Speaker 1: Hello, I'm Francisca Rudkin and I'm Louise Ariie. Welcome to
Speaker 1: season three of this New Zealand Herald podcast, The Little Things,
Speaker 1: a podcast that looks at the little things that can
Speaker 1: make a positive impact on our day to day life.
Speaker 2: We're so excited to be back, aren't we, Francisco, We
Speaker 2: certainly are, and as we have with previous seasons, our
Speaker 2: aim is to cut through all the confusing noise and
Speaker 2: information out there to focus on the facts, and we
Speaker 2: have a fabulous collection of experts joining us to talk
Speaker 2: about a whole range of issues.
Speaker 3: This season.
Speaker 1: Now The Little Things has covered perimenopause and menopause with
Speaker 1: Nicky Bizant and doctor Jenny Mansburg, both episodes worth listening
Speaker 1: to if you haven't already.
Speaker 3: If I can say that.
Speaker 2: No totally I hosted that you're particularly good in them Noise.
Speaker 2: Today we want to focus on a very topical aspect
Speaker 2: of this HRT, the crazy shortages of it and other
Speaker 2: options if it's not for you.
Speaker 1: I've got a friend who said to me the other day,
Speaker 1: she actually texted me, you have to do a podcast
Speaker 1: on this. She said, I've never really had a conversation
Speaker 1: with any of my friends about HIT. She's a couple
Speaker 1: of years younger than I am, and she said, I
Speaker 1: have had three conversations with different women this week. They're
Speaker 1: all beside themselves. So if you are on HIT, then
Speaker 1: you'll know that there has been a shortage of it
Speaker 1: in New Zealand the patches, and that's been a case
Speaker 1: for a while now. Pharmacists are doing their best. If
Speaker 1: you were lucky, you might have been given a different
Speaker 1: dosage and told to cut it to your dosage size.
Speaker 1: That is what I have been doing terribly well now
Speaker 1: for quite a few months. But for many women they're
Speaker 1: just told we don't have it.
Speaker 3: Sorry.
Speaker 2: So we're getting nuggets of news telling us we should
Speaker 2: be happy because we could soon have the option of
Speaker 2: a funded gel which could help ease the HRT shortages.
Speaker 2: But when what has to happen for that to get
Speaker 2: off the ground. So how do we handle the shortage
Speaker 2: that we're in at the moment? How do we advocate
Speaker 2: for ourselves better to know whether HRT is even for
Speaker 2: us and what is our access to other options?
Speaker 1: Joining us today is doctor Cement the Newman, a GP
Speaker 1: with a specialist interest in women's health. Samantha also lectures
Speaker 1: at the University of Auckland, does research with the University
Speaker 1: of My Nation Oz and is a fabulous human who
Speaker 1: is constantly advocating for women's health needs.
Speaker 3: Welcome Cement, the good to have you with.
Speaker 4: Us, Curta, thank you for having me.
Speaker 1: Okay, for those thinking about using HRT in the future
Speaker 1: or now, can you give us a quick rundown of
Speaker 1: what it is?
Speaker 5: Yeah, absolutely so. By definition, HRT is hormone replacement therapy
Speaker 5: and it's also known as menopause hormone therapy. But as
Speaker 5: we're going to kind of cover over the next wee while,
Speaker 5: it can be used not just to replace hormones, so
Speaker 5: I can kind of you know, for me, I often
Speaker 5: talk about it supporting hormones. So it depends on when
Speaker 5: you use it as to what the role exactly is.
Speaker 3: It's a lot more nuanced than just going estrogen.
Speaker 5: Yeah, definitely, and I think that's for me about you know, actually,
Speaker 5: why as a door, if I prescribe any medication, I
Speaker 5: need to know what I'm prescribing it for, what I'm
Speaker 5: expecting the outcomes to be. And actually so my patients
Speaker 5: know what to expect and you know that's going to
Speaker 5: be with side effects and with benefits as well. And
Speaker 5: that's one of the things I see really kind of
Speaker 5: like not done wrong, but I feel we could do
Speaker 5: better if we understood actually what we're trying to treat.
Speaker 4: And the names are both a little bit misgiving.
Speaker 5: And so if you go back to literally like the hormone,
Speaker 5: I call it the reproductive journey. Then actually, at puberty,
Speaker 5: our hormones are increasing, so we get rises in estrogen
Speaker 5: levels while our body settles things out. And then while
Speaker 5: we're in our twenties and our early thirties, things are
Speaker 5: pretty regular and we're our peak fertility, so things are predictable.
Speaker 5: And then as we go into our mid thirties at
Speaker 5: late thirties, this was a really huge light bulb moment
Speaker 5: for me because actually we get even more hormone change
Speaker 5: in our late thirties onwards than we do at puberty.
Speaker 5: And what I mean by that, and this is how
Speaker 5: I describe it's my patient, So is every month the
Speaker 5: brain is telling the ovary to release an egg, and
Speaker 5: the over releases estrogen in perimenopause. So after our peak reproductivity,
Speaker 5: then the brain has to shout a bit louder because
Speaker 5: the over is getting a bit tired, and it's like, seriously,
Speaker 5: come on, I want a little break. And so that's
Speaker 5: when we get a hormone the f S eight and
Speaker 5: you don't have to remember that rises and then eventually
Speaker 5: the ovary kicks in and shouts really really loud, and
Speaker 5: estrogen shoots up. And this happens just before ovulation. So
Speaker 5: in perimenopause, this rise in ovulation and estrogen is actually
Speaker 5: greater than that at puberty. Then after ovulation, estrogen drops
Speaker 5: a little bit and then it rises again. So if
Speaker 5: you're starting hormone replacement therapy in perimenopause, well you're not
Speaker 5: replacing the easter because the hormone is a tiny dose
Speaker 5: compared to these huge, bigger levels at perimenopause. So therefore,
Speaker 5: this is why I say, at perrymenopause, we're supporting these
Speaker 5: high levels of estrogen, and yeah, we are buffering it,
Speaker 5: particularly as things go on by you know, positrogen does
Speaker 5: drop over time, but in principle, the majority of terrymenopause
Speaker 5: symptoms are because of huge hormone chains, So that makes sense.
Speaker 2: Yeah, so sorry, you're saying that contrary to the idea
Speaker 2: that we've Estrogent is lowering at certain times of the month,
Speaker 2: that's actually keeping stronger, right.
Speaker 3: Yeah.
Speaker 5: Yeah, So that was a total light Bob moment for me.
Speaker 5: And it's amazing when I'm with patients and I'm going
Speaker 5: to use the example of migraines. So a lot of
Speaker 5: the time people come and they're like, oh, my migraines
Speaker 5: are getting worse. And because I like to see everything
Speaker 5: through hormones, I ask them when was you When do
Speaker 5: you get the migraine?
Speaker 4: When was it?
Speaker 5: And they're like, oh, well, you know, but every two weeks,
Speaker 5: and I'm like, okay, so tell me when. And so
Speaker 5: frequently it corresponds to about ovulation and then again pre menstrual,
Speaker 5: and that's because our ovulation you've got this huge rise
Speaker 5: in estrogen. And typically the rise is often exacerbate migraines
Speaker 5: with aura the way you get funny neuro things as well,
Speaker 5: and the drop is often migraine without aura. And then
Speaker 5: it happens again pre menstrual and menstrual, and so it's
Speaker 5: just amazing when I have like a drawing in my
Speaker 5: planet and I and whiteboard markers and I like literally
Speaker 5: go through the menstrual cycle with my patients. And when
Speaker 5: you know that every other week, basically your hormones are
Speaker 5: going up and down. Then that in essence gives you
Speaker 5: a bit more clarity and understanding because often mood changes,
Speaker 5: you know, correspond to these body pains, fatigue, irritability as well.
Speaker 5: So I think, you know, that's the first the first
Speaker 5: clue is, you know, taking a history and finding out
Speaker 5: what's going on.
Speaker 1: It just amazes me, you know, I've learned more about perimenipals.
Speaker 1: We'll only learned that peri perimenopause existed about three years ago.
Speaker 1: I've learned more though about perimenopause and menopause in the
Speaker 1: last sort of three years, and I have in my
Speaker 1: entire life, and yet I'm still constantly learning. And I
Speaker 1: just think so many women don't even really even understand
Speaker 1: how their cycle works.
Speaker 2: No, no, and we don't know what's happening in our
Speaker 2: late thirties and early fall.
Speaker 3: No, that's news to me as well. So it's just crazy.
Speaker 1: If we are looking at the kind of symptoms then,
Speaker 1: and obviously they can be different compared to dependent on
Speaker 1: whether you're in perimenopause or menopause. What kind of symptoms
Speaker 1: though might women be suffering from where hit can come
Speaker 1: in and an assist, so, you know, just.
Speaker 5: To add further levels of complexity. Oh, how do I
Speaker 5: phrase this? So traditionally, perimenopause is diagnosed or defined by
Speaker 5: a change in your menstrual cycle, and that's what their
Speaker 5: straw criteria say. And the reason I'm saying this is
Speaker 5: because last week the Australasian Menopause Society released a statement
Speaker 5: saying HRT is being prescribed too much in cases that
Speaker 5: aren't menopause, so therefore we need to be looking at
Speaker 5: the straw criteria, which is based on periods and using
Speaker 5: HRT appropriately. However, it's really hard for me and other
Speaker 5: doctors when we see these hormone changes occurring in the
Speaker 5: late thirties, and often it starts as anxiety and irritability
Speaker 5: and pre menstrual symptoms.
Speaker 4: So I kind of wanted.
Speaker 5: To just, you know, say that, because actually, if anybody
Speaker 5: listens to this and is like, oh, I completely agree,
Speaker 5: this is me and then they go to their doctor
Speaker 5: who like, but one of our advisory bodies is saying
Speaker 5: this isn't perimenopause. I don't want my patients to feel
Speaker 5: or don't want any of your listeners to feel dismissed
Speaker 5: or unvalidated. But actually for me, does it matter is
Speaker 5: by definition this old definition of perimenopause which needs to
Speaker 5: be updated or what they say the fun NDA. Mentally,
Speaker 5: the best most effective treatment is hormone treatment. And I believe,
Speaker 5: and there's some incredible doctors in Australia and worldwide, but
Speaker 5: that the psychological symptoms of menopause often occur five years
Speaker 5: before their physical symptoms, which then also I'm like, why
Speaker 5: can't I try hormones if that suits the patient and
Speaker 5: it's appropriate. You know, it's a patient choice and there's
Speaker 5: other factors at play when it's the most effective.
Speaker 4: So whenever I see.
Speaker 5: Anyone in clinic, I'm always like new onset insomnia, irritability,
Speaker 5: burnout and worsening migrains, recurrent injuries, chronic plane fibromialdia.
Speaker 4: I'm like, what's your period's doing?
Speaker 5: Because I think those are the clues that as doctors
Speaker 5: we need to be hanging onto. And that's because in
Speaker 5: my experience, when you experience these, it's this heads up
Speaker 5: that perimenopause is going to be more challenged. And then
Speaker 5: as time goes on and the hormone level has changed,
Speaker 5: you almost lose that cycle where you have these two
Speaker 5: peaks and it kind of then can almost blur into one.
Speaker 5: And as the symptoms become more pronounced, I think.
Speaker 1: There's probably a lot of women out there going, well,
Speaker 1: hang on a moment and just going back five to
Speaker 1: ten years.
Speaker 3: I no, I am, I know, I am. I'm just thinking.
Speaker 2: So you're saying that they said that the Australasian Australasian
Speaker 2: or Australian.
Speaker 4: Yah Oustralaian menapause society, as.
Speaker 2: I've taken it back to just the bleeding phase effectively,
Speaker 2: Yeah right, Yeah, well that's.
Speaker 4: Straw minus two. Yeah.
Speaker 2: Yeah, that's interesting because you know, as we've talked about
Speaker 2: over and over again, the symptoms are so many and varied,
Speaker 2: and the bleeding is a sub symptom almost. It's the
Speaker 2: thing that you say, like you say, becomes more radic.
Speaker 2: But a lot has gone a lot of water has
Speaker 2: gone under the bridge before that. So I find that
Speaker 2: a little bit unusual, I guess as a blanket statement.
Speaker 5: Yeah, yeah, and kept mean that, you know, actually this
Speaker 5: is why And I'm really happy to like really honor
Speaker 5: to have this opportunity today because I think if we
Speaker 5: can all understand what's going on in ourselves. Then we
Speaker 5: can advocate better for what our needs are, and actually
Speaker 5: we can set ourselves up to succeed because it's about
Speaker 5: patient choice and what's safe for the patient. And also
Speaker 5: the other flip side is as a doctor, I don't
Speaker 5: want to miss anything. So if you've got, like you know,
Speaker 5: new onset severe mental health problems, I don't want to
Speaker 5: miss a clinical depression and a psychosis. But actually it's
Speaker 5: rare that I can't consider it alongside is this hormones
Speaker 5: and the same as palpitations and cardiology. But actually generally
Speaker 5: I can consider it alongside.
Speaker 1: Absolutely, as we become more knowledgeable and as more women
Speaker 1: understanding men of pause, it's very quick to immediately just
Speaker 1: presume a symptom is associated with it, and of course
Speaker 1: they must be must be cheeked out.
Speaker 3: Don't just make a presumption that's right now.
Speaker 2: The woman I've talked to about this, since we've been
Speaker 2: doing a lot more on this, the one thing I've
Speaker 2: sort of they've gone on, I haven't really looked into
Speaker 2: HRT or they're putting up with symptoms. I've tried to
Speaker 2: remind them or actually just told them to listen to
Speaker 2: Genny Orniky or you now that it's actually a medical
Speaker 2: there are medical implications to this. You could be feeling better,
Speaker 2: but you also could be doing your actual health favor
Speaker 2: as well.
Speaker 5: Ah yeah, And it's just I think women have been
Speaker 5: dismissed for so long and everybody's saying, now, oh, HRT
Speaker 5: like it's the fad.
Speaker 4: Everybody's going on it.
Speaker 5: But I'm like, actually, women have had so from puberty,
Speaker 5: rates of depression and mental health in women suddenly double.
Speaker 5: You know, it's one to one pre puberty and it's
Speaker 5: two to one post puberty, and every reproductive transition, mental
Speaker 5: health diagnoses increase so much more so.
Speaker 4: Actually, I just wonder what.
Speaker 5: Really is female mental health when you factor in hormones
Speaker 5: and we need to kind of like look at it
Speaker 5: on the table and be like, can we do this
Speaker 5: better rather than saying, oh, now we're over diagnosing it,
Speaker 5: but actually we'll be missing it before. And I never
Speaker 5: thought i'd like feel really confident to stand up and
Speaker 5: say that, but I'm just blown away by my patients
Speaker 5: who have like trusted me, and I'm like, h putting this,
Speaker 5: this and this together. We could try hormones or and
Speaker 5: we can talk a bit more about how I try
Speaker 5: the hormones as well, but they get better.
Speaker 4: And I'm like, if.
Speaker 5: I am prescribing and working with patients that haven't worked
Speaker 5: for ten years or have come to me from psychiatrists
Speaker 5: or from the concussion planic, I almost have a little
Speaker 5: bit of a responsibility now to say try it, particularly
Speaker 5: if there's no conflict indications, because what could these benefits
Speaker 5: be for you? And I still doubt myself, you know,
Speaker 5: I doubt. I'm like, oh, well, maybe it's not. But
Speaker 5: I've also learned, you know, doing it alongside. So if
Speaker 5: I've started someone on hormone therapy and you know, three
Speaker 5: months later there's no improvements, six months later there's no improvement,
Speaker 5: now I'm actually confident to say, actually, I don't think
Speaker 5: this is hormones. And you know, sometimes we stop the
Speaker 5: HRT and you know it doesn't make a difference, But
Speaker 5: other times their improvement has been a bit insidious, and
Speaker 5: it can unmask other conditions as well.
Speaker 4: So it's a.
Speaker 5: Constant, like dynamic reassessment, where am I at kind of thing.
Speaker 1: I'm not sure a lot of GPS talk or have
Speaker 1: the same knowledge as you cement that which your course
Speaker 1: is quite a concern for women who go in and
Speaker 1: you know, who've maybe got the carriage to go in
Speaker 1: and have this conversation and say I think I need
Speaker 1: some help here, and I think it could be quite
Speaker 1: They can get quite a black and white response. Would
Speaker 1: it be fair to say no offense to GPS out there?
Speaker 5: So I just, yeah, I think you're right, But I
Speaker 5: also think we need to reframe it because this is like,
Speaker 5: you know, who GPS actually really want to learn. I
Speaker 5: ran the fair I think it was the first GP
Speaker 5: education day on menopause in May and we had over
Speaker 5: four hundred healthcare professional that ten awesome. It's been so
Speaker 5: much command the Good Fellow Unit and now offering it
Speaker 5: as a pay per view the healthcare professionals as well.
Speaker 5: But actually, you know, in everybody's defense, you know, I've
Speaker 5: kind of navigated my own way because I'm a bit
Speaker 5: of a super geek and my teachers from school will
Speaker 5: always say that, but it's not been easy finding that out,
Speaker 5: and it's.
Speaker 4: All over the place.
Speaker 5: So I like teaching or more talking about women's health
Speaker 5: and making things easier for people. But actually, if our
Speaker 5: community can also figure out what do I need to
Speaker 5: do to kind of communicate this to make that journey easier.
Speaker 5: But also I think when I'm doing community sessions, they
Speaker 5: actually give the DP space or the doctor space to
Speaker 5: actually go back to what their needs are because actually
Speaker 5: is a doctor, I don't want to miss anything. I
Speaker 5: want to get it right and I want and it's
Speaker 5: the best option. And also HRT prescribing has changed so
Speaker 5: much over the years that it is really hard to
Speaker 5: keep on top of everything and to confidently prescribe it.
Speaker 5: And the guidelines are all still say you should only
Speaker 5: use HRT for like moderate to severe hot flushes when
Speaker 5: everything else has not worked, and for low dose for
Speaker 5: as short as possible. So you know, actually, in doctor's defense,
Speaker 5: it's really bloody heart.
Speaker 2: It's a case of not the blinding the blind, but
Speaker 2: a little bit of a snowstorm for the patient.
Speaker 3: The woman and the doctors. Yeah, so we're kind of
Speaker 3: just nevi getting this all together, aren't we.
Speaker 5: That's almost how we've got how we've got to reframe it.
Speaker 5: And that's how I learned from my patients. So also
Speaker 5: when I do my teaching, and like patients will say,
Speaker 5: like when I first started, oh, my ringing in my
Speaker 5: ears has stopped, and like you know over the years
Speaker 5: now I've made mental notes of all of these things.
Speaker 4: Oh you're so you're ringing in your ears? Are stopped its?
Speaker 3: Yeah?
Speaker 5: Yeah, because there's progesterone receptors and that affects the fluid balance.
Speaker 5: There's estrogen receptors in their ears as well.
Speaker 3: And you can also say, gosh, I had not put
Speaker 3: to and two together.
Speaker 1: I'm having a little moment here because I was thinking
Speaker 1: it was my life wearing headphones and being in radio
Speaker 1: and listening to loud music too much to me there,
Speaker 1: and I was sure I was heading down the road
Speaker 1: to tatus. And actually, now you mentioned that it has
Speaker 1: lessened so much, I see to the list, still learning
Speaker 1: a bit to the list. Hey, we should probably touch
Speaker 1: on the fact there's a lot of women going yep, no,
Speaker 1: we're hearing you and keen to try this or and
Speaker 1: trying to use it at the moment. But we've got
Speaker 1: this ridiculous situation of a shortage, and I know it's global,
Speaker 1: and I know that far Maker is trying to sort
Speaker 1: it out, but what impact is it having on women
Speaker 1: who are on hi T And then all of a
Speaker 1: sudden you can't get the patch that you've been on.
Speaker 4: Oh it's really tough.
Speaker 5: So a few weeks ago, at seven p thirty on
Speaker 5: a Saturday night, I was doing my repeat prescriptions and
Speaker 5: a patient that I've known for a long time had
Speaker 5: emailed me and was like, Sam, I haven't got any estrogen.
Speaker 5: I haven't had it for two weeks. And I was like, what,
Speaker 5: this has taken us years to get you feeling as
Speaker 5: good as you are, and this individual is not in
Speaker 5: Hawk's day anymore. So I ended up calling the farharmacies
Speaker 5: in their area then sent a script half an hour
Speaker 5: away from my patient. I was like, a center script here,
Speaker 5: and I was like, this is just not okay. So
Speaker 5: I then developed a survey to try and capture some
Speaker 5: of these stories because I think people don't realize the impact.
Speaker 5: And that's actually because you're going back to what we've
Speaker 5: said already about setting the scene, so people don't know
Speaker 5: the improvement it is. So actually, if it's just top flushes,
Speaker 5: then actually, why why does it really.
Speaker 4: Matter that much?
Speaker 5: But if it is preventing suicidality, if it's keeping people
Speaker 5: in the workplace, if it's keeping people in relationships, then.
Speaker 4: Actually, you know that's very different.
Speaker 5: And so what I wanted to do is actually share
Speaker 5: these stories that I hear every day, to be like,
Speaker 5: this is why it's really important. So just under twenty
Speaker 5: three hundred people filled it out in two weeks, and
Speaker 5: it's a really humbling read actually, even though it's kind
Speaker 5: of what I see every day. But with you mentioning
Speaker 5: before about changing the patches, so fifty percent of users
Speaker 5: have an improvement with Estra dot, so one of the
Speaker 5: brands and not Estra dile And so why is that
Speaker 5: so significant. Well, if you are one of the four
Speaker 5: point six percent who is better with the other option
Speaker 5: and you have no improvement with Estra dot, well if
Speaker 5: you're given extra dot and it doesn't help you feel better,
Speaker 5: everybody's going to say it's not hormones. Right, So then
Speaker 5: we've now got people not well controlled because they've got
Speaker 5: to cut patches, they've got to have time off. Some
Speaker 5: people are really I believe slow to accumulate, not scientifically
Speaker 5: correct the impact of it.
Speaker 4: So then you know, actually that tiny.
Speaker 5: Drop in the dose is really destabilizing others. Literally they
Speaker 5: don't change a patch for a day and they get
Speaker 5: body pains, flu like symptoms. And so this is why
Speaker 5: I think it's more than just there's not a patch shortage.
Speaker 5: It's a real dismissal of what your needs are at
Speaker 5: that time to enable you to live a well life.
Speaker 2: Yeah, we were going to touch on that whether these
Speaker 2: treatments are all the same. For example, you know there's
Speaker 2: been reports about FAMIC having conversations about funding the how
Speaker 2: do I say estrod dial gel?
Speaker 3: The Yeah?
Speaker 2: Yeah, is that equivalent to the dot?
Speaker 3: Is it the same?
Speaker 5: Like?
Speaker 3: Do these things all deliver the same thing equally?
Speaker 4: So I think we've got to say no.
Speaker 5: But I think we've also got to say that estrogel
Speaker 5: is a fantastic option.
Speaker 4: You know, it's transderm l so it's.
Speaker 5: Estrogen absorbed through the skin, which is the main symptom
Speaker 5: and health improver. Putting it really bluntly and simply, and
Speaker 5: actually some people will need more than one hundred micrograms
Speaker 5: of estro dot or estradyl, but they may only need
Speaker 5: half the dose equivalent of estrogel.
Speaker 1: Right, But that gets tricky then too, doesn't it cemant
Speaker 1: that the doctor's understanding what the patient's going to need
Speaker 1: and the difference in the in the prescribing to these products.
Speaker 5: Yeah, absolutely, So I did do a leaflet and I
Speaker 5: can you can have this for your resources as well
Speaker 5: about kind of the common questions and a bit of
Speaker 5: a dose comparison. But I definitely frame it with my
Speaker 5: patients that you know, actually I believe you when you
Speaker 5: tell me life is now awful, or I believe you
Speaker 5: when you're like, oh, actually I feel much better. That's
Speaker 5: a sign we should increase the dose and just kind
Speaker 5: of try to give people that flexibility as well. But
Speaker 5: you know that's not the system isn't set up for that.
Speaker 5: So you know, I had to build I had to
Speaker 5: build time into counsel and to make it easier with
Speaker 5: the pharmacists and the prescriptions. So you know, it's really
Speaker 5: labor intensive for all of us involved. It'd be really
Speaker 5: cool to just actually, and I think we can just
Speaker 5: completely rearrange women's health overall and just make it easier
Speaker 5: in every way.
Speaker 3: Let's do that exactly.
Speaker 1: Why not samant that at the moment we've got the petures,
Speaker 1: the Instra dot or extile, do we have Cream's Julls sprays?
Speaker 3: Are what else is actually available now to New Zealand women.
Speaker 5: The funded options of estrogen in New Zealand transdermally so
Speaker 5: that's estrogen that goes through the skin, so it's much
Speaker 5: safer is the patches. Only the gel is available and
Speaker 5: it's unfunded, and because pharmacies are private businesses, Farmac or
Speaker 5: nobody can price set how much you pay for a
Speaker 5: for a tube of gel.
Speaker 4: I normally have an old one as a model.
Speaker 5: I don't have it with me, so there's a real
Speaker 5: variety in price. But last week Farmac did release a
Speaker 5: statement to ask for opinions and thoughts about whether to
Speaker 5: fund the gel.
Speaker 4: So it's looking.
Speaker 5: Positive, which is really cool. But to get to that stage,
Speaker 5: the gel's actually we've had to campaign to get rid
Speaker 5: of some extra legislation around it as well, and we
Speaker 5: still I don't know. I'm still a bit skeptical as
Speaker 5: to what are the supply is like if the gel,
Speaker 5: so actually I feel we still need to know more.
Speaker 4: But there is oral estrogen, and.
Speaker 5: You know, for young for younger people who are low risk,
Speaker 5: actually oral is really is pretty safe.
Speaker 4: Some people do better with oral as.
Speaker 5: Well, and for some users even the anxiety you know,
Speaker 5: of not having to am I going to get my
Speaker 5: medication every month can be offset by knowing that maybe
Speaker 5: their symptoms are slightly not as well controlled with the
Speaker 5: oral which is like from my perspective, you know, I
Speaker 5: always want to practice gold standard best practice medicine, and
Speaker 5: suddenly my best practice is actually which you know, what's
Speaker 5: the lesser evil?
Speaker 4: Pick your poison, what's worse for you?
Speaker 2: If you're taking oral dose, what can you prescribe? Is
Speaker 2: it one month at a time? Two months at a time,
Speaker 2: Like how often does the woman have to go back?
Speaker 5: Yeah, so if oral estrogen by itself is like the
Speaker 5: kind of regular medication, so I can prescribe three months
Speaker 5: at a time, but pharmacies cannot should only be dispensing
Speaker 5: one month at a time, which again I think, you know,
Speaker 5: from a practical perspective, it's logistically harder for women. You know, busy,
Speaker 5: you've got loads on in life. But that's a whole other,
Speaker 5: you know, a whole other national thing together. The flip
Speaker 5: side is you can prescribe six months of the pill.
Speaker 5: So actually some women and there's some new unfunded pills
Speaker 5: that are really good for mood challenges in perimenopause. So
Speaker 5: for some women they control bleeding better, they better for mood.
Speaker 5: They're you know, they're pricey, but actually that's beneficial. So
Speaker 5: there are other options depending on what their priorities and
Speaker 5: needs of the individual are.
Speaker 1: Louise, do you want to tell Samantha where you thought
Speaker 1: you put the estrogen gel?
Speaker 2: Well, I think I might have been confused when I
Speaker 2: saw gel. I thought that you put it in your vagina.
Speaker 2: Why it's there a gel?
Speaker 4: That ye cream?
Speaker 2: Like?
Speaker 5: Yeah, definitely, I love book about vaginas.
Speaker 2: I can tell you about these please, But but the
Speaker 2: normal h I T GL doesn't go.
Speaker 3: You can just put it on.
Speaker 5: It's on your from your shoulder to your shoulder to
Speaker 5: your wrist right right and Sandrna another gel rubs on
Speaker 5: your tummy, on.
Speaker 4: Your belly right.
Speaker 3: That gels for everybody part there are.
Speaker 5: But yes, the vaginal cream is a vestin and that's
Speaker 5: a different kind of estrogen called strile, which is likes
Speaker 5: the genital the genita here and I talk about it
Speaker 5: is like as we get older, or you know, our
Speaker 5: skin dries, and the vaginal skin dries as well, and
Speaker 5: it becomes thinner and it does get a bit smaller,
Speaker 5: and even regardless of sexual relations, it impacts bladder function,
Speaker 5: pelvic muscle function, sexual function and comfort. Whereas if you
Speaker 5: use a vestin it's like a moisturizer if your vagina,
Speaker 5: so it can really prevent like loads and loads of
Speaker 5: the symptoms. And it's the only condition of menopause that
Speaker 5: will never get better. So once you have vaginal dryness,
Speaker 5: you've got vaginal dryness.
Speaker 4: But using some.
Speaker 5: Grain, which is the you know, the gold standard, prevents
Speaker 5: it decreasing and you always need to use it.
Speaker 2: But it doesn't have any other It doesn't do anything
Speaker 2: for the recently unapaus or somebod just for the vagina.
Speaker 4: It shouldn't.
Speaker 5: But if you've had if you've got conditions where you
Speaker 5: can't have estrogen, for example breast cancer or liver and
Speaker 5: liver issues, then you can still have vaginal estrogen because
Speaker 5: it's not thought to go systemically in the body.
Speaker 4: However I do so it doesn't have an impact on
Speaker 4: the other tissues.
Speaker 5: However, I do always say to my patients that actually,
Speaker 5: when the tissues are really dry, they're often really thin,
Speaker 5: so you do get more absorption, but really quickly that
Speaker 5: stops being absorbed because I think you know, if you're
Speaker 5: just say you know, I give you estrogen and I've
Speaker 5: told you it's safe, it's not going to impact your
Speaker 5: breast tissue at all, and suddenly you get breast tenderness.
Speaker 5: You're going to be like, what what on earth the
Speaker 5: doctor told? And you can feel it, so you know
Speaker 5: it's true. So I always tell my patients that. And
Speaker 5: for those that are really kind of, you know, hormone
Speaker 5: averse or just it just doesn't lie right with them,
Speaker 5: then you can bring the doses down even more because
Speaker 5: some people are more sensitive to it.
Speaker 1: If you're listening to the little things in Our guest
Speaker 1: on the podcast today is GP and Women's health specialist
Speaker 1: doctor Cement, the newman talking everything HRT.
Speaker 3: We're going to be back shortly after this break.
Speaker 2: So it's not just a hormonal cancer that would cause
Speaker 2: you to not be able to take HRT.
Speaker 3: And I know you would need a proper consult. Can
Speaker 3: you go to a GP? Do you need an endochronologist?
Speaker 2: Who do you talk to if you don't know whether
Speaker 2: something you've had in the past like apatitis for example,
Speaker 2: or or you're on a blood finner or whatever. Is
Speaker 2: your GP still the first stop for advice about that?
Speaker 3: Yeah?
Speaker 5: I think your GP should be the first stop because
Speaker 5: they know you, they know your history, and for me,
Speaker 5: as a DP, any medication is about the whole person.
Speaker 5: It's about you know, what is right with you, your
Speaker 5: family history, what your FINO is saying, and actually is
Speaker 5: a GP we're best place to do that. Obviously, you know,
Speaker 5: we're not experts in every other condition as well, but
Speaker 5: we are general practitioners. We that's what we specialize in,
Speaker 5: and we also specialize in kind of that general risk assessment.
Speaker 5: So therefore, some gps who are really confident with hormone
Speaker 5: replacement therapy will actually be happy to, you know, work
Speaker 5: with the guidelines and maybe do things which aren't necessarily
Speaker 5: typical and recommended because it's in the best interest of
Speaker 5: the patient and for that relationship. But I think it's
Speaker 5: you know, it's really important that everybody has their needs met,
Speaker 5: and even if that's you know, actually that you do
Speaker 5: need to go to a specialist and find out what
Speaker 5: are your needs and how can these be met? Because
Speaker 5: EP and as I kind of like as I said
Speaker 5: at the beginning, when I see the impact that the
Speaker 5: appropriate management option can be in someone, it's about framing
Speaker 5: that is, can we achieve that? Because then I think
Speaker 5: you have to consider the risks in the context of
Speaker 5: that and being a bit kind of airy fairy, But no.
Speaker 3: I know you mean.
Speaker 2: I think it's that thing of population health versus the
Speaker 2: individual's health as well, and that keyword management.
Speaker 3: And that's great.
Speaker 2: If you have somewhat health literate and you have a
Speaker 2: GP who you can easy access and describe your symptoms too,
Speaker 2: you could get through that snowstorm a little bit easier.
Speaker 3: I just worry.
Speaker 2: I suppose for those people out there that are just
Speaker 2: they don't even they go, oh, well, I'm probably excluded.
Speaker 3: I don't know what to do.
Speaker 2: You know, I can't see anybody and they're kind of
Speaker 2: putting up the stuff they don't need to. I know
Speaker 2: that estrogen HRT in general deals with the range of
Speaker 2: issues that come up with without aestrogen dropping off and things.
Speaker 2: So would somebody who can't take that they could take.
Speaker 2: Is vitamin D a good thing to be taking, or
Speaker 2: like once a month? Or there are things that we
Speaker 2: can do for our bones that we if we can't
Speaker 2: take HRT.
Speaker 5: Yeah, I think it's about what are your symptoms and
Speaker 5: what are we targeting? So putting it bluntly, you know,
Speaker 5: HRT is the best option for managing hot flushes and
Speaker 5: managing mood that are related to hormone changes, but that
Speaker 5: doesn't mean it's right for everyone, and not just because
Speaker 5: of a medical you know, contraindication. And so then I
Speaker 5: tend to break it down so like lifestyle things that
Speaker 5: you can do, and then there's some supplements and then
Speaker 5: non hormonal medications. So even some lifestyle things can be
Speaker 5: pretty transformational, such as you know, changing the way we
Speaker 5: eat because our metabolism changes, and eating at slightly different
Speaker 5: times of day, and then supplements. Also you do have
Speaker 5: to be careful of with medical conditions too, like phytoestrogens.
Speaker 5: If you've got any student sensitive cancer and you do
Speaker 5: not want any estrogen, then it's pretty counterintuitive to go
Speaker 5: and take as much estrogen through food as you can
Speaker 5: through the phytoestrodents. But vitamin D is it helps with immunity,
Speaker 5: it helps with probably some cancer prevention, probably some mental health,
Speaker 5: brains infection. So that's for me, what menopause and hormonal
Speaker 5: health is. It's actually taking a step back and looking
Speaker 5: at what else can you do to optimize well being,
Speaker 5: and I think we need to do that alongside any
Speaker 5: kind of hormones as well. There are non hormonal medications
Speaker 5: which can be prescribed specifically as such for menopause, and
Speaker 5: some gps still have these as their first line and
Speaker 5: they're not wrong. So antidepressants can improve hot flushes in
Speaker 5: fifty percent, and that says so many things to me,
Speaker 5: because actually there's a huge brain hormone link, so that's
Speaker 5: also where it helps, but also the serotonin and the
Speaker 5: eater and they all interact with temperature regulation too. Sleep
Speaker 5: is another really big thing. So for example, if somebody
Speaker 5: has got really marked sleep disturbance secondary to menopause, then
Speaker 5: I might go for something like gabapentin, which is a
Speaker 5: medication that we use for chronic pain and for some
Speaker 5: other kind of neurological conditions, and so that can be
Speaker 5: really helpful there, but it also can help hot flushes
Speaker 5: as well. There's some other antidepressants called venola vaccine, and
Speaker 5: I'd often use that one if somebody has got bad
Speaker 5: body pains at the same time too. And with all
Speaker 5: of these options, there's different kind of doses and things
Speaker 5: and durations and how long it takes to work. And
Speaker 5: I also think that it's about being realistic about what
Speaker 5: our gains are. So when I first started prescribing HILT,
Speaker 5: the teaching was you have to be eighty percent better,
Speaker 5: but actually you shouldn't have.
Speaker 4: To be eighty percent better to continue any medication.
Speaker 5: It may be that you don't want hormones and the
Speaker 5: whatever antidepressant medication decreases your hot flashes by one per
Speaker 5: night or they're not as much, but actually that is
Speaker 5: enough to improve your quality of life without the side effects.
Speaker 4: So yeah, and there are others.
Speaker 5: As well, but hopefully that's kind of given you a
Speaker 5: little bit of an.
Speaker 1: Overdam Yeah, for sure, it's really positive because for women
Speaker 1: who maybe can't take hormones or want to and have
Speaker 1: some issues, there are some other ways to sort the
Speaker 1: mountain things. If you're a relative, if you're a sister
Speaker 1: or a daughter of a woman with a hormone in cancer,
Speaker 1: should you be questioning whether HIT is still a go
Speaker 1: for you.
Speaker 5: So I think it's a bit too broad to say
Speaker 5: a hormone related cancer, because actually a lot of cancers
Speaker 5: are hormone sensitive in different ways, and it's probably beyon
Speaker 5: the scope to go through that. But putting it kind
Speaker 5: of a little bit more broadly, it's about what breast cancer. No,
Speaker 5: if you've got a family history of breast cancer, it's
Speaker 5: not a contraindication for you to have it. But what
Speaker 5: I would be doing is I'd be like, Okay, what
Speaker 5: could this medication do to you? Because if it means
Speaker 5: that you're going to get more sleep, if it means
Speaker 5: you're going to be able to exercise so you don't
Speaker 5: put on weight, if it means you're going to stop
Speaker 5: drinking your alcohol, that's going to decrease your risk more
Speaker 5: than not having it. The flip side is I'm like, Okay, great,
Speaker 5: this is a really wonderful opportunity to talk about how
Speaker 5: we can pick up any form of cancer depending on
Speaker 5: you know what it is. So for breast cancer, I'd
Speaker 5: be like, great, so we can look at how are
Speaker 5: we going to do your screening, how are we going
Speaker 5: to optimize it, When are we going to do it?
Speaker 4: What about examinations.
Speaker 5: I mean, I've got some women who have got family
Speaker 5: histories of breast cancer and they are like, well, I
Speaker 5: can't cope right now, but I really don't want hormones.
Speaker 5: But right now I know that that tiniest dose of
Speaker 5: hormones may make me a little bit better, and then
Speaker 5: I'm going to stop it. Because the data when you've
Speaker 5: been on some forms of HRT for five years or more.
Speaker 5: The risk of breast cancer increases, but still with any
Speaker 5: form of breast cancer bavarian cancer, women are more likely
Speaker 5: to die of cardiovascular disease than cancer. And starting hormone
Speaker 5: replacement therapy in the perimenopause decreases cardiovascular disease by thirty
Speaker 5: to fifty percent. It decreases diabetes, chdorectal cancer, depression, psychosis,
Speaker 5: autoimmune disease. So we've really got to kind of, you know,
Speaker 5: step back and enable our community to look at what
Speaker 5: are your needs and what's the best way to support
Speaker 5: you forward from you know, a symptoms to review, from
Speaker 5: a screening, from a supporting health changes as you transition
Speaker 5: through mid life.
Speaker 2: No, you're dead right, because if you're in your early
Speaker 2: forties as I was, actually you know, not sleeping, stressed,
Speaker 2: cars ale, pulsing through the body, not coping with the
Speaker 2: smaller things that even the little things in life kind
Speaker 2: of hitting the wall bloody, how could have been metopausal?
Speaker 4: You know?
Speaker 2: And also that that is really taken away from your
Speaker 2: quality of life and potentially can be linked to disease.
Speaker 3: Right, So it is that balance, as you say, and.
Speaker 2: I think so quite often we go to the GP
Speaker 2: as a last resort instead of at the beginning of
Speaker 2: the thing. It's the GP is really not supposed to
Speaker 2: be the ambulance at the bottom of the cliff, and
Speaker 2: we need to make that time. You know, don't do
Speaker 2: it just as an emergency. Everyone says, oh, you can't
Speaker 2: get into GP when you need to, but you probably
Speaker 2: needed too three or four weeks ago.
Speaker 3: Aye.
Speaker 5: And that's just I think where we almost need to
Speaker 5: step back and look at what can we do as
Speaker 5: women who see that we have needs to support that
Speaker 5: health system. Because I don't want because needs aren't going
Speaker 5: to be mere if we tell every midlife women to
Speaker 5: go to the GP to have a discussion on HRT.
Speaker 5: But actually, you know, as a health system, we weren't
Speaker 5: set up to educate everybody on the whole of every
Speaker 5: single medication and health condition.
Speaker 4: So we need to kind of look at what else
Speaker 4: can we do.
Speaker 5: And that's why you know, like your podcast is great
Speaker 5: because actually hopefully that will give some people some ideas
Speaker 5: so they can also maximize the time with their GP
Speaker 5: on the GP strengths, which should be diagnosing, putting things together,
Speaker 5: and interpreting appropriate investigations.
Speaker 1: And it's really important to say as well that we
Speaker 1: don't just expect people to turn to medication to solve
Speaker 1: all their problems, but a lot, a lot of women
Speaker 1: are turning to it. How do they have done all
Speaker 1: the things they're supposed to do? You know that they've
Speaker 1: tried to get their good sleep, they've cut back on
Speaker 1: their alcohol, they're watching their diet, they're trying to exercise.
Speaker 1: You know, like, it's not one person's problem to solve.
Speaker 1: We've got to take some personal responsibility for getting through
Speaker 1: this period in our lives a beast that we can
Speaker 1: as well. Knowing about it is a good but knowing
Speaker 1: about it is a very very good start. And I
Speaker 1: just love the way that you are just advocating for
Speaker 1: women's health so strongly submit that. And I was thrilled
Speaker 1: to hear about the course that you're running for GPS.
Speaker 1: But I believe that you're also you have a menopause
Speaker 1: course for women as well.
Speaker 4: Yeah, you're right.
Speaker 5: I just I've learned so much from my patients, and
Speaker 5: I think, you know, I can't do what I do
Speaker 5: in fifteen minutes, So what I wanted to do is
Speaker 5: make my colleagues lives easier. So I kind of like
Speaker 5: a little bit of a walk through of what I
Speaker 5: do with my patients to help understand what your symptoms are,
Speaker 5: Could it be hormonal either when you've gone through it
Speaker 5: at the moment, or what could you expect and how
Speaker 5: these kind of like the hormones change. And we've put
Speaker 5: some resources there as well, and you made a work
Speaker 5: book too that you can take to your GP to
Speaker 5: work through with it. And I'm hoping that through staying
Speaker 5: really closely intact with like my Women's Health Network and
Speaker 5: the GPS are interested in it, but also general GPS
Speaker 5: because it's so inseparable. And I've had really cool positive
Speaker 5: feedback which has been really nice as well. And we've
Speaker 5: got a podcast on sorry of course, on hormone replacement
Speaker 5: therapy coming so where I can like dive a little
Speaker 5: bit more deeper about what to expect, what the side
Speaker 5: effects are, what happens if.
Speaker 4: It doesn't work, and.
Speaker 3: Are people find you? Yeah?
Speaker 5: It's my website's ww dot female, gt dot co dot NZ.
Speaker 4: And it's forward slash all.
Speaker 5: And the reason I've done it like that is because
Speaker 5: I've been just like amazed by men I see and
Speaker 5: fin and I'm like, ah, this makes sense based on
Speaker 5: my knowledge of women's health. So kind of my dream
Speaker 5: moving forward is to pick up some of my women's
Speaker 5: health knowledge and to put it in a different framework
Speaker 5: to help more people than just midlife women, because I think,
Speaker 5: you know, hormones are just a part of it. But
Speaker 5: when you see things through a hormone lens, it gets
Speaker 5: it's easier.
Speaker 3: Oh my goshes so sure does.
Speaker 2: So. Look, I know you've given us so much to
Speaker 2: think about, but if you're going to get of that
Speaker 2: woman who's teacherly, I don't know, early like thirties, early forties,
Speaker 2: a little bit exasperated feeling, you know, could it be this?
Speaker 3: Could it be that?
Speaker 2: What's the one piece of advice you've given a woman
Speaker 2: wanting to start or to start to investigate HRT at
Speaker 2: the moment in our current setting, I'd say be open minded.
Speaker 5: So be open minded about what your symptoms could be
Speaker 5: caused for prying different options and also reassessing when it
Speaker 5: doesn't work to help understand what it is. And I
Speaker 5: often use hormones as a diagnostic trial, so actually, is
Speaker 5: it working or not? Is that going to help us
Speaker 5: kind of figure out what's going on?
Speaker 1: Brilliant, It has been such a delight to meet you, Samantha.
Speaker 1: Thank you so much for your time today.
Speaker 4: Oh no, thank you for having me.
Speaker 3: How fantastic is Samantha.
Speaker 1: I'm just I so appreciate the work that she is
Speaker 1: doing in the advocacy she's doing on behalf of all women,
Speaker 1: enabling us to get the healthcare that we deserve. She's
Speaker 1: certainly passionate about it, but in an incredibly practical way, yes,
Speaker 1: which is exactly.
Speaker 3: What we need.
Speaker 1: Hey. Something that we sort of spoke to her before
Speaker 1: the podcast on which we didn't get to was talking
Speaker 1: about women who might have had a hysterectomy and the menopause.
Speaker 2: Yeah, which touches on the comment that the Australasian Menopausal
Speaker 2: Society said that to go back to focusing on your
Speaker 2: cycle and bleeding and things, those women won't bleed. They
Speaker 2: still have the ovaries, but they won't have a period
Speaker 2: to gauge anything on. Or you could be on a
Speaker 2: mini pil and not be getting a period. There are
Speaker 2: a number of reasons you won't be getting a period
Speaker 2: that you should still be taking your hormones into consideration.
Speaker 3: Absolutely so, just making a mention of that there.
Speaker 1: Thank you so much for joining us on our new
Speaker 1: Zealand Herald podcast Serious for Little Things. We hope you
Speaker 1: share this podcast with the women in your life so
Speaker 1: that every woman that wants or needs the estrogen gets
Speaker 1: the estrogen will their help.
Speaker 2: You can follow this podcast on iHeartRadio or wherever you
Speaker 2: get your podcasts, and for more on this and other topics,
Speaker 2: head to inzid Herald dot co dot z and
Speaker 3: We'll catch you next time on the Little Things