WEBVTT - What you need to know about HRT with Dr Samantha Newman 0:00:08.880 --> 0:00:12.400 Hello, I'm Francisca Rudkin and I'm Louise Ariie. Welcome to 0:00:12.480 --> 0:00:15.360 season three of this New Zealand Herald podcast, The Little Things, 0:00:15.520 --> 0:00:17.480 a podcast that looks at the little things that can 0:00:17.520 --> 0:00:19.480 make a positive impact on our day to day life. 0:00:19.560 --> 0:00:21.720 We're so excited to be back, aren't we, Francisco, We 0:00:21.760 --> 0:00:25.040 certainly are, and as we have with previous seasons, our 0:00:25.120 --> 0:00:27.560 aim is to cut through all the confusing noise and 0:00:27.600 --> 0:00:30.360 information out there to focus on the facts, and we 0:00:30.440 --> 0:00:33.080 have a fabulous collection of experts joining us to talk 0:00:33.080 --> 0:00:34.400 about a whole range of issues. 0:00:34.440 --> 0:00:34.920 This season. 0:00:35.360 --> 0:00:38.920 Now The Little Things has covered perimenopause and menopause with 0:00:39.040 --> 0:00:43.920 Nicky Bizant and doctor Jenny Mansburg, both episodes worth listening 0:00:43.920 --> 0:00:44.839 to if you haven't already. 0:00:44.920 --> 0:00:45.680 If I can say that. 0:00:45.840 --> 0:00:50.120 No totally I hosted that you're particularly good in them Noise. 0:00:51.080 --> 0:00:53.760 Today we want to focus on a very topical aspect 0:00:53.800 --> 0:00:57.360 of this HRT, the crazy shortages of it and other 0:00:57.400 --> 0:00:58.800 options if it's not for you. 0:00:59.000 --> 0:01:00.960 I've got a friend who said to me the other day, 0:01:01.120 --> 0:01:03.600 she actually texted me, you have to do a podcast 0:01:03.640 --> 0:01:05.920 on this. She said, I've never really had a conversation 0:01:06.000 --> 0:01:08.640 with any of my friends about HIT. She's a couple 0:01:08.680 --> 0:01:10.000 of years younger than I am, and she said, I 0:01:10.000 --> 0:01:12.680 have had three conversations with different women this week. They're 0:01:12.720 --> 0:01:15.320 all beside themselves. So if you are on HIT, then 0:01:15.319 --> 0:01:16.880 you'll know that there has been a shortage of it 0:01:16.920 --> 0:01:19.160 in New Zealand the patches, and that's been a case 0:01:19.200 --> 0:01:22.320 for a while now. Pharmacists are doing their best. If 0:01:22.319 --> 0:01:24.119 you were lucky, you might have been given a different 0:01:24.120 --> 0:01:26.800 dosage and told to cut it to your dosage size. 0:01:27.160 --> 0:01:29.800 That is what I have been doing terribly well now 0:01:29.920 --> 0:01:32.600 for quite a few months. But for many women they're 0:01:32.640 --> 0:01:34.400 just told we don't have it. 0:01:34.560 --> 0:01:34.920 Sorry. 0:01:35.640 --> 0:01:38.160 So we're getting nuggets of news telling us we should 0:01:38.160 --> 0:01:40.720 be happy because we could soon have the option of 0:01:40.760 --> 0:01:44.440 a funded gel which could help ease the HRT shortages. 0:01:44.480 --> 0:01:47.520 But when what has to happen for that to get 0:01:47.560 --> 0:01:50.360 off the ground. So how do we handle the shortage 0:01:50.400 --> 0:01:52.760 that we're in at the moment? How do we advocate 0:01:52.800 --> 0:01:55.240 for ourselves better to know whether HRT is even for 0:01:55.360 --> 0:01:58.720 us and what is our access to other options? 0:01:58.960 --> 0:02:02.000 Joining us today is doctor Cement the Newman, a GP 0:02:02.160 --> 0:02:05.560 with a specialist interest in women's health. Samantha also lectures 0:02:05.600 --> 0:02:07.800 at the University of Auckland, does research with the University 0:02:07.840 --> 0:02:10.799 of My Nation Oz and is a fabulous human who 0:02:10.880 --> 0:02:14.120 is constantly advocating for women's health needs. 0:02:14.600 --> 0:02:16.280 Welcome Cement, the good to have you with. 0:02:16.320 --> 0:02:18.440 Us, Curta, thank you for having me. 0:02:19.240 --> 0:02:22.720 Okay, for those thinking about using HRT in the future 0:02:23.040 --> 0:02:25.880 or now, can you give us a quick rundown of 0:02:25.960 --> 0:02:26.560 what it is? 0:02:27.000 --> 0:02:31.480 Yeah, absolutely so. By definition, HRT is hormone replacement therapy 0:02:32.160 --> 0:02:35.400 and it's also known as menopause hormone therapy. But as 0:02:35.440 --> 0:02:38.680 we're going to kind of cover over the next wee while, 0:02:39.280 --> 0:02:43.440 it can be used not just to replace hormones, so 0:02:43.480 --> 0:02:45.320 I can kind of you know, for me, I often 0:02:45.320 --> 0:02:48.280 talk about it supporting hormones. So it depends on when 0:02:48.320 --> 0:02:51.000 you use it as to what the role exactly is. 0:02:51.560 --> 0:02:54.919 It's a lot more nuanced than just going estrogen. 0:02:55.800 --> 0:02:58.959 Yeah, definitely, and I think that's for me about you know, actually, 0:02:59.160 --> 0:03:02.840 why as a door, if I prescribe any medication, I 0:03:02.960 --> 0:03:06.359 need to know what I'm prescribing it for, what I'm 0:03:06.400 --> 0:03:10.480 expecting the outcomes to be. And actually so my patients 0:03:10.560 --> 0:03:12.920 know what to expect and you know that's going to 0:03:12.919 --> 0:03:15.600 be with side effects and with benefits as well. And 0:03:15.639 --> 0:03:17.600 that's one of the things I see really kind of 0:03:17.680 --> 0:03:20.480 like not done wrong, but I feel we could do 0:03:20.560 --> 0:03:23.920 better if we understood actually what we're trying to treat. 0:03:24.120 --> 0:03:26.400 And the names are both a little bit misgiving. 0:03:27.360 --> 0:03:30.160 And so if you go back to literally like the hormone, 0:03:30.200 --> 0:03:34.600 I call it the reproductive journey. Then actually, at puberty, 0:03:34.639 --> 0:03:37.960 our hormones are increasing, so we get rises in estrogen 0:03:38.040 --> 0:03:42.680 levels while our body settles things out. And then while 0:03:42.720 --> 0:03:45.520 we're in our twenties and our early thirties, things are 0:03:45.520 --> 0:03:49.480 pretty regular and we're our peak fertility, so things are predictable. 0:03:50.360 --> 0:03:52.920 And then as we go into our mid thirties at 0:03:53.040 --> 0:03:56.120 late thirties, this was a really huge light bulb moment 0:03:56.200 --> 0:03:59.520 for me because actually we get even more hormone change 0:03:59.720 --> 0:04:03.960 in our late thirties onwards than we do at puberty. 0:04:04.520 --> 0:04:06.160 And what I mean by that, and this is how 0:04:06.200 --> 0:04:08.760 I describe it's my patient, So is every month the 0:04:08.800 --> 0:04:13.320 brain is telling the ovary to release an egg, and 0:04:13.360 --> 0:04:19.120 the over releases estrogen in perimenopause. So after our peak reproductivity, 0:04:19.760 --> 0:04:22.520 then the brain has to shout a bit louder because 0:04:22.520 --> 0:04:24.760 the over is getting a bit tired, and it's like, seriously, 0:04:24.880 --> 0:04:27.440 come on, I want a little break. And so that's 0:04:27.480 --> 0:04:29.839 when we get a hormone the f S eight and 0:04:29.880 --> 0:04:34.160 you don't have to remember that rises and then eventually 0:04:34.360 --> 0:04:38.080 the ovary kicks in and shouts really really loud, and 0:04:38.320 --> 0:04:42.320 estrogen shoots up. And this happens just before ovulation. So 0:04:42.440 --> 0:04:47.040 in perimenopause, this rise in ovulation and estrogen is actually 0:04:47.080 --> 0:04:51.600 greater than that at puberty. Then after ovulation, estrogen drops 0:04:51.600 --> 0:04:54.560 a little bit and then it rises again. So if 0:04:54.560 --> 0:04:58.880 you're starting hormone replacement therapy in perimenopause, well you're not 0:04:58.960 --> 0:05:03.640 replacing the easter because the hormone is a tiny dose 0:05:03.800 --> 0:05:09.160 compared to these huge, bigger levels at perimenopause. So therefore, 0:05:09.240 --> 0:05:13.760 this is why I say, at perrymenopause, we're supporting these 0:05:13.839 --> 0:05:16.600 high levels of estrogen, and yeah, we are buffering it, 0:05:16.640 --> 0:05:19.680 particularly as things go on by you know, positrogen does 0:05:19.760 --> 0:05:23.400 drop over time, but in principle, the majority of terrymenopause 0:05:23.440 --> 0:05:27.720 symptoms are because of huge hormone chains, So that makes sense. 0:05:27.800 --> 0:05:31.200 Yeah, so sorry, you're saying that contrary to the idea 0:05:31.240 --> 0:05:35.560 that we've Estrogent is lowering at certain times of the month, 0:05:35.600 --> 0:05:37.960 that's actually keeping stronger, right. 0:05:38.000 --> 0:05:38.320 Yeah. 0:05:38.839 --> 0:05:41.000 Yeah, So that was a total light Bob moment for me. 0:05:41.000 --> 0:05:44.120 And it's amazing when I'm with patients and I'm going 0:05:44.120 --> 0:05:46.880 to use the example of migraines. So a lot of 0:05:46.920 --> 0:05:48.680 the time people come and they're like, oh, my migraines 0:05:48.720 --> 0:05:51.920 are getting worse. And because I like to see everything 0:05:52.000 --> 0:05:54.560 through hormones, I ask them when was you When do 0:05:54.600 --> 0:05:55.440 you get the migraine? 0:05:55.720 --> 0:05:56.159 When was it? 0:05:56.200 --> 0:05:59.040 And they're like, oh, well, you know, but every two weeks, 0:05:59.040 --> 0:06:02.640 and I'm like, okay, so tell me when. And so 0:06:02.920 --> 0:06:06.920 frequently it corresponds to about ovulation and then again pre menstrual, 0:06:07.720 --> 0:06:10.680 and that's because our ovulation you've got this huge rise 0:06:10.720 --> 0:06:15.080 in estrogen. And typically the rise is often exacerbate migraines 0:06:15.120 --> 0:06:18.520 with aura the way you get funny neuro things as well, 0:06:18.720 --> 0:06:22.480 and the drop is often migraine without aura. And then 0:06:22.520 --> 0:06:26.760 it happens again pre menstrual and menstrual, and so it's 0:06:26.800 --> 0:06:28.920 just amazing when I have like a drawing in my 0:06:29.000 --> 0:06:32.239 planet and I and whiteboard markers and I like literally 0:06:32.240 --> 0:06:35.920 go through the menstrual cycle with my patients. And when 0:06:35.960 --> 0:06:39.240 you know that every other week, basically your hormones are 0:06:39.279 --> 0:06:41.800 going up and down. Then that in essence gives you 0:06:41.839 --> 0:06:45.040 a bit more clarity and understanding because often mood changes, 0:06:45.400 --> 0:06:51.279 you know, correspond to these body pains, fatigue, irritability as well. 0:06:51.400 --> 0:06:53.840 So I think, you know, that's the first the first 0:06:53.960 --> 0:06:56.680 clue is, you know, taking a history and finding out 0:06:56.720 --> 0:06:57.360 what's going on. 0:06:58.040 --> 0:07:01.480 It just amazes me, you know, I've learned more about perimenipals. 0:07:01.480 --> 0:07:05.080 We'll only learned that peri perimenopause existed about three years ago. 0:07:05.480 --> 0:07:08.160 I've learned more though about perimenopause and menopause in the 0:07:08.240 --> 0:07:09.720 last sort of three years, and I have in my 0:07:10.000 --> 0:07:14.320 entire life, and yet I'm still constantly learning. And I 0:07:14.760 --> 0:07:17.160 just think so many women don't even really even understand 0:07:17.200 --> 0:07:18.440 how their cycle works. 0:07:19.240 --> 0:07:21.640 No, no, and we don't know what's happening in our 0:07:21.680 --> 0:07:22.920 late thirties and early fall. 0:07:22.960 --> 0:07:26.320 No, that's news to me as well. So it's just crazy. 0:07:26.800 --> 0:07:29.160 If we are looking at the kind of symptoms then, 0:07:29.200 --> 0:07:32.240 and obviously they can be different compared to dependent on 0:07:32.280 --> 0:07:36.160 whether you're in perimenopause or menopause. What kind of symptoms 0:07:36.200 --> 0:07:39.400 though might women be suffering from where hit can come 0:07:39.440 --> 0:07:41.760 in and an assist, so, you know, just. 0:07:41.720 --> 0:07:44.960 To add further levels of complexity. Oh, how do I 0:07:45.040 --> 0:07:53.120 phrase this? So traditionally, perimenopause is diagnosed or defined by 0:07:53.160 --> 0:07:56.040 a change in your menstrual cycle, and that's what their 0:07:56.400 --> 0:08:00.280 straw criteria say. And the reason I'm saying this is 0:08:00.320 --> 0:08:04.320 because last week the Australasian Menopause Society released a statement 0:08:04.400 --> 0:08:08.480 saying HRT is being prescribed too much in cases that 0:08:08.560 --> 0:08:11.760 aren't menopause, so therefore we need to be looking at 0:08:11.760 --> 0:08:14.560 the straw criteria, which is based on periods and using 0:08:14.720 --> 0:08:19.440 HRT appropriately. However, it's really hard for me and other 0:08:20.040 --> 0:08:23.920 doctors when we see these hormone changes occurring in the 0:08:24.000 --> 0:08:28.679 late thirties, and often it starts as anxiety and irritability 0:08:29.080 --> 0:08:30.520 and pre menstrual symptoms. 0:08:31.800 --> 0:08:33.280 So I kind of wanted. 0:08:33.000 --> 0:08:35.440 To just, you know, say that, because actually, if anybody 0:08:35.480 --> 0:08:38.080 listens to this and is like, oh, I completely agree, 0:08:38.120 --> 0:08:40.000 this is me and then they go to their doctor 0:08:40.040 --> 0:08:42.960 who like, but one of our advisory bodies is saying 0:08:43.360 --> 0:08:47.480 this isn't perimenopause. I don't want my patients to feel 0:08:47.600 --> 0:08:49.480 or don't want any of your listeners to feel dismissed 0:08:49.520 --> 0:08:54.000 or unvalidated. But actually for me, does it matter is 0:08:54.080 --> 0:08:57.599 by definition this old definition of perimenopause which needs to 0:08:57.600 --> 0:09:00.600 be updated or what they say the fun NDA. Mentally, 0:09:01.440 --> 0:09:08.160 the best most effective treatment is hormone treatment. And I believe, 0:09:08.440 --> 0:09:13.280 and there's some incredible doctors in Australia and worldwide, but 0:09:13.400 --> 0:09:18.280 that the psychological symptoms of menopause often occur five years 0:09:18.320 --> 0:09:22.200 before their physical symptoms, which then also I'm like, why 0:09:22.240 --> 0:09:26.240 can't I try hormones if that suits the patient and 0:09:26.280 --> 0:09:28.520 it's appropriate. You know, it's a patient choice and there's 0:09:28.559 --> 0:09:31.199 other factors at play when it's the most effective. 0:09:31.600 --> 0:09:32.720 So whenever I see. 0:09:32.559 --> 0:09:37.960 Anyone in clinic, I'm always like new onset insomnia, irritability, 0:09:38.400 --> 0:09:43.960 burnout and worsening migrains, recurrent injuries, chronic plane fibromialdia. 0:09:44.000 --> 0:09:45.400 I'm like, what's your period's doing? 0:09:45.880 --> 0:09:50.200 Because I think those are the clues that as doctors 0:09:50.600 --> 0:09:53.760 we need to be hanging onto. And that's because in 0:09:53.760 --> 0:09:58.240 my experience, when you experience these, it's this heads up 0:09:58.280 --> 0:10:00.920 that perimenopause is going to be more challenged. And then 0:10:00.920 --> 0:10:04.640 as time goes on and the hormone level has changed, 0:10:04.840 --> 0:10:08.320 you almost lose that cycle where you have these two 0:10:08.320 --> 0:10:11.040 peaks and it kind of then can almost blur into one. 0:10:11.600 --> 0:10:14.560 And as the symptoms become more pronounced, I think. 0:10:14.440 --> 0:10:15.920 There's probably a lot of women out there going, well, 0:10:15.960 --> 0:10:17.959 hang on a moment and just going back five to 0:10:18.000 --> 0:10:18.679 ten years. 0:10:18.640 --> 0:10:20.439 I no, I am, I know, I am. I'm just thinking. 0:10:20.440 --> 0:10:24.679 So you're saying that they said that the Australasian Australasian 0:10:24.760 --> 0:10:25.920 or Australian. 0:10:26.000 --> 0:10:28.720 Yah Oustralaian menapause society, as. 0:10:28.679 --> 0:10:31.760 I've taken it back to just the bleeding phase effectively, 0:10:32.320 --> 0:10:36.280 Yeah right, Yeah, well that's. 0:10:35.400 --> 0:10:36.560 Straw minus two. Yeah. 0:10:36.640 --> 0:10:40.240 Yeah, that's interesting because you know, as we've talked about 0:10:40.360 --> 0:10:42.760 over and over again, the symptoms are so many and varied, 0:10:42.840 --> 0:10:46.880 and the bleeding is a sub symptom almost. It's the 0:10:46.960 --> 0:10:49.080 thing that you say, like you say, becomes more radic. 0:10:49.120 --> 0:10:50.760 But a lot has gone a lot of water has 0:10:50.760 --> 0:10:53.760 gone under the bridge before that. So I find that 0:10:53.800 --> 0:10:57.680 a little bit unusual, I guess as a blanket statement. 0:10:57.800 --> 0:11:00.920 Yeah, yeah, and kept mean that, you know, actually this 0:11:01.080 --> 0:11:03.720 is why And I'm really happy to like really honor 0:11:03.880 --> 0:11:06.560 to have this opportunity today because I think if we 0:11:06.600 --> 0:11:09.840 can all understand what's going on in ourselves. Then we 0:11:09.880 --> 0:11:12.800 can advocate better for what our needs are, and actually 0:11:12.840 --> 0:11:16.120 we can set ourselves up to succeed because it's about 0:11:16.280 --> 0:11:19.240 patient choice and what's safe for the patient. And also 0:11:19.600 --> 0:11:21.280 the other flip side is as a doctor, I don't 0:11:21.280 --> 0:11:24.240 want to miss anything. So if you've got, like you know, 0:11:24.400 --> 0:11:28.240 new onset severe mental health problems, I don't want to 0:11:28.280 --> 0:11:31.320 miss a clinical depression and a psychosis. But actually it's 0:11:31.480 --> 0:11:34.360 rare that I can't consider it alongside is this hormones 0:11:34.679 --> 0:11:38.960 and the same as palpitations and cardiology. But actually generally 0:11:39.120 --> 0:11:40.720 I can consider it alongside. 0:11:40.960 --> 0:11:44.360 Absolutely, as we become more knowledgeable and as more women 0:11:44.960 --> 0:11:47.520 understanding men of pause, it's very quick to immediately just 0:11:47.559 --> 0:11:49.920 presume a symptom is associated with it, and of course 0:11:49.960 --> 0:11:51.920 they must be must be cheeked out. 0:11:52.000 --> 0:11:54.360 Don't just make a presumption that's right now. 0:11:54.480 --> 0:11:56.480 The woman I've talked to about this, since we've been 0:11:56.520 --> 0:11:59.080 doing a lot more on this, the one thing I've 0:11:59.120 --> 0:12:00.719 sort of they've gone on, I haven't really looked into 0:12:00.880 --> 0:12:03.520 HRT or they're putting up with symptoms. I've tried to 0:12:04.080 --> 0:12:06.240 remind them or actually just told them to listen to 0:12:06.280 --> 0:12:10.959 Genny Orniky or you now that it's actually a medical 0:12:11.240 --> 0:12:14.319 there are medical implications to this. You could be feeling better, 0:12:14.600 --> 0:12:17.520 but you also could be doing your actual health favor 0:12:17.559 --> 0:12:17.920 as well. 0:12:18.440 --> 0:12:21.360 Ah yeah, And it's just I think women have been 0:12:21.400 --> 0:12:26.080 dismissed for so long and everybody's saying, now, oh, HRT 0:12:26.480 --> 0:12:27.640 like it's the fad. 0:12:27.920 --> 0:12:28.960 Everybody's going on it. 0:12:29.000 --> 0:12:32.679 But I'm like, actually, women have had so from puberty, 0:12:33.240 --> 0:12:36.400 rates of depression and mental health in women suddenly double. 0:12:36.679 --> 0:12:38.480 You know, it's one to one pre puberty and it's 0:12:38.520 --> 0:12:43.440 two to one post puberty, and every reproductive transition, mental 0:12:43.440 --> 0:12:47.120 health diagnoses increase so much more so. 0:12:47.240 --> 0:12:49.319 Actually, I just wonder what. 0:12:49.200 --> 0:12:52.439 Really is female mental health when you factor in hormones 0:12:53.080 --> 0:12:55.800 and we need to kind of like look at it 0:12:55.840 --> 0:12:57.719 on the table and be like, can we do this 0:12:57.880 --> 0:13:01.600 better rather than saying, oh, now we're over diagnosing it, 0:13:01.640 --> 0:13:05.360 but actually we'll be missing it before. And I never 0:13:05.440 --> 0:13:08.160 thought i'd like feel really confident to stand up and 0:13:08.200 --> 0:13:11.520 say that, but I'm just blown away by my patients 0:13:11.559 --> 0:13:15.560 who have like trusted me, and I'm like, h putting this, 0:13:15.559 --> 0:13:18.720 this and this together. We could try hormones or and 0:13:19.200 --> 0:13:20.640 we can talk a bit more about how I try 0:13:20.679 --> 0:13:23.079 the hormones as well, but they get better. 0:13:23.559 --> 0:13:24.640 And I'm like, if. 0:13:24.440 --> 0:13:28.600 I am prescribing and working with patients that haven't worked 0:13:28.600 --> 0:13:31.120 for ten years or have come to me from psychiatrists 0:13:31.160 --> 0:13:33.400 or from the concussion planic, I almost have a little 0:13:33.400 --> 0:13:37.439 bit of a responsibility now to say try it, particularly 0:13:37.480 --> 0:13:41.319 if there's no conflict indications, because what could these benefits 0:13:41.360 --> 0:13:43.960 be for you? And I still doubt myself, you know, 0:13:44.200 --> 0:13:46.240 I doubt. I'm like, oh, well, maybe it's not. But 0:13:46.280 --> 0:13:50.120 I've also learned, you know, doing it alongside. So if 0:13:50.160 --> 0:13:54.040 I've started someone on hormone therapy and you know, three 0:13:54.040 --> 0:13:56.960 months later there's no improvements, six months later there's no improvement, 0:13:57.240 --> 0:14:00.720 now I'm actually confident to say, actually, I don't think 0:14:00.720 --> 0:14:04.120 this is hormones. And you know, sometimes we stop the 0:14:04.280 --> 0:14:07.640 HRT and you know it doesn't make a difference, But 0:14:07.720 --> 0:14:10.520 other times their improvement has been a bit insidious, and 0:14:10.559 --> 0:14:12.400 it can unmask other conditions as well. 0:14:12.800 --> 0:14:13.360 So it's a. 0:14:13.280 --> 0:14:17.680 Constant, like dynamic reassessment, where am I at kind of thing. 0:14:18.320 --> 0:14:20.800 I'm not sure a lot of GPS talk or have 0:14:20.880 --> 0:14:23.200 the same knowledge as you cement that which your course 0:14:23.280 --> 0:14:25.640 is quite a concern for women who go in and 0:14:26.000 --> 0:14:29.520 you know, who've maybe got the carriage to go in 0:14:29.560 --> 0:14:31.480 and have this conversation and say I think I need 0:14:31.520 --> 0:14:34.040 some help here, and I think it could be quite 0:14:34.080 --> 0:14:35.960 They can get quite a black and white response. Would 0:14:36.000 --> 0:14:38.360 it be fair to say no offense to GPS out there? 0:14:39.480 --> 0:14:42.280 So I just, yeah, I think you're right, But I 0:14:42.280 --> 0:14:45.520 also think we need to reframe it because this is like, 0:14:45.720 --> 0:14:50.720 you know, who GPS actually really want to learn. I 0:14:50.840 --> 0:14:52.680 ran the fair I think it was the first GP 0:14:52.840 --> 0:14:55.560 education day on menopause in May and we had over 0:14:55.640 --> 0:14:59.600 four hundred healthcare professional that ten awesome. It's been so 0:14:59.680 --> 0:15:02.960 much command the Good Fellow Unit and now offering it 0:15:03.000 --> 0:15:06.280 as a pay per view the healthcare professionals as well. 0:15:06.720 --> 0:15:12.000 But actually, you know, in everybody's defense, you know, I've 0:15:12.080 --> 0:15:14.520 kind of navigated my own way because I'm a bit 0:15:14.520 --> 0:15:16.440 of a super geek and my teachers from school will 0:15:16.440 --> 0:15:19.280 always say that, but it's not been easy finding that out, 0:15:19.280 --> 0:15:19.720 and it's. 0:15:19.560 --> 0:15:20.440 All over the place. 0:15:21.240 --> 0:15:26.480 So I like teaching or more talking about women's health 0:15:26.760 --> 0:15:30.240 and making things easier for people. But actually, if our 0:15:30.280 --> 0:15:33.120 community can also figure out what do I need to 0:15:33.160 --> 0:15:37.240 do to kind of communicate this to make that journey easier. 0:15:37.280 --> 0:15:40.600 But also I think when I'm doing community sessions, they 0:15:40.680 --> 0:15:43.440 actually give the DP space or the doctor space to 0:15:43.600 --> 0:15:46.480 actually go back to what their needs are because actually 0:15:46.480 --> 0:15:47.920 is a doctor, I don't want to miss anything. I 0:15:48.000 --> 0:15:49.440 want to get it right and I want and it's 0:15:49.480 --> 0:15:54.160 the best option. And also HRT prescribing has changed so 0:15:54.280 --> 0:15:57.120 much over the years that it is really hard to 0:15:57.200 --> 0:15:59.920 keep on top of everything and to confidently prescribe it. 0:16:00.640 --> 0:16:04.560 And the guidelines are all still say you should only 0:16:04.640 --> 0:16:07.360 use HRT for like moderate to severe hot flushes when 0:16:07.400 --> 0:16:10.040 everything else has not worked, and for low dose for 0:16:10.040 --> 0:16:14.120 as short as possible. So you know, actually, in doctor's defense, 0:16:14.280 --> 0:16:15.360 it's really bloody heart. 0:16:15.600 --> 0:16:18.000 It's a case of not the blinding the blind, but 0:16:18.400 --> 0:16:21.120 a little bit of a snowstorm for the patient. 0:16:21.360 --> 0:16:23.960 The woman and the doctors. Yeah, so we're kind of 0:16:24.000 --> 0:16:25.560 just nevi getting this all together, aren't we. 0:16:25.920 --> 0:16:28.360 That's almost how we've got how we've got to reframe it. 0:16:28.640 --> 0:16:30.640 And that's how I learned from my patients. So also 0:16:30.640 --> 0:16:33.000 when I do my teaching, and like patients will say, 0:16:33.000 --> 0:16:34.760 like when I first started, oh, my ringing in my 0:16:34.840 --> 0:16:38.320 ears has stopped, and like you know over the years 0:16:38.320 --> 0:16:40.360 now I've made mental notes of all of these things. 0:16:40.520 --> 0:16:43.120 Oh you're so you're ringing in your ears? Are stopped its? 0:16:43.880 --> 0:16:44.600 Yeah? 0:16:44.680 --> 0:16:47.600 Yeah, because there's progesterone receptors and that affects the fluid balance. 0:16:47.640 --> 0:16:49.640 There's estrogen receptors in their ears as well. 0:16:49.960 --> 0:16:51.800 And you can also say, gosh, I had not put 0:16:51.880 --> 0:16:52.560 to and two together. 0:16:52.560 --> 0:16:54.920 I'm having a little moment here because I was thinking 0:16:54.960 --> 0:16:57.760 it was my life wearing headphones and being in radio 0:16:57.880 --> 0:17:00.200 and listening to loud music too much to me there, 0:17:00.240 --> 0:17:02.400 and I was sure I was heading down the road 0:17:02.400 --> 0:17:05.080 to tatus. And actually, now you mentioned that it has 0:17:05.240 --> 0:17:11.040 lessened so much, I see to the list, still learning 0:17:11.560 --> 0:17:14.880 a bit to the list. Hey, we should probably touch 0:17:14.920 --> 0:17:16.679 on the fact there's a lot of women going yep, no, 0:17:16.760 --> 0:17:19.800 we're hearing you and keen to try this or and 0:17:20.119 --> 0:17:22.280 trying to use it at the moment. But we've got 0:17:22.280 --> 0:17:25.280 this ridiculous situation of a shortage, and I know it's global, 0:17:25.320 --> 0:17:26.880 and I know that far Maker is trying to sort 0:17:26.920 --> 0:17:29.520 it out, but what impact is it having on women 0:17:29.560 --> 0:17:31.080 who are on hi T And then all of a 0:17:31.119 --> 0:17:34.280 sudden you can't get the patch that you've been on. 0:17:34.800 --> 0:17:35.960 Oh it's really tough. 0:17:36.359 --> 0:17:39.080 So a few weeks ago, at seven p thirty on 0:17:39.119 --> 0:17:42.239 a Saturday night, I was doing my repeat prescriptions and 0:17:42.240 --> 0:17:45.160 a patient that I've known for a long time had 0:17:45.400 --> 0:17:48.159 emailed me and was like, Sam, I haven't got any estrogen. 0:17:48.200 --> 0:17:50.280 I haven't had it for two weeks. And I was like, what, 0:17:51.760 --> 0:17:54.399 this has taken us years to get you feeling as 0:17:54.440 --> 0:17:56.919 good as you are, and this individual is not in 0:17:56.960 --> 0:18:00.600 Hawk's day anymore. So I ended up calling the farharmacies 0:18:00.640 --> 0:18:02.920 in their area then sent a script half an hour 0:18:02.960 --> 0:18:05.240 away from my patient. I was like, a center script here, 0:18:05.440 --> 0:18:07.919 and I was like, this is just not okay. So 0:18:08.440 --> 0:18:11.439 I then developed a survey to try and capture some 0:18:11.480 --> 0:18:14.560 of these stories because I think people don't realize the impact. 0:18:14.600 --> 0:18:16.280 And that's actually because you're going back to what we've 0:18:16.280 --> 0:18:19.600 said already about setting the scene, so people don't know 0:18:19.840 --> 0:18:22.720 the improvement it is. So actually, if it's just top flushes, 0:18:23.240 --> 0:18:25.320 then actually, why why does it really. 0:18:25.119 --> 0:18:25.919 Matter that much? 0:18:26.040 --> 0:18:29.640 But if it is preventing suicidality, if it's keeping people 0:18:29.680 --> 0:18:33.080 in the workplace, if it's keeping people in relationships, then. 0:18:32.960 --> 0:18:34.440 Actually, you know that's very different. 0:18:35.040 --> 0:18:37.520 And so what I wanted to do is actually share 0:18:37.560 --> 0:18:39.919 these stories that I hear every day, to be like, 0:18:40.080 --> 0:18:43.320 this is why it's really important. So just under twenty 0:18:43.440 --> 0:18:46.760 three hundred people filled it out in two weeks, and 0:18:47.200 --> 0:18:50.040 it's a really humbling read actually, even though it's kind 0:18:50.040 --> 0:18:53.080 of what I see every day. But with you mentioning 0:18:53.119 --> 0:18:58.639 before about changing the patches, so fifty percent of users 0:18:59.800 --> 0:19:02.760 have an improvement with Estra dot, so one of the 0:19:02.800 --> 0:19:06.760 brands and not Estra dile And so why is that 0:19:06.840 --> 0:19:10.560 so significant. Well, if you are one of the four 0:19:10.600 --> 0:19:13.800 point six percent who is better with the other option 0:19:14.160 --> 0:19:16.800 and you have no improvement with Estra dot, well if 0:19:16.840 --> 0:19:19.480 you're given extra dot and it doesn't help you feel better, 0:19:19.760 --> 0:19:23.480 everybody's going to say it's not hormones. Right, So then 0:19:23.720 --> 0:19:27.360 we've now got people not well controlled because they've got 0:19:27.359 --> 0:19:29.840 to cut patches, they've got to have time off. Some 0:19:29.880 --> 0:19:34.800 people are really I believe slow to accumulate, not scientifically 0:19:34.840 --> 0:19:36.280 correct the impact of it. 0:19:36.720 --> 0:19:38.840 So then you know, actually that tiny. 0:19:38.560 --> 0:19:42.359 Drop in the dose is really destabilizing others. Literally they 0:19:42.440 --> 0:19:44.520 don't change a patch for a day and they get 0:19:44.720 --> 0:19:48.680 body pains, flu like symptoms. And so this is why 0:19:48.720 --> 0:19:51.440 I think it's more than just there's not a patch shortage. 0:19:51.600 --> 0:19:54.560 It's a real dismissal of what your needs are at 0:19:54.560 --> 0:19:58.640 that time to enable you to live a well life. 0:19:58.960 --> 0:20:00.919 Yeah, we were going to touch on that whether these 0:20:01.200 --> 0:20:04.520 treatments are all the same. For example, you know there's 0:20:04.560 --> 0:20:10.560 been reports about FAMIC having conversations about funding the how 0:20:10.680 --> 0:20:12.680 do I say estrod dial gel? 0:20:13.359 --> 0:20:13.880 The Yeah? 0:20:14.000 --> 0:20:17.320 Yeah, is that equivalent to the dot? 0:20:17.480 --> 0:20:18.200 Is it the same? 0:20:18.400 --> 0:20:18.480 Like? 0:20:18.760 --> 0:20:21.160 Do these things all deliver the same thing equally? 0:20:21.800 --> 0:20:23.480 So I think we've got to say no. 0:20:23.840 --> 0:20:27.280