The effects of trauma, gender bias and the peri/menopause with Dr Jan Smith
Dr Jan Smith is a chartered psychologist, executive coach, author, campaigner and the director of Healthy You Ltd. She has over 15 years’ experience providing psychological support to those affected by injury and clinical negligence. In 2014, Jan developed a birth trauma service and campaigns to improve safety in maternity services for families and staff and provides training in the UK and internationally to maternity students and healthcare professionals on birth trauma and its impact.
In this episode, Jan describes to Dr Louise Newson how women can feel after a difficult birth or medical experience, and how trauma related emotions can resurface many years later at peri/menopause when psychological and genitourinary changes occur, often affecting relationships and intimacy.
Jan’s 3 pieces of advice:
- If you had a difficult birth or healthcare related experience that affects how you feel about your genitals and intimacy, it is never too late to get help, even if it is years down the line.
- Workplaces need to view women’s health as a continuum, not separate stand-alone events like pregnancy or menopause.
- Think about ‘reaching in’ to help other women going through it – to listen, to validate and let them know they are heard and seen. This can be hugely beneficial for everyone’s mental health.
For more about Jan and Healthy You, visit www.healthyyoultd.co.uk
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 [00:00:46] So today on the podcast, I’m delighted to introduce to you Dr Jan Smith who’s a psychologist who I’ve recently been interested in her work and especially the work that she does, focusing on women who have had birth trauma, which might seem a bit weird talking about birth trauma on a menopause podcast, but hopefully bear with us and we will reveal why. So, hi Jan. Thanks so much for joining me today.
Dr Jan Smith [00:01:09] Hi, Louise. Thanks for inviting me.
Dr Louise Newson [00:01:12] So tell me a bit about your work and your background and why you do what you do, if that’s okay.
Dr Jan Smith [00:01:17] Yeah. So I am the director of Healthy You Ltd, which is an independent psychology practice and we do lots of work supporting birth and women and people who’ve been impacted by trauma, which is a really big word. And in births, we also support people through fertility, loss and also, I guess in that continuum of women’s health, right through perimenopause, the menopause, and postmenopause. And we do lots of work with organisations in supporting women’s health around those spaces.
Dr Louise Newson [00:01:55] So huge amounts of work.
Dr Jan Smith [00:01:57] Yeah, yeah, absolutely.
Dr Louise Newson [00:01:58] So how did you get into that then? What made you be interested in it?
Dr Jan Smith [00:02:02] I think probably from a personal experience, you know, I had a Mum who is very ‘equality’, ‘women’. And, you know, I grew up in a house with five brothers and we were all equal. There wasn’t a difference between, you know, genders. And my Mum has done a lot for women within our area to champion and support them. So I think women and supporting women has always been something that has run through the thread of my life. And then when I left university, I’d done a lot of work in supporting women who were sex workers and in that space around maternity. And it just kind of evolves, I guess. I never felt like I set out with a plan. It’s just sort of – I’m here now.
Dr Louise Newson [00:02:57] Yeah, it’s interesting, isn’t it? I never have a plan with anything that I do but – and people might laugh when they hear this – I saw a clairvoyant several years ago. My mother-in-law’s very spiritual. And I saw this lady actually, we were trying to decide about moving house and changing various things. And I just really wanted to talk to her actually. And she revealed all sorts of things. I just don’t know how she knew, what she knew. And at the very end, she said, ‘Oh, you’re going to do a job where you’re helping lots of women’. And I looked at her and I thought, ‘Well, you’ve got that wrong, actually, because I’m not interested in gynaecology. I’m more interested in disease. I can’t imagine ever doing a job where I predominantly see women’. And now look at me, all I do is think about women! And so it’s interesting how your, you know, your sort of focus – and I think it’s also – I’m very, very driven by stories that I hear. And I think the more I hear about suffering and women, the more determined I am to make a difference, actually. And it would be really lovely to say that men and women are treated as equal, but I don’t think they are in a lot of space actually.
Dr Jan Smith [00:04:00] No, absolutely not.
Dr Louise Newson [00:04:02] And I think it’s very hard sometimes for women to also understand what’s normal and what isn’t normal because, you know, we’re talking about pregnancy, which is a normal process. We’re talking about menopause, which for many women is a natural process, but it has absolutely devastating ramifications. And I know even when I was pregnant with my first baby and I went into labour – and it was a very long, awful labour, and I had to demand a caesarean section, and I was worried about my pelvic floor – and I said to the consultant, I did not want a terrible pelvic floor, and to have a section, just do a section. And it was, yeah, I’ve still got some PTSD because it’s such a horrible experience having this emergency C-section. But actually if I didn’t have the knowledge and didn’t have the gumption to really demand for something that I knew was right, I know my pelvic floor would have been awful. But then everyone will say ‘yes, but it will be sore because you’ve had a baby and you will expect some stitches and you will have this discomfort and it won’t be the same having sexual intercourse’. So then how do women know how to ask for help? And I’m sure you hear this a lot in your work. You know what is normal and what, you know, because women put up with so much, don’t they?
Dr Jan Smith [00:05:13] Yeah. And I think they’re expected to, you know, certainly within the pregnancy space as well. And the countless times that I’ve heard from women, you know, ‘I’ve gone to the GP or my health visitor and said’, you know, ‘I’ve times where I’m incontinent, even up to a year postnatally’ and are told that’s ‘all fine, you’ve had a baby, what do you expect?’ And I think there’s a massive stigma around it, you know, and if it’s your first baby and if none of your friends are saying ‘do you know sometimes when I laugh, I wee’ that can be really, really difficult then first of all, to know what is expected and also what to do whenever they do experience it.
Dr Louise Newson [00:06:02] Absolutely. And I think it is that whole, you know, how do you define normal? And certainly, you know, I’ve got quite a few friends who don’t jog because of their urinary incontinence. Or they wouldn’t go on their child’s trampoline for example, in the garden, they just said, ‘oh, no way’. And I gosh it wouldn’t even cross my mind to think about because my pelvic floor, thankfully, is very good. But actually they think it’s normal. They think when you reach the thirties, forties even, still really young isn’t it, that you are allowed to have a bit of incontinence and that’s terrible.
Dr Jan Smith [00:06:31] Yeah, and especially, I think it can really impact on quality of life or even do you know, flatulence as well. Do you know that is another big thing that we see really impacts women’s confidence and self-esteem. You know, I think having a baby, irrespective of if it’s your first, second or beyond, there is a period of transition with each of those pregnancies, conception and birth. And as I said to you, ‘trauma’ is, such a big word isn’t it. But if you’ve had a difficult birth, then that is going to impact on how you feel. And it is very much in the eye of the beholder, do you know, it’s a very subjective experience.
Dr Louise Newson [00:07:16] Yes, definitely. And it affects relationships so much, not just intimate relationships with partners, but also even the relationship with the baby or future births as well. And like you say, sometimes the trauma, whether it’s physical or psychological trauma, and often both isn’t realised until later down the line either, is it?
Dr Jan Smith [00:07:34] Yeah, absolutely. And I think that’s certainly what we see in practice and also you know, with organisations that we work with, you have people who are on those very early stages of trauma and then you have those people who are years, sometimes decades, down the line, do you know, when they are in the perimenopausal, menopausal or postmenopausal phases. And they’re having a lot of physical symptoms or incontinence or other difficulties. And for the first time then, do you know, all of those dormant feelings or those feelings that they’ve worked incredibly hard to suppress, then all come to the surface and actually they come about their difficulties with menopause, but actually it’s trauma.
Dr Louise Newson [00:08:31] Yes.
Dr Jan Smith [00:08:31] You know, what we’re treating as the trauma.
Dr Louise Newson [00:08:34] I remember seeing one of my first patients in my clinic who came from Wales actually, and she had driven – in fact, she hadn’t driven her brother had driven her – it was about 3 hours to come to the clinic and the only way she could come was lying on the back seat and she hadn’t been out of the house. So she had been struggling for quite a few years, mainly with localised symptoms. So putting on underclothes was impossible for her. Sitting down was really awful and she was having some incontinence. So the tissues were very excoriated, very inflamed, you know, because of this leakage of urine as well – wearing pads was making things worse. The skin was very thin (because she was menopausal) around the vulva and vaginal area and she’d been labelled as mad actually. She’d been given a diagnosis of fibromyalgia and chronic fatigue. She was on lots of different antidepressants and because she was housebound, she kept phoning for help and very few people would visit her. So she had this awful label. But actually, when she came and I just said to her, ‘look, there’s lots I can do to help you’. Then she unmasked this whole story about when she gave birth and how traumatic – and the pain was similar. And there was just so much to unravel, actually, and no one had actually – well, I was really shocked as no one had ever examined her because she had been housebound. And when I said to her, ‘Would you like me to examine?’ Because I always offer it. Some women don’t want to be examined, understandably, the first time they see me. Then she still goes, ‘Gosh, can you do that?’ I was like ‘yes, of course’. And you realise how vulnerable some women are actually, and I think as a doctor I feel that we have a lot of power, but it has to be done in the right way and we also we take a lot for granted. I would expect every woman who had bad symptoms certainly, as extreme as that, would have been examined, whereas a lot of women haven’t been examined or they don’t want to be examined because it will rekindle maybe a very traumatic examination in the past.
Dr Jan Smith [00:10:36] Yeah, absolutely. And I think that’s something that you are touching on there around examinations are incredibly triggering for people because actually in the sort of perimenopause/menopausal period where, you know, sexual relationships are changing potentially, and they are getting more localised pain and actually some of the pain for those women are the pain that they experienced in the early recovery phase, postnatally. And so even though they don’t want to think about it, actually, they’re in that cycle of, ‘oh, I remember this’ and then starting to feel like, because of their heightened anxiety and depression, that they might be experiencing the cause of hormonal changes, they think there is something fundamentally wrong with them.
Dr Louise Newson [00:11:30] Yes. And I think it is you know, there’s a couple of patients actually that come to mind, one of them is, well, she still is a psychiatrist. And I lectured to some psychiatrists a long time ago about mental health and the menopause. And then this lady came to see me and she had actually got a bus, a boat, a train, a taxi, massive journey. And she’d had a hysterectomy about two or three years before I saw her. And she came with a long, floaty skirt, again, wasn’t wearing underclothes because it was so painful, but she actually thought that her surgeon had mutilated her vulva and clitoris and the areas around because everything had shrunk, everything had changed visibly and obviously essentially it was very different. She had a lot of pain, a lot of burning, a lot of irritation. But she was really shocked when she held a mirror and saw, you know, anatomically everything was different. So she actually had this belief for two years that the surgeon had cut her or done something without her consent. And this is a medical practitioner. And I examined her and I said, ‘no, you’ve got symptoms related to vaginal dryness. This is all going to be related to the low estrogen and probably low testosterone in the tissues. You also need HRT. I’m going to give you HRT and some local treatments’. And I saw her for review recently and she’s horse riding, which is her passion.
Dr Jan Smith [00:12:50] Yaaaay!
Dr Louise Newson [00:12:51] She’s having the life, but also all the anatomy – it took a while, it took a few months – but it’s reversed, so it’s come back to normal. And she said to me, she said a few times to me, ‘Gosh, Louise, if I hadn’t have sat in that lecture listening to you, I wonder what my life would have become?’ Because she was also very anxious because she was menopausal. We know anxiety worsens through the menopause. Women often ruminate and they go round and round, and any little obsession gets bigger and bigger and bigger. So she’d had this – she knew it was irrational thinking the surgeon had cut her badly, of course he hadn’t – but that was all she was worried about. Every morning she’d wake up with these fears and it would be exaggerated. And it was controlling her life. She’d given up working as a psychiatrist, and she’d become quite recluse, not wanting to go out or do anything. And you think, Goodness, how many other women are suffering like this without being able to see and not knowing what’s going on with their bodies as well?
Dr Jan Smith [00:13:43] Yeah. And I think as well, you know, whenever someone has surgical intervention so they’re going into the menopause, then quickly, do you know, some of those ripple effects, psychologically, that happens whenever they have experienced difficulties in birth or trauma is around, you know, feeling like a lack of control, feeling that something is ‘being done to you’. And I think that can really, really exacerbate a lot of those symptoms even further. So even people – like I’ve seen people who have had intervention and support and therapy and has felt that their trauma has resolved within that postnatal period, but it can start to resurface again when some of these changes come later on in life. And I think we don’t talk enough about it. Do you know? I know I’m Irish, I’m a psychologist, so I’m going to say that, but I just think the stigma is huge and then, you know, returning to work and how that looks like then becomes a really, really difficult thing for many women.
Dr Louise Newson [00:14:57] It’s very hard. Yeah. I mean, the second patient that I might have mentioned before in a previous podcast actually was a young lady in her late thirties who had a history of vaginal cancer. So that had resulted in her having a lot of radiotherapy to the area. And so when people have radiotherapy, often the tissues become quite scarred and her vaginal opening was very narrow. The whole vagina actually was narrowed and there’s a lot of scar tissue around her vulva as well. And she was really struggling with menopausal symptoms. She had been told she was too young to be menopausal, although she knew that she wasn’t having periods, that her treatment had brought on an earlier menopause. And so she came over to talk to me about options, and I offered again to examine her and she was quite surprised that I’d offered and she had a lot of radiotherapy burns, but she had been told categorically she would never be able to have an intimate relationship with her husband again. No one had given her any information nor any treatment. And so I didn’t examine her internally because it would have been too painful, but just looking, there was lots of scarring, but there was also a lot of vaginal atrophy as well, related to her hormones. And so I said to her, well, let’s just give you treatment – but there’s always options. You know, you don’t have to have penetrative sex to have a sexual relationship and no one, I know that sounds very obvious to a lot of people listening probably, but actually no one had even told her that. No one even said, you know, there are other things that you can do and explore with your partner. And it’s taken her a long time to get over this sort of trauma because she had so many examinations and so much treatment in an area that it became a very clinical area for her rather than a sexual area, if that makes sense.
Dr Jan Smith [00:16:37] Yeah, absolutely. And I think when you have things that are done to that area, understandably, you’re going to have significant associations. You know, it’s the same with people with childhood sexual abuse or have had sexual assault encounters, experiences that can be something that also is really difficult for them as well. And I think when couples come, do you know a large part of what I discuss with couples is expanding the range of what intimacy means. It’s the connection between, you know, two people in that space, in which they love one another and what does that look like? And that can generate, you know, the fun back into it because I think there’s a danger when there’s sexual difficulties within a relationship, understandably, it can feel really serious. You know, there’s the embarrassment and the stigma. And so I think there’s something about how to generate that explorative element that lots of us have in those early stages in a relationship.
Dr Louise Newson [00:17:44] Yes and it’s lost isn’t it? I mean most women I see in the clinic have stopped having a sexual relationship, which I find really sad. But what I find more sad is that they’ve never spoken about it, and often they don’t even talk to their partner about it. And it’s stopped them having any intimacy because they say, ‘Oh gosh, if I held his hand, he’ll think that he might be able to have sex later and I don’t want that because it’s too painful’.
Dr Jan Smith [00:18:02] Yeah, yeah, yeah.
Dr Louise Newson [00:18:04] But actually then I’ve heard, you know, my teenagers are very open about everything, which is great, and I think I’m very fortunate I’ve been with my husband since I was 18. So we started off being very open with each other and I sometimes play mind games – I’m not going to leave him don’t worry – but I think ‘what if I was starting a new relationship, age 51?’ Would I be so open with my body? I probably would be a bit more reserved actually. And certainly if I had any sort of symptoms or signs of perimenopause or menopause that was affecting, you know, my vulva vagina, I don’t know how would I explain it to somebody? You know, I think it’s really difficult, isn’t it? I did a talk once for Trekstock, amazing charity. I know lots of young women in the audience, they’ve all had cancer. And there was someone on the panel with me saying that she had had cancer of her womb and she had a lot of really awful symptoms because of her menopause. She was only 24. She said, ‘I’ve decided to become gay because women don’t ask the same questions as men. And I can have different relationships and I can be open from the start. I can tell someone about my symptoms’ and I thought, ‘gosh, isn’t that..’. But also, you know, men who have prostate surgery have a lot of counselling about having erectile problems, problems with intercourse afterwards. You know, there’s a lot of counselling if people have had prostate cancer. Women who’ve had breast cancer who will either become menopausal because of their treatment, or just because of them getting older, are given very little information. So there’s – I think us clinicians have got it wrong actually – it’s about men being able to have sex and not about women, whereas we know more women are affected. I don’t know if that comes to you with any of the work that you’ve done?
Dr Jan Smith [00:19:44] I’m laughing because I think that’s like a whole other podcast. Yeah, absolutely. How the system and how health is very gender-based towards men and supportive of men, do you know? And I think that’s definitely you know, we see that massively in the workplace with women and organisations that we’re asked to go into to support them on how to talk to women. And I think unfortunately we’re still not seeing a joined up journey I guess, that overall umbrella of ‘women’s health’. It’s like, maybe we’ll be asked to go in and support them around ‘How can they support their workforce around fertility’ or ‘birth transition back after birth’ or ‘menopause or perimenopause’. And actually, it’s not circumscribed, you know, because what we see a lot is that you have women who are maybe undergoing fertility treatment or not, but are having babies later in life. And actually a lot of them, when they come back from maternity leave, are already in the perimenopausal phase. So they’re attributing everything to they’ve just been on maternity leave and that pressure of ‘I need to really perform, I need to really show that I can still be in this job and that I’m not going to go off and have a baby and then my performance is massively diminished’. So I think that is a very different conversation and discussion that we have compared to when dads who have experienced some trauma or loss in the perinatal journey. That’s very different as well.
Dr Louise Newson [00:21:40] There’s so much that needs to be done, isn’t there? Certainly, even menopause in the workplace, there’s so much about women not being promoted at work, not taking roles. Someone recently said to me, ‘Of course I’ve taken a lesser role now, I’m menopausal’. What? What on earth? You know? Have you not had treatment? ‘Well, no, I wouldn’t want treatment because it’s a natural process’. Well, actually, it isn’t that natural to live without hormones. And maybe you should be signposted to some proper information and get some treatment from a healthcare professional. And so I think women are silenced so much, actually.
Dr Jan Smith [00:22:12] Yeah.
Dr Louise Newson [00:22:12] And this is such a shame. And I think also when it’s talking about anything that’s birth, anything that’s urinary, anything that’s sex related, it’s always we feel shame to talk about it. And I’m not quite sure why really, because if I had a weeping wound on my arm or a big rash on my face, I think it would be very easy to talk about it and people would also want me to talk about it or give me some sympathy. And that’s so much harder, isn’t it, when it’s things you can’t see, but they’re affecting you in worst ways actually.
Dr Jan Smith [00:22:50] Yeah, absolutely. And I think as well, you get some amazing, well-meaning people that sometimes, you know, get the language of it wrong. However, there’s something about the recipient of that acknowledging that they’re making an effort to try, and we can’t know everything, do you know? So I guess it’s also based on what does that person need and in that organisational way asking them. We do a lot of leadership programmes, particularly women and leadership, and increasingly that perimenopause/menopause phase is something that is coming more and more into the work that we’re doing because they’re saying, ‘okay, so I’m the only female on the board, I’ve had to work even harder to get here. I’m in my fifties. I’m at the top of my game and the anxiety that comes, not as a result of the menopause, but in that anticipatory way of what are the symptoms going to bring and is that going to impact my performance, and can you just sort out my mind and then I’ll be okay?’ You know, you can hear that panic in them.
Dr Louise Newson [00:24:12] Yeah, and it is very hard. I mean, I’m a menopausal woman, but I take HRT, so thankfully I don’t have any menopausal symptoms. But I still I said to someone this morning, actually, I think I would be listened to a lot more if I was male. Some of the strategic, higher-level work I’m doing, there’s still a lot of bullying going on. I get phone, I get emailed, I have meetings with, usually men actually, who are telling me off for doing things and the things that I’m doing to help other women. I’m not doing it for my advantage. I’m doing it out of pocket. And I’ve been told off and to the extent I’ve even cried at meetings, which I’m quite a strong person, but nobody’s ever reflected or contacted me afterwards to say, ‘Are you okay?’ And I’m crying because I’m so frustrated listening to stories and I’ve explained the reason that because once you start crying, you can’t stop, can you? I can’t. And I said, ‘look, I’m really sorry. I’m crying because I’ve heard of another suicide and nothing’s happening for mental health’. ‘Well Louise, you need to compartmentalise yourself, Louise it’s not your problem’. Well, actually, it’s not my problem, but it’s no one else’s problem. And I really want to do something to make change. And I have often reflected and thought, ‘gosh, if I was male, firstly, you know, if I cried, I think people just wouldn’t understand at all. But actually they wouldn’t talk to me in that voice. It’s that ‘there there dear, never mind dear. It’s not… you can’t do everything’. And it’s very patronising, isn’t it?
Dr Jan Smith [00:25:37] Totally. Totally. I mean, I’ve been introduced to boards where I’m going in to deliver leadership as the person who’s going to talk about the ‘women’s issues’, and it’s yeah I think there is so much in that isn’t there. And you know, I’m in a fortunate position where working independently you don’t have to take on all the work.
Dr Louise Newson [00:26:04] Yeah.
Dr Jan Smith [00:26:04] So you can pick and choose those organisations that have already started some of those change in the cultures and come from a place of genuinely valuing the workforce and the needs of the workforce and to make it better.
Dr Louise Newson [00:26:21] Yes. And you can really see the difference. We certainly do a lot of work with workplaces and some of them are very interested in the balance app. And now where we’ve got this ‘plus’ section, where people can pay for extra advice about wellbeing and everything else. But what I really want to do is corporates to pay for it. I really don’t want women to have to pay for anything. And you know, it’s taking a little while, but I think it will come and you’ll see the good corporates that will do it. Because my thing is, if everyone pays just a pound for every female employer, you could make a massive difference. Because if we’re given the tools to help us as women, we can achieve so much. But what hasn’t happened in the past is we haven’t been allowed to have the information and the tools and the confidence to do it, or to talk about it. So I think things are changing, aren’t they?
Dr Jan Smith [00:27:07] Yeah, and I think awareness is being raised and certainly women are talking more about it. Yeah, I just hear it more, even just socially women talking about it.
Dr Louise Newson [00:27:18] Yeah. Which is fantastic. I know if I was doing a men’s health clinic, we wouldn’t have the same media attraction because men would not talk about how painful it is to have sex or how it is to forget, you know, various things or how terrible their sleep is. They would not talk about it at all. So women talking is really good. So I feel like we’re doing the first stage. The second stage is women receiving the treatment that they so desperately need.
Dr Jan Smith [00:27:44] Yeah, absolutely.
Dr Louise Newson [00:27:46] So there’s a lot that needs to be done. But, you know, the work you’re doing is incredible. And I’m really looking forward to seeing how it shapes and changes. And I’d love to have you back at one stage so we can talk a bit more about gender inequality because there’s quite a lot to cover there. So just before we end, I’d really like to just ask you three tips for people who have been listening and thinking, ‘gosh, actually, I wonder if some of my ways that I’m feeling have been related to maybe birth trauma or something that’s happened in the past’ and they’ve not joined the dots until now. What three ways would you say would be most helpful for them?
Dr Jan Smith [00:28:22] What I would say is trauma is my word. It might be that you had a birth that you find really difficult. And if that is the case, it doesn’t matter what age you are. The oldest person that I had coming to me was in her late seventies. There are still things that can be done to support you and work through that. It’s not ‘you’ve left it too late’ that’s the first thing. I think as well, for workplaces to shift the focus that women’s health is on a continuum, that it isn’t just, you know, conception, pregnancy, menopause, that actually we bring our whole selves to work and all of our experiences. And I think another thing that we talk a lot, probably more within the mental health space, which is about reaching out, which is fantastic. But I think a huge part of that message that’s missing is by reaching ‘in’ to, you know, like you said there, every organisation spent £1 on a woman. The impact that that would have, imagine, just in our circle. Do you know if we reached out to one person each day to just say, ‘I’ve been thinking of you, how are you doing?’ You know, it doesn’t mean you have to take on their stuff too, you know, but create that space where you can hear, you can listen and you can validate and say, ‘I see you, I hear you’. I think has such a massive impact on women’s and anyone’s mental health and wellbeing.
Dr Louise Newson [00:30:06] Yeah, that’s so important and such a good way to end. And it is being listened to knowing that you’re not a burden, but you are allowed to talk or share is absolutely key. So thank you so much for your time Jan. It’s been a great conversation and I look forward to having you again in the future.
Dr Jan Smith [00:30:20] Thanks, Louise.
Dr Louise Newson [00:30:23] 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.