Latest / The Menopause Resource Hub Podcast / Am I going through the change now? A menopause GP explains, with Dr Nirmala Daya
Transcript
- speaker-0: I have to admit I've learned more about menopause from my patients than I learned from Medical Tech's book. speaker-1: I want to welcome Dr. Namala Dea. She is a specialist GP in Pimble in New South Wales, in Sydney. And I've invited her here to have this conversation about what she does for women and in the menopause space. So let's, I just want to explain to people: like, how did you become a specialist GP? What does that mean? speaker-0: What does that mean? speaker-1: and for women that are looking for help in the menopause area, what's the differentiator? speaker-0: So having worked in general practice for well over 25 years and as a surgical assistant, I was working alongside a lot of obstetricians, gynaecologists, and that certainly I pursued my interest in women's health and gynae, right? And then I had a few of the specialists saying, Narmala, you should just do gynae in general practice. And I think that was the impetus for me to then start North Shore Women's Health. And maintain my focus purely on women's gynecological and breast issues. And with that, obviously menopause has become, you know, a major condition that I've been managing. I have to admit, I've learned more about menopause from my patients than I learned from medical textbooks. I also have to admit that In a general practice setting, it's very hard to take your normal general practice, because I was a solo practitioner, to take that same practice with pediatrics and geriatrics and everybody in between to then make it entirely focused on women's health. So I had to give my general practice away and start this from scratch. speaker-1: So that's how North North Shore women's health came into being. Well you know, because you were the one that said to me that really stuck in my mind that, you know, a lot of GPs, menopause is not a sickness. Therefore, they don't focus on it for all the current information, whatever, in a way that the specialist GP would do. So that's why I think some women are having difficulty. They're going to their GP hoping they'll give them all the answers and they just not fully Prepared yeah for that. speaker-0: I agree with that statement. So, menopause is a physiological process. Every woman's gonna go through that change of life. Yes, at some stage or the other. Yes. Right. So it's not a disease or illness that makes the foundation of medicine. Medicine is about how to manage disease and illness. This is a physiological process. Yeah. And that's why in our textbooks there's little information. Yes, even in our training, there's very little that we are taught how to manage and what to do. We've been given certain tools like the old HRT. Yes, it helps. Yes, we know it helps those women with the symptoms, but we didn't at that time when I trained, we were not even made aware of the long term consequences of menopause. Short term, yes, everybody knew hot flashes and your period stopped. speaker-1: And I think it's a tricky space, isn't it? Because like you've said to me in conversation where you know, so people can come in thinking it's one thing, but when you're looking holistically at the woman, right? So you've got to go, they're saying to you, I've got this symptom, I've got this symptom. And as a as a GP, you've got to go, okay, I hear you, but it it may not be menopause, right? It may be an underlying health issue. So as a GP you have to be able to differentiate or pull apart, right? Like back to what it actually speaker-0: Yes, yes. So that comes down to foundations of medicine training, right? You've got to start with history first. And the history is when the patient shares what they're going through. Then it's examination, then it's investigations necessary. Can't jump backwards, you know? And that's how patients can be well managed for their condition. The other bit of medicine that we need to work out is are we sort of missing something important that's quite treatable? Because some medical conditions can overlap with similar symptoms and it takes time to work that out. speaker-1: Well, and I guess that's part of the challenge of the expectation of the woman, right? Yes. Of coming to the G P hoping for the solution. Boom. So, you know, for some people it's I've got menopause, I need HRT. That's the that's the only solution I'm prepared to consider. Right? They've got ten minutes with the G P. They come in and they go blah blah blah blah blah blah. I call it verbal diarrhea, which is a horrific way of saying it, but is it Women tend to gush, right? We've got this, this, this, this, this, because our minds are full of it. We're dealing with everything. And then the GP sits there almost goes, No, you know, or whatever. And and look, and that could be because they're not trained in it. It could be that they're really not even understanding the patient. And I think that's part of the the advantage of now the government's funding for the longer appointments gives a little bit more scope. So just as an example on the website. I created a just a workshop guide, right? A workshop with the video to help women start to prepare for that appointment. So instead of coming into the appointment with no kind of pre-thinking, it helps them collect their thoughts. Write down, okay, this is this like go through symptoms. This speaker-0: Yes. speaker-1: is how it's impacting me. So by the time you actually sit in front of the GP, you're more collected than look. speaker-0: Yes, it's a starting point. Yes. You know, and there are certainly information out there on the internet or with friends or so. There's a whole group of symptoms, be it physical symptoms and emotional symptoms and other symptoms that women go through. So it's really lovely if a patient has even with a pen and paper written down these other symptoms that I'm experiencing and I need to come and discuss it with the doctor. Quite often if they come and they're really anxious or scared about what's happening to them, they may forget a fair bit of that information. So I think writing things down and then coming and discussing it with the doctor, it helps the doctor as well. We need to focus on these symptoms. Are these symptoms all related to menopause or could it be another underlying condition? And for all us medical people, the first thing we need exclude. It's nothing sinister. It's nothing that's also overlooked before, just say it's all related to animals. So that's an important factor as well. speaker-1: Yes. 'Cause you especially well, I guess as a GP, as a general practitioner, let alone even if you've gone into specialists. But because as a GP they've gotta have knowledge across. What is the expectation coming into the room? You know what I mean? That the instant you're there they have the solution. So sometimes it is a bit of grace and knowing that you're on a journey to get that health. And and one of the real pleasures I've had l is speaking to different disciplines of health and hearing people understand that the woman is a whole, this is a life experience over a number of years. Yes. Different people coming around become a team that support the women rather than I just got HRT and it did everything for me. Like it's, do you know what I mean? That whole transition. Do you find that if women are walking through that with you, are they talking about that element of bringing other elements into that experience? speaker-0: Certainly do. I think in the last probably about five or more years there's been so much more information there about menopause. There's more awareness amongst women about menopause and how best to manage it as well. And using allied health services as well to help them cope with the transition in menopause and even thereafter. So we do need the services of allied health as well. And one good area would be in menopause. I would recommend most women must have a baseline bone density done because you never know how strong your bones or weak your bones are. And people can be at risk of osteoporosis because of this family history as well. So, you know, using the services of dietician, nutritionist, exercise physiologist, physios, gym to maintain the bone health. I think is so important because we are living that much longer. Yes. Right? Yes. And at 60, 65, even 70, I think we'll all call ourselves still it's very young. Not looking at you. speaker-1: No, that's right. No. No right so speaker-0: Yes, we need our internal speaker-1: Help speaker-0: help to carry us through for all those years we live. Yes. And certainly HRT has now shown, or MHT I should say, has been shown to have benefits on quite a few fronts. that's cognitive wellbeing, heart wellbeing, and bone health. And I would also add soft tissue and ligaments. you know, it's the energy in the women, okay. speaker-1: But again, for some people they can't have that, correct? speaker-0: Yeah, some people can't, but there are other treatment options available to support the women who can't have HRT or who've got hesitation about using HRT. There quite a few other products available that we can use to support the women. And sometimes just talking to the professional to get a better understanding of your health and your wellbeing can work well as well. speaker-1: Well, information is power. It is speaker-0: For sure, being well informed, right? speaker-1: Yes, yes, yes. So let's have a look at in your time, what's changed most in how women arrive at the first appointment? More informed, more anxious, more dismissed elsewhere. All of the above. speaker-0: of the above. Yes, I get all of the above coming right. I've been fortunate of being in this practice for well over 18 years or so and I've had many of the women come from the premenopausal period transitioning into menopause and postmenopause. Okay. So we were both aware of the changes that they're going to be going through or I could make them aware of it that they're likely to go through a change. speaker-1: And do you have a typical time frame? Even if we're talking broad strokes, like everybody's different clearly. But you know broad? You know, 'cause I think a lot of people think I'll get HRT, I'll be better, or but we know that really perimenopause menopause can be what, four to ten years or so. speaker-0: Or even longer than that. So I think a lot of women are going to start undergoing some subtle changes in the 40s. Usually around mid-40s. So you're going to notice certain changes. Hair changes, skin changes, sleep changes, a breast maybe bit more tender than normal. Period changes are a big thing. They can either become heavier, more frequent, they can become lighter and infrequent, changing in the body a bit. as well. Many of them complain about gaining weight for no other reason. And you think you're still eating the same, you're still exercising the same or even more. What's changed? Yes. What is changing? And yes, we keep an eye on it and do some blood tests to work out is a change happening. Menopause basically means you haven't had a period for one whole year, but it's a retrospective calculation. Yes. But in that whole period, Some women are going to go through a difficult journey and other women, very fortunate for them, will just sail through. Yes, they hardly get simchips and good on them. speaker-1: So do you think people are getting younger coming into perimenopause? Because you know, I again I think that one thing we've been told is that some people they get to the GP and they're told you're too young, it's just stress, or you know, you're just kind of complaining about something that's natural, you know what I mean, that kind of thing. So for the woman who has the questions, let's say they're mid to late 30s even and they're noticing something is going on their body. And it could be menopause, it could be something else, but The best path forward, right? Because not every GP is going to be equipped to go on the woman's health journey. I mean, they do their best, like we said, right? But you really want to find a doctor that like is a specialist or less focused on that. Yes. Because as as a woman, we are different to men. And speaker-0: we are. speaker-1: like physiologically, it is a very different journey. So you it's not a have a pen and roll go home. So how do you deal with that when women come to you speaker-0: for that concerned about menopause? Well, firstly, the first initial question is about these menopause happening in the young women. Only in a small percentage of women, it could be happening a lot younger. Okay, and there's certain groups, those that may have had chemo, early surgical menopause, injuries, ovaries, right? And then you've got another category of women where their mothers or grandmothers went through early menopause. They're at a greater risk of going through menopause early. Okay, so there's certainly a percentage of them, I think you said about five to ten percent that go through early menopause. But a lot of the young ones are more aware about the change now. Yes. Because it's come to in the forefront of discussions and social conversations. And I think people are more aware of it. And that's why they're coming to find out, am I going through the change now? Right. But We need to work out, firstly, are you actually going through the chain or are you just going through the big hormonal fluctuation before your periods finish? So as I explained to my patients, your hormones are not just going down a sliding scale. They'll go up and down, up and down. So over the few years, so when the hormone levels are almost normal, you feel 100%. When the hormone levels dip down, you're getting those symptoms and you think, menopause has happened. And then you feel fine again. You think I've sailed through menopause until it comes back again and the symptoms and causes this confusion as am I going through menopause or am I not? But coming and getting investigated, you know, examined, investigated, worked out to establish, you perimenopause? Menopause? Yes. And that's important. And that's why sometimes maybe our colleagues are not ready to give their MHT at the first appointment, thinking that is going to fix my problem. speaker-1: Yes. Well Doctor Deia has been a GP how many years? speaker-0: Lost cow. speaker-1: she's been a G P for over forty years. Over forty years. We're not aging anybody. We're not aging anyone that's like it's experience is worth gold. But you know, the the s the change over the years in terms of the focus, the development of all the but that idea of bringing people into the current day when they've got this holistic look of their health. And so you have expanded beyond your general practice into specialist GP and then you're focusing on breast and gynecological so you know how do how does the wider view help you deal with your patients compared to say the isolated journey people can speaker-0: I think having had so many years of general practice and being a solo practitioner, I managed things on my own. And now the focus is mainly on gynae, menopause and breast issues. I was able to take all that experience, still have it with me, but focus very much on all these issues for a woman. Because I think many people speaker-1: Be patient. speaker-0: would also feel when it comes to women's health of gynae or breast, it's got a bit of neglect. to certain extent until things get really bad. A good example would be even a young person with heavy periods. Every woman gets periods, so it's normalized. And then you become really tired and low iron you've got and you just give an iron supplement to say, take those tablets. But it's like you haven't fixed a leaking tap. And you've got to have those young girls coming to improve their quality of life, make the periods more bearable and prevent... other things from developing, similar with menopause. When the change happens, and I think, as I said, more and more young people are more aware of it, who will come and see the GP, have these conversations, have the discussion, do baseline measurements. So we've got a starting point to see how you're changing, because as I said, the hormone levels keep on going up and down. I could do a blood test on the... perimenopausal women or around the menopause time and one sort of blood test may show that the ovaries are not functioning very well or very in hypo function. Six months later, the patient may come and say, I had a slight bleed, very slight bleed. We do blood tests at the time and it may show normal levels. So are you going through menopause or not going through menopause? speaker-1: Like to stick your box. No. speaker-0: It's not like a patient coming in and blood sugars are high, shows on the blood tests, and then we do further tests and I'm sorry, you're a diabetic now. It is not easy. And for many women, they may have that same discussion about menopause with some of their friends. And if they're not going through similar symptoms, they feel, well, you can't identify with me or my journey. And you can't get support or understanding. speaker-1: One of the things that I have seen in conversation is the challenge that some women have in their in their marriages, right? In their relationships because they can't really fully communicate or if they do, they're usually very emotional about how they're communicating. And the husband is just like, go to the doctor, get a solution, put a band-aid on, whatever they're speaker-0: think it's a biograph for people. speaker-1: Or it's like you never shut up because you're always whinging, that kind of thing. And and look, for some people it can end up in divorce even like it which is an extreme. You don't want any of that. So I think building a team of people that help your overall health. Like you said, dietitian or someone's helping you to eat well, someone's helping you to exercise well. Like having a team, it's like building a business, right? You've got a financial officer, you've got an employment person, you've got different Yeah. And I think women's health needs to be more holistic like that. Rather than menopause is my flag. Yeah. You know, everything is around that. It speaker-0: There's more to it for sure and you've touched on a very, I think very important part and that's where I also have conversations with my patients going through the perimenopause or menopause because one of the things that most women are going to go through is a lowered libido. We know it because your body is making less hormones, right? Yeah. And it can have a significant impact on the relationship as well as how many men have a good understanding of menopause and what the woman goes through. as well. And many of my patients I find are in a difficult position because you've got teenage kids or empty nesters but you're also caring for elderly people. You're going through the physical and emotional changes. Plus maybe the change in relationship going to missy. and to hold everything together. And it seems so important that it either comes up in conversations or I'll be happy to ask patients these questions because I think it's so important. And there's certainly some easy treatment options to treat a lot of those conditions offered to them. Yes, to help with maintaining the total wellbeing of them. Yes. speaker-1: 'Cause sometimes it could be just that a change in your diet is actually the thing that kind of helps you course correct instead of a medication. Yeah. But again, the understanding speaker-0: What's it? speaker-1: what to do. So if if you were to say to somebody who is considering, right, they're they're starting to feel the symptoms, they don't know where to go, what to do, right? Yeah. If you had kind of one thing that you wanted to speaker-0: Give them. speaker-1: to take with, what would that be? speaker-0: I would recommend ask people, look on menopausal resources, find the right practitioners to see to you that would listen to you, right? That would take the time to take a detailed history and examination and offer the best possible treatment options to you. Right? At the end of the day, we want your wellbeing as our foremost goal. Yes, right. Physical well-being, emotional well-being. Yeah. Right. As well as long term. speaker-1: A lot of women are working the portfolio. If a that big percentage are going through 'cause we've got an aging population, if you have this aging population that are confused about what to do, you have a problem, right? So we you know, I think it's great that women can be talking about it now. There's a lot more information. People are a bit more prepared to come. Obviously No one can give treatments generally, right? We can't talk about specific things or specific products and you know that that's not the goal here. The goal is to be aware of the options, right? Aware of options, aware of the different forms of practitioners. And the the thing is a lot of if you come and you have a treatment with somebody, an appointment and they've said something to you. You're with well within your rights to go to a second person and get another opinion opinion. You don't have to pick the one that you first encountered, but you I think you have to be prepared that menopause, like we said, it's a transition, right? So it's not it's not day one, I have speaker-0: Day one is going to take some time to work out and we will certainly be able to offer you a range of treatment options or sometimes no treatment. Sometimes patients just want to come talk about what they're going through and be reassured it's just a normal physiological process and it depends on how long their symptoms last and more so what impact it's having on their day-to-day life. If for example hot flushes is causing so much of disturbed sleep Can a woman carry on day after day, month after month or year after year with disturbed sleep? Because yes, the tiredness creeps in, the irritability creeps in, the mood changes. A lot would happen. And that same woman has got so much to juggle. She's got a home, she's a wife, a mother, a daughter, an aunt. She's got so much on her plate. Can speaker-1: Yes. speaker-0: she still forget work? Correct. Yes. And at 50 or even 60, we're still in that very active stage. speaker-1: Yes. speaker-0: So we need our well-being in every way and form. speaker-1: I think I think I know I can say for myself, right? You sometimes you don't really appreciate the diminishing of your vitality because you you put it down to the fact that you're tired, right? You are doing a lot of things. You've got your family, your work, your whatever, whatever. So you you kind of reason it. You're not n necessarily looking at it in a sense of getting health support. You're you're just going, eat more oranges or something. But I I think it's really helpful to understand that the the pathway that they would come into working with someone like yourself, be supported in that journey and be directed to speaker-0: options. Certainly, certainly. And one of those we talked about short-term symptom control as well as long-term health, And long-term, yes, it's cognitive well-being, bone health, and heart health. Yes. And also soft tissues and ligaments. It's not uncommon for women to complain around menopause. Everything hurts. Yes. And you think, why would it? You're still so active, you've still been exercising. Many women eat very healthy, they'll go for the salad first before the steak and chips. You know, things like that and you think, well no, there's a bit more to this. you know, average life expectancy in Australia is increasing with time. So even women in their 70s is expected to feel good, look good. No pressure. And to be able to still do things that they want to do. speaker-1: Yes. Yeah, without the fear of the decreasing and getting old those kinds of speaker-0: Absolutely. Yeah, totally agree. So it's nice to be aware and get started early, I'd say. Not necessarily with treatment, but in terms of having yourself checked, honoured. speaker-1: So can I ask you? So the the Metopause Resource Hub when I created it, it was an idea. It was exploring an idea. And so there were people that came on as founding providers in the sense that they partnered with the idea of it. What what made you decide to do it? speaker-0: What appealed to me was somebody like you, Sharon. I was like, speaker-1: Fuck me. speaker-0: what have you been doing all this time? yes, I've been quietly working here in the corner of Pimble doing exactly all the ideas that you had. But yes, I'm not in the position to bring a whole lot of allied health people together under one umbrella to embrace conditions like menopause. It's not just an age-related transition. It's going to start at some stage and carry on for a lot longer. So there's a lot of other issues, not issues, but medical risks that would need managing as a consequence of menopause in some women. Right? And a good example of that would be the osteoporosis part. Okay, yes. Right. Yes. want to remain active, healthy, eat well, but it's good to know how strong your bones are. Because you want those strong bones to still carry you when you're 80, right? Yes. And stay out of the hospital and fractures. speaker-1: Exactly. So you've got your GP, you've got your physio, you've got your gym that speaker-0: And you've got your dietitian. speaker-1: was part of what motivated me, right? To to have that speaker-0: And you did it. Collective Groovy. I'm just a small... speaker-1: No no no but all of you are that's the that's the you're the stars of the show. So speaker-0: So thank you for reaching out to me and making me part of the Menopause Resource Hub because I'm certain that having this whole resource of practitioners with a similar goal in helping women have the best health outcomes. a natural process. Yes. Let's not talk about disease or illness. Yes. Menopause is a natural physiological process, but we want the best possible outcomes. Yes. short term and long term for all those women. And also what was appealing with Menopause Resource Hub is women that are out where medical services are not that readily available. So if you take country patients, they find it hard to find such doctors or people. speaker-1: being indicative of that. Yes. Because some people, even in their local suburb, can't find a GP that's actually focused on it. And I've found that in the process of developing the concept, I've become a lot stricter even from when I first started. Yes. Because we initially put this whole group of people on the site. I went back and like got rid of about half of them. And like they're fine in their space. It's more the fact that that they're not specifically focused around perimenopause, menopause, that midlife Woman. Yes. And I thought you men deserve the deserve it. speaker-0: Because we carry a lot of hats. Correct. And we certainly deserve better and better care and stuff. And I can proudly say I've got patients as far as Melbourne and more re-coming. speaker-1: So do you do you do ha telehealth here? Well speaker-0: Well, I do, but they have to at some stage come and we do a face to face because I think what is really important is having that examination. Yes. Okay. Right. One important aspect because I've been doing work with quite a few breast surgeons and breast cancer patients. I do a fair bit of support for patients going through menopause who have had breast cancer. So quite a few of the specialists would refer patients over to me to sort of say. Can you help them through the menopause phase to support them? But also if somebody is going to be taking the chart in a long-term basis, I think it's important to have breast checks and perhaps meas down. So I think it's important that at some stage we can have a face-to-face consult with these patients that we are sometimes just only doing a telehealth. It's not necessarily good medicine. speaker-1: That menopause is. Yes. Like it might be okay as an initial connection to explore things, but to look after your health, I think. There's nothing like face-to-face anyway, right? There's nothing like well, we've been speaking for a few months now since since we started this. And that's how this relationship grew because I I was like, to find GPs who really do care about women is the goal, right? It's part of the goal. And so when I find them, I'm like, Ding ding ding. And yes, I know I really I appreciate the time you've taken today. We've taken a we've taken a bit of your schedule today. speaker-0: That's no problem if this time I've taken off to help hopefully thousands of women out there. Or give them a good guideline as to in their own territories or states to find like-minded practitioners. Or also for women to go better informed to the GP consultation. Yes. Right? Don't hesitate to write those lists down or the symptoms you're concerned about. Yeah. It's a great starting point. for us and I'm sure as your resource hub expands that journey for many of the patients to navigate and find their practitioner is going to be that much easier. That much easier. speaker-1: That I that's the goal. No. speaker-0: And there's only a few practitioners I know for this, but this is going far and wide. reaching out to women in all corners of Australia and whether they got access to services or not, but at least they got access to your resource and information to help them further. speaker-1: We all together we're gonna make a difference for women in Australia and who knows, beyond. So thank you very much for your time today. speaker-0: Thanks for coming all the way out. speaker-1: All right. Dr. Dea is in North Shore Women's Health in Pimble in New South Wales. The address here is speaker-0: Suite 6, level 1, 55 Grand U Street Pimble and we're directly opposite Pimble. speaker-1: And you'll find her listing on the directory. But also just ring her office, come and visit her, have the chat. Hopefully we've answered some questions. If you have any questions for Dr. Day or you want to reach out, you can always contact us.