the most important thing. Absolutely. I totally agree. And knowing that you can change your mind as well is really important. So nothing that anyone decides today has to be there tomorrow and making sure that women are completely in control of their bodies is the most important thing. So then women can rule the world and make a big difference.

Dr Heather Hirsch [00:32:30] As we should.

Dr Louise Newson [00:32:31] Thank you so much, Heather. It’s been great. Thank you.

Dr Heather Hirsch [00:32:34] It was wonderful to be back on the show. Thank you so much for having me.

Dr Louise Newson [00:32:40] 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.

END.

Pushing against social and political constraints on women’s health with Dr Heather Hirsch

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