August 2, 2024 • 41 mins
The Little Things is back for Season 3, and for the first episode, Francesca and Louise are digging into one of the most contentious topics in women's health at the moment - Hormone Replacement Therapy. Dr Samantha Newman joins to discuss all you need to know about the treatment and hormone changes in women, and why she thinks HRT is worth trying.
For more from Dr Newman, head to: https://allaboutus.teachable.com/p/is-it-hormones-discuss-perimenopause-with-your-gp and use discount code LITTLETHINGS for 20% off the course.
See omnystudio.com/listener for privacy information.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:08):
Hello, I'm Francisca Rudkin and I'm Louise Ariie. Welcome to
season three of this New Zealand Herald podcast, The Little Things,
a podcast that looks at the little things that can
make a positive impact on our day to day life.
Speaker 2 (00:19):
We're so excited to be back, aren't we, Francisco, We
certainly are, and as we have with previous seasons, our
aim is to cut through all the confusing noise and
information out there to focus on the facts, and we
have a fabulous collection of experts joining us to talk
about a whole range of issues.
Speaker 3 (00:34):
This season.
Speaker 1 (00:35):
Now The Little Things has covered perimenopause and menopause with
Nicky Bizant and doctor Jenny Mansburg, both episodes worth listening
to if you haven't already.
Speaker 3 (00:44):
If I can say that.
Speaker 2 (00:45):
No totally I hosted that you're particularly good in them Noise.
Today we want to focus on a very topical aspect
of this HRT, the crazy shortages of it and other
options if it's not for you.
Speaker 1 (00:59):
I've got a friend who said to me the other day,
she actually texted me, you have to do a podcast
on this. She said, I've never really had a conversation
with any of my friends about HIT. She's a couple
of years younger than I am, and she said, I
have had three conversations with different women this week. They're
all beside themselves. So if you are on HIT, then
you'll know that there has been a shortage of it
in New Zealand the patches, and that's been a case
(01:19):
for a while now. Pharmacists are doing their best. If
you were lucky, you might have been given a different
dosage and told to cut it to your dosage size.
That is what I have been doing terribly well now
for quite a few months. But for many women they're
just told we don't have it.
Speaker 3 (01:34):
Sorry.
Speaker 2 (01:35):
So we're getting nuggets of news telling us we should
be happy because we could soon have the option of
a funded gel which could help ease the HRT shortages.
But when what has to happen for that to get
off the ground. So how do we handle the shortage
that we're in at the moment? How do we advocate
for ourselves better to know whether HRT is even for
us and what is our access to other options?
Speaker 1 (01:58):
Joining us today is doctor Cement the Newman, a GP
with a specialist interest in women's health. Samantha also lectures
at the University of Auckland, does research with the University
of My Nation Oz and is a fabulous human who
is constantly advocating for women's health needs.
Speaker 3 (02:14):
Welcome Cement, the good to have you with.
Speaker 4 (02:16):
Us, Curta, thank you for having me.
Speaker 1 (02:19):
Okay, for those thinking about using HRT in the future
or now, can you give us a quick rundown of
what it is?
Speaker 5 (02:27):
Yeah, absolutely so. By definition, HRT is hormone replacement therapy
and it's also known as menopause hormone therapy. But as
we're going to kind of cover over the next wee while,
it can be used not just to replace hormones, so
I can kind of you know, for me, I often
talk about it supporting hormones. So it depends on when
(02:48):
you use it as to what the role exactly is.
Speaker 3 (02:51):
It's a lot more nuanced than just going estrogen.
Speaker 5 (02:55):
Yeah, definitely, and I think that's for me about you know, actually,
why as a door, if I prescribe any medication, I
need to know what I'm prescribing it for, what I'm
expecting the outcomes to be. And actually so my patients
know what to expect and you know that's going to
be with side effects and with benefits as well. And
that's one of the things I see really kind of
(03:17):
like not done wrong, but I feel we could do
better if we understood actually what we're trying to treat.
Speaker 4 (03:24):
And the names are both a little bit misgiving.
Speaker 5 (03:27):
And so if you go back to literally like the hormone,
I call it the reproductive journey. Then actually, at puberty,
our hormones are increasing, so we get rises in estrogen
levels while our body settles things out. And then while
we're in our twenties and our early thirties, things are
pretty regular and we're our peak fertility, so things are predictable.
(03:50):
And then as we go into our mid thirties at
late thirties, this was a really huge light bulb moment
for me because actually we get even more hormone change
in our late thirties onwards than we do at puberty.
And what I mean by that, and this is how
I describe it's my patient, So is every month the
brain is telling the ovary to release an egg, and
(04:13):
the over releases estrogen in perimenopause. So after our peak reproductivity,
then the brain has to shout a bit louder because
the over is getting a bit tired, and it's like, seriously,
come on, I want a little break. And so that's
when we get a hormone the f S eight and
you don't have to remember that rises and then eventually
(04:34):
the ovary kicks in and shouts really really loud, and
estrogen shoots up. And this happens just before ovulation. So
in perimenopause, this rise in ovulation and estrogen is actually
greater than that at puberty. Then after ovulation, estrogen drops
a little bit and then it rises again. So if
(04:54):
you're starting hormone replacement therapy in perimenopause, well you're not
replacing the easter because the hormone is a tiny dose
compared to these huge, bigger levels at perimenopause. So therefore,
this is why I say, at perrymenopause, we're supporting these
high levels of estrogen, and yeah, we are buffering it,
(05:16):
particularly as things go on by you know, positrogen does
drop over time, but in principle, the majority of terrymenopause
symptoms are because of huge hormone chains, So that makes sense.
Speaker 2 (05:27):
Yeah, so sorry, you're saying that contrary to the idea
that we've Estrogent is lowering at certain times of the month,
that's actually keeping stronger, right.
Speaker 3 (05:38):
Yeah.
Speaker 5 (05:38):
Yeah, So that was a total light Bob moment for me.
And it's amazing when I'm with patients and I'm going
to use the example of migraines. So a lot of
the time people come and they're like, oh, my migraines
are getting worse. And because I like to see everything
through hormones, I ask them when was you When do
you get the migraine?
Speaker 4 (05:55):
When was it?
Speaker 5 (05:56):
And they're like, oh, well, you know, but every two weeks,
and I'm like, okay, so tell me when. And so
frequently it corresponds to about ovulation and then again pre menstrual,
and that's because our ovulation you've got this huge rise
in estrogen. And typically the rise is often exacerbate migraines
with aura the way you get funny neuro things as well,
(06:18):
and the drop is often migraine without aura. And then
it happens again pre menstrual and menstrual, and so it's
just amazing when I have like a drawing in my
planet and I and whiteboard markers and I like literally
go through the menstrual cycle with my patients. And when
you know that every other week, basically your hormones are
(06:39):
going up and down. Then that in essence gives you
a bit more clarity and understanding because often mood changes,
you know, correspond to these body pains, fatigue, irritability as well.
So I think, you know, that's the first the first
clue is, you know, taking a history and finding out
what's going on.
Speaker 1 (06:58):
It just amazes me, you know, I've learned more about perimenipals.
We'll only learned that peri perimenopause existed about three years ago.
I've learned more though about perimenopause and menopause in the
last sort of three years, and I have in my
entire life, and yet I'm still constantly learning. And I
just think so many women don't even really even understand
how their cycle works.
Speaker 2 (07:19):
No, no, and we don't know what's happening in our
late thirties and early fall.
Speaker 3 (07:22):
No, that's news to me as well. So it's just crazy.
Speaker 1 (07:26):
If we are looking at the kind of symptoms then,
and obviously they can be different compared to dependent on
whether you're in perimenopause or menopause. What kind of symptoms
though might women be suffering from where hit can come
in and an assist, so, you know, just.
Speaker 5 (07:41):
To add further levels of complexity. Oh, how do I
phrase this? So traditionally, perimenopause is diagnosed or defined by
a change in your menstrual cycle, and that's what their
straw criteria say. And the reason I'm saying this is
because last week the Australasian Menopause Society released a statement
(08:04):
saying HRT is being prescribed too much in cases that
aren't menopause, so therefore we need to be looking at
the straw criteria, which is based on periods and using
HRT appropriately. However, it's really hard for me and other
doctors when we see these hormone changes occurring in the
late thirties, and often it starts as anxiety and irritability
(08:29):
and pre menstrual symptoms.
Speaker 4 (08:31):
So I kind of wanted.
Speaker 5 (08:33):
To just, you know, say that, because actually, if anybody
listens to this and is like, oh, I completely agree,
this is me and then they go to their doctor
who like, but one of our advisory bodies is saying
this isn't perimenopause. I don't want my patients to feel
or don't want any of your listeners to feel dismissed
or unvalidated. But actually for me, does it matter is
(08:54):
by definition this old definition of perimenopause which needs to
be updated or what they say the fun NDA. Mentally,
the best most effective treatment is hormone treatment. And I believe,
and there's some incredible doctors in Australia and worldwide, but
that the psychological symptoms of menopause often occur five years
(09:18):
before their physical symptoms, which then also I'm like, why
can't I try hormones if that suits the patient and
it's appropriate. You know, it's a patient choice and there's
other factors at play when it's the most effective.
Speaker 4 (09:31):
So whenever I see.
Speaker 5 (09:32):
Anyone in clinic, I'm always like new onset insomnia, irritability,
burnout and worsening migrains, recurrent injuries, chronic plane fibromialdia.
Speaker 4 (09:44):
I'm like, what's your period's doing?
Speaker 5 (09:45):
Because I think those are the clues that as doctors
we need to be hanging onto. And that's because in
my experience, when you experience these, it's this heads up
that perimenopause is going to be more challenged. And then
as time goes on and the hormone level has changed,
you almost lose that cycle where you have these two
(10:08):
peaks and it kind of then can almost blur into one.
And as the symptoms become more pronounced, I think.
Speaker 1 (10:14):
There's probably a lot of women out there going, well,
hang on a moment and just going back five to
ten years.
Speaker 3 (10:18):
I no, I am, I know, I am. I'm just thinking.
Speaker 2 (10:20):
So you're saying that they said that the Australasian Australasian
or Australian.
Speaker 4 (10:26):
Yah Oustralaian menapause society, as.
Speaker 2 (10:28):
I've taken it back to just the bleeding phase effectively,
Yeah right, Yeah, well that's.
Speaker 4 (10:35):
Straw minus two. Yeah.
Speaker 2 (10:36):
Yeah, that's interesting because you know, as we've talked about
over and over again, the symptoms are so many and varied,
and the bleeding is a sub symptom almost. It's the
thing that you say, like you say, becomes more radic.
But a lot has gone a lot of water has
gone under the bridge before that. So I find that
a little bit unusual, I guess as a blanket statement.
Speaker 5 (10:57):
Yeah, yeah, and kept mean that, you know, actually this
is why And I'm really happy to like really honor
to have this opportunity today because I think if we
can all understand what's going on in ourselves. Then we
can advocate better for what our needs are, and actually
we can set ourselves up to succeed because it's about
patient choice and what's safe for the patient. And also
(11:19):
the other flip side is as a doctor, I don't
want to miss anything. So if you've got, like you know,
new onset severe mental health problems, I don't want to
miss a clinical depression and a psychosis. But actually it's
rare that I can't consider it alongside is this hormones
and the same as palpitations and cardiology. But actually generally
I can consider it alongside.
Speaker 1 (11:40):
Absolutely, as we become more knowledgeable and as more women
understanding men of pause, it's very quick to immediately just
presume a symptom is associated with it, and of course
they must be must be cheeked out.
Speaker 3 (11:52):
Don't just make a presumption that's right now.
Speaker 2 (11:54):
The woman I've talked to about this, since we've been
doing a lot more on this, the one thing I've
sort of they've gone on, I haven't really looked into
HRT or they're putting up with symptoms. I've tried to
remind them or actually just told them to listen to
Genny Orniky or you now that it's actually a medical
there are medical implications to this. You could be feeling better,
(12:14):
but you also could be doing your actual health favor
as well.
Speaker 5 (12:18):
Ah yeah, And it's just I think women have been
dismissed for so long and everybody's saying, now, oh, HRT
like it's the fad.
Speaker 4 (12:27):
Everybody's going on it.
Speaker 5 (12:29):
But I'm like, actually, women have had so from puberty,
rates of depression and mental health in women suddenly double.
You know, it's one to one pre puberty and it's
two to one post puberty, and every reproductive transition, mental
health diagnoses increase so much more so.
Speaker 4 (12:47):
Actually, I just wonder what.
Speaker 5 (12:49):
Really is female mental health when you factor in hormones
and we need to kind of like look at it
on the table and be like, can we do this
better rather than saying, oh, now we're over diagnosing it,
but actually we'll be missing it before. And I never
thought i'd like feel really confident to stand up and
say that, but I'm just blown away by my patients
(13:11):
who have like trusted me, and I'm like, h putting this,
this and this together. We could try hormones or and
we can talk a bit more about how I try
the hormones as well, but they get better.
Speaker 4 (13:23):
And I'm like, if.
Speaker 5 (13:24):
I am prescribing and working with patients that haven't worked
for ten years or have come to me from psychiatrists
or from the concussion planic, I almost have a little
bit of a responsibility now to say try it, particularly
if there's no conflict indications, because what could these benefits
be for you? And I still doubt myself, you know,
I doubt. I'm like, oh, well, maybe it's not. But
(13:46):
I've also learned, you know, doing it alongside. So if
I've started someone on hormone therapy and you know, three
months later there's no improvements, six months later there's no improvement,
now I'm actually confident to say, actually, I don't think
this is hormones. And you know, sometimes we stop the
HRT and you know it doesn't make a difference, But
(14:07):
other times their improvement has been a bit insidious, and
it can unmask other conditions as well.
Speaker 4 (14:12):
So it's a.
Speaker 5 (14:13):
Constant, like dynamic reassessment, where am I at kind of thing.
Speaker 1 (14:18):
I'm not sure a lot of GPS talk or have
the same knowledge as you cement that which your course
is quite a concern for women who go in and
you know, who've maybe got the carriage to go in
and have this conversation and say I think I need
some help here, and I think it could be quite
They can get quite a black and white response. Would
it be fair to say no offense to GPS out there?
Speaker 5 (14:39):
So I just, yeah, I think you're right, But I
also think we need to reframe it because this is like,
you know, who GPS actually really want to learn. I
ran the fair I think it was the first GP
education day on menopause in May and we had over
four hundred healthcare professional that ten awesome. It's been so
(14:59):
much command the Good Fellow Unit and now offering it
as a pay per view the healthcare professionals as well.
But actually, you know, in everybody's defense, you know, I've
kind of navigated my own way because I'm a bit
of a super geek and my teachers from school will
always say that, but it's not been easy finding that out,
and it's.
Speaker 4 (15:19):
All over the place.
Speaker 5 (15:21):
So I like teaching or more talking about women's health
and making things easier for people. But actually, if our
community can also figure out what do I need to
do to kind of communicate this to make that journey easier.
But also I think when I'm doing community sessions, they
actually give the DP space or the doctor space to
(15:43):
actually go back to what their needs are because actually
is a doctor, I don't want to miss anything. I
want to get it right and I want and it's
the best option. And also HRT prescribing has changed so
much over the years that it is really hard to
keep on top of everything and to confidently prescribe it.
And the guidelines are all still say you should only
(16:04):
use HRT for like moderate to severe hot flushes when
everything else has not worked, and for low dose for
as short as possible. So you know, actually, in doctor's defense,
it's really bloody heart.
Speaker 2 (16:15):
It's a case of not the blinding the blind, but
a little bit of a snowstorm for the patient.
Speaker 3 (16:21):
The woman and the doctors. Yeah, so we're kind of
just nevi getting this all together, aren't we.
Speaker 5 (16:25):
That's almost how we've got how we've got to reframe it.
And that's how I learned from my patients. So also
when I do my teaching, and like patients will say,
like when I first started, oh, my ringing in my
ears has stopped, and like you know over the years
now I've made mental notes of all of these things.
Speaker 4 (16:40):
Oh you're so you're ringing in your ears? Are stopped its?
Speaker 3 (16:43):
Yeah?
Speaker 5 (16:44):
Yeah, because there's progesterone receptors and that affects the fluid balance.
There's estrogen receptors in their ears as well.
Speaker 3 (16:49):
And you can also say, gosh, I had not put
to and two together.
Speaker 1 (16:52):
I'm having a little moment here because I was thinking
it was my life wearing headphones and being in radio
and listening to loud music too much to me there,
and I was sure I was heading down the road
to tatus. And actually, now you mentioned that it has
lessened so much, I see to the list, still learning
a bit to the list. Hey, we should probably touch
(17:14):
on the fact there's a lot of women going yep, no,
we're hearing you and keen to try this or and
trying to use it at the moment. But we've got
this ridiculous situation of a shortage, and I know it's global,
and I know that far Maker is trying to sort
it out, but what impact is it having on women
who are on hi T And then all of a
sudden you can't get the patch that you've been on.
Speaker 4 (17:34):
Oh it's really tough.
Speaker 5 (17:36):
So a few weeks ago, at seven p thirty on
a Saturday night, I was doing my repeat prescriptions and
a patient that I've known for a long time had
emailed me and was like, Sam, I haven't got any estrogen.
I haven't had it for two weeks. And I was like, what,
this has taken us years to get you feeling as
good as you are, and this individual is not in
(17:56):
Hawk's day anymore. So I ended up calling the farharmacies
in their area then sent a script half an hour
away from my patient. I was like, a center script here,
and I was like, this is just not okay. So
I then developed a survey to try and capture some
of these stories because I think people don't realize the impact.
And that's actually because you're going back to what we've
said already about setting the scene, so people don't know
(18:19):
the improvement it is. So actually, if it's just top flushes,
then actually, why why does it really.
Speaker 4 (18:25):
Matter that much?
Speaker 5 (18:26):
But if it is preventing suicidality, if it's keeping people
in the workplace, if it's keeping people in relationships, then.
Speaker 4 (18:32):
Actually, you know that's very different.
Speaker 5 (18:35):
And so what I wanted to do is actually share
these stories that I hear every day, to be like,
this is why it's really important. So just under twenty
three hundred people filled it out in two weeks, and
it's a really humbling read actually, even though it's kind
of what I see every day. But with you mentioning
before about changing the patches, so fifty percent of users
(18:59):
have an improvement with Estra dot, so one of the
brands and not Estra dile And so why is that
so significant. Well, if you are one of the four
point six percent who is better with the other option
and you have no improvement with Estra dot, well if
you're given extra dot and it doesn't help you feel better,
everybody's going to say it's not hormones. Right, So then
(19:23):
we've now got people not well controlled because they've got
to cut patches, they've got to have time off. Some
people are really I believe slow to accumulate, not scientifically
correct the impact of it.
Speaker 4 (19:36):
So then you know, actually that tiny.
Speaker 5 (19:38):
Drop in the dose is really destabilizing others. Literally they
don't change a patch for a day and they get
body pains, flu like symptoms. And so this is why
I think it's more than just there's not a patch shortage.
It's a real dismissal of what your needs are at
that time to enable you to live a well life.
Speaker 2 (19:58):
Yeah, we were going to touch on that whether these
treatments are all the same. For example, you know there's
been reports about FAMIC having conversations about funding the how
do I say estrod dial gel?
Speaker 3 (20:13):
The Yeah?
Speaker 2 (20:14):
Yeah, is that equivalent to the dot?
Speaker 3 (20:17):
Is it the same?
Speaker 5 (20:18):
Like?
Speaker 3 (20:18):
Do these things all deliver the same thing equally?
Speaker 4 (20:21):
So I think we've got to say no.
Speaker 5 (20:23):
But I think we've also got to say that estrogel
is a fantastic option.
Speaker 4 (20:29):
You know, it's transderm l so it's.
Speaker 5 (20:30):
Estrogen absorbed through the skin, which is the main symptom
and health improver. Putting it really bluntly and simply, and
actually some people will need more than one hundred micrograms
of estro dot or estradyl, but they may only need
half the dose equivalent of estrogel.
Speaker 1 (20:49):
Right, But that gets tricky then too, doesn't it cemant
that the doctor's understanding what the patient's going to need
and the difference in the in the prescribing to these products.
Speaker 5 (20:59):
Yeah, absolutely, So I did do a leaflet and I
can you can have this for your resources as well
about kind of the common questions and a bit of
a dose comparison. But I definitely frame it with my
patients that you know, actually I believe you when you
tell me life is now awful, or I believe you
when you're like, oh, actually I feel much better. That's
a sign we should increase the dose and just kind
(21:20):
of try to give people that flexibility as well. But
you know that's not the system isn't set up for that.
So you know, I had to build I had to
build time into counsel and to make it easier with
the pharmacists and the prescriptions. So you know, it's really
labor intensive for all of us involved. It'd be really
cool to just actually, and I think we can just
(21:41):
completely rearrange women's health overall and just make it easier
in every way.
Speaker 3 (21:46):
Let's do that exactly.
Speaker 1 (21:47):
Why not samant that at the moment we've got the petures,
the Instra dot or extile, do we have Cream's Julls sprays?
Speaker 3 (21:56):
Are what else is actually available now to New Zealand women.
Speaker 5 (22:01):
The funded options of estrogen in New Zealand transdermally so
that's estrogen that goes through the skin, so it's much
safer is the patches. Only the gel is available and
it's unfunded, and because pharmacies are private businesses, Farmac or
nobody can price set how much you pay for a
for a tube of gel.
Speaker 4 (22:22):
I normally have an old one as a model.
Speaker 5 (22:24):
I don't have it with me, so there's a real
variety in price. But last week Farmac did release a
statement to ask for opinions and thoughts about whether to
fund the gel.
Speaker 4 (22:34):
So it's looking.
Speaker 5 (22:34):
Positive, which is really cool. But to get to that stage,
the gel's actually we've had to campaign to get rid
of some extra legislation around it as well, and we
still I don't know. I'm still a bit skeptical as
to what are the supply is like if the gel,
so actually I feel we still need to know more.
Speaker 4 (22:53):
But there is oral estrogen, and.
Speaker 5 (22:56):
You know, for young for younger people who are low risk,
actually oral is really is pretty safe.
Speaker 4 (23:02):
Some people do better with oral as.
Speaker 5 (23:04):
Well, and for some users even the anxiety you know,
of not having to am I going to get my
medication every month can be offset by knowing that maybe
their symptoms are slightly not as well controlled with the
oral which is like from my perspective, you know, I
always want to practice gold standard best practice medicine, and
(23:26):
suddenly my best practice is actually which you know, what's
the lesser evil?
Speaker 4 (23:31):
Pick your poison, what's worse for you?
Speaker 2 (23:34):
If you're taking oral dose, what can you prescribe? Is
it one month at a time? Two months at a time,
Like how often does the woman have to go back?
Speaker 5 (23:41):
Yeah, so if oral estrogen by itself is like the
kind of regular medication, so I can prescribe three months
at a time, but pharmacies cannot should only be dispensing
one month at a time, which again I think, you know,
from a practical perspective, it's logistically harder for women. You know, busy,
you've got loads on in life. But that's a whole other,
you know, a whole other national thing together. The flip
(24:05):
side is you can prescribe six months of the pill.
So actually some women and there's some new unfunded pills
that are really good for mood challenges in perimenopause. So
for some women they control bleeding better, they better for mood.
They're you know, they're pricey, but actually that's beneficial. So
(24:27):
there are other options depending on what their priorities and
needs of the individual are.
Speaker 1 (24:33):
Louise, do you want to tell Samantha where you thought
you put the estrogen gel?
Speaker 2 (24:37):
Well, I think I might have been confused when I
saw gel. I thought that you put it in your vagina.
Why it's there a gel?
Speaker 4 (24:45):
That ye cream?
Speaker 2 (24:48):
Like?
Speaker 5 (24:48):
Yeah, definitely, I love book about vaginas.
Speaker 2 (24:51):
I can tell you about these please, But but the
normal h I T GL doesn't go.
Speaker 3 (24:57):
You can just put it on.
Speaker 5 (24:59):
It's on your from your shoulder to your shoulder to
your wrist right right and Sandrna another gel rubs on
your tummy, on.
Speaker 4 (25:06):
Your belly right.
Speaker 3 (25:08):
That gels for everybody part there are.
Speaker 5 (25:11):
But yes, the vaginal cream is a vestin and that's
a different kind of estrogen called strile, which is likes
the genital the genita here and I talk about it
is like as we get older, or you know, our
skin dries, and the vaginal skin dries as well, and
it becomes thinner and it does get a bit smaller,
(25:33):
and even regardless of sexual relations, it impacts bladder function,
pelvic muscle function, sexual function and comfort. Whereas if you
use a vestin it's like a moisturizer if your vagina,
so it can really prevent like loads and loads of
the symptoms. And it's the only condition of menopause that
will never get better. So once you have vaginal dryness,
(25:55):
you've got vaginal dryness.
Speaker 4 (25:56):
But using some.
Speaker 5 (25:59):
Grain, which is the you know, the gold standard, prevents
it decreasing and you always need to use it.
Speaker 2 (26:05):
But it doesn't have any other It doesn't do anything
for the recently unapaus or somebod just for the vagina.
Speaker 4 (26:10):
It shouldn't.
Speaker 5 (26:11):
But if you've had if you've got conditions where you
can't have estrogen, for example breast cancer or liver and
liver issues, then you can still have vaginal estrogen because
it's not thought to go systemically in the body.
Speaker 4 (26:25):
However I do so it doesn't have an impact on
the other tissues.
Speaker 5 (26:28):
However, I do always say to my patients that actually,
when the tissues are really dry, they're often really thin,
so you do get more absorption, but really quickly that
stops being absorbed because I think you know, if you're
just say you know, I give you estrogen and I've
told you it's safe, it's not going to impact your
breast tissue at all, and suddenly you get breast tenderness.
(26:49):
You're going to be like, what what on earth the
doctor told? And you can feel it, so you know
it's true. So I always tell my patients that. And
for those that are really kind of, you know, hormone
averse or just it just doesn't lie right with them,
then you can bring the doses down even more because
some people are more sensitive to it.
Speaker 1 (27:07):
If you're listening to the little things in Our guest
on the podcast today is GP and Women's health specialist
doctor Cement, the newman talking everything HRT.
Speaker 3 (27:14):
We're going to be back shortly after this break.
Speaker 2 (27:21):
So it's not just a hormonal cancer that would cause
you to not be able to take HRT.
Speaker 3 (27:26):
And I know you would need a proper consult. Can
you go to a GP? Do you need an endochronologist?
Speaker 2 (27:32):
Who do you talk to if you don't know whether
something you've had in the past like apatitis for example,
or or you're on a blood finner or whatever. Is
your GP still the first stop for advice about that?
Speaker 3 (27:45):
Yeah?
Speaker 5 (27:45):
I think your GP should be the first stop because
they know you, they know your history, and for me,
as a DP, any medication is about the whole person.
It's about you know, what is right with you, your
family history, what your FINO is saying, and actually is
a GP we're best place to do that. Obviously, you know,
we're not experts in every other condition as well, but
(28:07):
we are general practitioners. We that's what we specialize in,
and we also specialize in kind of that general risk assessment.
So therefore, some gps who are really confident with hormone
replacement therapy will actually be happy to, you know, work
with the guidelines and maybe do things which aren't necessarily
(28:27):
typical and recommended because it's in the best interest of
the patient and for that relationship. But I think it's
you know, it's really important that everybody has their needs met,
and even if that's you know, actually that you do
need to go to a specialist and find out what
are your needs and how can these be met? Because
EP and as I kind of like as I said
at the beginning, when I see the impact that the
(28:49):
appropriate management option can be in someone, it's about framing
that is, can we achieve that? Because then I think
you have to consider the risks in the context of
that and being a bit kind of airy fairy, But no.
Speaker 3 (29:03):
I know you mean.
Speaker 2 (29:04):
I think it's that thing of population health versus the
individual's health as well, and that keyword management.
Speaker 3 (29:10):
And that's great.
Speaker 2 (29:11):
If you have somewhat health literate and you have a
GP who you can easy access and describe your symptoms too,
you could get through that snowstorm a little bit easier.
Speaker 3 (29:20):
I just worry.
Speaker 2 (29:21):
I suppose for those people out there that are just
they don't even they go, oh, well, I'm probably excluded.
Speaker 3 (29:26):
I don't know what to do.
Speaker 2 (29:27):
You know, I can't see anybody and they're kind of
putting up the stuff they don't need to. I know
that estrogen HRT in general deals with the range of
issues that come up with without aestrogen dropping off and things.
So would somebody who can't take that they could take.
Is vitamin D a good thing to be taking, or
like once a month? Or there are things that we
can do for our bones that we if we can't
(29:49):
take HRT.
Speaker 5 (29:50):
Yeah, I think it's about what are your symptoms and
what are we targeting? So putting it bluntly, you know,
HRT is the best option for managing hot flushes and
managing mood that are related to hormone changes, but that
doesn't mean it's right for everyone, and not just because
of a medical you know, contraindication. And so then I
tend to break it down so like lifestyle things that
(30:11):
you can do, and then there's some supplements and then
non hormonal medications. So even some lifestyle things can be
pretty transformational, such as you know, changing the way we
eat because our metabolism changes, and eating at slightly different
times of day, and then supplements. Also you do have
to be careful of with medical conditions too, like phytoestrogens.
(30:34):
If you've got any student sensitive cancer and you do
not want any estrogen, then it's pretty counterintuitive to go
and take as much estrogen through food as you can
through the phytoestrodents. But vitamin D is it helps with immunity,
it helps with probably some cancer prevention, probably some mental health,
brains infection. So that's for me, what menopause and hormonal
(30:58):
health is. It's actually taking a step back and looking
at what else can you do to optimize well being,
and I think we need to do that alongside any
kind of hormones as well. There are non hormonal medications
which can be prescribed specifically as such for menopause, and
some gps still have these as their first line and
(31:18):
they're not wrong. So antidepressants can improve hot flushes in
fifty percent, and that says so many things to me,
because actually there's a huge brain hormone link, so that's
also where it helps, but also the serotonin and the
eater and they all interact with temperature regulation too. Sleep
is another really big thing. So for example, if somebody
(31:40):
has got really marked sleep disturbance secondary to menopause, then
I might go for something like gabapentin, which is a
medication that we use for chronic pain and for some
other kind of neurological conditions, and so that can be
really helpful there, but it also can help hot flushes
as well. There's some other antidepressants called venola vaccine, and
I'd often use that one if somebody has got bad
(32:03):
body pains at the same time too. And with all
of these options, there's different kind of doses and things
and durations and how long it takes to work. And
I also think that it's about being realistic about what
our gains are. So when I first started prescribing HILT,
the teaching was you have to be eighty percent better,
but actually you shouldn't have.
Speaker 4 (32:24):
To be eighty percent better to continue any medication.
Speaker 5 (32:27):
It may be that you don't want hormones and the
whatever antidepressant medication decreases your hot flashes by one per
night or they're not as much, but actually that is
enough to improve your quality of life without the side effects.
Speaker 4 (32:41):
So yeah, and there are others.
Speaker 5 (32:42):
As well, but hopefully that's kind of given you a
little bit of an.
Speaker 1 (32:45):
Overdam Yeah, for sure, it's really positive because for women
who maybe can't take hormones or want to and have
some issues, there are some other ways to sort the
mountain things. If you're a relative, if you're a sister
or a daughter of a woman with a hormone in cancer,
should you be questioning whether HIT is still a go
for you.
Speaker 5 (33:04):
So I think it's a bit too broad to say
a hormone related cancer, because actually a lot of cancers
are hormone sensitive in different ways, and it's probably beyon
the scope to go through that. But putting it kind
of a little bit more broadly, it's about what breast cancer. No,
if you've got a family history of breast cancer, it's
(33:25):
not a contraindication for you to have it. But what
I would be doing is I'd be like, Okay, what
could this medication do to you? Because if it means
that you're going to get more sleep, if it means
you're going to be able to exercise so you don't
put on weight, if it means you're going to stop
drinking your alcohol, that's going to decrease your risk more
than not having it. The flip side is I'm like, Okay, great,
(33:47):
this is a really wonderful opportunity to talk about how
we can pick up any form of cancer depending on
you know what it is. So for breast cancer, I'd
be like, great, so we can look at how are
we going to do your screening, how are we going
to optimize it, When are we going to do it?
Speaker 4 (34:00):
What about examinations.
Speaker 5 (34:02):
I mean, I've got some women who have got family
histories of breast cancer and they are like, well, I
can't cope right now, but I really don't want hormones.
But right now I know that that tiniest dose of
hormones may make me a little bit better, and then
I'm going to stop it. Because the data when you've
been on some forms of HRT for five years or more.
The risk of breast cancer increases, but still with any
(34:26):
form of breast cancer bavarian cancer, women are more likely
to die of cardiovascular disease than cancer. And starting hormone
replacement therapy in the perimenopause decreases cardiovascular disease by thirty
to fifty percent. It decreases diabetes, chdorectal cancer, depression, psychosis,
(34:46):
autoimmune disease. So we've really got to kind of, you know,
step back and enable our community to look at what
are your needs and what's the best way to support
you forward from you know, a symptoms to review, from
a screening, from a supporting health changes as you transition
through mid life.
Speaker 2 (35:05):
No, you're dead right, because if you're in your early
forties as I was, actually you know, not sleeping, stressed,
cars ale, pulsing through the body, not coping with the
smaller things that even the little things in life kind
of hitting the wall bloody, how could have been metopausal?
Speaker 4 (35:20):
You know?
Speaker 2 (35:20):
And also that that is really taken away from your
quality of life and potentially can be linked to disease.
Speaker 3 (35:26):
Right, So it is that balance, as you say, and.
Speaker 2 (35:31):
I think so quite often we go to the GP
as a last resort instead of at the beginning of
the thing. It's the GP is really not supposed to
be the ambulance at the bottom of the cliff, and
we need to make that time. You know, don't do
it just as an emergency. Everyone says, oh, you can't
get into GP when you need to, but you probably
needed too three or four weeks ago.
Speaker 3 (35:53):
Aye.
Speaker 5 (35:53):
And that's just I think where we almost need to
step back and look at what can we do as
women who see that we have needs to support that
health system. Because I don't want because needs aren't going
to be mere if we tell every midlife women to
go to the GP to have a discussion on HRT.
But actually, you know, as a health system, we weren't
(36:13):
set up to educate everybody on the whole of every
single medication and health condition.
Speaker 4 (36:20):
So we need to kind of look at what else
can we do.
Speaker 5 (36:22):
And that's why you know, like your podcast is great
because actually hopefully that will give some people some ideas
so they can also maximize the time with their GP
on the GP strengths, which should be diagnosing, putting things together,
and interpreting appropriate investigations.
Speaker 1 (36:37):
And it's really important to say as well that we
don't just expect people to turn to medication to solve
all their problems, but a lot, a lot of women
are turning to it. How do they have done all
the things they're supposed to do? You know that they've
tried to get their good sleep, they've cut back on
their alcohol, they're watching their diet, they're trying to exercise.
You know, like, it's not one person's problem to solve.
We've got to take some personal responsibility for getting through
this period in our lives a beast that we can
(36:59):
as well. Knowing about it is a good but knowing
about it is a very very good start. And I
just love the way that you are just advocating for
women's health so strongly submit that. And I was thrilled
to hear about the course that you're running for GPS.
But I believe that you're also you have a menopause
course for women as well.
Speaker 4 (37:18):
Yeah, you're right.
Speaker 5 (37:19):
I just I've learned so much from my patients, and
I think, you know, I can't do what I do
in fifteen minutes, So what I wanted to do is
make my colleagues lives easier. So I kind of like
a little bit of a walk through of what I
do with my patients to help understand what your symptoms are,
Could it be hormonal either when you've gone through it
at the moment, or what could you expect and how
(37:41):
these kind of like the hormones change. And we've put
some resources there as well, and you made a work
book too that you can take to your GP to
work through with it. And I'm hoping that through staying
really closely intact with like my Women's Health Network and
the GPS are interested in it, but also general GPS
because it's so inseparable. And I've had really cool positive
(38:01):
feedback which has been really nice as well. And we've
got a podcast on sorry of course, on hormone replacement
therapy coming so where I can like dive a little
bit more deeper about what to expect, what the side
effects are, what happens if.
Speaker 4 (38:16):
It doesn't work, and.
Speaker 3 (38:18):
Are people find you? Yeah?
Speaker 5 (38:21):
It's my website's ww dot female, gt dot co dot NZ.
Speaker 4 (38:26):
And it's forward slash all.
Speaker 5 (38:28):
And the reason I've done it like that is because
I've been just like amazed by men I see and
fin and I'm like, ah, this makes sense based on
my knowledge of women's health. So kind of my dream
moving forward is to pick up some of my women's
health knowledge and to put it in a different framework
to help more people than just midlife women, because I think,
you know, hormones are just a part of it. But
(38:50):
when you see things through a hormone lens, it gets
it's easier.
Speaker 3 (38:54):
Oh my goshes so sure does.
Speaker 2 (38:56):
So. Look, I know you've given us so much to
think about, but if you're going to get of that
woman who's teacherly, I don't know, early like thirties, early forties,
a little bit exasperated feeling, you know, could it be this?
Speaker 3 (39:07):
Could it be that?
Speaker 2 (39:08):
What's the one piece of advice you've given a woman
wanting to start or to start to investigate HRT at
the moment in our current setting, I'd say be open minded.
Speaker 5 (39:17):
So be open minded about what your symptoms could be
caused for prying different options and also reassessing when it
doesn't work to help understand what it is. And I
often use hormones as a diagnostic trial, so actually, is
it working or not? Is that going to help us
kind of figure out what's going on?
Speaker 1 (39:37):
Brilliant, It has been such a delight to meet you, Samantha.
Thank you so much for your time today.
Speaker 4 (39:43):
Oh no, thank you for having me.
Speaker 3 (39:51):
How fantastic is Samantha.
Speaker 1 (39:53):
I'm just I so appreciate the work that she is
doing in the advocacy she's doing on behalf of all women,
enabling us to get the healthcare that we deserve. She's
certainly passionate about it, but in an incredibly practical way, yes,
which is exactly.
Speaker 3 (40:07):
What we need.
Speaker 1 (40:08):
Hey. Something that we sort of spoke to her before
the podcast on which we didn't get to was talking
about women who might have had a hysterectomy and the menopause.
Speaker 2 (40:17):
Yeah, which touches on the comment that the Australasian Menopausal
Society said that to go back to focusing on your
cycle and bleeding and things, those women won't bleed. They
still have the ovaries, but they won't have a period
to gauge anything on. Or you could be on a
mini pil and not be getting a period. There are
a number of reasons you won't be getting a period
(40:39):
that you should still be taking your hormones into consideration.
Speaker 3 (40:43):
Absolutely so, just making a mention of that there.
Speaker 1 (40:47):
Thank you so much for joining us on our new
Zealand Herald podcast Serious for Little Things. We hope you
share this podcast with the women in your life so
that every woman that wants or needs the estrogen gets
the estrogen will their help.
Speaker 2 (40:58):
You can follow this podcast on iHeartRadio or wherever you
get your podcasts, and for more on this and other topics,
head to inzid Herald dot co dot z and
Speaker 3 (41:08):
We'll catch you next time on the Little Things
Hello, I'm Francisca Rudkin and I'm Louise Ariie. Welcome to
season three of this New Zealand Herald podcast, The Little Things,
a podcast that looks at the little things that can
make a positive impact on our day to day life.
Speaker 2 (00:19):
We're so excited to be back, aren't we, Francisco, We
certainly are, and as we have with previous seasons, our
aim is to cut through all the confusing noise and
information out there to focus on the facts, and we
have a fabulous collection of experts joining us to talk
about a whole range of issues.
Speaker 3 (00:34):
This season.
Speaker 1 (00:35):
Now The Little Things has covered perimenopause and menopause with
Nicky Bizant and doctor Jenny Mansburg, both episodes worth listening
to if you haven't already.
Speaker 3 (00:44):
If I can say that.
Speaker 2 (00:45):
No totally I hosted that you're particularly good in them Noise.
Today we want to focus on a very topical aspect
of this HRT, the crazy shortages of it and other
options if it's not for you.
Speaker 1 (00:59):
I've got a friend who said to me the other day,
she actually texted me, you have to do a podcast
on this. She said, I've never really had a conversation
with any of my friends about HIT. She's a couple
of years younger than I am, and she said, I
have had three conversations with different women this week. They're
all beside themselves. So if you are on HIT, then
you'll know that there has been a shortage of it
in New Zealand the patches, and that's been a case
(01:19):
for a while now. Pharmacists are doing their best. If
you were lucky, you might have been given a different
dosage and told to cut it to your dosage size.
That is what I have been doing terribly well now
for quite a few months. But for many women they're
just told we don't have it.
Speaker 3 (01:34):
Sorry.
Speaker 2 (01:35):
So we're getting nuggets of news telling us we should
be happy because we could soon have the option of
a funded gel which could help ease the HRT shortages.
But when what has to happen for that to get
off the ground. So how do we handle the shortage
that we're in at the moment? How do we advocate
for ourselves better to know whether HRT is even for
us and what is our access to other options?
Speaker 1 (01:58):
Joining us today is doctor Cement the Newman, a GP
with a specialist interest in women's health. Samantha also lectures
at the University of Auckland, does research with the University
of My Nation Oz and is a fabulous human who
is constantly advocating for women's health needs.
Speaker 3 (02:14):
Welcome Cement, the good to have you with.
Speaker 4 (02:16):
Us, Curta, thank you for having me.
Speaker 1 (02:19):
Okay, for those thinking about using HRT in the future
or now, can you give us a quick rundown of
what it is?
Speaker 5 (02:27):
Yeah, absolutely so. By definition, HRT is hormone replacement therapy
and it's also known as menopause hormone therapy. But as
we're going to kind of cover over the next wee while,
it can be used not just to replace hormones, so
I can kind of you know, for me, I often
talk about it supporting hormones. So it depends on when
(02:48):
you use it as to what the role exactly is.
Speaker 3 (02:51):
It's a lot more nuanced than just going estrogen.
Speaker 5 (02:55):
Yeah, definitely, and I think that's for me about you know, actually,
why as a door, if I prescribe any medication, I
need to know what I'm prescribing it for, what I'm
expecting the outcomes to be. And actually so my patients
know what to expect and you know that's going to
be with side effects and with benefits as well. And
that's one of the things I see really kind of
(03:17):
like not done wrong, but I feel we could do
better if we understood actually what we're trying to treat.
Speaker 4 (03:24):
And the names are both a little bit misgiving.
Speaker 5 (03:27):
And so if you go back to literally like the hormone,
I call it the reproductive journey. Then actually, at puberty,
our hormones are increasing, so we get rises in estrogen
levels while our body settles things out. And then while
we're in our twenties and our early thirties, things are
pretty regular and we're our peak fertility, so things are predictable.
(03:50):
And then as we go into our mid thirties at
late thirties, this was a really huge light bulb moment
for me because actually we get even more hormone change
in our late thirties onwards than we do at puberty.
And what I mean by that, and this is how
I describe it's my patient, So is every month the
brain is telling the ovary to release an egg, and
(04:13):
the over releases estrogen in perimenopause. So after our peak reproductivity,
then the brain has to shout a bit louder because
the over is getting a bit tired, and it's like, seriously,
come on, I want a little break. And so that's
when we get a hormone the f S eight and
you don't have to remember that rises and then eventually
(04:34):
the ovary kicks in and shouts really really loud, and
estrogen shoots up. And this happens just before ovulation. So
in perimenopause, this rise in ovulation and estrogen is actually
greater than that at puberty. Then after ovulation, estrogen drops
a little bit and then it rises again. So if
(04:54):
you're starting hormone replacement therapy in perimenopause, well you're not
replacing the easter because the hormone is a tiny dose
compared to these huge, bigger levels at perimenopause. So therefore,
this is why I say, at perrymenopause, we're supporting these
high levels of estrogen, and yeah, we are buffering it,
(05:16):
particularly as things go on by you know, positrogen does
drop over time, but in principle, the majority of terrymenopause
symptoms are because of huge hormone chains, So that makes sense.
Speaker 2 (05:27):
Yeah, so sorry, you're saying that contrary to the idea
that we've Estrogent is lowering at certain times of the month,
that's actually keeping stronger, right.
Speaker 3 (05:38):
Yeah.
Speaker 5 (05:38):
Yeah, So that was a total light Bob moment for me.
And it's amazing when I'm with patients and I'm going
to use the example of migraines. So a lot of
the time people come and they're like, oh, my migraines
are getting worse. And because I like to see everything
through hormones, I ask them when was you When do
you get the migraine?
Speaker 4 (05:55):
When was it?
Speaker 5 (05:56):
And they're like, oh, well, you know, but every two weeks,
and I'm like, okay, so tell me when. And so
frequently it corresponds to about ovulation and then again pre menstrual,
and that's because our ovulation you've got this huge rise
in estrogen. And typically the rise is often exacerbate migraines
with aura the way you get funny neuro things as well,
(06:18):
and the drop is often migraine without aura. And then
it happens again pre menstrual and menstrual, and so it's
just amazing when I have like a drawing in my
planet and I and whiteboard markers and I like literally
go through the menstrual cycle with my patients. And when
you know that every other week, basically your hormones are
(06:39):
going up and down. Then that in essence gives you
a bit more clarity and understanding because often mood changes,
you know, correspond to these body pains, fatigue, irritability as well.
So I think, you know, that's the first the first
clue is, you know, taking a history and finding out
what's going on.
Speaker 1 (06:58):
It just amazes me, you know, I've learned more about perimenipals.
We'll only learned that peri perimenopause existed about three years ago.
I've learned more though about perimenopause and menopause in the
last sort of three years, and I have in my
entire life, and yet I'm still constantly learning. And I
just think so many women don't even really even understand
how their cycle works.
Speaker 2 (07:19):
No, no, and we don't know what's happening in our
late thirties and early fall.
Speaker 3 (07:22):
No, that's news to me as well. So it's just crazy.
Speaker 1 (07:26):
If we are looking at the kind of symptoms then,
and obviously they can be different compared to dependent on
whether you're in perimenopause or menopause. What kind of symptoms
though might women be suffering from where hit can come
in and an assist, so, you know, just.
Speaker 5 (07:41):
To add further levels of complexity. Oh, how do I
phrase this? So traditionally, perimenopause is diagnosed or defined by
a change in your menstrual cycle, and that's what their
straw criteria say. And the reason I'm saying this is
because last week the Australasian Menopause Society released a statement
(08:04):
saying HRT is being prescribed too much in cases that
aren't menopause, so therefore we need to be looking at
the straw criteria, which is based on periods and using
HRT appropriately. However, it's really hard for me and other
doctors when we see these hormone changes occurring in the
late thirties, and often it starts as anxiety and irritability
(08:29):
and pre menstrual symptoms.
Speaker 4 (08:31):
So I kind of wanted.
Speaker 5 (08:33):
To just, you know, say that, because actually, if anybody
listens to this and is like, oh, I completely agree,
this is me and then they go to their doctor
who like, but one of our advisory bodies is saying
this isn't perimenopause. I don't want my patients to feel
or don't want any of your listeners to feel dismissed
or unvalidated. But actually for me, does it matter is
(08:54):
by definition this old definition of perimenopause which needs to
be updated or what they say the fun NDA. Mentally,
the best most effective treatment is hormone treatment. And I believe,
and there's some incredible doctors in Australia and worldwide, but
that the psychological symptoms of menopause often occur five years
(09:18):
before their physical symptoms, which then also I'm like, why
can't I try hormones if that suits the patient and
it's appropriate. You know, it's a patient choice and there's
other factors at play when it's the most effective.
Speaker 4 (09:31):
So whenever I see.
Speaker 5 (09:32):
Anyone in clinic, I'm always like new onset insomnia, irritability,
burnout and worsening migrains, recurrent injuries, chronic plane fibromialdia.
Speaker 4 (09:44):
I'm like, what's your period's doing?
Speaker 5 (09:45):
Because I think those are the clues that as doctors
we need to be hanging onto. And that's because in
my experience, when you experience these, it's this heads up
that perimenopause is going to be more challenged. And then
as time goes on and the hormone level has changed,
you almost lose that cycle where you have these two
(10:08):
peaks and it kind of then can almost blur into one.
And as the symptoms become more pronounced, I think.
Speaker 1 (10:14):
There's probably a lot of women out there going, well,
hang on a moment and just going back five to
ten years.
Speaker 3 (10:18):
I no, I am, I know, I am. I'm just thinking.
Speaker 2 (10:20):
So you're saying that they said that the Australasian Australasian
or Australian.
Speaker 4 (10:26):
Yah Oustralaian menapause society, as.
Speaker 2 (10:28):
I've taken it back to just the bleeding phase effectively,
Yeah right, Yeah, well that's.
Speaker 4 (10:35):
Straw minus two. Yeah.
Speaker 2 (10:36):
Yeah, that's interesting because you know, as we've talked about
over and over again, the symptoms are so many and varied,
and the bleeding is a sub symptom almost. It's the
thing that you say, like you say, becomes more radic.
But a lot has gone a lot of water has
gone under the bridge before that. So I find that
a little bit unusual, I guess as a blanket statement.
Speaker 5 (10:57):
Yeah, yeah, and kept mean that, you know, actually this
is why And I'm really happy to like really honor
to have this opportunity today because I think if we
can all understand what's going on in ourselves. Then we
can advocate better for what our needs are, and actually
we can set ourselves up to succeed because it's about
patient choice and what's safe for the patient. And also
(11:19):
the other flip side is as a doctor, I don't
want to miss anything. So if you've got, like you know,
new onset severe mental health problems, I don't want to
miss a clinical depression and a psychosis. But actually it's
rare that I can't consider it alongside is this hormones
and the same as palpitations and cardiology. But actually generally
I can consider it alongside.
Speaker 1 (11:40):
Absolutely, as we become more knowledgeable and as more women
understanding men of pause, it's very quick to immediately just
presume a symptom is associated with it, and of course
they must be must be cheeked out.
Speaker 3 (11:52):
Don't just make a presumption that's right now.
Speaker 2 (11:54):
The woman I've talked to about this, since we've been
doing a lot more on this, the one thing I've
sort of they've gone on, I haven't really looked into
HRT or they're putting up with symptoms. I've tried to
remind them or actually just told them to listen to
Genny Orniky or you now that it's actually a medical
there are medical implications to this. You could be feeling better,
(12:14):
but you also could be doing your actual health favor
as well.
Speaker 5 (12:18):
Ah yeah, And it's just I think women have been
dismissed for so long and everybody's saying, now, oh, HRT
like it's the fad.
Speaker 4 (12:27):
Everybody's going on it.
Speaker 5 (12:29):
But I'm like, actually, women have had so from puberty,
rates of depression and mental health in women suddenly double.
You know, it's one to one pre puberty and it's
two to one post puberty, and every reproductive transition, mental
health diagnoses increase so much more so.
Speaker 4 (12:47):
Actually, I just wonder what.
Speaker 5 (12:49):
Really is female mental health when you factor in hormones
and we need to kind of like look at it
on the table and be like, can we do this
better rather than saying, oh, now we're over diagnosing it,
but actually we'll be missing it before. And I never
thought i'd like feel really confident to stand up and
say that, but I'm just blown away by my patients
(13:11):
who have like trusted me, and I'm like, h putting this,
this and this together. We could try hormones or and
we can talk a bit more about how I try
the hormones as well, but they get better.
Speaker 4 (13:23):
And I'm like, if.
Speaker 5 (13:24):
I am prescribing and working with patients that haven't worked
for ten years or have come to me from psychiatrists
or from the concussion planic, I almost have a little
bit of a responsibility now to say try it, particularly
if there's no conflict indications, because what could these benefits
be for you? And I still doubt myself, you know,
I doubt. I'm like, oh, well, maybe it's not. But
(13:46):
I've also learned, you know, doing it alongside. So if
I've started someone on hormone therapy and you know, three
months later there's no improvements, six months later there's no improvement,
now I'm actually confident to say, actually, I don't think
this is hormones. And you know, sometimes we stop the
HRT and you know it doesn't make a difference, But
(14:07):
other times their improvement has been a bit insidious, and
it can unmask other conditions as well.
Speaker 4 (14:12):
So it's a.
Speaker 5 (14:13):
Constant, like dynamic reassessment, where am I at kind of thing.
Speaker 1 (14:18):
I'm not sure a lot of GPS talk or have
the same knowledge as you cement that which your course
is quite a concern for women who go in and
you know, who've maybe got the carriage to go in
and have this conversation and say I think I need
some help here, and I think it could be quite
They can get quite a black and white response. Would
it be fair to say no offense to GPS out there?
Speaker 5 (14:39):
So I just, yeah, I think you're right, But I
also think we need to reframe it because this is like,
you know, who GPS actually really want to learn. I
ran the fair I think it was the first GP
education day on menopause in May and we had over
four hundred healthcare professional that ten awesome. It's been so
(14:59):
much command the Good Fellow Unit and now offering it
as a pay per view the healthcare professionals as well.
But actually, you know, in everybody's defense, you know, I've
kind of navigated my own way because I'm a bit
of a super geek and my teachers from school will
always say that, but it's not been easy finding that out,
and it's.
Speaker 4 (15:19):
All over the place.
Speaker 5 (15:21):
So I like teaching or more talking about women's health
and making things easier for people. But actually, if our
community can also figure out what do I need to
do to kind of communicate this to make that journey easier.
But also I think when I'm doing community sessions, they
actually give the DP space or the doctor space to
(15:43):
actually go back to what their needs are because actually
is a doctor, I don't want to miss anything. I
want to get it right and I want and it's
the best option. And also HRT prescribing has changed so
much over the years that it is really hard to
keep on top of everything and to confidently prescribe it.
And the guidelines are all still say you should only
(16:04):
use HRT for like moderate to severe hot flushes when
everything else has not worked, and for low dose for
as short as possible. So you know, actually, in doctor's defense,
it's really bloody heart.
Speaker 2 (16:15):
It's a case of not the blinding the blind, but
a little bit of a snowstorm for the patient.
Speaker 3 (16:21):
The woman and the doctors. Yeah, so we're kind of
just nevi getting this all together, aren't we.
Speaker 5 (16:25):
That's almost how we've got how we've got to reframe it.
And that's how I learned from my patients. So also
when I do my teaching, and like patients will say,
like when I first started, oh, my ringing in my
ears has stopped, and like you know over the years
now I've made mental notes of all of these things.
Speaker 4 (16:40):
Oh you're so you're ringing in your ears? Are stopped its?
Speaker 3 (16:43):
Yeah?
Speaker 5 (16:44):
Yeah, because there's progesterone receptors and that affects the fluid balance.
There's estrogen receptors in their ears as well.
Speaker 3 (16:49):
And you can also say, gosh, I had not put
to and two together.
Speaker 1 (16:52):
I'm having a little moment here because I was thinking
it was my life wearing headphones and being in radio
and listening to loud music too much to me there,
and I was sure I was heading down the road
to tatus. And actually, now you mentioned that it has
lessened so much, I see to the list, still learning
a bit to the list. Hey, we should probably touch
(17:14):
on the fact there's a lot of women going yep, no,
we're hearing you and keen to try this or and
trying to use it at the moment. But we've got
this ridiculous situation of a shortage, and I know it's global,
and I know that far Maker is trying to sort
it out, but what impact is it having on women
who are on hi T And then all of a
sudden you can't get the patch that you've been on.
Speaker 4 (17:34):
Oh it's really tough.
Speaker 5 (17:36):
So a few weeks ago, at seven p thirty on
a Saturday night, I was doing my repeat prescriptions and
a patient that I've known for a long time had
emailed me and was like, Sam, I haven't got any estrogen.
I haven't had it for two weeks. And I was like, what,
this has taken us years to get you feeling as
good as you are, and this individual is not in
(17:56):
Hawk's day anymore. So I ended up calling the farharmacies
in their area then sent a script half an hour
away from my patient. I was like, a center script here,
and I was like, this is just not okay. So
I then developed a survey to try and capture some
of these stories because I think people don't realize the impact.
And that's actually because you're going back to what we've
said already about setting the scene, so people don't know
(18:19):
the improvement it is. So actually, if it's just top flushes,
then actually, why why does it really.
Speaker 4 (18:25):
Matter that much?
Speaker 5 (18:26):
But if it is preventing suicidality, if it's keeping people
in the workplace, if it's keeping people in relationships, then.
Speaker 4 (18:32):
Actually, you know that's very different.
Speaker 5 (18:35):
And so what I wanted to do is actually share
these stories that I hear every day, to be like,
this is why it's really important. So just under twenty
three hundred people filled it out in two weeks, and
it's a really humbling read actually, even though it's kind
of what I see every day. But with you mentioning
before about changing the patches, so fifty percent of users
(18:59):
have an improvement with Estra dot, so one of the
brands and not Estra dile And so why is that
so significant. Well, if you are one of the four
point six percent who is better with the other option
and you have no improvement with Estra dot, well if
you're given extra dot and it doesn't help you feel better,
everybody's going to say it's not hormones. Right, So then
(19:23):
we've now got people not well controlled because they've got
to cut patches, they've got to have time off. Some
people are really I believe slow to accumulate, not scientifically
correct the impact of it.
Speaker 4 (19:36):
So then you know, actually that tiny.
Speaker 5 (19:38):
Drop in the dose is really destabilizing others. Literally they
don't change a patch for a day and they get
body pains, flu like symptoms. And so this is why
I think it's more than just there's not a patch shortage.
It's a real dismissal of what your needs are at
that time to enable you to live a well life.
Speaker 2 (19:58):
Yeah, we were going to touch on that whether these
treatments are all the same. For example, you know there's
been reports about FAMIC having conversations about funding the how
do I say estrod dial gel?
Speaker 3 (20:13):
The Yeah?
Speaker 2 (20:14):
Yeah, is that equivalent to the dot?
Speaker 3 (20:17):
Is it the same?
Speaker 5 (20:18):
Like?
Speaker 3 (20:18):
Do these things all deliver the same thing equally?
Speaker 4 (20:21):
So I think we've got to say no.
Speaker 5 (20:23):
But I think we've also got to say that estrogel
is a fantastic option.
Speaker 4 (20:29):
You know, it's transderm l so it's.
Speaker 5 (20:30):
Estrogen absorbed through the skin, which is the main symptom
and health improver. Putting it really bluntly and simply, and
actually some people will need more than one hundred micrograms
of estro dot or estradyl, but they may only need
half the dose equivalent of estrogel.
Speaker 1 (20:49):
Right, But that gets tricky then too, doesn't it cemant
that the doctor's understanding what the patient's going to need
and the difference in the in the prescribing to these products.
Speaker 5 (20:59):
Yeah, absolutely, So I did do a leaflet and I
can you can have this for your resources as well
about kind of the common questions and a bit of
a dose comparison. But I definitely frame it with my
patients that you know, actually I believe you when you
tell me life is now awful, or I believe you
when you're like, oh, actually I feel much better. That's
a sign we should increase the dose and just kind
(21:20):
of try to give people that flexibility as well. But
you know that's not the system isn't set up for that.
So you know, I had to build I had to
build time into counsel and to make it easier with
the pharmacists and the prescriptions. So you know, it's really
labor intensive for all of us involved. It'd be really
cool to just actually, and I think we can just
(21:41):
completely rearrange women's health overall and just make it easier
in every way.
Speaker 3 (21:46):
Let's do that exactly.
Speaker 1 (21:47):
Why not samant that at the moment we've got the petures,
the Instra dot or extile, do we have Cream's Julls sprays?
Speaker 3 (21:56):
Are what else is actually available now to New Zealand women.
Speaker 5 (22:01):
The funded options of estrogen in New Zealand transdermally so
that's estrogen that goes through the skin, so it's much
safer is the patches. Only the gel is available and
it's unfunded, and because pharmacies are private businesses, Farmac or
nobody can price set how much you pay for a
for a tube of gel.
Speaker 4 (22:22):
I normally have an old one as a model.
Speaker 5 (22:24):
I don't have it with me, so there's a real
variety in price. But last week Farmac did release a
statement to ask for opinions and thoughts about whether to
fund the gel.
Speaker 4 (22:34):
So it's looking.
Speaker 5 (22:34):
Positive, which is really cool. But to get to that stage,
the gel's actually we've had to campaign to get rid
of some extra legislation around it as well, and we
still I don't know. I'm still a bit skeptical as
to what are the supply is like if the gel,
so actually I feel we still need to know more.
Speaker 4 (22:53):
But there is oral estrogen, and.
Speaker 5 (22:56):
You know, for young for younger people who are low risk,
actually oral is really is pretty safe.
Speaker 4 (23:02):
Some people do better with oral as.
Speaker 5 (23:04):
Well, and for some users even the anxiety you know,
of not having to am I going to get my
medication every month can be offset by knowing that maybe
their symptoms are slightly not as well controlled with the
oral which is like from my perspective, you know, I
always want to practice gold standard best practice medicine, and
(23:26):
suddenly my best practice is actually which you know, what's
the lesser evil?
Speaker 4 (23:31):
Pick your poison, what's worse for you?
Speaker 2 (23:34):
If you're taking oral dose, what can you prescribe? Is
it one month at a time? Two months at a time,
Like how often does the woman have to go back?
Speaker 5 (23:41):
Yeah, so if oral estrogen by itself is like the
kind of regular medication, so I can prescribe three months
at a time, but pharmacies cannot should only be dispensing
one month at a time, which again I think, you know,
from a practical perspective, it's logistically harder for women. You know, busy,
you've got loads on in life. But that's a whole other,
you know, a whole other national thing together. The flip
(24:05):
side is you can prescribe six months of the pill.
So actually some women and there's some new unfunded pills
that are really good for mood challenges in perimenopause. So
for some women they control bleeding better, they better for mood.
They're you know, they're pricey, but actually that's beneficial. So
(24:27):
there are other options depending on what their priorities and
needs of the individual are.
Speaker 1 (24:33):
Louise, do you want to tell Samantha where you thought
you put the estrogen gel?
Speaker 2 (24:37):
Well, I think I might have been confused when I
saw gel. I thought that you put it in your vagina.
Why it's there a gel?
Speaker 4 (24:45):
That ye cream?
Speaker 2 (24:48):
Like?
Speaker 5 (24:48):
Yeah, definitely, I love book about vaginas.
Speaker 2 (24:51):
I can tell you about these please, But but the
normal h I T GL doesn't go.
Speaker 3 (24:57):
You can just put it on.
Speaker 5 (24:59):
It's on your from your shoulder to your shoulder to
your wrist right right and Sandrna another gel rubs on
your tummy, on.
Speaker 4 (25:06):
Your belly right.
Speaker 3 (25:08):
That gels for everybody part there are.
Speaker 5 (25:11):
But yes, the vaginal cream is a vestin and that's
a different kind of estrogen called strile, which is likes
the genital the genita here and I talk about it
is like as we get older, or you know, our
skin dries, and the vaginal skin dries as well, and
it becomes thinner and it does get a bit smaller,
(25:33):
and even regardless of sexual relations, it impacts bladder function,
pelvic muscle function, sexual function and comfort. Whereas if you
use a vestin it's like a moisturizer if your vagina,
so it can really prevent like loads and loads of
the symptoms. And it's the only condition of menopause that
will never get better. So once you have vaginal dryness,
(25:55):
you've got vaginal dryness.
Speaker 4 (25:56):
But using some.
Speaker 5 (25:59):
Grain, which is the you know, the gold standard, prevents
it decreasing and you always need to use it.
Speaker 2 (26:05):
But it doesn't have any other It doesn't do anything
for the recently unapaus or somebod just for the vagina.
Speaker 4 (26:10):
It shouldn't.
Speaker 5 (26:11):
But if you've had if you've got conditions where you
can't have estrogen, for example breast cancer or liver and
liver issues, then you can still have vaginal estrogen because
it's not thought to go systemically in the body.
Speaker 4 (26:25):
However I do so it doesn't have an impact on
the other tissues.
Speaker 5 (26:28):
However, I do always say to my patients that actually,
when the tissues are really dry, they're often really thin,
so you do get more absorption, but really quickly that
stops being absorbed because I think you know, if you're
just say you know, I give you estrogen and I've
told you it's safe, it's not going to impact your
breast tissue at all, and suddenly you get breast tenderness.
(26:49):
You're going to be like, what what on earth the
doctor told? And you can feel it, so you know
it's true. So I always tell my patients that. And
for those that are really kind of, you know, hormone
averse or just it just doesn't lie right with them,
then you can bring the doses down even more because
some people are more sensitive to it.
Speaker 1 (27:07):
If you're listening to the little things in Our guest
on the podcast today is GP and Women's health specialist
doctor Cement, the newman talking everything HRT.
Speaker 3 (27:14):
We're going to be back shortly after this break.
Speaker 2 (27:21):
So it's not just a hormonal cancer that would cause
you to not be able to take HRT.
Speaker 3 (27:26):
And I know you would need a proper consult. Can
you go to a GP? Do you need an endochronologist?
Speaker 2 (27:32):
Who do you talk to if you don't know whether
something you've had in the past like apatitis for example,
or or you're on a blood finner or whatever. Is
your GP still the first stop for advice about that?
Speaker 3 (27:45):
Yeah?
Speaker 5 (27:45):
I think your GP should be the first stop because
they know you, they know your history, and for me,
as a DP, any medication is about the whole person.
It's about you know, what is right with you, your
family history, what your FINO is saying, and actually is
a GP we're best place to do that. Obviously, you know,
we're not experts in every other condition as well, but
(28:07):
we are general practitioners. We that's what we specialize in,
and we also specialize in kind of that general risk assessment.
So therefore, some gps who are really confident with hormone
replacement therapy will actually be happy to, you know, work
with the guidelines and maybe do things which aren't necessarily
(28:27):
typical and recommended because it's in the best interest of
the patient and for that relationship. But I think it's
you know, it's really important that everybody has their needs met,
and even if that's you know, actually that you do
need to go to a specialist and find out what
are your needs and how can these be met? Because
EP and as I kind of like as I said
at the beginning, when I see the impact that the
(28:49):
appropriate management option can be in someone, it's about framing
that is, can we achieve that? Because then I think
you have to consider the risks in the context of
that and being a bit kind of airy fairy, But no.
Speaker 3 (29:03):
I know you mean.
Speaker 2 (29:04):
I think it's that thing of population health versus the
individual's health as well, and that keyword management.
Speaker 3 (29:10):
And that's great.
Speaker 2 (29:11):
If you have somewhat health literate and you have a
GP who you can easy access and describe your symptoms too,
you could get through that snowstorm a little bit easier.
Speaker 3 (29:20):
I just worry.
Speaker 2 (29:21):
I suppose for those people out there that are just
they don't even they go, oh, well, I'm probably excluded.
Speaker 3 (29:26):
I don't know what to do.
Speaker 2 (29:27):
You know, I can't see anybody and they're kind of
putting up the stuff they don't need to. I know
that estrogen HRT in general deals with the range of
issues that come up with without aestrogen dropping off and things.
So would somebody who can't take that they could take.
Is vitamin D a good thing to be taking, or
like once a month? Or there are things that we
can do for our bones that we if we can't
(29:49):
take HRT.
Speaker 5 (29:50):
Yeah, I think it's about what are your symptoms and
what are we targeting? So putting it bluntly, you know,
HRT is the best option for managing hot flushes and
managing mood that are related to hormone changes, but that
doesn't mean it's right for everyone, and not just because
of a medical you know, contraindication. And so then I
tend to break it down so like lifestyle things that
(30:11):
you can do, and then there's some supplements and then
non hormonal medications. So even some lifestyle things can be
pretty transformational, such as you know, changing the way we
eat because our metabolism changes, and eating at slightly different
times of day, and then supplements. Also you do have
to be careful of with medical conditions too, like phytoestrogens.
(30:34):
If you've got any student sensitive cancer and you do
not want any estrogen, then it's pretty counterintuitive to go
and take as much estrogen through food as you can
through the phytoestrodents. But vitamin D is it helps with immunity,
it helps with probably some cancer prevention, probably some mental health,
brains infection. So that's for me, what menopause and hormonal
(30:58):
health is. It's actually taking a step back and looking
at what else can you do to optimize well being,
and I think we need to do that alongside any
kind of hormones as well. There are non hormonal medications
which can be prescribed specifically as such for menopause, and
some gps still have these as their first line and
(31:18):
they're not wrong. So antidepressants can improve hot flushes in
fifty percent, and that says so many things to me,
because actually there's a huge brain hormone link, so that's
also where it helps, but also the serotonin and the
eater and they all interact with temperature regulation too. Sleep
is another really big thing. So for example, if somebody
(31:40):
has got really marked sleep disturbance secondary to menopause, then
I might go for something like gabapentin, which is a
medication that we use for chronic pain and for some
other kind of neurological conditions, and so that can be
really helpful there, but it also can help hot flushes
as well. There's some other antidepressants called venola vaccine, and
I'd often use that one if somebody has got bad
(32:03):
body pains at the same time too. And with all
of these options, there's different kind of doses and things
and durations and how long it takes to work. And
I also think that it's about being realistic about what
our gains are. So when I first started prescribing HILT,
the teaching was you have to be eighty percent better,
but actually you shouldn't have.
Speaker 4 (32:24):
To be eighty percent better to continue any medication.
Speaker 5 (32:27):
It may be that you don't want hormones and the
whatever antidepressant medication decreases your hot flashes by one per
night or they're not as much, but actually that is
enough to improve your quality of life without the side effects.
Speaker 4 (32:41):
So yeah, and there are others.
Speaker 5 (32:42):
As well, but hopefully that's kind of given you a
little bit of an.
Speaker 1 (32:45):
Overdam Yeah, for sure, it's really positive because for women
who maybe can't take hormones or want to and have
some issues, there are some other ways to sort the
mountain things. If you're a relative, if you're a sister
or a daughter of a woman with a hormone in cancer,
should you be questioning whether HIT is still a go
for you.
Speaker 5 (33:04):
So I think it's a bit too broad to say
a hormone related cancer, because actually a lot of cancers
are hormone sensitive in different ways, and it's probably beyon
the scope to go through that. But putting it kind
of a little bit more broadly, it's about what breast cancer. No,
if you've got a family history of breast cancer, it's
(33:25):
not a contraindication for you to have it. But what
I would be doing is I'd be like, Okay, what
could this medication do to you? Because if it means
that you're going to get more sleep, if it means
you're going to be able to exercise so you don't
put on weight, if it means you're going to stop
drinking your alcohol, that's going to decrease your risk more
than not having it. The flip side is I'm like, Okay, great,
(33:47):
this is a really wonderful opportunity to talk about how
we can pick up any form of cancer depending on
you know what it is. So for breast cancer, I'd
be like, great, so we can look at how are
we going to do your screening, how are we going
to optimize it, When are we going to do it?
Speaker 4 (34:00):
What about examinations.
Speaker 5 (34:02):
I mean, I've got some women who have got family
histories of breast cancer and they are like, well, I
can't cope right now, but I really don't want hormones.
But right now I know that that tiniest dose of
hormones may make me a little bit better, and then
I'm going to stop it. Because the data when you've
been on some forms of HRT for five years or more.
The risk of breast cancer increases, but still with any
(34:26):
form of breast cancer bavarian cancer, women are more likely
to die of cardiovascular disease than cancer. And starting hormone
replacement therapy in the perimenopause decreases cardiovascular disease by thirty
to fifty percent. It decreases diabetes, chdorectal cancer, depression, psychosis,
(34:46):
autoimmune disease. So we've really got to kind of, you know,
step back and enable our community to look at what
are your needs and what's the best way to support
you forward from you know, a symptoms to review, from
a screening, from a supporting health changes as you transition
through mid life.
Speaker 2 (35:05):
No, you're dead right, because if you're in your early
forties as I was, actually you know, not sleeping, stressed,
cars ale, pulsing through the body, not coping with the
smaller things that even the little things in life kind
of hitting the wall bloody, how could have been metopausal?
Speaker 4 (35:20):
You know?
Speaker 2 (35:20):
And also that that is really taken away from your
quality of life and potentially can be linked to disease.
Speaker 3 (35:26):
Right, So it is that balance, as you say, and.
Speaker 2 (35:31):
I think so quite often we go to the GP
as a last resort instead of at the beginning of
the thing. It's the GP is really not supposed to
be the ambulance at the bottom of the cliff, and
we need to make that time. You know, don't do
it just as an emergency. Everyone says, oh, you can't
get into GP when you need to, but you probably
needed too three or four weeks ago.
Speaker 3 (35:53):
Aye.
Speaker 5 (35:53):
And that's just I think where we almost need to
step back and look at what can we do as
women who see that we have needs to support that
health system. Because I don't want because needs aren't going
to be mere if we tell every midlife women to
go to the GP to have a discussion on HRT.
But actually, you know, as a health system, we weren't
(36:13):
set up to educate everybody on the whole of every
single medication and health condition.
Speaker 4 (36:20):
So we need to kind of look at what else
can we do.
Speaker 5 (36:22):
And that's why you know, like your podcast is great
because actually hopefully that will give some people some ideas
so they can also maximize the time with their GP
on the GP strengths, which should be diagnosing, putting things together,
and interpreting appropriate investigations.
Speaker 1 (36:37):
And it's really important to say as well that we
don't just expect people to turn to medication to solve
all their problems, but a lot, a lot of women
are turning to it. How do they have done all
the things they're supposed to do? You know that they've
tried to get their good sleep, they've cut back on
their alcohol, they're watching their diet, they're trying to exercise.
You know, like, it's not one person's problem to solve.
We've got to take some personal responsibility for getting through
this period in our lives a beast that we can
(36:59):
as well. Knowing about it is a good but knowing
about it is a very very good start. And I
just love the way that you are just advocating for
women's health so strongly submit that. And I was thrilled
to hear about the course that you're running for GPS.
But I believe that you're also you have a menopause
course for women as well.
Speaker 4 (37:18):
Yeah, you're right.
Speaker 5 (37:19):
I just I've learned so much from my patients, and
I think, you know, I can't do what I do
in fifteen minutes, So what I wanted to do is
make my colleagues lives easier. So I kind of like
a little bit of a walk through of what I
do with my patients to help understand what your symptoms are,
Could it be hormonal either when you've gone through it
at the moment, or what could you expect and how
(37:41):
these kind of like the hormones change. And we've put
some resources there as well, and you made a work
book too that you can take to your GP to
work through with it. And I'm hoping that through staying
really closely intact with like my Women's Health Network and
the GPS are interested in it, but also general GPS
because it's so inseparable. And I've had really cool positive
(38:01):
feedback which has been really nice as well. And we've
got a podcast on sorry of course, on hormone replacement
therapy coming so where I can like dive a little
bit more deeper about what to expect, what the side
effects are, what happens if.
Speaker 4 (38:16):
It doesn't work, and.
Speaker 3 (38:18):
Are people find you? Yeah?
Speaker 5 (38:21):
It's my website's ww dot female, gt dot co dot NZ.
Speaker 4 (38:26):
And it's forward slash all.
Speaker 5 (38:28):
And the reason I've done it like that is because
I've been just like amazed by men I see and
fin and I'm like, ah, this makes sense based on
my knowledge of women's health. So kind of my dream
moving forward is to pick up some of my women's
health knowledge and to put it in a different framework
to help more people than just midlife women, because I think,
you know, hormones are just a part of it. But
(38:50):
when you see things through a hormone lens, it gets
it's easier.
Speaker 3 (38:54):
Oh my goshes so sure does.
Speaker 2 (38:56):
So. Look, I know you've given us so much to
think about, but if you're going to get of that
woman who's teacherly, I don't know, early like thirties, early forties,
a little bit exasperated feeling, you know, could it be this?
Speaker 3 (39:07):
Could it be that?
Speaker 2 (39:08):
What's the one piece of advice you've given a woman
wanting to start or to start to investigate HRT at
the moment in our current setting, I'd say be open minded.
Speaker 5 (39:17):
So be open minded about what your symptoms could be
caused for prying different options and also reassessing when it
doesn't work to help understand what it is. And I
often use hormones as a diagnostic trial, so actually, is
it working or not? Is that going to help us
kind of figure out what's going on?
Speaker 1 (39:37):
Brilliant, It has been such a delight to meet you, Samantha.
Thank you so much for your time today.
Speaker 4 (39:43):
Oh no, thank you for having me.
Speaker 3 (39:51):
How fantastic is Samantha.
Speaker 1 (39:53):
I'm just I so appreciate the work that she is
doing in the advocacy she's doing on behalf of all women,
enabling us to get the healthcare that we deserve. She's
certainly passionate about it, but in an incredibly practical way, yes,
which is exactly.
Speaker 3 (40:07):
What we need.
Speaker 1 (40:08):
Hey. Something that we sort of spoke to her before
the podcast on which we didn't get to was talking
about women who might have had a hysterectomy and the menopause.
Speaker 2 (40:17):
Yeah, which touches on the comment that the Australasian Menopausal
Society said that to go back to focusing on your
cycle and bleeding and things, those women won't bleed. They
still have the ovaries, but they won't have a period
to gauge anything on. Or you could be on a
mini pil and not be getting a period. There are
a number of reasons you won't be getting a period
(40:39):
that you should still be taking your hormones into consideration.
Speaker 3 (40:43):
Absolutely so, just making a mention of that there.
Speaker 1 (40:47):
Thank you so much for joining us on our new
Zealand Herald podcast Serious for Little Things. We hope you
share this podcast with the women in your life so
that every woman that wants or needs the estrogen gets
the estrogen will their help.
Speaker 2 (40:58):
You can follow this podcast on iHeartRadio or wherever you
get your podcasts, and for more on this and other topics,
head to inzid Herald dot co dot z and
Speaker 3 (41:08):
We'll catch you next time on the Little Things
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