What is the right dose of HRT for you? Hormones and premature ovarian insufficiency
How do you work out what the right dose of HRT is for you and balance the benefits with any potential risks?
In this episode, Dr Louise talks about HRT doses with Corinna Bordoli, who began experiencing menopausal symptoms when she was just 10 years old.
Corinna shares her experience of premature ovarian insufficiency (POI) – menopause before the age of 40 – and of the challenges she faced in getting a prescription for a higher dose of estrogen to help both her symptoms and future health.
Dr Louise and Corinna discuss why hormone needs and absorption can vary from woman to woman, particularly for those with POI.
Corinna’s three tips for those who may suspect they have POI:
1. Keep track of your perimenopausal and menopausal symptoms so that you have evidence when you go to see your doctor.
2. If you are diagnosed with POI, make sure you seek out a specialist in the condition to get the best care.
3. If you have POI, find a community of other people with similar experiences for support, such as through the Daisy Network. Sharing your story and hearing other people’s stories can make a huge difference and be healing.
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. Today on the podcast, we’re going to talk about people who are neglected when it comes to the menopause. There’s lots of people who are neglected, but the group of women that I really worry about, the people that actually do keep me awake at night, are young women who are really often not listened to, not believed, and often not diagnosed as having an early menopause. And when I was at medical school, I was taught, if a woman doesn’t have her periods, Louise, just make sure she’s not pregnant. And if she’s not pregnant, you can reassure her. And obviously, thankfully I’ve learnt a lot and that was completely wrong advice. So very delighted to introduce Corinna to the podcast who is going to share her story and also some of the work she’s doing to help other young women. So welcome today.
Corinna Bordoli: [00:01:27] Thank you, Louise. Thank you so much for having me.
Dr Louise Newson: [00:01:30] That’s fine. Do you mind just saying how old you are?
Corinna Bordoli: [00:01:32] Yes, I’m 27 years old. And shall I also say when I started having symptoms? Yes, I was ten years old.
Dr Louise Newson: [00:01:39] Ten years old. So we’ll talk about that. But if I Google menopause, I don’t think I’ve ever found a 27-year-old or a ten-year-old or a teenager. It’s usually people with grey hair, actually. So even me as a 52-year-old do not identify myself with the people that are portrayed often as menopause. It’s always someone with a fan, isn’t it? With their head in their hands with a fan, usually grey haired, obviously white, usually Caucasian women. It’s just so wrong. And actually when I’ve been talking to people recently with some of the book festival tours that I’ve gone on and I’ve said to people, no one’s too young. And one of my youngest patients was 14 when she was diagnosed. I can actually hear the audience go [sharp intake of breath] as if, oh my goodness, that’s really…and it’s not actually, it’s something that we need to think about more and we really need to be aware not just necessarily for ourselves, but for our children or our children’s friends or relatives or people we work with as well. Because there’s also this whole midlife conversation, which must really wind you up as well, because it’s not, even as a 52-year-old menopausal, I might not live till I’m 104. So I don’t think I’m in my midlife either. You know, there’s lots of words that must really wind you up. So just before we talk about that, just tell me a bit more. So you were ten, so 17 years ago at ten, you’re you know, that age, people are starting to develop a little bit sometimes. Not always, my three daughters have been quite late developers, so, you know, it’s not unusual is it at ten to not be starting your periods. But then what happened?
Corinna Bordoli: [00:03:23] Yes, actually, I felt like I was starting to develop in some bits and then eventually that stopped. And so I was very aware of it. I knew that there was something wrong with my body and I was going through lots of various things. So I was a child singer. And then very quickly my voice started drying up. Basically, I’m just developing some singers’ problems like nodules, which normally go away, like with a little bit of voice therapy and they just were not going away. And then I kept getting injured. When I was doing sports, I was literally on crutches like three times a year for six years. And again, every time I went to A&E or a specialist, they would just say, well, just give it time. You know, you’re growing really tall and, you know, this is the time where your body is changing. So just, you know, just be patient and give it time. I also had heart palpitations at night. I couldn’t sleep. I had a lot of anxiety. Again, I went to different specialists for each and every one of these issues, and I was just told I was fine, but I knew I wasn’t fine. And I also knew that all of these things were connected to the fact that I wasn’t having my period yet. And I kept telling my GP and just getting this message, well, let’s wait one more year before we investigate this.
Dr Louise Newson: [00:04:39] So you sensed that there was something not right? But you still you didn’t know how to get the right help.
Corinna Bordoli: [00:04:45] Yeah. Yeah. I think very often, like you’ll know within your body if there’s something that’s wrong. But it was years and years of being told that actually, no, there wasn’t anything that was wrong that really obviously impacted how I felt about myself as well.
Dr Louise Newson: [00:05:00] And then what happened?
Corinna Bordoli: [00:05:01] So finally, at 15 and a half probably, so I was almost 16 years old. My GP gives me a referral to a paediatric endocrinologist to check my hormones, basically. And so I went to the best clinic in Italy there is, and I was basically told my ovaries didn’t work and I couldn’t have children, but I wasn’t really told this was the same as the menopause and it wasn’t really explained what this was going to be like. So I was just put on the birth control pill and yeah, just told to just take this once a day for the rest of your life. You’ll be fine.
Dr Louise Newson: [00:05:36] And did that make any difference being on the contraceptive pill?
Corinna Bordoli: [00:05:39] So it gave me a bleed. So I developed in some ways, although my breasts did not, almost didn’t develop at all, so I don’t think I developed properly. I did feel good about having a period finally or something like that, so at least I felt a little bit more normal. But my symptoms very much continued. And yeah, that’s a little bit unfortunate because had I known back then that that wasn’t the best treatment. I would have definitely chosen the best treatment to feel better.
Dr Louise Newson: [00:06:08] Yeah. And that’s really important, isn’t it? Because the contraceptive pill for those of you listening, usually is a combination contraceptive pill we’re talking about here. So it contains estrogen and progesterone, two of the hormones that obviously are low when people are menopausal, but they’re both synthetic. So it means that they’ve just been chemically altered so that the estrogen isn’t quite the same as the pure estrodial in our body, the progesterone – there’s lots of different types of synthetic progestogens, but they’ve all been chemically altered, so they don’t fit the receptors beautifully like the natural hormones do, and they are different doses as well. But when we’re younger we produce different amounts of hormones to when we are older, of course, as well. But this is a fixed dose combination pill and some of the guidelines for women with POI, premature ovarian insufficiency, do state we can consider HRT, so hormone replacement, or the combined contraceptive pill. The other hormone that obviously isn’t acknowledged when people have the combined oral contraceptive pill is testosterone and actually having oral estrogen can increase something called the sex hormone binding globulin, which actually reduces freely available testosterone. So if women do have some testosterone in their body, then taking the contraceptive pill will lower that anyway, for a lot of women they don’t really notice. But even women without POI who take the contraceptive pill can notice that they have reduced libido, feel a bit more fed up, a bit flatter in their mood, a bit less energy. And that often can be because there’s less effective testosterone in the body. But if your ovaries weren’t working, we know then that your estrogen, progesterone and testosterone are likely to be low, aren’t they? So taking the combined oral contraceptive pill for some people is fine, but if it’s not helping your symptoms, then it’s not good enough, is it? So. So what did you do?
Corinna Bordoli: [00:08:02] Yeah. So the thing is, I obviously didn’t know what it was like to feel normal, and so I just accepted, I guess, that was me. So I thought I was a very anxious person. I had lots of mood swings. I was also on one of those pills that give you a week’s break. So for a whole week I was, my mood was really, really low and I was suicidal. It was really, really difficult. But also I wasn’t back to sort of my old self, I guess, although obviously my old self was a child self. So it was really difficult to know if that was just normal or not. But I also kept getting injured again, a bit less than I did without anything before my diagnosis. But still I broke my foot by doing pilates when I was 20 by literally just going onto my tiptoes. And since then that’s gone into necrosis and all sorts. And you know, I was very young and it’s just a little bit, you know, unfair that again, that happened. And I just wasn’t aware, you know, I just assume my body just doesn’t work, really.
Dr Louise Newson: [00:09:01] Yeah. And that’s so important obviously a lot of the work that I do is about allowing women to have education. But when we look at premature ovarian insufficiency, POI, or what it’s defined as, it actually means women under the age of 40, as you know, and we’ve always quoted it’s one in a hundred women. A recent study said it’s probably three in 100 women. Women living with HIV, it’s actually more like 20% of women. And I think globally that the percentage is actually quite a bit higher. I don’t know what you think, out of your reading?
Corinna Bordoli: [00:09:34] Yeah. I mean, it sounds like it’s a lot more, it sounds like it takes years and years for people to actually get diagnosed. And lots of them never actually get diagnosed cause they’re on the pill or there’s some other reasons and maybe they just realise they have POI just before they’re actually menopausal. So yeah, to be honest, it’s really, really scary to just speak to other people who’ve lived decades and decades like me. And so they’re just trying to figure out if that’s them, if that’s their hormones, and they just have no sort of baseline. They can’t just be like, well, two years ago I felt really good and now I don’t feel good anymore now. It’s the whole of their lives they’ve led.
Dr Louise Newson: [00:10:12] Yeah, and that is a problem because it’s also we talk about the menopause, but there’s also the perimenopause. So for a lot of women whose ovaries just naturally fail earlier or don’t work as efficiently, then they might still have periods. And so then it’s very difficult, isn’t it, to know? But we know I’ve read some studies that say that it takes seven years for women to be made the diagnosis and that they see at least seven doctors as well. And they would have seen doctors like me 20 years ago saying, oh, if you’re not pregnant, don’t worry. And, you know, you’re probably a bit stressed. That’s why you’re feeling anxious or, you know, there’s something else going on, which is awful or given the contraceptive pill. But if you have a week off, a week pill free, that means a quarter of your time is without hormones. And then the other thing, it’s not just about symptoms. Clearly, it’s outrageous that women are being ignored when they have so many symptoms. But even if we put that aside and there’s some evidence that women with POI don’t have the same classical symptoms as older women or they present sometimes differently, every single woman with an early menopause, whatever the cause, has health risks associated with it. And that’s something that’s really important, isn’t it, for people to know from the outset.
Corinna Bordoli: [00:11:29] Yeah. I mean, I was told, luckily to do my DEXA scan every few years, and that’s obviously like one of the main issues, I guess, you know, check your bone density, but also heart and brain function. And I think that is something that maybe there isn’t just one easy way to sort of check or check hormone levels are fine. But I guess, you know, immediately when I went onto HRT, like the way I also felt more, I guess, I’m not clever, that doesn’t sound right, but less brain fatigued really, really changed. And yeah, just generally, you know, I felt better as a whole, as a whole human as opposed to just, you know, being able to get out of bed, that was an achievement.
Dr Louise Newson: [00:12:14] Yeah, which is amazing. So if you don’t mind saying you’re taking HRT now rather than the contraceptive pill. And how are you taking the HRT? Are you taking the hormones separately?
Corinna Bordoli: [00:12:24] Yes, I’m taking the patches for my estrogen and I’m on a 200 dosage at the moment, which again the NHS isn’t particularly happy about and they’d rather me be on a lower one. I then take my progesterone as a sort of 12 day cycle. So I still have a bleed and I was on the Utrogestan which is the body identical one, but for shortages. Now I’m back on the synthetic one for a while and I’m also on testosterone. So it’s a gel and I put half a pea sized lump on every day.
Dr Louise Newson: [00:12:56] And do you think the testosterone has made much difference to you at all?
Corinna Bordoli: [00:12:59] 100%. I literally felt it the day I started it. Like I had absolutely no doubt. So energy levels just in general, how it’s like helped my body just grow stronger. I don’t have, like, massive muscles, but I was really, really, really skinny and I was exercising quite a lot and not really feeling the benefits. I always liked exercising, so I still did it. But absolutely did nothing. Well, now, since I’m on testosterone, I actually feel like I can feel stronger and that’s incredible for my joints as well. I have a lot less joint pain because I can exercise it actually, and it’s doing something to my body, but also brain fog. And energy levels, it’s been incredible. If one day I forget to take it, then I know immediately that I’ve forgotten to take it because my brain’s less functioning, really. I just forget things and I’m just a lot slower.
Dr Louise Newson: [00:13:51] Which is so important. So there’s a couple of things I’d really like to explore, if you don’t mind. One of the things is you’re saying you’re on 200 micrograms of Evorel or estrogen patches, so the patches we use to apply to the skin to allow the estrogen, the body identical, the natural hormone to go through the skin into the bloodstream. And when we talk about maximum doses of drugs, it’s often what the drug company have defined due to the way that they’ve done the trials and got the drug licensed. Actually in the British National Formulary, the BNF that we work out of as doctors, it says that we titrate the dose according to symptoms and they don’t define a maximum dose. The SPC, so the product characteristics with the drug company will say the maximum is 100 micrograms when it comes to patches, but that’s not based on risk, it’s just based that they haven’t done the studies. In other countries they don’t have the maximum in the same way. So prescribing a higher dose is off label use, but it’s not off licence use and sometimes with painkillers we’ll give higher doses, sometimes with other hormones such as thyroxine, there isn’t a maximum dose on the SPC. So I’ve had some patients who are on 225 micrograms of thyroxine and others who are on 25 micrograms and everyone’s different. But when we apply things on medication on the skin, our skin types are very different. And so we know from other studies looking at all sorts of drugs through the skin is that the absorption can be very unreliable and unpredictable. It could depend on the thickness of the skin, the temperature of the skin, the vasculature of the skin, but also the adhesive that’s used. So some people find that the patches don’t stick on very well. And I use more than one patch, but they just don’t stick very well. They crinkle a bit. So having more than one just means that I’ll just get a bit more absorbed. But it’s probably not as much as one patch in another person’s skin that sticks really well. So there’s lots of this going on. But at the same time, we’ve recently, as you know, there’s been a news alert from the British Menopause Society, the Royal College of Obstetrics and Gynaecology, the Royal College of GPs, the Royal College of Nursing, saying that we shouldn’t be prescribing more than 100 micrograms. And if people do, then they have to take it at their own risk and have the responsibility as a prescriber. Well, a lot of people are scared of HRT anyway, due to unfounded fears. So this is making them really scared. And there is evidence and it is mentioned in some of the guidelines as well, the ESHRE guidelines for POI, that younger women often or might need higher doses. So you’re saying you can’t get a higher dose on the NHS? So it just doesn’t seem right. I don’t really understand what the concern is. What have you been told that are the concerns of having 200 micrograms?
Corinna Bordoli: [00:16:37] So I’ve been told there’s just no evidence that that will be safe in the long term, which is the same as there’s no evidence that I’ll be fine on a smaller dose. And the thing is, I know that I’m not well if I’m on a much lower dose. So when I switched from the pill to HRT, I was put on a 50 microgram patch for quite a while and I was really, really unwell, I was feeling better mentally, but physically I actually had all sorts of symptoms. Like really, I really struggled. So anything from headaches, like feeling, you know, completely not able to function because I was so tired, but also a lot of sort of intestinal problems. I always had IBS and when my estrogen is very, very low, I literally don’t keep anything down. So I was losing a lot of weight and being referred to all sorts of specialists to check that my, you know, I didn’t have some sort of cancer in my digestive system somewhere. So, you know, obviously this costs a lot of money to the NHS as well. It obviously worried everyone because I couldn’t keep any food down. But then as soon as my estrogen was up like this completely disappeared and again, they couldn’t find anything else. And I knew it, as we kept sort of increasing it every three to four months, finally getting up to a higher dose that I was feeling better. But on 100 dose, I still was not feeling good. And I think everyone just needs a different dose and they will know within their body if they’re well or not. And I still have lots of symptoms on the 200 one to be honest. So I think until probably you feel good, you can probably still up the dose? I’m not sure. What would you say?
Dr Louise Newson: [00:18:21] Yeah, well the thing is about estrogen is it’s very anti-inflammatory in the body, it’s very beneficial. And often when people are on HRT, we do do blood tests to see if the estrogen is being absorbed, if the level is low and a woman is on a certain dose, then we do often increase. There are some women that still have high levels, but they actually still feel better when they increase. But then you repeat the level and it can be low again. And so if you do blood tests in the perimenopause, hormones can fluctuate so they can be very high and they can be very low. So sometimes a high reading is just because you’ve taken it at a time when the hormone is sort of fluctuated up. The other thing is there is some cross-reactivity with the hormone blood test. So if some people have certain supplements, such as biotin, it can cross react with the blood test. So you get a falsely high reading. In medicine, I’ve been always taught and I always practice, in that we have to look at the patient first and the blood tests or the scans or whatever can help us with the diagnosis. But we can’t just be looking at the blood test the whole time. And this is, I think, very important when it comes to hormone levels, because everyone’s different. And what you need as a 27-year-old of estrogen in your body is bound to be different to me, who’s you know, nearly twice your age. I probably don’t need as much in my body. And when I’m another 20 years older, I probably won’t need as much as I have now. But we’re very clear with the guidelines that every year people need to be reviewed and assessed, looking at the benefits and the risks. Now, the theoretical risks of estrogen, if you have too much, is people worry about the lining of the womb. So in the old days, so decades ago people prescribed estrogen on its own, they didn’t think about progesterone and then they noticed that more women were having bleeding, some of these women had endometrial cancer. But when you actually look at the studies, the risk of endometrial cancer for women who only have estrogen is still very, very low. If you have progesterone as well, then you’re protecting the lining of the womb and you’re reducing that risk. Now, with risk, you can never say never. So you cannot say people who take HRT are never going to have endometrial cancer in the same way that saying people who take HRT are never going to fall down the stairs and trip over. You know, it doesn’t protect us from everything. Of course it doesn’t, because there’s a background risk of endometrial cancer. We know the commonest reasons or risk factors for endometrial cancer are being overweight, having type two diabetes, being hypertensive. So nothing to do with HRT. We do know that women who take HRT, especially when the progesterone’s continuous, are less likely to develop endometrial cancer, they are more likely to develop bleeding, but bleeding doesn’t usually mean endometrial cancer. So there’s lots of reasons why people bleed. And clearly you’re taking the progesterone for 12 days a month in a cyclical way. So you are going to have bleeding, which is absolutely normal. And because you’re shedding the lining of your womb. A 27 year old, very slim, very healthy lady, the risk of endometrial cancer is incredibly low. Even if you take 100 or 200 micrograms of estrogen because you’re replacing whether you’re actually giving yourself what you need, you know, your body or others who are 27 with normal periods probably are producing more estrogen than you’re having. But what’s happened with this news alert and everything else, people have put all women together in a box and saying, No, we can’t. We shouldn’t be giving more than 100 micrograms. They’re not thinking of this individualisation. They’re not thinking of certain groups of women that really benefit from higher doses. And it really worries me because women shouldn’t be paying for their HRT, especially as we’ve got free prescriptions now, not free but, you know, you just pay for one, don’t you, for the whole HRT. But actually, that’s not you’re not allowing to have your hormones back. I’m not aware of any studies showing that higher doses of antidepressants have long term benefits or don’t have risks. Those studies haven’t been done in the same ways that long term higher dose estrogen studies have never been done, but people don’t seem to worry about that. And I feel it’s a real disservice to women just saying, no, you can’t have it. The other thing, as you might know, we’ve produced and it’s available on the www.newsonhealth.co.uk website, it’s some audit data that we’ve done a service evaluation looking at our estradiol dosing, looking at our levels, looking at patterns of bleeding. And we’ve actually found there’s no correlation even between doses and levels in the body because some people absorb very well. Some people on lower doses have a higher level of estrogen in their body than others who are on a higher dose because they’re just not absorbing as much, which makes sense as bearing in mind, as I said, about skin type and absorption and everything else. But common sense and menopause just don’t seem to be united at the minute. It seems to be very fragmented, very polarised, with poor women in the middle not knowing who to believe, what to do. Do I trust that clinic who are giving me higher doses? Do I trust the Royal Colleges who are saying we can’t have more? Or do I trust my body that’s telling me that I don’t feel right? And that’s really hard, isn’t it, for individuals I think.
Corinna Bordoli: [00:23:42] It’s really difficult. And I think most people would just, you know, feel really, really scared to risk anything, you know, actively decide that, yes, I’m going to try and risk something. If a doctor has said, look, this is not proven, this is not sure, because obviously we’ve got already so many other health issues coming from other side. You don’t want to risk anything else. But obviously, if you understand like what this means and the reason for this risk being just, well, we don’t actually know if there is one then, that would help.
Dr Louise Newson: [00:24:15] Yes, absolutely. And I think with risk, it’s very difficult because as an individual, you want to know about you. You don’t want to know the percentage risk or one in whatever risk. I want to know for me the risk. But the other thing I always think about what are the risks of not having HRT or not having the right dose of HRT. We know if you don’t have enough and you have low estrogen, then you get this pro-inflammatory state in the body, which means that our immune system doesn’t work very well. There’s an increased risk of infections of course, but more importantly there’s an increased risk of inflammatory diseases. And we know that because the longer a woman is without her hormones, the greater the risk that the woman is of heart disease, osteoporosis, diabetes, dementia, mental health issues. Work by Walter Rocca from the Mayo Institute shows that other diseases such as chronic kidney disease, psychosis, drug addiction and autoimmune diseases, some types of cancer can all increase the longer a woman is without hormones. And that sounds horrendous. And I’m saying all that when you’re young, but that’s why it’s so important to have your hormones back, because if you have your hormones back, then that risk really does reduce. And the less time you have without your hormones, the better. So this long time for diagnosis is exposing women to an increased risk, and we don’t know how quickly it reverses or not. So it is is a real priority that young women who have an early menopause are really listened to and given treatment and the right dose and types for them as soon as possible, isn’t it?
Corinna Bordoli: [00:25:48] Yeah, 100%. And it’s about making sure that, I guess medical professionals are really listening to them, especially as a young, I was a child, I definitely was not listened to. And definitely, you know, my mum also wasn’t listened to. So there’s a lot to say. And, you know, possibly listening to the person whose body we’re sort of discussing. But you know, if you’re not feeling great because you’re going through POI or the menopause, then you probably are doubting yourself a lot as well. So maybe you’re not asserting yourself at the appointment.
Dr Louise Newson: [00:26:21] Absolutely. Yeah. So very important. So just before we finish, you do quite a lot of work with the charity the Daisy Network, don’t you? Can you just explain briefly what the Daisy Network is?
Corinna Bordoli: [00:26:31] Yeah, definitely. So the Daisy Network is a charity working with women with POI which is premature menopause. So it’s a community essentially. So there’s a lot of information and a lot of support for anyone that has been going through POI. So we do local meetups, so sometimes we meet in parks and do some walks. I meet the ladies in London, but there’s lots of different networks around the UK and internationally and there’s also support groups online and just a lot of information. So yeah, do join the Daisy Network. Yes, that’s helpful. Really, really helpful for me, for sure.
Dr Louise Newson: [00:27:05] Yeah. Brilliant. I think just it’s like anything, a problem shared is a problem halved, and just sharing with like-minded people who understand. You can talk, share experiences because I’ve learned a huge amount over the last seven years running a menopause clinic. I learn from my patients, I learn from the women, I learn from stories, and I learn from seeing people get better as well. But actually we learn from each other as well, and we can be advocates for each other, which I think is really important to patients. So before we finish, I’m very grateful for your time. I’d just like three take home tips, so three tips for people who have been listening who either think they might have an early menopause or perimenopause themselves, or they might be recognising it in others from our conversation. What three things do you think they should do as a priority to help them and their future health?
Corinna Bordoli: [00:27:54] Yes, the first one definitely listen to your body and yourself. Maybe keep track of your symptoms. If they’re changing, like balance, for example, is amazing at doing that, allowing you to really track your symptoms, but you can literally just journal whatever works just to make sure that when you go to your appointment, you can actually show evidence of how you’ve been feeling and don’t doubt yourself at an appointment. So really go to the appointment, prepare and ask for what you want, which is unfortunate that you have to do your own research and sometimes ask for things yourself. And the second one, do find a POI specialist if you are diagnosed with POI. Because actually they can prescribe you things like testosterone for example, a lot more easily than GPs, at least in my experience. And they should be able to help with slightly higher doses as well. We’ll see if that can still happen on the NHS at some point, that would be really good. And then the last one I would say yeah, definitely find your community and tribe. I felt so much more myself when I was able to share my story with other people and hear their stories. And I’ve made amazing friends and sometimes knowing people who are going through the same thing that you’re going through is the most healing thing that can happen to you.
Dr Louise Newson: [00:29:04] Absolutely. So very empowering, very positive. I really hope people now will look at the menopause as a problem for half the population, not a problem for older women, which is really important. So I’m very grateful for you sharing your story and look forward to hearing more about what the Daisy Network can do and what we can all do together to help young women. So thanks ever so much today, Corinna.
Corinna Bordoli: [00:29:28] Thank you, Louise. Thanks for the work you do.
Dr Louise Newson: [00:29:33] 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.