Latest / The Dr Louise Newson Podcast / 21 - Breaking barriers in women’s health: Hormones, education and HRT with Dr Fionnuala Vernon

Transcript

21 - Breaking barriers in women’s health: Hormones, education and HRT with Dr Fionnuala Vernon · The Dr Louise Newson Podcast

• 0:00
  In my podcast today, I've got Doctor Fanula Vernon with me
• 0:03
  who's a GP and educator from Ireland.
• 0:06
  We have a really open conversation about how the
• 0:09
  healthcare system is failing women and how we need to improve
• 0:12
  education for all healthcare professionals.
• 0:15
  So hope you enjoy it. So exciting.
• 0:20
  You're over from Ireland, yes, Last time I saw you was in the
• 0:24
  conference, I think. Yeah, we're in the Royal
• 0:25
  College. Surgeons.
• 0:26
  Yeah. Which was great, actually.
• 0:28
  This is a conference that I'd organised for healthcare
• 0:30
  professionals and we had people from 18 different countries.
• 0:34
  And he was like, yeah, yeah, I did say to someone it felt even
• 0:36
  more exciting than my wedding. And they said that probably
• 0:39
  wasn't the right thing. To yeah, Paul was really
• 0:41
  reassured by that. I'm sure Husband was there.
• 0:43
  Yeah, he was. He spoke.
• 0:44
  He was. But it was what I found about
• 0:46
  that day, I don't know what you felt sort of sitting there was
• 0:49
  that everyone had this fire in their belly.
• 0:51
  Everyone was like looking at hormones in a different way.
• 0:55
  There were gynecologists there. There were psychiatrists there.
• 0:58
  There were GPS there, nurses, pharmacists, people coming from
• 1:02
  all sorts of educational backgrounds.
• 1:05
  But there was this real. And it got noisier and noisier,
• 1:07
  actually, as the day went on, didn't it?
• 1:09
  It did, yeah. It was a kind of an unruly bunch
• 1:11
  at the end. We're there with very like
• 1:13
  minded people, cardiologists, surgeons, gynecologists, GPS,
• 1:17
  nurses as you say, and the fire in their belly is coming from
• 1:21
  people's kind of want and need to help patients and to make a
• 1:26
  change. And I think that momentum was
• 1:28
  very palpable on that day. For sure.
• 1:30
  Yeah. I mean, I was really honoured
• 1:32
  because we had great lectures including, as you know, from US
• 1:35
  and Singapore, and they came because they wanted to.
• 1:39
  The conference was not funded by pharmaceutical companies.
• 1:42
  So it, you know, we had a really lean budget.
• 1:45
  Everyone knew that and it that was fine.
• 1:47
  But also, I've been, and I don't know if you have, but you
• 1:50
  probably have been to conferences where in the break
• 1:53
  people are just a bit awkward. They're not really chatting,
• 1:55
  they're not talking, you know, and it's almost a bit hostile.
• 1:58
  Whereas here it was very inclusive.
• 2:00
  It was. Lovely.
• 2:01
  It was lovely. And it was just great even just
• 2:03
  to get kind of anecdotes from other clinicians.
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  And yeah, it was a really, really great day.
• 2:09
  Yeah, because, you know, medicine, I've said before, is a
• 2:12
  science in an arts. So the science is looking
• 2:15
  academically at the papers. We have guidelines which are as,
• 2:19
  as the word implies, a guide, but also it's a patient
• 2:23
  experience. This is the art of medicine,
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  isn't it? And I made sure that the
• 2:27
  lectures all spoke about patients because I've been to
• 2:30
  many menopause conferences where it's all about slides and
• 2:33
  figures and statistics, never once about Mrs. Smith, 49 year
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  old lady who's given up her job, who's struggling with brain fog
• 2:41
  and memory problems and sore joints.
• 2:43
  So that brings it back to the reason that we went into
• 2:46
  medicine, isn't it really? Well, that that's the reason.
• 2:49
  I mean, certainly that's where the conference really resonated
• 2:51
  with me. See patients all day, every day,
• 2:54
  patients who are really struggling.
• 2:55
  And I loved Haley and J, that was such a great conversation
• 2:59
  and they were so brave to come and tell their story.
• 3:02
  And I know patients like that and it's lovely for patients,
• 3:06
  for your listeners to, to hear their story and lots of that is
• 3:11
  going to resonate. So as doctors we and especially
• 3:15
  as GPS, we are best placed. 90% of all of the work of the NHS
• 3:20
  happens in primary care. So we live with patients, we're
• 3:23
  in their communities. We know the difficulties you're
• 3:26
  facing. And conferences for me are
• 3:29
  bringing our patient experience, meeting the experts, having then
• 3:34
  those connections that if we are struggling with evidence or
• 3:37
  we're not too sure or we need a little bit of support to treat
• 3:42
  maybe difficult cases, we've got those connections.
• 3:44
  And I think that's why it was such a lovely, lovely banter,
• 3:47
  great rapport because it was very open and people were very
• 3:51
  generous with their advice and support, which is great.
• 3:54
  Which is great. And, and it's also, you know, we
• 3:57
  know it's a global problem that hormones are not being addressed
• 4:01
  enough for women. But when you talk to other
• 4:04
  healthcare professionals in other countries, you know, in,
• 4:07
  in Iceland, in South Africa, in Netherlands, they're all
• 4:12
  experiencing the same. And, and actually, when you say
• 4:15
  why, you know, what's your experience of testosterone with
• 4:17
  your patients or what are the symptoms that they get, you know
• 4:21
  that it's, you know, women are the same really, you know,
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  biologically we're the same. We might present differently,
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  different ethnicities and also have different health beliefs as
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  well. And that's, that's one of the
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  things that you hear more and more actually from other
• 4:36
  countries. Is this the patients?
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  The women have been scared away from hormones for the wrong
• 4:42
  reasons often, haven't they? Yeah, I mean, it is absolutely a
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  global problem and we've always had a very interesting
• 4:47
  relationship with menopause in Ireland because traditionally,
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  well, there have been church views and things like
• 4:51
  contraceptions. So traditionally we have maybe
• 4:53
  larger families, maybe 1012 kids.
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  One of my patients is 1 of 19 children.
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  Oh my gosh, so you can imagine when when, when his mum got to
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  the 19th baby when menopause came, it was probably a welcomed
• 5:06
  relief period stopped. There were no more kids.
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  So for those women and now they, I mean, we obviously don't have,
• 5:14
  have as many, many kids start per capita, but but in other in
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  other countries and in other tribes and in other communities
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  that may still be part of of their culture.
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  But we didn't know. We didn't know the symptoms,
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  especially the the mental health symptoms.
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  They are probably the most prevalent and the most
• 5:37
  distressing symptoms that people come to us with.
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  Yeah. And I think that's probably
• 5:43
  those are the symptoms that have the biggest impact on
• 5:45
  relationships. As Jay and Healy challenged us
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  about in our mail where we have one of our biggest clinics.
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  We have a beautiful Georgian city, the top of the cities that
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  we have a huge park, not just similar to Hyde Park.
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  We have a, a former women's jail and it closed in the 1960s.
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  And then at the bottom of the town we have an old asylum, a
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  mental health, umm, asylum for want of a better word.
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  And the number of patients I see now who with the education that
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  they're getting on your platforms and other platforms
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  are now joining the dots. And while those patients who
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  were in patients in either the jail or in, in the, the mental
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  health asylum will never have the opportunity to thank you for
• 6:29
  all the work that you're doing. Some of those women are being
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  exonerated. Some of those women were now
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  giving an explanation as to how they were there.
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  We also see, again, as GPS, we see the children of those women
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  and the children who very often they'll say, I didn't have a
• 6:46
  relationship with my mum at all. You know, we didn't get on, it
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  must have been a personality clash, it must have been
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  difficult. And now when they're looking
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  back they're saying actually there maybe was a different
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  reason and they interesting have a story to tell.
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  When I ask about the older siblings, what what were your
• 7:03
  older siblings relationship with your mum?
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  It was great. They don't remember difficult
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  times, they remember great times.
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  So, and it's us tying that all together, looking back over
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  history, looking back over generations.
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  And certainly as GPS, we are interested, we want to know,
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  we're interested in your social history or family history.
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  And very often as GPS, we know the history because we know your
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  families. Yeah.
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  Communities, absolutely, it does really connect.
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  But the The thing is also is it's often all in the history,
• 7:32
  isn't it? And there's something I was
• 7:34
  taught at medical school. Take a really good history,
• 7:36
  Louise, listen to your patients. The story is there.
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  You have to ask the right questions, but I didn't ask the
• 7:42
  right questions for many years because I didn't think about
• 7:45
  periods, I didn't think about hormones changing.
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  I never thought about mental health and hormones because
• 7:51
  doing psychiatry, no one taught me and I shudder when I look
• 7:54
  back. But medicines, progressive, you
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  learn by experiences, you share the knowledge and also you work
• 8:01
  out. Could it be a placebo?
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  Could it be a coincidence? Or could it be that hormones
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  have a role in the brain? So that's going back to the old
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  textbooks really. Yes, realising that of course
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  they have a role in the brain, so therefore it makes sense.
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  And when things make sense, you join the dots, don't you?
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  And. You.
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  Absolutely. You then think about other
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  patients. But Haley's experience was
• 8:21
  really interesting because it was so extreme.
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  But I've seen a lot of similar patients, as have you.
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  But then when I met her the first time, and I just asked her
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  the very simple question, how did you feel when you were
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  pregnant? Yeah.
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  And she grinned. Isn't it?
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  Yeah, yeah. And then I also, the other
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  question was, you know, how did you feel when you were having
• 8:41
  your periods that run up to your periods?
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  How did you feel? She said no, that was that was
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  the time I was drinking more. I felt awful.
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  And then it's night and day when my period comes.
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  So sad. So she's told me in a way that
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  my hormones have affected my mental health.
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  I know. But no one had picked up on it.
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  It's so difficult and that's what this is very frustrating.
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  And I see patients like this and we've always great band during
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  clinics. I mean, the things patients tell
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  me are, you know, sometimes they're hilarious.
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  And I said, please can I repeat that because that's so funny.
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  And then other times we hear really sad stories.
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  I mean, one patient not dissimilar to Healy and we're
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  chatting and the tears just streaming down her face.
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  And I'm saying because there's something, you know, and she
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  she's like connected with his PMDD and she's saying have all
• 9:25
  my admissions to hospital or have my mental health
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  breakdowns, my relationship breakdowns, the ability to not
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  be able to meet someone, all being affected by hormones.
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  And that is something that someone could affect had they
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  realized that and that that that's grief.
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  Yeah, that's a grief reaction. And I've seen it a lot.
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  And, you know, I'm used to it now.
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  But when I first started it, I remember a lady came back to me
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  and she started crying and on her symptom question asked what
• 9:55
  everything was better. And she was young.
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  She was only 44. And she'd had symptoms for about
• 10:00
  10 years. But before that, PMS and PMDD.
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  And she started crying. I thought, what have I done?
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  She said, I'm just grieving for those years that I've lost.
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  I could have felt like this. My life could have been
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  different. And I thought, gosh, actually,
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  this is really, really significant.
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  And you know, as doctors, as GPS, we often only have really
• 10:23
  short consultations. But I think, you know, we can
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  make a huge difference in 10 minutes.
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  We can. And.
• 10:30
  To the to a good or bad, if we get it wrong, Yeah.
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  And it's a lot of responsibility, actually.
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  Isn't it huge? Responsibility.
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  And it's probably probably, I mean, I went into general
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  practice because I absolutely loved everything I did loads of
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  ABS and Guinea. I'm in my 20th year as a doctor.
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  I graduated 20 years ago with this this summer.
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  And I loved psychiatry. I loved ABS and Guinea.
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  I loved it all, loved Pediatrics and in general practice.
• 10:54
  Let me have it all. Umm, which was, which was
• 10:58
  amazing. So it means that we can, we can
• 10:59
  call on our experiences and lots of other aspects of our
• 11:04
  learning. I'm AGP educator and I train GPS
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  and I'm really passionate about education and I'm really
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  passionate about about kind of encouraging our GP trainees to
• 11:14
  stay in the workforce, to be interested, to ask these
• 11:17
  questions. And if we can educate patients
• 11:21
  to know what to look for. We also want to educate.
• 11:24
  We're educating men. We do a lot of work in industry.
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  So we want to educate men. And I know that there are people
• 11:32
  out there who Haley's story will have resonated.
• 11:35
  There might be some of the conversation that are resonating
• 11:38
  with people today. It's very difficult for them to
• 11:40
  find the words. Choosing your timing and that
• 11:45
  you know would would be very important.
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  But even just linking the podcast, even if you can't find
• 11:49
  the words to say to someone to reach out, just link the podcast
• 11:53
  or just send, send a link and hopefully some of what we're
• 11:56
  talking about will resonate and we'll know what to ask for, know
• 11:59
  what to look for. Yeah, I mean, I feel women are
• 12:02
  learning really quickly actually.
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  And they're partners, they're work colleagues.
• 12:07
  So men and women get it actually.
• 12:09
  But there is still a real resistance from healthcare
• 12:11
  professionals. There are some doctors and I
• 12:14
  spoke to 4 yesterday who are really keen to do menopause as
• 12:17
  their future career and hormones and they said to me, gosh
• 12:21
  Louise, it's amazing. I love it when people come into
• 12:24
  the clinic, they think they've got hormonal issues, they might
• 12:26
  be perimenopausal PMDZ and I just love it.
• 12:30
  It's great. It's so transformational.
• 12:32
  But then I have other people saying to me, Louise, because of
• 12:34
  your work, we now are seeing far too many women in our surgeries.
• 12:39
  We're so busy with menopausal women that we can't get to see
• 12:42
  other patients. They think they've got
• 12:45
  perimenopausal symptoms and how dare they think that they've
• 12:48
  never had hot flashes. So this is sort of, it's like a
• 12:51
  parallel universe really. And if as healthcare
• 12:55
  professionals, we had better education, we could serve our
• 13:00
  patients better. I was at a conference recently
• 13:02
  in Spain and they were saying we have to do this blood test in
• 13:06
  young women, the raised FSH blood test, to make a diagnosis
• 13:09
  of POI, premature ovarian insufficiency.
• 13:12
  So I asked the panel for the evidence because I haven't read
• 13:15
  the evidence that is very clear that 100% of women have this
• 13:19
  raised test. Because in my clinicals
• 13:21
  practice, I see a lot of women with a normal level or the low
• 13:24
  level and they've definitely got POI or their perimenopausal and
• 13:28
  of a young age. So then someone on the panel,
• 13:31
  the professor said to me, but Louise, how else would you
• 13:34
  diagnose? And I said by taking a really
• 13:37
  good. Height.
• 13:38
  Yeah, medicine stop working. Wait, I said.
• 13:39
  But. In other things in medicine, we
• 13:41
  don't always have a test. A defendant of so I have
• 13:45
  migraine. You can take a really Clear
• 13:47
  History and you'll be very clear that it's migraine.
• 13:49
  You don't need to refer me to for a scan or a blood test or
• 13:52
  anything. And also often in medicine we
• 13:55
  give a therapeutic trial. So there's often a push back
• 13:58
  saying these women think that testosterone will improve their
• 14:01
  mood or estrogen will improve their joint pain.
• 14:04
  Well, we don't know whether it will or won't, but we try it and
• 14:07
  see. And we do this with other
• 14:09
  medicines. Yes, of course I.
• 14:11
  Don't quite know why sometimes people are so scared, but it's
• 14:15
  also because they've so you haven't been trained and I
• 14:18
  wasn't trained before, I didn't have that knowledge.
• 14:20
  So it's difficult it. Is difficult.
• 14:22
  It comes down to training and it comes down to our fear.
• 14:25
  I mean, we went into medicine to help people, that's the bottom
• 14:28
  line. And we also came into medicine,
• 14:30
  took the Hippocratic Oath not to do harm and sometimes to do
• 14:34
  nothing is no defence. It's harmful to do nothing and
• 14:39
  we won't all be experts in everything.
• 14:42
  And it's very reasonable to put your hands up and say this is
• 14:44
  not my area of expertise, but it is our job to signpost people to
• 14:48
  wear, to get the help and the support.
• 14:50
  And because menopause is not a linear thing, and I mean, I'd be
• 14:55
  very risk averse. You're a pathologist as well.
• 14:58
  So, I mean, you are, as I say, attention to detail and the
• 15:01
  science, but to diagnose diabetes is very easy.
• 15:05
  You're either a diabetic or you're not.
• 15:07
  You're either a really bad diabetic and really poor
• 15:09
  controlled or it's very well controlled.
• 15:12
  And I think because menopause and perimenopause is not a
• 15:16
  linear thing, it's difficult, but it's about the history.
• 15:19
  Yeah. That's what we're trained to do.
• 15:20
  And it's inevitable that when we raise awareness, we've seen the
• 15:23
  same level of interest with things like prostate cancer,
• 15:27
  when when celebrities or when people who are very well known
• 15:31
  in the media develop prostate cancer.
• 15:33
  And then we'll see a surge in in requests for PSA testing.
• 15:37
  And so it's inevitable that if we're raising awareness of
• 15:39
  menopausal symptoms and the issues we have with menopause,
• 15:42
  that we're going to see more menopausal women.
• 15:44
  Yeah. But we're trained to take the
• 15:46
  history, we're trained to, to understand.
• 15:50
  We're trained to exclude other things.
• 15:52
  Yes, we're very mindful of the fact that not everything is
• 15:55
  hormone related, but it's feel and I'd sometimes explain it to
• 15:59
  kids. I'd say like if your mum didn't,
• 16:01
  if your mum didn't, perpetual in the cart wouldn't go very well
• 16:03
  with it. And it's exactly the same with
• 16:05
  us with. But if it's thyroxin, your
• 16:08
  thyroid hormones, if it's your female hormones, even for men,
• 16:11
  if it's testosterone, they're countless examples.
• 16:13
  Yeah, and it's, it is really difficult.
• 16:15
  And it's the same in anything in medicine.
• 16:17
  You know, going back to my migraine, I might have a brain
• 16:20
  tumour. And every so often someone will
• 16:22
  present with similar symptoms. And as AGP, you cannot test
• 16:26
  everybody. You can't do scan on everyone.
• 16:28
  It's different in hospital, you have more access, but it's not
• 16:31
  appropriate actually to always be testing for people.
• 16:35
  And you know some people will say to people, how do you know
• 16:38
  what if you're going to miss an arthritis for their joint pain?
• 16:41
  Well, we can make more than one diagnosis is one thing.
• 16:45
  We can still send people for tests and give them hormones
• 16:48
  often in medicine. Well, it's often not in
• 16:50
  medicine, just a one thing. There's lots of things.
• 16:53
  And recently I've been talking to people who have been very
• 16:57
  socially, economically deprived saying, well, these women have
• 17:01
  trauma, Louise, so it's not related to their hormones.
• 17:04
  Well, they have trauma. They've had difficult times.
• 17:07
  They might have drug abuse and alcohol abuse affecting their
• 17:09
  mental health but they've also haven't had periods for everyone
• 17:13
  else. So some of it is just 5 or 10%.
• 17:16
  But that all adds up in a persons life and I feel as a
• 17:19
  doctor we really need to be holistic.
• 17:21
  And also we can't just say, well, your hormones will fix
• 17:24
  everything for you. We have to be thinking about
• 17:27
  everything else too. Yeah.
• 17:29
  But it's it's just this wilful blindness that sometimes is
• 17:32
  happening, isn't it? Yeah.
• 17:33
  Well, certainly as GPS, as I say, we are best placed.
• 17:36
  Hmm. We are in the communities.
• 17:37
  We also have the ability, we know our patients really well.
• 17:41
  Yeah. And we have the ability to say
• 17:43
  come back to me, yes, you know and we, we know our patients so
• 17:46
  we can safely net. It was one of the things we were
• 17:48
  taught from day one. Safely net.
• 17:50
  If you're not any better, please come back.
• 17:52
  If you're any worse, please come back.
• 17:54
  Yeah. And we certainly do that a lot
• 17:56
  with patients all the time because we're also, even if it
• 17:59
  is related to hormones, we sometimes change the dose, the
• 18:02
  type, we sometimes add in testosterone, sometimes
• 18:05
  progesterone, if even if they've had a hysterectomy.
• 18:08
  And everybody's different. But I'll always say to patients,
• 18:12
  if this doesn't work or if, you know, leave it this length or,
• 18:14
  you know, like you say, if you have any symptoms that concern
• 18:17
  you, come back. But usually women know actually
• 18:20
  when you ask enough, whether it's hormonal or not, because
• 18:23
  they've had similar symptoms just before their periods,
• 18:26
  haven't they? And.
• 18:26
  Women are very chained in and we're great talkers.
• 18:29
  I mean, we'll have these conversations in the tea room
• 18:31
  and the workplace on football sidelines and we're very open.
• 18:37
  Yeah, we're very open about our symptoms and, and telling.
• 18:39
  And it's great to just create this really safe environment
• 18:42
  that women can continue to do that.
• 18:43
  Umm, which is, which is great. As I say, even in the workplace,
• 18:47
  I would often say to patients, you know, umm, don't be afraid.
• 18:51
  Don't be afraid to mention hormones.
• 18:53
  Don't be afraid. As I said earlier, it's umm,
• 18:57
  sometimes some of the stories patients tell me are umm, some
• 19:02
  of them are very distressing and some of them are absolutely
• 19:04
  hilarious, you know, So it's, it's just trying to tie all of
• 19:08
  those symptoms in and nobody is on their own.
• 19:13
  That's really important and that there is help and support there.
• 19:17
  And I think training for GPS and all health care professionals
• 19:21
  has has got to improve globally it because it's a global
• 19:26
  problem. All the guidelines are very
• 19:28
  clear that HRT is first line treatment for the majority of
• 19:31
  women. Globally, 5% of women take
• 19:34
  hormones. In the UK it's about 14% and
• 19:38
  it's plateaued. It's not going up.
• 19:40
  That is not majority. So like you say, there are harms
• 19:44
  of doing nothing and we need to think about what are the risks
• 19:47
  to the bone health, the heart health, brain health and
• 19:51
  day-to-day symptoms by denying an evidence based treatment
• 19:54
  because of unfounded fears. And this is where we really have
• 19:59
  a responsibility, I think to be training the medical students,
• 20:03
  junior doctors, senior doctors, different specialties.
• 20:06
  I mean, everybody should know something, shouldn't they?
• 20:09
  Even if they don't treat, they should be signposting I.
• 20:11
  Suppose there's two aspects to that and I think medicine has
• 20:14
  changed. So we'd have, we would have had
• 20:16
  a very doctor centred approach to care for years and now we're
• 20:21
  moving into this very patient centred approach where we're
• 20:23
  asking patients to become involved in their decision
• 20:26
  making. And then there's also a piece of
• 20:28
  work around supporting colleagues.
• 20:31
  We're all in the same team and I think that's really important.
• 20:34
  We're all in the same team. No one, no doctor ever wants to
• 20:38
  cause harm to patients. And if we are supporting each
• 20:41
  other with the evidence, with the anecdotal evidence looking
• 20:45
  after patients, that's just better for patient care across
• 20:49
  the board. Yeah, absolutely.
• 20:51
  And it is multidisciplinary and we need to be involving all
• 20:55
  specialties and working together.
• 20:58
  And, and it's the whole history of medicine in women that
• 21:03
  there's always been this sort of antagonism and people are sort
• 21:07
  of scared or we we do it this way, we're not going to change.
• 21:11
  And I do think social media is good and bad, but patients learn
• 21:15
  a lot from social media. Some of it is.
• 21:18
  Bad. Some of it is brilliant, but if
• 21:21
  they're not getting help from their doctor, it can be very
• 21:24
  difficult and really tricky. Yeah, I mean, I have a lot of
• 21:26
  women that contact me through my social media, from Southern
• 21:30
  Ireland especially, who can't go and see someone else because
• 21:34
  they're very rural and they only have one Doctor Who's telling
• 21:37
  them. To get chatting to them, yeah.
• 21:40
  Yeah, but it's hard, isn't it, it?
• 21:42
  Is really difficult and I mean the communities are difficult.
• 21:46
  We've a great, we're on a, we're on a Crest of a wave in Ireland
• 21:49
  at the minute. We have had, we've had a very
• 21:52
  poor relationship with Women's Health that just, I suppose
• 21:55
  again, it's a global problem. Women's Health has never had its
• 21:59
  place in the sun and it has never been given the funding or
• 22:04
  the time. We're coming off the back of the
• 22:08
  revelations of these terrible atrocities in mother and baby
• 22:10
  homes. And I think we've lots of great
• 22:13
  women in politics, both North and South, and that makes a
• 22:16
  massive difference. Women get stuff done and we are
• 22:20
  on the Crest of a wave, as I say, where women are now using
• 22:24
  the momentum from that movement and all of their emotions
• 22:28
  associated what has gone before and I made a big win in June
• 22:33
  this year across the country that HRT is free to everyone in
• 22:38
  Ireland so that. Includes testosterone, yeah.
• 22:40
  But certainly in the South, testosterone is there and it's a
• 22:44
  great win. Testosterone is is difficult to
• 22:46
  get as we as we chatted about earlier on, but that's a great
• 22:51
  win. I mean that that's certainly
• 22:53
  something for us to boast about at home and we're hoping to just
• 22:58
  continue on that trajectory. Which is amazing and over here
• 23:02
  we have this prepayment so people can get HRT cheaper but
• 23:05
  it doesn't include testosterone. So in the north we've we're NHS
• 23:09
  in the north, but we have free prescriptions.
• 23:11
  So HRT is free. To patients, yeah.
• 23:14
  And in the site it's a slightly different system, but now
• 23:16
  there's a new exemption card where HRT is free to everyone.
• 23:20
  So which is great. So is HRT prescribing increasing
• 23:22
  in Ireland? There is an increased
• 23:24
  prescribing of HRT for sure and women are more aware and women
• 23:30
  are coming forward. So in our clinic, we've taken a
• 23:33
  physical clinics in an online clinic and what I would do with
• 23:36
  patients is because they're able to get their prescriptions free,
• 23:40
  I'll ask their GPS. So it'll be a prescribing
• 23:42
  recommendation. And my GP colleagues are
• 23:44
  amazing. They're so understanding and
• 23:47
  they are doing great work. And very often they left the
• 23:49
  phone because I like to think I was approachable.
• 23:51
  They left the phone and they said what were you thinking
• 23:53
  there or what was the rationale? And I am very risk averse person
• 23:57
  anyway and but it's great just to be able to have that
• 24:00
  conversation and be able to get women certainly their estrogen,
• 24:04
  their progesterone on the NHS or an NHSC in the South and just
• 24:10
  kind of, I suppose we're educating as we go.
• 24:12
  Yeah. And and we, I've learnt that a
• 24:14
  lot over the years in the clinic because a lot of our patients
• 24:16
  start with us and then they get their HRT, sometimes their
• 24:20
  testosterone or sometimes they just come back to us every year.
• 24:23
  But we write really detailed clinic letters, and then so many
• 24:27
  the doctors I meet say, gosh, I've learned so much.
• 24:30
  From we save your letters, we get them and we file them.
• 24:33
  They're a great reference, but it's great.
• 24:36
  Though, isn't it? Because that's the whole thing.
• 24:38
  You, you learn by osmosis, actually.
• 24:40
  And the more clinically experienced you are, the more
• 24:43
  confident you are. But also I'm, I'm very happy to
• 24:47
  share uncertainties with other colleagues, you know, Oh, I
• 24:50
  don't know about this lady. I'm not sure.
• 24:52
  Do you mind seeing her? And we do that a lot.
• 24:55
  We're lucky in our clinic. We've got lots of doctors, but
• 24:57
  we're constantly asking each other and I think that's
• 25:00
  important because it can be quite isolating as AGP
• 25:03
  sometimes, can't it? Yeah.
• 25:05
  Absolutely. I mean, I came to England and
• 25:07
  Scotland for my menopause training.
• 25:09
  There wasn't the level of training where there wasn't the
• 25:11
  availability of credited trainers or training programs.
• 25:15
  So I mean, we can, I can get forward and back on the same day
• 25:19
  and that's where I did a lot of my training.
• 25:21
  Yeah, you know, but sitting in in clinics, yes, I think just
• 25:25
  quizzing people who see a lot of patients is really important
• 25:28
  because like every every clinic, I'm learning something and
• 25:32
  trying something different. And then if it works, great.
• 25:35
  If it doesn't work, then you might think, well, maybe not,
• 25:38
  but it's evolving. And there's so much in menopause
• 25:41
  hormonal care that we haven't got the research.
• 25:44
  Yeah, but you can't wait for the research if you've got someone
• 25:47
  sitting in front of you. Well.
• 25:48
  That's it. I mean, we're building research.
• 25:50
  We're we're, we're learning as we go.
• 25:52
  And I think that community, getting back to that Royal
• 25:54
  College of Surgeons day that we had with you and your team, it's
• 25:58
  building that network of experts.
• 26:00
  And that's a really secure place, certainly for me to find
• 26:04
  myself and be able to pass it on to patients.
• 26:06
  Yeah. So how do you say things going
• 26:09
  in the next 10 years if you were coming back here in 10 years
• 26:11
  time, how do you think landscape would be changing for I think
• 26:14
  we'll. Both be a bit older and grayer,
• 26:16
  there's no doubt about that. I'd like to think that Women's
• 26:20
  Health is going to be put on the front burner going forward.
• 26:22
  I'd like to think that women will have that opportunity.
• 26:26
  They won't be the same barriers to accessing healthcare the NHS
• 26:31
  will lack in 10 years. It's very difficult at home at
• 26:34
  the moment. We are general practice is on
• 26:38
  its knees. We just as I said before, 90% of
• 26:42
  all of the work in the NHSS is done in primary care, less than
• 26:45
  10% of the budget. So it's very difficult.
• 26:49
  But I'd like to think that Women's Health will be further
• 26:52
  up the agenda. We will have more women and able
• 26:55
  to access treatment for whatever it is they need, whether it's
• 26:59
  contraception, whether it's HRT, whether it's menopause care.
• 27:02
  We're all living longer as well and it's very important that we
• 27:06
  have quality of life. So many of my patients will say
• 27:10
  I want quality. I don't want to live to him 120.
• 27:13
  I want to be able to live and enjoy my grandchildren or enjoy
• 27:17
  my kids or, you know, have not. Yeah.
• 27:21
  And I think changing it to thinking about a way of
• 27:24
  preventing disease is really important.
• 27:25
  I was talking to an orthopaedic surgeon in America, and she said
• 27:27
  all her colleagues don't even know that HRT is licensed to
• 27:31
  prevent osteoporosis. So if we can see it as something
• 27:34
  to help symptoms and prevent disease, that's going to have a
• 27:38
  massively positive impact going forward.
• 27:40
  So, you know, there'll be less fractures, there'll be less
• 27:42
  heart attacks, there'll be less, you know, recurrent admissions
• 27:45
  to hospital, less urinary tract infections.
• 27:48
  So it would be great to see that landscape changing.
• 27:51
  But we've still got a lot of work to do.
• 27:54
  I know there are a lot of healthcare professionals that
• 27:56
  listen to this podcast, GPS, pharmacists, nurses.
• 28:00
  What would you say the three things that we should do as
• 28:03
  educators or people that wanting education about hormones?
• 28:07
  What are the three things that we should be doing, do you
• 28:09
  think? I think the first thing is
• 28:11
  remembering that we're all in the same team.
• 28:13
  We all have the same goals. We want to protect patients, we
• 28:16
  want to help patients, We do not want to do harm.
• 28:18
  Yeah, that is the most important thing.
• 28:21
  We have a very safe space for sharing information and sharing
• 28:25
  guidelines and sharing anecdotes and conferences like yours in
• 28:31
  London a few months ago. Attending very safe places and
• 28:36
  spaces like that can only improve the quality of care that
• 28:39
  we deliver. So I think that's certainly the
• 28:41
  most important thing from a healthcare point of view.
• 28:45
  And I, I'm also as an educator. So I think that learning and
• 28:51
  getting more knowledge and you know, being very open minded to
• 28:56
  change and being mindful of the fact that we probably don't have
• 29:01
  a lot of the evidence that we really need to be able to make
• 29:05
  the changes that we want to do. But certainly continuing to to
• 29:09
  bang that drama, making plenty of noise, which is really
• 29:11
  important. And then I suppose the final tip
• 29:14
  is for patients and for them to have an awareness and for them
• 29:18
  to recognise symptoms of perimenopause and menopausal
• 29:21
  symptoms in themselves and their loved ones and in loved ones
• 29:25
  that have gone before us as well.
• 29:27
  So it's lovely to be in that position where we can shed some
• 29:30
  light on the history of the very difficult history and the very
• 29:32
  difficult times that patients have had before.
• 29:35
  But going forward, if they can't find the words, if they've had a
• 29:40
  catastrophic ride with a sister or a loved one and they just
• 29:44
  can't find a way of healing those bridges.
• 29:47
  Or if they've had a complete breakdown in work and they can't
• 29:50
  find the words to go back lengthy podcast and and maybe
• 29:55
  something will resonate and they might be able to reconnect those
• 29:58
  relationships, which is so important.
• 30:00
  Oh, thank you. Well, thank you so much for
• 30:02
  having me. Thank.
• 30:03
  You to be here.