Latest / The Dr Louise Newson Podcast / 61 – Living with untreated urinary symptoms

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61 – Living with untreated urinary symptoms · The Dr Louise Newson Podcast

0:02
So Penny, you're here in London, I've seen you in Amsterdam where
0:07
you live. But I met you in London
0:09
actually, didn't I? Because I was on my theatre
0:12
tour, my last theatre tour, and you came up at the end and said
0:16
I want you to come and talk in Amsterdam.
0:18
One minute, yeah. I had one minute at the book
0:21
signing, yeah. And I saw my chance, Yeah.
0:24
It was a little bit over a year ago.
0:26
And yes, I feel like we've done a lot, So much.
0:29
Yeah. So we brought you over to
0:30
Amsterdam for the Connected Health Weekend.
0:33
Then I interviewed you for the article about long COVID and
0:37
hormones, and you were so kind to review it and we were in
0:41
touch. And yeah, it's great to be here.
0:45
I mean, you know, I, I called you already back in Amsterdam.
0:48
I work in sports advertising. So I, I think now you know this
0:52
term goat. Yeah.
0:53
Which doesn't mean the animal, but it's the greatest of all
0:56
time. Oh, you're so kind.
0:58
So and I think you are the GOAT of menopause.
1:02
Oh so owner. You know, I was in Amsterdam.
1:05
We had a great weekend. I gave a lot of presentations to
1:09
women, men, healthcare professionals, and the
1:11
healthcare professional section was really busy.
1:14
I gave my presentation and then you gave yours, and I thought I
1:18
knew you really well. I knew you'd had a story and I
1:20
knew that your health had improved on hormones, but I
1:23
didn't know how much you'd suffered.
1:26
And you have kindly agreed to talk about your suffering
1:30
because lots of women get symptoms.
1:32
And when I read articles, it will say the majority of women
1:36
have symptoms related to genital urinary syndrome of menopause,
1:40
like 70%. And probably only about 810% of
1:44
those women have treatment. When you read it on black and
1:47
white, you think, oh that's bad and you keep reading the
1:50
article. But when you talk to women who
1:53
have symptoms, it's not just words on a page.
1:57
And when I first learned about genital urine syndrome, the
2:01
menopause, it wasn't called that.
2:02
It was called VVA, which was Volvo vagina atrophy.
2:07
The word atrophy, if you look it up in the dictionary, is
2:11
withering and wasting away thinning.
2:13
Like. And actually, I don't want to
2:14
think of my anatomy withering and wasting away.
2:18
And then some people, even then VVA was a bit of a mouthful, so
2:21
they'd just say any vaginal dryness.
2:24
But as yours talking a bit, it's not just always dryness.
2:29
We're trying to change the terminology actually with a
2:31
group of people I know in US, in America to just genital urinary
2:36
syndrome because it's not just menopause.
2:39
My 23 year old Jess was on the podcast recently talking about
2:44
her use of vaginal hormones and she has PMDD.
2:48
She's not menopausal. If I wasn't her mum and she
2:51
didn't have access to a good menopause specialist, she would
2:54
be having lots of symptoms. I think back in the past as AGPI
2:59
had lots of patients with, I thought, recurrent thrush, a lot
3:03
of vaginal soreness, irritation, urinary tract symptoms.
3:08
Never once did I think about hormones in them.
3:11
So I don't think it should be called GSMI.
3:15
Think the M is wrong and for you?
3:17
It certainly wasn't menopause where you started to experience
3:20
symptoms, was it? Yeah, in hindsight, it was
3:23
perimenopause, Yeah. So it started definitely from my
3:28
fortieths because I I have letters from the gynecologist
3:32
and I can see the the the year. But I think actually it probably
3:37
started already late 30s and it started just with first
3:44
irritation after sex. And then it, it, it was a few
3:48
days, then it turned into irritation just out of no
3:52
reason. And then I, I noticed a pattern
3:55
myself where I would have irritation just before I had my
3:59
period because at the time I, I was, I still had my period every
4:04
four weeks. So, yeah, now I know it was
4:10
perimenopause and I went to the GP, then I went to after, I
4:17
think it took two years. Then I I went to see a
4:21
gynecologist. And again, I mean, this was,
4:25
we're talking 2012, 13. So I'd like to think now that
4:31
people know more about it, but it's quite sad.
4:34
And I actually at some point I, I even, and I have the letter
4:39
still at home back from 2013 where the gynecologist actually
4:42
writes in her report saying patient thinks it's also linked
4:46
with hormones. You're crazy.
4:50
No, not crazy, but she just put it there as a fact because I'd
4:54
mentioned it and I, I thought it was linked to my periods, which
4:58
in a way it was, but it was hormones paramenopause and I, I
5:04
basically it went on like that. So were you given any hormones
5:08
at that time? No, no, and they never really
5:12
figured out what it was in the letter.
5:15
Literally that went back to the GP.
5:18
It says it could be listen sclerosis.
5:20
Maybe it's, it's too like they listed basically everything.
5:23
So I never really got worried, but it was just super annoying.
5:27
And it was like, and I see a lot of I'm in a international sport
5:31
group. I see a lot of women using the
5:33
word flare up. So, and it started with a few
5:36
days of flare ups, then over the years it went into weeks and
5:42
eventually even months and of this and again, like I never had
5:47
any bladder infection or UTI. And that that's the thing,
5:51
right? The janitorial synonyms can be
5:53
many things. So my main problem was just like
5:57
this crazy irritation. I described it, I think in the
6:01
presentation, it was like this constant feeling of having like
6:05
a fire and a whole colony of ants going 24/7 through your
6:12
your underwear. And you still have to to
6:17
function, right? And it's not something you're
6:20
going to moan about at work. You know, you can say, oh, I
6:23
have a headache or I pulled my back, but you're not going to
6:26
say like I had this horrible problem with my private parts.
6:30
You probably would get reported to HR, right?
6:33
You would say these? Things and was it affecting your
6:35
sleep? Yeah, sometimes it was difficult
6:38
to fall asleep. Yeah.
6:39
But I think mainly throughout the day, you know, at at night
6:43
you can also like not wear underwear, but throughout the
6:47
day and with cycling and there were whole periods where I could
6:50
only wear leggings and even sitting like towards the end.
6:56
So I basically struggled through like I think eight years and in
7:01
the beginning it was just the thing where I thought I need to
7:05
solve this because this is going to, it's interfering with my sex
7:09
life. So as you know, I work as a
7:13
producer, so I'm used as a producer.
7:16
You're responsible for like organizing, managing everything.
7:20
So a good producer will always be a hat 2 steps of everybody
7:25
else and have like a plan. So if this happens, we have plan
7:29
BC so and I feel like this is how I manage everything in my
7:34
life. So I was thinking like, OK, this
7:36
is a problem now I need to get this fixed because this is not
7:41
good for the for the future. And so that's how it started.
7:46
But I mean, eventually over years, it got so bad and the
7:50
flare ups got longer and longer. I mean, I, I, it was more like,
7:56
how can I get through the day? How can I actually cycle?
7:59
How can I sit down? So it, it was really, yeah, if I
8:03
think about it, so sad. And then because I couldn't
8:08
accept it, I, I, I kept searching.
8:10
And again, this is quite a long time ago now, nearly 15 years.
8:14
So luckily now there's a lot of information and you know, we're
8:18
doing the podcast. And so eventually I, I think in
8:25
2023 is your, you did the first podcast with Rachel Rubin.
8:31
And that's when I really realized it was janitor cinema
8:35
of menopause. I had already kind of figured
8:38
out before a few years before that, that it was probably this
8:41
vaginal atrophy. But again, like that, that term,
8:46
as you were just saying, is it's wrong.
8:49
And, and the interesting thing was what you guys were saying on
8:53
the podcast. And that's when I was really
8:55
like, Oh my God, I think it was Rachel saying that very often
9:01
she would see those symptoms starting even before any other
9:06
perimenopause symptoms started. And that's when I I realized
9:11
that's me. That's amazing.
9:13
So if you hadn't have listened to the podcast with Rachel
9:16
Rubin, things might have been very different.
9:18
Yeah, and I probably would have struggled even longer.
9:23
So eventually I found another gynecologist and she actually
9:31
she diagnosed, she said, yes, this janitor cinema menopause.
9:36
I still have that letter at home as well.
9:39
And for me to actually read that and like a specialist finally
9:42
saying that already helped. But then it it took a year to
9:48
actually heal properly. And also because I, I'd read
9:53
this in the, the international online support group where
9:57
someone had said they actually need a much more of the
10:02
traditional doses, which is 2 weeks every day, right?
10:05
And then you're supposed to do it twice a week.
10:09
And I I read about someone saying that she actually needed
10:12
it. Every day.
10:13
Every day for a long period. So I discussed that with my
10:17
gynecologist and I'm so glad that she was actually, she said,
10:21
that's fine here you have a long standing prescription and, you
10:25
know, just experiment yourself. Because I also see a lot of
10:29
women in that support group in, in different countries where
10:33
their doctors just refuse to prescribe more or they're
10:38
saying, oh, it's not helping, but it's probably because they,
10:41
they don't, you know, they need more.
10:44
So I, it took me a year, I needed at least five times a
10:47
week. And now it's all under control
10:51
and I was able to reverse, but it's so I've basically, so that
10:56
was 2023 when I got properly diagnosed and then it took
11:00
another year. So now that was 14 years of
11:04
yeah, wasted a little bit. Yeah, it's, it's so sad because
11:10
it is one of those symptoms that just progresses without
11:13
treatment. You know, some people find that
11:16
their flushes or sweats don't last, that, you know, they might
11:19
last months, they might last a few years, but generally they
11:22
tend to improve with time. But this is one of the symptoms
11:26
that doesn't. And it's like I say, so common,
11:30
but people don't always know what to look out for.
11:33
And I think if anyone has any irritation at all or any sort of
11:38
awareness, like, I know, you know, as we're sitting talking,
11:41
we shouldn't be aware of our vulva and our vagina.
11:44
You know, we're not aware of other parts of our body in the
11:46
same way. Whereas if you are aware, then
11:48
there's probably something that's not quite right.
11:51
And just the I say universal commas, irritation, burning
11:55
symptoms that you say you're at work, you're in a meeting,
11:58
you're trying to sit down. And I wasn't really taught about
12:01
it as a as a medical student or a postgraduate.
12:04
And I remember the first time I saw someone with, with symptoms,
12:07
similar tools in my clinic. And she she said, oh, do you
12:09
mind if I don't sit down for the whole consultation?
12:12
And I thought, what, the chairs are quite comfortable.
12:14
And then she said, I've just driven in my car to come here.
12:18
I really need to stand up. And she was wearing this long,
12:20
floaty skirt. And I said, oh, can I examine
12:22
you? And she said, yeah, but she
12:24
wasn't wearing underclothes. And I'd never seen anyone that
12:27
extreme because as a GPI would always get on and treat people.
12:30
She, like you had seen lots of doctors, tried to get help.
12:33
She'd had biopsies, she'd had steroid creams, nothing had
12:36
helped at all. But the doses of the vaginal
12:39
hormonal preparations are very, very low, incredibly low.
12:43
And so using them every day really isn't a problem.
12:47
And some people need to use a pessary.
12:49
And then I often give a cream or a gel to use externally as well.
12:54
And quite often people use prasterone, which is DHEA, so it
12:57
converts to estradiol and testosterone.
13:00
And using systemic hormones can make quite a difference as well.
13:04
Yeah, I have the whole whole picture now.
13:07
Yeah, including testosterone, which has been like that the the
13:11
last thing to really help it. And has that made a difference?
13:16
Yeah. Yeah.
13:16
Yeah. And now I can really do it 2-2
13:20
nights a week. Yeah, with the vaginal hormones.
13:24
Yeah, yeah, yeah. But I'm, I'm never coming off
13:28
them. No.
13:28
And you don't need to. And I think that again is really
13:30
important because some women sadly are taken off them after a
13:34
certain length of time. But there is no risk with these
13:37
hormones because they are such a low dose.
13:40
So they don't get absorbed into the system.
13:43
And once you stop using them, the symptoms are likely to come
13:46
back and you do not want them coming back at all.
13:49
Other some friends in, in my circle of women, I've, I've told
13:55
them one who had recurring bladder infections, I said, you,
14:00
you, you need to go and get a prescription for this.
14:04
And she started another friend who had some issues, who had
14:08
some doubts about starting hormones, but she was really
14:12
happy. And it's it's like everybody
14:14
needs to know about this. You know, if this was a a male
14:18
problem, I always try to like explain.
14:21
So let let's see how this was if this was an issue, Mana, right.
14:25
So let's try and explain this to man.
14:26
So you have this constant burning penis.
14:30
Your foreskin is, is really hurting.
14:33
You have small cuts appearing out of nowhere.
14:36
You know, you don't even want to have sex.
14:38
So how would this be like no man would accept this, right?
14:43
Like the whole world would be. I think it's one of your
14:48
colleagues saying there would be a vaccine or maybe Rachel Rubin
14:51
is saying this. There would already be a vaccine
14:53
for many years. And I think also janitorial
14:56
synonym of of menopause or hormones.
14:58
It's probably the last taboo of menopause.
15:04
This year I'm taking a new show around the UK called Breaking
15:08
the Cycle, The Power of Hormones.
15:11
I'll be visiting theatres across the country to talk about
15:14
something that affects every part of our lives.
15:17
It is still widely misunderstood.
15:19
And of course, that's our hormones.
15:22
They shape how we feel, how we sleep, how our bodies function
15:26
and how our health changes over time.
15:29
And yet so many women are left confused, misinformed, or simply
15:33
not listened to. So in this show, I'm going to be
15:37
unpacking how hormones really work, where medicine has gone
15:40
wrong, and why Women's Health has so often been overlooked.
15:45
I'll be sharing the science, some of the history, and also
15:49
real stories behind decades of misinformation alongside
15:53
practical insights that can help you understand your own body
15:57
better. There will be moments that
15:59
challenge what you think and know, and space to ask questions
16:02
you may never have been given answers to before.
16:05
If you want to learn, reflect, and leave feeling more confident
16:09
about your own health, I'd love you to join me.
16:12
Tickets are on sale now. There's a link in the show
16:15
notes. I think.
16:18
It's trivialized as well. I think a lot of people don't
16:23
understand the association with the urinary symptoms and the
16:26
localised symptoms. A lot of people think, oh, it's
16:30
not that bad and they don't understand or they don't want to
16:33
understand. The treatment is so easy
16:36
actually, but it can take so long and I think also a lot of
16:41
clinicians still are embarrassed talking about sex or they're
16:46
talking about these localised symptoms, which is.
16:49
Crazy. I think, you know, in the
16:50
Netherlands, I think we're quite, I think your sister was
16:53
saying after my presentation, oh, it's so good.
16:56
Dutch people are so open. And normally I must say I'm a
17:00
very private person. But I think after my struggle
17:04
for, you know, like I said, it took me 14 years, I feel like
17:10
every woman on the earth needs to know.
17:13
And also because symptoms can start in your 30s, but also if
17:19
if you don't get this around your menopause, I know a woman
17:23
who's in her 70s who just recently started getting these
17:27
symptoms. So I've been helping her with
17:28
like, you know, getting the right treatment.
17:31
So, and I was reading another article where they sat between,
17:38
it's like some really random numbers between 27 and 78% of
17:44
women get these symptoms. That's a wide range.
17:48
It's probably because a lot of women don't talk.
17:50
About it but let's. Say so basically almost
17:54
everyone, right? That's nearly 80% of women who
17:57
can get this at somewhere between, well, you're saying
18:01
your, your daughter has it. So let's say between your and
18:04
your hundreds because a lot of women in the care homes or older
18:11
women get all these Utis, right? My sister works in a care home.
18:16
I've once asked her, I said, is this actually true?
18:19
And she says, yes, a lot of them.
18:21
And the doctors give them a lot of antibiotics.
18:24
And it's so sad. It is, yeah.
18:27
And I, I remember going, visiting a lot of nursing homes
18:30
as AGP and they'd often smell of urine.
18:33
Yeah. You know.
18:33
The glowing. Incontinent and but again, I
18:37
didn't think about hormones, you know, I feel really embarrassed
18:41
and I didn't. But actually now we've got this
18:43
knowledge, everybody should know about it and like the forums
18:47
that the people that you're giving advice to, it's so
18:49
important because then they know there's an option for them so
18:52
they don't have to suffer. Also, the doctors in the care
18:55
homes, when you came over to the Netherlands, I, I was trying to
19:00
get in touch with the Doctor Who was at the care home where my
19:04
mother lived because I wanted her to see.
19:08
Also, your presentation about the risk of not taking hormones,
19:11
because I think the people that are the cariatric doctors that
19:15
are treating elderly, I don't think they are aware, right, of
19:20
this link where? And yes, it might be too late to
19:23
start a 80 year old woman maybe on hormones.
19:26
Not at all. Yeah, that's the whole
19:27
discussion too, right? But at least I think it's good
19:31
if those doctors understand. But there seems to be a gap.
19:36
Yeah, there is, I mean, there, there is a big gap with
19:39
education for the doctors and education for women.
19:42
And I think actually that gap is getting wider because women are
19:46
understanding it's a lot more. But there's still this
19:49
resistance by doctors and I'm not quite sure why.
19:52
Some of it is due to lack of education, some of it is due to
19:56
the misunderstanding. So for example, you wouldn't
19:58
start an older woman on synthetic hormones.
20:01
So women in their 70s or 80s, I wouldn't start the older types
20:05
of estrogen. And the pregnant horses urine,
20:08
estrogen, all the synthetic progesterone because there are
20:10
risks with them. But the natural hormone
20:12
estradiol, the natural progesterone, the natural
20:15
testosterone, there's no reason. And in fact, one of my doctors
20:18
who works with me yesterday was saying that she had a lady in
20:21
her late 70s who came to see her with her daughter three months
20:25
ago and she was barely climbing the stairs to go to the
20:28
consulting room. Every step was a real ethics was
20:31
so painful. And she came back for a review
20:34
this week and she just walked upstairs and she didn't really
20:37
realize it was the same person. And she said that's just three
20:40
months of being on hormones. And so I do worry when you look
20:44
at the older generation who have missed out, you know, we're both
20:48
similar age, in our mid 50s, and we're lucky we've chosen to take
20:51
hormones. But there are women in the
20:54
generation above us really, who are struggling and you see them
20:59
in the nursing homes and I often wondered what would their lives
21:03
have been if they had had hormones available to them.
21:06
Yeah, yeah. So my mother passed away about a
21:09
little bit over a year and a half ago.
21:11
And the last nine months of her life, she was living in a care
21:14
home. And when I was each time when I,
21:18
when the more I, I was there, I looked around and I thought must
21:22
be 70% of the people living here that are women and they all had
21:27
similar things. And, and you know, you never,
21:29
you got, you don't get into these care homes anymore.
21:32
Just went one thing. And my mother, she had
21:36
rheumatoid arthritis. She had a severe heart disease.
21:41
She had a pacemaker. She had macular degeneration,
21:46
which I think is linked to oestrogen, lack of oestrogen.
21:49
And then about a year before she she died, she was also diagnosed
21:53
with Alzheimer, which is also linked to that.
21:56
Yeah, I always said the only thing she didn't have was
21:59
osteoporosis, but I think the the rheumatoid arthritis was
22:02
quite bad. But looking around, like a a lot
22:07
of women had Alzheimer's, they had osteoporosis, you know, they
22:10
were all yeah, this. My sister was saying a lot.
22:13
A lot of them have the Utis. And I think it was about four
22:19
months after she died when I saw your show in London in October
22:23
24. And in the first half of the
22:26
show, you had this picture of like what happens when your
22:31
hormones kind of basically get lower and lower?
22:35
And you showed this picture of this old woman being hunched.
22:38
And I just sat there and it's like, you're just describing my
22:44
mother. And I realized actually more and
22:48
more I realized after she died, like I think everything that she
22:53
she was suffering was probably the lack of hormones and looking
22:58
at all the other other women. And I recently saw a Dutch
23:05
doctor on LinkedIn who apparently has she's now working
23:09
with menopausal women. But she apparently has had been
23:12
a doctor working in a care home. And she was actually putting on
23:16
a post saying exactly my thoughts thinking.
23:21
But isn't that if all these women would have had hormones
23:26
earlier, maybe they they they would be in better health?
23:30
Yeah, it's so interesting. Just before I left my GP
23:32
practice, I the penny dropped and I realized that a lot of the
23:36
women I visited went on hormones.
23:38
They weren't using vaginal hormones or systemic hormones.
23:40
So I did a search just in the record.
23:43
It was quite a big practice. So I wanted to see how many
23:47
people who were in nursing homes, residential homes, care
23:51
homes, warden control flats, had carers visiting them.
23:55
How many of those women were using either HRT or vaginal
23:59
hormones? You could probably guess the
24:02
number. Yes, 0, nothing.
24:05
And Rebecca Lewis, the Doctor Who set up the clinic with me,
24:08
did the same in her practice. It was in a different region, so
24:11
different women. Again, she couldn't find any
24:14
patients. And we were both really, we was
24:17
not really surprised, but we just thought how disappointing.
24:20
I mean, that was eight years ago, so.
24:22
But I don't think it's any better.
24:25
But you do wonder when people are going to suddenly realise
24:29
and I don't know what it's going to take for people to realise.
24:32
I think it's, yeah, our generation who's probably now
24:35
kind of saying this, this is it because it's quite.
24:39
Again, I'm not a doctor, I don't have any statistics, but if I
24:43
look back at my mother around mid her mid 70s, her problems
24:48
started, her heart problems, her rheumatoid arthritis and
24:53
basically the last 12 years of her life she was living in in
24:57
really bad health. It was like constant going see
25:00
having to see different specialists.
25:02
One of her friends who is a lot younger than than my mother
25:05
who's in her mid 70s now. So in the last then 12 months
25:09
she started to have similar issues.
25:12
She has osteoporosis, she has some Romat issue where she had
25:16
to take Prednisone. And I'm thinking, you know how
25:20
it is when you have your car and the, the, the petrol is nearly
25:24
empty and the little light will come on and you can probably
25:26
still drive, I don't know, 10 miles, 20 miles.
25:29
And the way I see it is so your, your period stops, your, your
25:35
menopause. So the, the red light comes on
25:40
and maybe you can still, you know, have another 10-15 years
25:45
in, in reasonable good health. But then it's like the car's
25:48
stopping. And.
25:50
I, I think it looks like that the light going off, finally
25:55
going off the, the, the, the, the petrol tank being empty is
25:59
around maybe your mid 70s. And the other gap is, and I've
26:04
seen this with my mother is because of medication and
26:08
treatments and the protocol for the doctors that you probably
26:12
know better, but also in the homes is they will try and keep
26:16
you alive as long as possible. But I've also thought about to
26:20
to what extent, you know, looking at my again, at my
26:24
mother, the amount of medications she was taking for
26:28
all these different diseases and and, and symptoms.
26:33
And then she was prescribed medication for the side effects
26:36
of other, you know, Yeah, it's. Layers and layers.
26:39
And you're absolutely right, because we know that as women
26:42
we're getting less healthy as we age.
26:45
The last 10 years of a woman's life is often in poor health.
26:50
And that's really sad because the number of conditions they
26:54
are diagnosed with, the number of medications they're on that
26:58
You say a lot of medications have side effects, so they have
27:00
more medication. And it's losing independence is
27:03
something that we don't want as well.
27:05
So anything we can do to improve future health, not just our
27:10
lifespan, but our health span is really important.
27:14
And if you look at humans, they tick so many boxes to improve,
27:19
But I still think there's this sort of willful blindness by a
27:22
lot of clinicians that they're not thinking ahead.
27:25
They're not thinking about how can we keep Penny as healthy as
27:28
possible. It's more let's wait till
27:30
Pennies ill and then we'll give their treatment.
27:32
And you've got to change that that.
27:34
Whole what I was saying earlier like this whole project manager
27:39
minds that that I think is anyway lacking in in.
27:43
A lot of industries to project manage medicine in a different
27:46
way really. But also so I I was a caretaker
27:50
for my mother in. The last few years.
27:51
Of her life and her palliative phase.
27:55
And I've also gotten a lot of experience and insights and
27:59
besides hormones, I'm also trying to raise a little bit
28:03
awareness about that. And I'm again, I'm seeing, I
28:07
don't know how it is here in, in, in Great Britain, but in the
28:10
Netherlands, they're saying about 5 million people are
28:14
caretakers and a lot of people have to take care also and work
28:20
their job. And I bet and I think I've, I
28:25
don't have statistics, but the majority is women.
28:28
But let's say even it is equal. Even in the.
28:32
I think it's more, but let's say that's still two and a half
28:35
million. You want to to make sure women
28:38
are healthy and also you want to make sure, because the other
28:42
discussion, which I think is the same here, everybody's saying
28:46
the healthcare system is collapsing.
28:51
Too many people are aging and it's a blind spot.
28:55
So we need people to stay healthy.
28:59
Also, we need people to work for the economy.
29:02
We need people to take care. And we have a healthcare system
29:07
that's collapsing. But why isn't more people like
29:11
yourself? Of course, thinking about Let's
29:14
look. It's so obvious, yeah.
29:16
Like start earlier and and half the population can potentially
29:22
have a lot of prevention. Yeah, yeah, we, it's a total
29:26
mind shift that needs to happen. And I, I don't know,
29:30
conversations like this will, will enable people to think
29:32
differently. And somewhere somehow things
29:35
have got to change for future generations who can't keep this
29:39
because it's just not fair on the women that are being harmed
29:42
by them being refusing hormones. So I'm really so thrilled that
29:46
you've come over, Penny and I haven't spoken in so much detail
29:50
about genital urine syndrome for a long time.
29:53
So I'm hoping this will really resonate with people.
29:55
And those of you listening, please share it with as many
29:58
people as possible. So before we end, three take
30:01
home tips. So three things that you think
30:04
people should do if they're experiencing any symptoms which
30:08
may be related to Genito urinary syndrome.
30:11
What are the three things that you would recommend them to do
30:13
so they don't suffer for years that you did?
30:16
Yeah, read up. Yeah, I've also, besides the
30:20
long COVID article, even before last year when the official
30:24
genitalism of menopause guidelines came out, I've
30:27
written another article. It's in Dutch.
30:30
Maybe I need to do a translation.
30:31
But yeah, read up. I think you have a lot of
30:34
information because you might find that maybe not all your
30:39
doctors have the right information.
30:41
And also be aware that janitorial synonym menopause is
30:45
basically like an umbrella term, right?
30:48
It can be anything from bladder infection to irritation to
30:52
clitoral atrophy. Yeah, lots of things.
30:59
So yeah, I think with anything menopause, educate yourself.
31:05
Yeah, so important. Yeah.
31:07
And share your knowledge with others.
31:09
I think is is even really so, so important because a lot of
31:13
people are trivialising their symptoms and we need to be
31:15
enabling them to have treatment as promptly as possible to
31:19
reduce suffering. So.
31:20
Well, thank you again so much for sharing today.
31:23
It's been great. Thanks for having me.
31:27
Thanks so much for listening. It would be amazing if you could
31:30
follow me or subscribe because it will really make a difference
31:33
to grow numbers enable this to reach even more people.
31:37
Thanks so much.