Hormones, HRT, Libido & mood with The Menopause Medic

Hi, I'm Gemma Ankinson, and I'm Claire Sanderson. We have just wrapped up on our chat with Dr. Fernula Barton, aka the Menopause Medic. And we've had to end the episode by saying, we're going to have to get it back. Absolutely. Because we could have chatted, I mean, it's very late in the day now, it's pitch black outside, and everyone is gone, but we could have kept talking to her. That was fascinating. Yeah, and we could have kept going for another hour, I think. I felt we sort of had a rapid prematurely, but she is so knowledgeable. And there's so much to discuss about a subject that I feel I know already know a lot about, but every time I speak to experts like her, I realise I know very little. She covered things we can eat during Perimenopause and Menopause. Symptoms how you can manage them. I asked about vaginal dryness and stuff, because I'd read, I'm not there yet, but I've watched Samantha on Sex and the City slapping that cream on in her office. And I remember watching that in the cinema thing. Is that really going to happen to us? She confirmed how it happens, why it happens, what you can do to stop it. She touched on HRT. Low libido. Low libido, sleep. Flectuating confidence. Stress. Yeah. And body confidence and how it can fluctuate dramatically over the space of three days, which is impossible for your body to change shape in three days, but your mind can binge you. I think you might. And it's also went into a detail about the coil that some women have, because although you don't have a physical bleed, you're still having a cycle, which is not a lot of people know about. Yeah, so the Marina coil is part of your HRT protocol, which a lot of women have for their progesterone rather than taking oral progesterone. You don't necessarily bleed, so you don't feel like you haven't a monthly cycle. But if you're going through the Perimenopause and have the Marina coil 4 HRT, the chances are you still are having a cycle. So these fluctuations in moods and in my case, there's times of the month where I want to go ahead first into the chocolate team. Snacky snack is all to do with the cycle. So even during the Perimenopause, you should try and track your cycle, which I don't do when I'm going to start. I like how you go into the biscuit, in my snacky snackies cheese when I get it. I like, what's your when I go to the fridge and eat cheese and biscuits? But it happens to all of us, as Dr. Fenola has just confirmed. So this episode, everyone needs to listen to it. Please send this to any female in your family. And any male actually, because one of the points she made was that she called them our allies. She said, "If our allies, our male allies, know what we're going through. It makes the household the workplace, everything run more smoothly." So yeah, please like and subscribe to us. Please enjoy this episode and we will do a follow-up, because as you'll see how it ends, you're just going to want more. Welcome to Just As Well. Today, we're tackling a subject that will affect half the population. Yet it's a subject that remains shrouded in silence, sometimes shame as well and also outdated advice. We're talking about the M word, which is menopause. Now, it's not just a medical event. It's a transformative life stage that deserves proper understanding, support and treatment. So joining us today, we're very proud to have Dr. Fenola Barton, better known to her thousands of followers as the menopause medic. And she's on a mission to revolutionize how we talk about and treat menopause, and she's armed with evidence-based medicine, and a refusal to accept just deal with it as an acceptable health care approach. So whether you're in your 30s, wondering what's ahead, or whether you're navigating paramedics right now, or you're supporting someone or your partner through this transition, this chat will really change how you think about menopause. So let's dive in. Thank you so much for joining us. It's brilliant. We're learning so much about parodies and menopause now, which is very much needed. What was it about your journey becoming the menopause medic? Why did you want to delve into it for yourself as a career? So I've always had a really passionate interest in women's health, specifically through my undergrad postgraduate training as a doctor. And when I became a GP, I became quite frustrated about the limitations, I suppose, on the amount of time that we have with some of our patients in clinical practice. And I remember vividly a few patients in particular, who there was just lots going on. They were really suffering, actually. And it was really difficult for the patients themselves to join the dots, equally. It was quite difficult to feel like I could support them adequately in that context, in that setting. And that was back at a time when air menopause and menopause weren't. So widely spoken about weren't so well understood and certainly treatment strategies for them were definitely not as well understood as they are now. And it really galvanised my passion really to want to really improve the lives of women, because it's so fundamentally important that women at this life stage in particular do feel well, because we're at our most dynamic. We're often at our most productive. And everything relies upon us. The world would cease to exist without women, and particularly wise women like us. It's incredibly important that we're supported that our needs are met and that we feel well through this transition. Are you surprised still by the number of women who are presenting your surgery who are not joining the dots? I'm not. And I think the reason for that is because the number of symptoms that we can experience as a result of these ovarian hormone changes are hugely vast and often very different from person to person. And even from day to day or week to week as an individual, are ovarian hormones which are declining over time through paramanopause and then persistently low after menopause are really powerful chemical messengers that have an impact at every cell of every organ system in our body. And so when those levels are fluctuating and in decline, it can have an impact throughout our whole body. It may not affect the same set cells in every individual. And as I said, it may not affect the same part of you every single day in the same way. So it can be enormously confusing to work out whether what you're experiencing is due to hormonal change or whether it's due to life stress or because you haven't slept well or perhaps you've over-exercised or you've under-nourished or quite the opposite. You haven't done enough exercise or you've eaten too much or you're metabolic health or at this stage of life there are also lots of other things that can happen and it can be incredibly confusing to sort of determine whether what you're experiencing is ovarian hormone related or whether it's other stuff, whether it's just life. I think it's because I was shocked. I always assumed, up until a few years ago, that your paramanopause and menopause happened from 50 to 60 or when you're in your 50s around. But I've heard research that it can start, symptoms can start as early as 3035, is that true? Absolutely. And this is what I'm on a bit of a mission to myth bust around, actually. So average age of menopause, as we currently understand it, based on the data sets that we currently have, which might argue are probably even slightly outdated as it is. Because self-identification, people don't understand if they're, I mean, they don't necessarily recognise if they're going through it, for example. But at the moment, average age of menopause is between 48 and 52 roughly. Now, we know that the average duration of paramanopause, this sort of more ill-defined period of time in the run-up to menopause, can be between two and eight years in duration, but actually for some women might be 10 or even 15 years in duration, which means, I mean, I'm no maths genius, but means that actually most women in their mid-30s should be thinking about their hormone health and how they can put in place strategies to optimize their hormone health as much as possible. And maybe even women in their earlier thirties. And a statistic that I think is often misunderstood is that premature ovarian insufficiency, or what we used to call premature menopause, is really common. And it will happen in one in 100 women under the age of 40, one in 1,000 women under the age of 30, and one in 10,000 women under the age of 20. So this isn't something that's only relevant to women over the age of 50. Yes, it's more relevant potentially to women in that age group, but it's something that we should all be aware of as women, but also as men, because, like you said, in the beginning, 51% of us will experience this directly. Should we be lucky enough to reach this age and stage of life? But the other half of the population will have a mother, or a sister, or a daughter, or a friend, or a colleague, who is likely to experience this. And so it's in everyone's interest to understand what it is that's going on so that we can have empowered conversations about it. Is there a main difference, because you talk about your in perimenopause, I don't know if I am, because I think I will be, from what I've told you. Is there a difference between perimenopause and menopause in terms of one being easier to cope with than the other? Is it a case of the pair is difficult, because you don't know what's happening. And once you're in it, it's like, bam, you're in it, you know this is happening. Is it the different, or is it the whole law right? Yes, they're different because the underlying biology is slightly different. So in perimenopause, essentially what you're experiencing is that kind of surface level experience of your hormone levels being in fluctuant decline over time. And so it's going to be changing, it's going to be variable, it's going to be unpredictable. And that can make perimenopause incredibly difficult, because your symptoms might be, you know, variable, changeable and unpredictable. At a time of life, when that's be honest, it's nice to have a bit of predictability and stability, isn't it? But when menopause happens, our ovarian reserve is exhausted. 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Yn-th14 surrounded gŵshmないllfo o shoutedog nhw yn ylwodaidd infly قwylu anwchydazth a elinwyr whelog yn yr hwy ffe i hynol o lefnodatau robust. I would say a good bullparked aim for for most women, which is probably achievable for most women, is about 90 grams of protein per day. If you're somebody who is doing a lot of exercise and you're breaking down a lot of muscle fiber because you're doing lots of resistance, then actually you may need more like 1.5 or 2 grams of protein per kilogram of body weight, which actually may be more like 160 or 170 grams of protein a day, which can be really difficult to get in within your daily energy target. So you may need to, if you're prioritising protein, think about deprioritising other food groups. Now I wouldn't say ever to cut out carbohydrates, because carbohydrates are a really important source of glucose. Glucose is our brain's primary energy source and we need that because gosh, apparently, my underpores is hard enough as it is without being hypoglycemic, but it's really important to make sure that you're getting your glucose from a low GI high fiber carbohydrate source so that you're getting a slow release of steady glucose into your bloodstream over the course of the day, avoiding those big peaks and avoiding those big dips, which can often then cause changes in energy and mood and irritability and all of those sort of things. So that's what I would suggest in terms of protein and carbohydrate. Increased dietary fiber, we talked about this before, but aiming for 30 grams of fiber a day, which is really hard, unless you actually look at like focusing on it. If you're not getting nearly that amount, then think about introducing or adding more fiber slowly and gradually over time to the diet and giving yourself a stomach upset or IBS type symptoms, making sure you're getting adequate dietary calcium. So there are lots of calcium calculators out there on the internet, just Google it, go through, make sure you're getting enough dietary calcium because often I see people who've developed sensitivities to things like dairy, impairment of paul and they've cut dairy out of their diet, which means they then may be a bit of a back foot in terms of calcium intake, which is of course crucial important for our bone health at this time. That's really important, but we don't want to be eating a lot of saturated fats. Those inflammatory fats that are going to increase our risk of heart disease, but we do want plenty of omega-3s, so you know, oily fish in the diet, salmon, macraw, anchovies, sardines, herring, I'm probably only getting one of those a week at the minute. If you're not getting two portions of oily fish a week, think about an omega-3 supplement, about a thousand milligrams a day of both the DHA, EPA, would be a really great place to start. That's really important for maintaining good vascular health, good neurological health, but also good mucosal health. We mentioned earlier about genital unicymptom actually this that wet skin, that mucosa really needs a sort of source of healthy fats in the diet in order to maintain itself adequately. In terms of other supplements, I would absolutely recommend everyone's using vitamin D supplement, and actually if you're at risk of having vitamin D deficiency, I would suggest trying to get a vitamin D test, because if you're deficient in vitamin D, you'll need a treatment dose of vitamin D, not just the supplement dose, and actually that that, you know, there's a big difference there, and it's particularly important for your bone health, but also neurological health and emotional health, so it is worthwhile getting that checked. If you're somebody who is plant-based and not eating any meat or animal products, I would also recommend thinking about having your iron checked and your beaver-tamin levels checked, because you may need to be supplementing or taking a treatment dose of iron and beaver-tamin as well. They can often end up being a little bit low, and they are really important for maintaining normal health in terms of your hormone health, but fast-cute health and neurological health as well, which is really important. Creating, I think, is a supplement that's worthwhile mentioning, particularly women's health, you know, exercise is a big part of our health and well-being, and if you're exercising on a regular basis, then creating can really help you build lean muscle. But also in more recent clinical studies, it's been shown actually to improve emotional health in mid-life women, which I think is a really nice side effect, and there've been some really interesting studies looking at creating supplementation to help with cognitive health, actually, in older adults without cymas disease. So there's a lot of really interesting research going on in that creatine space, and it's something that I do recommend to a lot of my patients, something that I take regularly myself, because you can get it in the diet, but predominantly from sort of poor can turkey, and I don't eat nearly enough of those two things in order to get adequate creatine daily. I'm so creatine, aren't we at women's health, yeah? Yeah, so I think it's a really great add-in. Anything that you're not likely to get in the diet, I think it's a good thing to be thinking about supplementing, but I truly think that you know a food first approach is really important. If you can get the nutrition piece right, then really you should just be supplementing it with the things that you need individualised to you. There are lots of herbal supplements and things out there that might improve things like libido, might improve your sleep, etc. But I think it's really important to be careful that you don't overdo the supplements, because every different supplement you take, your body's having to digest, your liver's having to process, and actually that adds a bit of burden. So thinking about it, being as simple and streamlined as possible, but as focused and specific to you and your needs as possible, the other thing I think is really important in terms of supplements and nutrition. Thinking about your gut health and the health of your microbiome. So again, something that we're learning more and more about important, as being important in pre-manopause and menopause, often, I mean, I was somebody who loved a good process merely in my 20s and definitely had lots of ultra-process foods when I was growing up. And now I don't have a huge palette for it, which is great, but we do have to improve our gut health by reducing ultra-process foods, eating lots of fiber and pre-biotic rich foods, and reducing the amount of toxins that we're consuming. So dare I say it, alcohol. You know, it's really bad for your microbiome, it's really not great for your liver health, and it can really negatively impact a lot of paramedical symptoms. So alcohol can disrupt sleep, it can reduce energy. It's silent calorie is ultimately in and in today, so it can significantly increase that energy intake that you're having on a daily basis, and it's one of the reasons why a lot of people will get away at this stage and age. There's probably lots more to say, but that would be the kind of nutshell. Well, I genuinely learn a lot. We need to get you back on. Yeah, we do. There's lots of questions. There are people who will have lots of questions and we can maybe do it. We will do a follow-up. Yeah. What we'll do is we'll open the questions out again to the audience, because yeah, there is lots we need to discuss, so anyone listening right now, if you have any questions, send them to us on, you can DM or DM me, Claire, we'll put all the input at the bottom, and we'll have you back if that's okay to answer the listener questions. Absolutely. Before we go, we have some quick fire questions. Okay. We ask all our guests these, so Gemma and I are quite cheeky because we're inviting ourselves to dinner at all our guests' homes. What are you going to cook us? Oh gosh, that's a really good one. So probably something Italian, because I just love Italian food. It would probably be something with lots of leafy greens, and maybe even some preserved bits as a starter, and then something really unctuous and delicious and warming and nourishing for dinner, probably something pasta, and then I don't know, tiramisu or something for dinner. Lovely. It sounds good. We're sending you off to a desert island. Yes. It's 12 months in the sun, but you can only take one thing, what you're going to take, my SPF. Yeah. And a hat. That's what Trini said. Trini said, yeah, she said that. Coffee or wine? At the moment, I'm probably airing more towards wine, just because coffee's giving me the jitters. So it's another thing you don't have one. Yeah, yeah, yeah. Yeah. What is the last thing that made you very laugh? Gemma McNally on her podcast with Vogue Williams, my therapist ghosted me, been listening to that. Oh yeah, it's supposed to be good though. Yes, it's very good. Almost just got us just as well. Oh, we're not quite. Not quite. It's not quite. It has its other benefits. And finally, what's one thing people listening today can do to make themselves feel just that little bit better? So this is a bit of a cop out, but I'm going to say prioritise themselves. Actually, genuinely, put themselves at the top of their to-do list, because that's the only way that that needle is going to move, because there are some things that are non-negotiable and you need to be in a position where you can implement those changes, but the first thing is putting yourself at the top of that list. Knowing that you deserve to be at the top of that list? Lovely thought to end on. Well, thank you so much for coming in. It's been brilliant. And like we say, we will do a follow-up. But thank you for listening. Thank you.