September 29, 2024 • 35 mins
What's it matter if hormone profiles change? Phillipa Butler is here to explain to Jack that we should be extremely bothered about the Menopause!
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Philippa Butler, welcome to Chewing it Over.
Why should we be bothered about the menopause?
(00:42):
Well, Jack, thank you for havingme.
By the way, we should be bothered because 47 million
women in the world right now aregoing through this experience of
menopause. And that is something that we
really cannot ignore. And Women's Health is something
that is so neglected. Really historically it has been
(01:05):
neglected in the research. And, you know, not on my watch.
That's what I say. So this is this is stopping
right now. Good.
No, I like that. And.
And I inadvertently stumbled into a pun, didn't I?
Just before we went live, I saidit's quite a hot topic.
And you said yeah, good, good pun.
I was, I don't know if it was first made aware, but I was
(01:27):
certainly, it brought to my attention in, in more recent
years, people like Gronnie Donnelly, Emma Brockwell, Elaine
Miller were really helping me asan MSK clinician to realise that
we needed to step up. They were willing to say that
they were just said, look, you, you need to, we need to be
better on this. You need to factor these things
in better. We're seeing stuff as second
(01:47):
opinions that should have been picked up within routine
tendinopathy care and, and it really did make me stand up and
listen. And I've, I've done what I can
to understand it more and more, but because it's a really urgent
area of, of understanding, it sometimes feels difficult to, as
a non specialist to, to keep up.So what do you feel are the
things that we now understand better about the menopause and
(02:10):
how it should be considered moreacutely by MSK clinicians
especially? Well, you know, just to say I am
an MSK clinician, that is my sphere of expertise.
And for many years as I was practising, this was not on my
radar. And, you know, I'm, I'm sorry
about that now. And, you know, and I really am
(02:30):
making amends with the work thatI'm doing now because I had a
horrific experience of menopause.
And so that was what prompted myresearch and, and my interest,
my own experiences of menopause.And, you know, how could I
optimize my experience of life? And so that sort of set off this
(02:52):
cascade of events. And but for for musculoskeletal
therapists, it might not be at the top of your list of
priorities to consider. But interestingly, I was
listening to one of your podcasts yesterday with the the
gent who was talking all about tendinopathy and, and he
mentioned all these potential risk factors that contribute
(03:14):
towards the development of tendinopathy.
And menopause was mentioned and then we moved on, you know, and
this is the thing. Menopause, OK, So remember
menopause. But but what is that?
What's what's that all about? And what are the ramifications?
And what we know is it's a systemic condition that we're
dealing with that has ramifications for the brain, the
(03:36):
heart, the blood vessels, the gastrointestinal system, the
urinal genital system and the musculoskeletal system.
And so you can't separate this. You know, what you've got in
front of you in the clinic is a person.
It's not a, a body part, is it? You know, and I don't know, I'm
preaching to the convicted here,but but you know, this is the
(03:59):
thing we zoom in, but let's zoomout and look at this whole
person that's sitting in front of us.
If they're a woman. And you know, and even don't
even necessarily think of a certain age because premature
menopause happens, surgical menopause happens And, and
actually it starts a lot sooner than we realise.
(04:20):
From the age of about 40 onwards, women are dealing with
fluctuating hormonal levels thatcan have an impact on the
musculoskeletal tissues. So you don't think of this as a
condition of older age. Now, we're therapists, OK?
We're all therapists here. But we've got women in our
lives, whether they're our mothers, our aunts, our sisters
(04:42):
or our patients. And so for me, it really is
about women in the broadest sense, whether they're on our
table or in our friendship circles.
And I think one of the things that's challenging, I suppose,
when we're considering such factors is that we as we become
more considerate to these thingsbeing relevant and you start to
(05:03):
your Spidey senses start going off mid subjective assessment,
really doors in a subjective assessment.
You'd be hopefully not so prejudice as to then done so
from understanding a date of birth or at the looks of
someone. But you want to be factoring
certain things in. And then when you do, you then
don't want to rush to then thinkthat everything therefore is is
resultant in that because then it can almost feel like
(05:25):
everything's been put in that bucket.
It's, and I had a lot of sympathy.
If you think about when, when wefirst started to learn about
some of the factors affecting tendinopathy, we learned a bit
about the fact that someone was smoking or whatever, if there
was smoking then. And then to even mention that
you could see the eyes roll intothe back of their heads thinking
it's just another I've, I've gota tennis elbow.
(05:46):
And now they're blaming smoke. Everything's blamed on smoking.
And I fear that if we're not precise and we don't learn those
lessons, then we want to make sure we don't just lump
everything into this bucket of, oh, it's menopausal.
As if therefore we can't do anything about it, which of
course isn't what we're suggesting.
But how do you think we might skillfully navigate those sorts
of things where we don't want toover imply or or sort of infer
(06:09):
that we therefore only a systemic change would be
recorded that the treatment isn't available to them for the
actual condition as well? Yeah.
Well, I mean the treatment is always going to be necessary and
appropriate, but to deliver the treatment in the context of this
person in front of us is what we're talking about.
And so this person may be sitting there in a complete days
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not knowing what's happening in the bodies.
And we do them a service by helping them to understand the
context of their health situation.
So, so this idea that we, we zoom out and look at the whole
person, their hormonal history, you know, have they had trouble
with endometriosis or, or a postpartum depression, you know,
(06:58):
and to really get a flavour of this person's hormonal pathway,
if you like. And to know for them to, to
understand that we are not labeling them as, as anything in
particular. And that what we're saying is
that if we can understand betterwhat's happening in your body,
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then we can deliver the treatments that are most
appropriate for you. Not only that, we could help to
signpost you to the services that you require in order for
what whatever it is that we're going to be doing to work as
well as it possibly can. What do you think therefore
would be obvious lines of questioning that we should make
(07:42):
sure we pursue when noticing if said body senses have gone off?
What do you feel are sort of appropriate lines of
questioning? Well, I suppose it is difficult
because we're all individual and, and it is different for
every woman. But you know, hot flashes or hot
flashes as we call them in this country is, is definitely a
(08:02):
symptom that a lot of women willexperience.
I think where it's important forus to make the distinction is
that there are symptoms that they can experience that they
didn't realise were associated with hormones.
So all those 34 recognised 35 recognised symptoms of
(08:24):
menopause, the brain fog, fatigue, insomnia.
And that's not just because you're having a hot sweat, mood
disturbances, genital, urinary, vaginal dryness, you know,
balance issues, vestibular disturbances, dry eyes, you, you
name it. I mean, there's every bit of our
(08:45):
bodies is struggling with the fact that the estrogen levels
are fluctuating. And, and so it's important for
us to have that level of understanding and, and then to
know that this, this hormonal shift that is occurring is
generating probably more than one musculoskeletal symptom.
(09:08):
But that then that we often, youknow, we go to the doctor, we
can only tell them about one thing at once.
You know, we get referred with one thing.
And so the physio, well, I can only really talk about this one
thing that you're talking about particularly, you know, if
you're talking about an NHS scenario.
And if there's anything else, it's not that we would neglect
that, it's just that it wouldn'tbe the first thing that we're
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we're exploring with that client.
So, but to to be aware that it'simportant for us to to just look
at this whole person in front ofus carpal tunnel, you know,
that's something that people will could be experiencing joint
aches and pains. And so if it's widespread as
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opposed to an individual joint and also the fact that there's
no history of injury is always going to point you to something
a little bit more curious, isn'tit, So and I.
Suppose as well it's when they're not recovering more
routinely from an innocuous injury or something that you'd
expect to have resolved Is another one, isn't it?
(10:12):
Where? Yeah, yeah, yeah.
Yeah, it's insidious onset sometimes the obvious WAG, but
then there's also then, yeah, I thought you'd have been kicking
on better than you did or the developing a tendinopathy around
a sprain or something like that,where it's just when you've got
these, these hormonal, when the hormonal fluctuation as we're
describing it. Do you?
(10:34):
I don't need to necessarily, if you feel free to give it, if you
want to like your hot take on the on HRT, but it's just that
what do you feel is our responsibility for signposting
for that medical conversation alongside our therapy?
So it doesn't need to be either or.
It doesn't mean that we then back all the way off and and and
just signpost. But it's just and I've had
(10:55):
varying different people, including on the podcast that
have got a different sort of threshold of which they would
then, you know, promote that conversation alongside therapy.
What's your take? Well, my own personal view on
this is that estrogen is too important for us to be without
it. And so that's, you know, the
(11:18):
bottom line for me. That's my choice and that is my
opinion. Now the question really comes at
what stage is this something that we start to consider as an
intervention. And so, you know, my research
and my understanding is that these pathways that exist for
(11:40):
estrogen in the receptor sites, those receptor sites will become
desensitized in the absence of estrogen.
And so if we are without estrogen for too long, then then
introducing estrogen at a later date is not as effective.
That's not to say it won't do something.
So this is sort of some emergingevidence and it's, you know, we,
(12:07):
we have to know that estrogen is, is something that women's
bodies are designed to have. So we'll say that.
And, and that estrogen fluctuation is the period of
perimenopause. So that's before menopause.
And that's why we get the symptoms predominantly because
our hormones are going up and down and your body's trying to
(12:27):
compensate this lack of estrogen.
And So what what estrogen therapy or sorry, hormone
replacement therapy does at thatstage is to kind of level us out
a bit. But it's because it's giving us
the estrogen that is lacking gradually, gradually decline.
So, you know, you don't go alongand then suddenly fall off a
Cliff. You, you know, it's gradually
(12:49):
declining. And so supplementing those
levels as you are experiencing fluctuating symptoms is going to
bring you onto a par. And then the decline continues
post menopause. The levels are continuing to
decline gradually over a period of time.
And I love that picture where there's women filled with
(13:09):
estrogen and then by the end when we're sort of 70 or 80,
it's only in your feet. So I mean, it's obviously not
only in your feet, is it? But, but I, I love that.
I love that visualization. So with.
That though, is there a do we have an assessment and titration
of dose process that can be as as accurate as this we're
(13:31):
describing? Because I like that in theory,
but in practice it can be a bit of a blunt instrument.
In my experience from what I've,you know, sometimes I've, I've
even regretted signposting whereessentially it's then been yay
or nay, you know, and this just a just a treatment dose that
might not necessarily be appropriate for that person.
So I certainly liked what you were describing in terms of
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supplementation, but how accurate is our tested?
How well can we accurately then infatuate a dose that's
appropriate for that individual?Yes, well, it's a really good
question and currently testing in perimenopause when your
hormones are fluctuating is not the what the nice guidance
supports. So that isn't going to happen
while your hormones are fluctuating.
(14:15):
If you wanted to have that test,you would have to pay for it.
And I know that there is a day in the month when it's an
optimal time and that, you know,if I wasn't post menopausal I
might be able to remember what day that was.
So if you tested on a certain day in the month, you'd get the
best reading possible. But you know, the more I listen
(14:35):
and consume this longevity medicine that I consume online
all the time, get in your levelsbefore before you start to
suffer symptoms. So you know, what is your
baseline? You're not going to find that
out when you're when you're fluctuating.
So that said, that would be the the ideal, wouldn't it?
(14:56):
But that's not happening. So if we think of it as a blunt
instrument, we're more likely tofeel that way.
But if we think that the best way to diagnose menopause is
from the symptoms that we suffer, and the best way to know
whether HRT is working is whether or not it is addressing
those symptoms, then we can feela bit more confident in that
(15:21):
approach. Yeah.
And, and I think we can be guilty of perpetuating, you
know, the idea that it's not, this is not right, the way in
which this is being approached, yes.
So, but the evidence is that thebest way to approach it is by
symptom. Man is through symptom
management now, once a woman is stabilised, then we can start to
(15:46):
think about testing. And I say we, I'm not a doctor,
I can't be doing that. But we, you know, that is
something that we could consult with other professionals around.
But so once you're stable, then we can start to look at levels.
And yes, there is a there is a sort of level, but post
menopause you're going to be maintained at a lower level
(16:08):
because that's really more normal for your body.
We won't be maintained at reproductive levels unless
you've had a surgical menopause and then that would be
appropriate for that age of woman.
Yes. So does that answer your
question adequately it? Does no, I I think where I where
(16:29):
part of my question remains is then if we are going off
symptoms, then you you're unlikely to recognise by
symptoms maybe taking more than you needed to.
You know, you'll end up with this window of a dosage that
would be appropriate. And if you are on the side of
higher, you'll get symptom response seem to decrease, but
(16:52):
you could have been twice as much as you needed.
Whereas you then if you if you heard on the side of less then
symptoms maybe would be you knowit's not sufficient, but.
I think how? We'd manage that.
Yeah, what I just said is that we will never be prescribed more
than we need. Right.
Yeah. OK.
So, so the guidance is that the levels that you'd be prescribed
(17:14):
and the maximum, if you had the maximum, it'll still be less
than it would have been when you're in your reproductive
years. So there is no overdosing on
estrogen unless you take that pump and spread it all over your
body of your own accord. And then we can't be held
responsible for that, can we? No.
I get it. Yeah, No, you're right.
The the prescribed dose wouldn'tbe in excess of anything, no.
(17:36):
No, OK that. Makes sense?
Yeah. And they'll always start with
the lower dose and work up as asrequired.
So yeah, I wouldn't be concernedabout getting too much.
Gotcha. And so when we're then factoring
those sorts of things in, in a musculoskeletal service and is
there as well as the sort of detection, diagnosis,
(17:58):
understanding and factoring in menopausal factors into that
assessment process. Once we get into then the
management of a musculoskeletal condition, are there hard and
fast rules as to what we need toapply?
Do we need to go steadier? Do we need to go lighter?
Do we actually want to go heavier but adjust the dosage
down in terms of repetitions? There's lots of evidence out
there at the moment that's mixing around.
(18:18):
What would you suggest would be sort of rules of thumb, although
of course we would tailor it. Well, absolutely.
I, I think what is has been perpetuated up to this point is
doing less to, to feel less painand, and so that approach isn't
working. So for me, it is about
(18:42):
challenging the tissues because if we don't challenge the
tissues, they're not going to change, but in in that measured
way. So for people.
And so you, it's the person in front of you then, isn't it?
Is this an athlete or is it somebody who played netball at
school and hasn't done anything for 40 years and sat at a desk
all day? So, you know, what are we
(19:04):
dealing with? But ultimately, you know, the
work that I do, I strive for people who have, you know, I
pride myself on the fact that I can work with anybody.
And people who have never done anything I can, we can gradually
get them there, you know, to a place where they are working
with resistance or against resistance, whichever way you
(19:25):
want to put it. And that they are working on all
those metrics that we know were so important.
So strength, power, balance, coordination skills, movement,
processing skills. You know what this, as I heard
you say yesterday, cortically rich experience of movement that
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we can tailor to the person in front of us.
And you know, we know a few different things from science.
One is people will get more benefit from doing things that
they enjoy. And, and so you, you know, we
can work with whatever it is that they that they're keen on
doing, whether it's a new thing or an old thing that they want
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to revive. And, you know, and I've worked
with so many people who've neverexercised before and come to
this place where I met a lady onSaturday evening.
I haven't seen her since before COVID.
And she'd come to my Pilates classes and she said, oh, gosh,
I absolutely loved Pilates. And and I'm thinking that's
(20:28):
amazing, you know, this person who had had really no exercise
history and in a mid middle lifecame to movement and absolutely
loved it. Now COVID came along and got in
the way of that. But anyway, this, you know, I
happened upon her and now we're going to get back in the saddle
with the with the thing that sheloves.
(20:50):
So you know. Yeah.
Well. Engaged.
Get him, get him back. Fired up.
Yes, Well, exactly so so so. The fact is, there's no one
thing social media would love usto believe that we had to do.
High intensity interval training.
Social media would say no. Forget that.
(21:11):
All you need to do is lift this weight 4 times and you'll be
fine. Well, you know what?
None of this is true. None of it.
We need a holistic approach to movement practices and that
includes cardiovascular output. You know, we know that has
anti-inflammatory effects. Exactly, Yeah.
So one of the things that you you've mentioned there is that
(21:33):
the approach for too long has been then almost just a kid
gloves approach. It's it's been just winding all
the way back. And so it ends up being like
really low dose, really easy stretching programs, yoga,
Pilates, which of course have their role.
But if they are in in isolation,then it's, it's something that
(21:55):
unfortunately, it's a bit like, I mean, like, and my, my good
friend Jim will be ranting at this if I don't mention it, but
in rheumatology services, it wasjust everyone got hydrotherapy
because God forbid we might loadthem up.
And it was just that the evidence never supported that it
was just all inflammation. And so that we were heard on the
side of not. And so it was almost like the
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first response to understanding these things a bit better, which
is a compassionate response is kid loves rather than thinking.
Actually, no, we need to still challenge tissues to change.
Then we still need to sort of stimulate an anti-inflammatory
response that would also be useful for hormonal profiles as
well, is to actually get out of breath now and again.
So the, the, the 1 golden rule is don't just do less for the
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sake of doing less. There's nothing kind about that.
No. And and I'm afraid you did say
something that I'm going to pickup on here, which is easy.
Things like Pilates and yoga. No, that's true, they can be
pretty difficult. Yeah, no, but The thing is, it
is, it is the default for the reason that often times we don't
(22:59):
want to hurt people in Group classes.
You know, you, you take the the lowest common denominator, you
layer on levels of challenge. But you know, invariably
everybody tries it, whatever it might be.
But, but these are disciplines that I so often hear dismissed
as as not difficult enough. I I've got a Pilates reformer in
(23:23):
that Conservatory. I'm in my, I'm in my house.
This is my home clinic here. Yeah.
So in my Conservatory, I have a Pilates reformer machine now.
I mean, it doesn't get much harder than that, I have to tell
you. So it's really the choices that
we make with these movements. I use rubber bands like you're
(23:44):
going out of fashion. We, we use hand weights now.
We're not doing heavy hard weights, but we are loading the
tissues. We are using all those
mechanical principles that we learn as physiotherapists, Long
lever, short lever, you know, tomake it as hard single leg
focus, you know, so you can makethis stuff difficult if if you
(24:08):
really want to, if you're reallythinking about it.
And yoga and Pilates are for me,integral in movement and
function preservation for the future.
So you can be a runner, you can be a cyclist, you can be a
triathlete. I've done these things.
But if you want to carry on after 50 and into your 70s,
(24:29):
which I do, I know that these movement approaches are integral
in a a body insurance policy andthat's what I call it that's.
Great. No, that's a great, great line.
I hope you didn't think I was being dismissive of.
Not at all, no. I.
Think one of the things we can sometimes do as well is then
interchangeably use low intensity with.
(24:52):
And that's. Not right.
Whereas I suppose you know, in it when I was thinking about hip
training or or say a cardio or going for a run and it's, it's
at least a different approach and we need to try.
And I mean, there was a great piece and I'm sorry to plug in
MSK mag piece here. It's a bit cheesy, but Sue
Julian's wrote a great piece about stretching in an MSK mag
recently where she was explaining about the research
(25:14):
she's increasingly pointing towards that having real
interesting vascular elements toit, whereby actually that
facilitates cardiovascular growth and gain.
So. Well, yes.
And I, I, I exposed myself to that same sort of principle
that, you know, with yoga, really the strong stretching
does condition muscles. It it doesn't just make you
(25:37):
bendier, you know, so. Sure, and that's something that
no, I remember as a team, we were reading the suit piece and
in the editing suite and thinking, wow, this is really
confronted us with against the bias and against the grain.
And so you then end up sort of reintroducing it into practice
and realizing that that can really attenuate better results.
So you regret having turned yourback on certain things.
(25:57):
So you know, it's it's definitely interesting.
One thing I really wanted to sort of I'll pick up with you if
I could is we've talked a lot about what MSK clinicians should
be bearing in mind and what theymight consider both in terms of
assessment and treatment and management.
But I've been thinking increasingly spoke to Jennifer
James, who's appearing on a on aphysio matter special soon.
(26:18):
And it's not been published yet.But in that conversation, I
ended up in a situation where I was talking about obesity with
her and we said about the fact that there are there are factors
affecting musculoskeletal conditions that we need to
consider when considering obesity.
But there's also this idea of primary weight loss services.
What is physiotherapy and MSK clinicians role in that and what
could we do better? Is this another space in which
(26:41):
instead of just considering withcoming to see you primarily for
pain and injury and police factor this in?
Is there a space for us as sort of health coaches that happen to
be physiotherapist by backgroundhaving primary services where
people are struggling with the menopausal symptoms, are keen to
understand their body as it changes and that's the primary
reasons for them coming in? Yes, and this is the work that
(27:03):
I've been pursuing over the lastfour years.
Really, I haven't got to that point yet because I, I keep
coming upon the stumbling block of not having a doctor that I
can work with at the moment to refer people on to.
And I and I really want to have that pathway hammered out if you
like. But but yes, it's you know,
(27:24):
physiotherapists are so well placed because we have all the
professions are the ones that will take this helicopter view
of people's physical capacity. This, you know, exercises in
with the bricks as physiotherapists.
And, and I really, you know, I've really endeavoured in my
(27:45):
career to be able to straddle that boundary between
rehabilitation and physical conditioning so that we can take
people all the way through that journey.
And even if you just save yourself for the rehabilitation
part and have some trusted source that you hand them on to,
you know, but so running these Pilates group classes, yoga
(28:07):
group classes in and alongside the private individuals that I
work with is, is a really helpful, you know, it flows both
ways. They come to the group classes.
I'm not saying that I break them, but things happen, don't
they, you know, life happens. Yeah.
And so then I'm, I'm there and on hand and I can deal with
(28:29):
those. And to be honest, that what I
find is because they come to me so quickly, you know, we, we get
things back on track and, and they're, and they're back in the
group sessions and, and firing on all cylinders.
And then for people who are coming from nowhere with no
movement experience, we work as in with individuals.
I work with them as individuals.And then they, you know, I'm
(28:51):
very happy for them to take a bit more agency and, and come
along to a group session, meet other people, offer that
community of, of people. Primary menopause symptoms.
I think what I would suggest is,and actually, this is not my
term at all. Vonda Wright is an American
(29:12):
orthopaedic surgeon, and she hascoined the term the
musculoskeletal syndrome of menopause.
And I, this is something that I feel physiotherapists are very
well placed to to approach because it is women with
multiple joint aches and pains, tendinopathies.
(29:35):
Yeah, arthralgias. And then put that together with
fatigue, put that together with mood disturbances where women
are getting anxious and depressed and, and feeling like
this is the start of the end really.
You know, for some women, that'show it feels.
But but the, you know, these elements, the sarcopenia, the
(29:58):
osteoporosis, if we can get ahead of this stuff and provide
women with that information, that and permission really to
push the envelope and to understand that pain is not
always about damage and that thethe more we think about our
(30:20):
pain, the worse it's going to feel, you know, And so to equip
them with all these tools and you mentioned health coaching
and it's really, you know, goingdown that Ave. of supporting
people to explore movement as medicine to tackle what are, I
mean, this is costing the healthservice a lot of money, women
(30:41):
falling over and breaking a hip.You know, ultimately it's
costing the health service a lotof money and people a lot of
pain and and heartache. And and so to arrest that
functional decline that that occurs, you know, that some
people think is inevitable. And you know what it isn't, This
(31:03):
is the thing that I am selling. If you were buying by any
chance, but you know what I mean.
Let's, let's help. Physiotherapists are so well
placed to prevent this physical decline and frailty and empower
people to live this long active lifestyle and should they wish
to and and not feel like there'san inevitability around ageing.
(31:29):
That's right. It's that fatalism, isn't it?
That when you can get people thepenny to drop, that that needn't
be the case. And that they needn't, needn't
just manage decline and they cankick on and they can feel like
themselves again. They can feel younger again.
This is such an exciting premiseand and something that I think
physiotherapy is a really well placed profession to do so.
(31:50):
So you're excited, excited by that?
Well, you know, and the other thing is, and this is true that,
you know, from all the research that I've done, I thought it was
true. And now I'm no more certain than
I could be that it is true that there is not one symptom of
menopause, that physical activity will not improve.
So our thermal regulation is improved by exercise, sleep,
(32:17):
stress management, you name it. There, there isn't a tissue, a
structure, a cellular process that isn't somehow enhanced by
movement and exercise. So, you know, with that, OK, HRT
is an option. It's a choice.
It's, it's not for everyone. Not everyone chooses it.
I do. I feel it's important, but you
(32:38):
know, if if not, if that's not possible or it's not a choice,
movement is the next best thing.You talked about nutrition.
Of course, they go hand in hand.You know that they're bedfellows
that live together and so they should.
But but but movement is medicinefor menopause.
That is that there is absolutelyno doubt for sure.
(33:00):
And it's so it's so therefore important for us to find an
appropriate tailored dose to that individual for what might
suit them both in terms of type and intensity.
Excuse me. So thank you so much for
catching up with me today. Could you tell people where they
might find out a little bit moreabout you and, and, and what
you're active on in social media?
(33:20):
Oh well, I'm precision.co.uk online.
And you know what? That's always the one question I
failed to prepare for. So I'm Precision UK on
Instagram. I'm on all the platforms because
I really am keen to spread the message.
I've got my Precision Moving through Menopause podcast, and
that's on Spotify and Apple Podcasts.
(33:43):
And I'm on YouTube. I've got my YouTube channel Move
with Philippa Precision UK. So Precision.
Oh, and guess what? I did a clever thing.
I spelt it with AZ. With AZ, I'm going to say, I was
just going to say I know it's with AZ.
In fact, I can see it in behind you as well.
Precision it. Is.
With AZ you. Love it.
No, it's makes it memorable. No thank you so much for your
(34:06):
time. Really appreciate it and thanks
for banging this drum so proudly.
It's an important area and one that it's quite exciting to see
how it's all developing and, and, and that the immense
suffering that we can decrease and the, and the clarity we can
bring, We are perfectly placed for, for helping with that.
And it's such a positive area of, of practice at the moment.
(34:26):
And thanks for your contributions to.
It Oh, you're very welcome. Thank you so much for having me.
No problem at all. Take care.
Here are physio matters. We think physio matters.
Become a member today and accessthe biggest MSK library on the
(34:48):
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(00:22):
trial now. Just go to
rehabmypatient.com/physio Matters.
Philippa Butler, welcome to Chewing it Over.
Why should we be bothered about the menopause?
(00:42):
Well, Jack, thank you for havingme.
By the way, we should be bothered because 47 million
women in the world right now aregoing through this experience of
menopause. And that is something that we
really cannot ignore. And Women's Health is something
that is so neglected. Really historically it has been
(01:05):
neglected in the research. And, you know, not on my watch.
That's what I say. So this is this is stopping
right now. Good.
No, I like that. And.
And I inadvertently stumbled into a pun, didn't I?
Just before we went live, I saidit's quite a hot topic.
And you said yeah, good, good pun.
I was, I don't know if it was first made aware, but I was
(01:27):
certainly, it brought to my attention in, in more recent
years, people like Gronnie Donnelly, Emma Brockwell, Elaine
Miller were really helping me asan MSK clinician to realise that
we needed to step up. They were willing to say that
they were just said, look, you, you need to, we need to be
better on this. You need to factor these things
in better. We're seeing stuff as second
(01:47):
opinions that should have been picked up within routine
tendinopathy care and, and it really did make me stand up and
listen. And I've, I've done what I can
to understand it more and more, but because it's a really urgent
area of, of understanding, it sometimes feels difficult to, as
a non specialist to, to keep up.So what do you feel are the
things that we now understand better about the menopause and
(02:10):
how it should be considered moreacutely by MSK clinicians
especially? Well, you know, just to say I am
an MSK clinician, that is my sphere of expertise.
And for many years as I was practising, this was not on my
radar. And, you know, I'm, I'm sorry
about that now. And, you know, and I really am
(02:30):
making amends with the work thatI'm doing now because I had a
horrific experience of menopause.
And so that was what prompted myresearch and, and my interest,
my own experiences of menopause.And, you know, how could I
optimize my experience of life? And so that sort of set off this
(02:52):
cascade of events. And but for for musculoskeletal
therapists, it might not be at the top of your list of
priorities to consider. But interestingly, I was
listening to one of your podcasts yesterday with the the
gent who was talking all about tendinopathy and, and he
mentioned all these potential risk factors that contribute
(03:14):
towards the development of tendinopathy.
And menopause was mentioned and then we moved on, you know, and
this is the thing. Menopause, OK, So remember
menopause. But but what is that?
What's what's that all about? And what are the ramifications?
And what we know is it's a systemic condition that we're
dealing with that has ramifications for the brain, the
(03:36):
heart, the blood vessels, the gastrointestinal system, the
urinal genital system and the musculoskeletal system.
And so you can't separate this. You know, what you've got in
front of you in the clinic is a person.
It's not a, a body part, is it? You know, and I don't know, I'm
preaching to the convicted here,but but you know, this is the
(03:59):
thing we zoom in, but let's zoomout and look at this whole
person that's sitting in front of us.
If they're a woman. And you know, and even don't
even necessarily think of a certain age because premature
menopause happens, surgical menopause happens And, and
actually it starts a lot sooner than we realise.
(04:20):
From the age of about 40 onwards, women are dealing with
fluctuating hormonal levels thatcan have an impact on the
musculoskeletal tissues. So you don't think of this as a
condition of older age. Now, we're therapists, OK?
We're all therapists here. But we've got women in our
lives, whether they're our mothers, our aunts, our sisters
(04:42):
or our patients. And so for me, it really is
about women in the broadest sense, whether they're on our
table or in our friendship circles.
And I think one of the things that's challenging, I suppose,
when we're considering such factors is that we as we become
more considerate to these thingsbeing relevant and you start to
(05:03):
your Spidey senses start going off mid subjective assessment,
really doors in a subjective assessment.
You'd be hopefully not so prejudice as to then done so
from understanding a date of birth or at the looks of
someone. But you want to be factoring
certain things in. And then when you do, you then
don't want to rush to then thinkthat everything therefore is is
resultant in that because then it can almost feel like
(05:25):
everything's been put in that bucket.
It's, and I had a lot of sympathy.
If you think about when, when wefirst started to learn about
some of the factors affecting tendinopathy, we learned a bit
about the fact that someone was smoking or whatever, if there
was smoking then. And then to even mention that
you could see the eyes roll intothe back of their heads thinking
it's just another I've, I've gota tennis elbow.
(05:46):
And now they're blaming smoke. Everything's blamed on smoking.
And I fear that if we're not precise and we don't learn those
lessons, then we want to make sure we don't just lump
everything into this bucket of, oh, it's menopausal.
As if therefore we can't do anything about it, which of
course isn't what we're suggesting.
But how do you think we might skillfully navigate those sorts
of things where we don't want toover imply or or sort of infer
(06:09):
that we therefore only a systemic change would be
recorded that the treatment isn't available to them for the
actual condition as well? Yeah.
Well, I mean the treatment is always going to be necessary and
appropriate, but to deliver the treatment in the context of this
person in front of us is what we're talking about.
And so this person may be sitting there in a complete days
(06:35):
not knowing what's happening in the bodies.
And we do them a service by helping them to understand the
context of their health situation.
So, so this idea that we, we zoom out and look at the whole
person, their hormonal history, you know, have they had trouble
with endometriosis or, or a postpartum depression, you know,
(06:58):
and to really get a flavour of this person's hormonal pathway,
if you like. And to know for them to, to
understand that we are not labeling them as, as anything in
particular. And that what we're saying is
that if we can understand betterwhat's happening in your body,
(07:18):
then we can deliver the treatments that are most
appropriate for you. Not only that, we could help to
signpost you to the services that you require in order for
what whatever it is that we're going to be doing to work as
well as it possibly can. What do you think therefore
would be obvious lines of questioning that we should make
(07:42):
sure we pursue when noticing if said body senses have gone off?
What do you feel are sort of appropriate lines of
questioning? Well, I suppose it is difficult
because we're all individual and, and it is different for
every woman. But you know, hot flashes or hot
flashes as we call them in this country is, is definitely a
(08:02):
symptom that a lot of women willexperience.
I think where it's important forus to make the distinction is
that there are symptoms that they can experience that they
didn't realise were associated with hormones.
So all those 34 recognised 35 recognised symptoms of
(08:24):
menopause, the brain fog, fatigue, insomnia.
And that's not just because you're having a hot sweat, mood
disturbances, genital, urinary, vaginal dryness, you know,
balance issues, vestibular disturbances, dry eyes, you, you
name it. I mean, there's every bit of our
(08:45):
bodies is struggling with the fact that the estrogen levels
are fluctuating. And, and so it's important for
us to have that level of understanding and, and then to
know that this, this hormonal shift that is occurring is
generating probably more than one musculoskeletal symptom.
(09:08):
But that then that we often, youknow, we go to the doctor, we
can only tell them about one thing at once.
You know, we get referred with one thing.
And so the physio, well, I can only really talk about this one
thing that you're talking about particularly, you know, if
you're talking about an NHS scenario.
And if there's anything else, it's not that we would neglect
that, it's just that it wouldn'tbe the first thing that we're
(09:31):
we're exploring with that client.
So, but to to be aware that it'simportant for us to to just look
at this whole person in front ofus carpal tunnel, you know,
that's something that people will could be experiencing joint
aches and pains. And so if it's widespread as
(09:52):
opposed to an individual joint and also the fact that there's
no history of injury is always going to point you to something
a little bit more curious, isn'tit, So and I.
Suppose as well it's when they're not recovering more
routinely from an innocuous injury or something that you'd
expect to have resolved Is another one, isn't it?
(10:12):
Where? Yeah, yeah, yeah.
Yeah, it's insidious onset sometimes the obvious WAG, but
then there's also then, yeah, I thought you'd have been kicking
on better than you did or the developing a tendinopathy around
a sprain or something like that,where it's just when you've got
these, these hormonal, when the hormonal fluctuation as we're
describing it. Do you?
(10:34):
I don't need to necessarily, if you feel free to give it, if you
want to like your hot take on the on HRT, but it's just that
what do you feel is our responsibility for signposting
for that medical conversation alongside our therapy?
So it doesn't need to be either or.
It doesn't mean that we then back all the way off and and and
just signpost. But it's just and I've had
(10:55):
varying different people, including on the podcast that
have got a different sort of threshold of which they would
then, you know, promote that conversation alongside therapy.
What's your take? Well, my own personal view on
this is that estrogen is too important for us to be without
it. And so that's, you know, the
(11:18):
bottom line for me. That's my choice and that is my
opinion. Now the question really comes at
what stage is this something that we start to consider as an
intervention. And so, you know, my research
and my understanding is that these pathways that exist for
(11:40):
estrogen in the receptor sites, those receptor sites will become
desensitized in the absence of estrogen.
And so if we are without estrogen for too long, then then
introducing estrogen at a later date is not as effective.
That's not to say it won't do something.
So this is sort of some emergingevidence and it's, you know, we,
(12:07):
we have to know that estrogen is, is something that women's
bodies are designed to have. So we'll say that.
And, and that estrogen fluctuation is the period of
perimenopause. So that's before menopause.
And that's why we get the symptoms predominantly because
our hormones are going up and down and your body's trying to
(12:27):
compensate this lack of estrogen.
And So what what estrogen therapy or sorry, hormone
replacement therapy does at thatstage is to kind of level us out
a bit. But it's because it's giving us
the estrogen that is lacking gradually, gradually decline.
So, you know, you don't go alongand then suddenly fall off a
Cliff. You, you know, it's gradually
(12:49):
declining. And so supplementing those
levels as you are experiencing fluctuating symptoms is going to
bring you onto a par. And then the decline continues
post menopause. The levels are continuing to
decline gradually over a period of time.
And I love that picture where there's women filled with
(13:09):
estrogen and then by the end when we're sort of 70 or 80,
it's only in your feet. So I mean, it's obviously not
only in your feet, is it? But, but I, I love that.
I love that visualization. So with.
That though, is there a do we have an assessment and titration
of dose process that can be as as accurate as this we're
(13:31):
describing? Because I like that in theory,
but in practice it can be a bit of a blunt instrument.
In my experience from what I've,you know, sometimes I've, I've
even regretted signposting whereessentially it's then been yay
or nay, you know, and this just a just a treatment dose that
might not necessarily be appropriate for that person.
So I certainly liked what you were describing in terms of
(13:53):
supplementation, but how accurate is our tested?
How well can we accurately then infatuate a dose that's
appropriate for that individual?Yes, well, it's a really good
question and currently testing in perimenopause when your
hormones are fluctuating is not the what the nice guidance
supports. So that isn't going to happen
while your hormones are fluctuating.
(14:15):
If you wanted to have that test,you would have to pay for it.
And I know that there is a day in the month when it's an
optimal time and that, you know,if I wasn't post menopausal I
might be able to remember what day that was.
So if you tested on a certain day in the month, you'd get the
best reading possible. But you know, the more I listen
(14:35):
and consume this longevity medicine that I consume online
all the time, get in your levelsbefore before you start to
suffer symptoms. So you know, what is your
baseline? You're not going to find that
out when you're when you're fluctuating.
So that said, that would be the the ideal, wouldn't it?
(14:56):
But that's not happening. So if we think of it as a blunt
instrument, we're more likely tofeel that way.
But if we think that the best way to diagnose menopause is
from the symptoms that we suffer, and the best way to know
whether HRT is working is whether or not it is addressing
those symptoms, then we can feela bit more confident in that
(15:21):
approach. Yeah.
And, and I think we can be guilty of perpetuating, you
know, the idea that it's not, this is not right, the way in
which this is being approached, yes.
So, but the evidence is that thebest way to approach it is by
symptom. Man is through symptom
management now, once a woman is stabilised, then we can start to
(15:46):
think about testing. And I say we, I'm not a doctor,
I can't be doing that. But we, you know, that is
something that we could consult with other professionals around.
But so once you're stable, then we can start to look at levels.
And yes, there is a there is a sort of level, but post
menopause you're going to be maintained at a lower level
(16:08):
because that's really more normal for your body.
We won't be maintained at reproductive levels unless
you've had a surgical menopause and then that would be
appropriate for that age of woman.
Yes. So does that answer your
question adequately it? Does no, I I think where I where
(16:29):
part of my question remains is then if we are going off
symptoms, then you you're unlikely to recognise by
symptoms maybe taking more than you needed to.
You know, you'll end up with this window of a dosage that
would be appropriate. And if you are on the side of
higher, you'll get symptom response seem to decrease, but
(16:52):
you could have been twice as much as you needed.
Whereas you then if you if you heard on the side of less then
symptoms maybe would be you knowit's not sufficient, but.
I think how? We'd manage that.
Yeah, what I just said is that we will never be prescribed more
than we need. Right.
Yeah. OK.
So, so the guidance is that the levels that you'd be prescribed
(17:14):
and the maximum, if you had the maximum, it'll still be less
than it would have been when you're in your reproductive
years. So there is no overdosing on
estrogen unless you take that pump and spread it all over your
body of your own accord. And then we can't be held
responsible for that, can we? No.
I get it. Yeah, No, you're right.
The the prescribed dose wouldn'tbe in excess of anything, no.
(17:36):
No, OK that. Makes sense?
Yeah. And they'll always start with
the lower dose and work up as asrequired.
So yeah, I wouldn't be concernedabout getting too much.
Gotcha. And so when we're then factoring
those sorts of things in, in a musculoskeletal service and is
there as well as the sort of detection, diagnosis,
(17:58):
understanding and factoring in menopausal factors into that
assessment process. Once we get into then the
management of a musculoskeletal condition, are there hard and
fast rules as to what we need toapply?
Do we need to go steadier? Do we need to go lighter?
Do we actually want to go heavier but adjust the dosage
down in terms of repetitions? There's lots of evidence out
there at the moment that's mixing around.
(18:18):
What would you suggest would be sort of rules of thumb, although
of course we would tailor it. Well, absolutely.
I, I think what is has been perpetuated up to this point is
doing less to, to feel less painand, and so that approach isn't
working. So for me, it is about
(18:42):
challenging the tissues because if we don't challenge the
tissues, they're not going to change, but in in that measured
way. So for people.
And so you, it's the person in front of you then, isn't it?
Is this an athlete or is it somebody who played netball at
school and hasn't done anything for 40 years and sat at a desk
all day? So, you know, what are we
(19:04):
dealing with? But ultimately, you know, the
work that I do, I strive for people who have, you know, I
pride myself on the fact that I can work with anybody.
And people who have never done anything I can, we can gradually
get them there, you know, to a place where they are working
with resistance or against resistance, whichever way you
(19:25):
want to put it. And that they are working on all
those metrics that we know were so important.
So strength, power, balance, coordination skills, movement,
processing skills. You know what this, as I heard
you say yesterday, cortically rich experience of movement that
(19:46):
we can tailor to the person in front of us.
And you know, we know a few different things from science.
One is people will get more benefit from doing things that
they enjoy. And, and so you, you know, we
can work with whatever it is that they that they're keen on
doing, whether it's a new thing or an old thing that they want
(20:08):
to revive. And, you know, and I've worked
with so many people who've neverexercised before and come to
this place where I met a lady onSaturday evening.
I haven't seen her since before COVID.
And she'd come to my Pilates classes and she said, oh, gosh,
I absolutely loved Pilates. And and I'm thinking that's
(20:28):
amazing, you know, this person who had had really no exercise
history and in a mid middle lifecame to movement and absolutely
loved it. Now COVID came along and got in
the way of that. But anyway, this, you know, I
happened upon her and now we're going to get back in the saddle
with the with the thing that sheloves.
(20:50):
So you know. Yeah.
Well. Engaged.
Get him, get him back. Fired up.
Yes, Well, exactly so so so. The fact is, there's no one
thing social media would love usto believe that we had to do.
High intensity interval training.
Social media would say no. Forget that.
(21:11):
All you need to do is lift this weight 4 times and you'll be
fine. Well, you know what?
None of this is true. None of it.
We need a holistic approach to movement practices and that
includes cardiovascular output. You know, we know that has
anti-inflammatory effects. Exactly, Yeah.
So one of the things that you you've mentioned there is that
(21:33):
the approach for too long has been then almost just a kid
gloves approach. It's it's been just winding all
the way back. And so it ends up being like
really low dose, really easy stretching programs, yoga,
Pilates, which of course have their role.
But if they are in in isolation,then it's, it's something that
(21:55):
unfortunately, it's a bit like, I mean, like, and my, my good
friend Jim will be ranting at this if I don't mention it, but
in rheumatology services, it wasjust everyone got hydrotherapy
because God forbid we might loadthem up.
And it was just that the evidence never supported that it
was just all inflammation. And so that we were heard on the
side of not. And so it was almost like the
(22:16):
first response to understanding these things a bit better, which
is a compassionate response is kid loves rather than thinking.
Actually, no, we need to still challenge tissues to change.
Then we still need to sort of stimulate an anti-inflammatory
response that would also be useful for hormonal profiles as
well, is to actually get out of breath now and again.
So the, the, the 1 golden rule is don't just do less for the
(22:37):
sake of doing less. There's nothing kind about that.
No. And and I'm afraid you did say
something that I'm going to pickup on here, which is easy.
Things like Pilates and yoga. No, that's true, they can be
pretty difficult. Yeah, no, but The thing is, it
is, it is the default for the reason that often times we don't
(22:59):
want to hurt people in Group classes.
You know, you, you take the the lowest common denominator, you
layer on levels of challenge. But you know, invariably
everybody tries it, whatever it might be.
But, but these are disciplines that I so often hear dismissed
as as not difficult enough. I I've got a Pilates reformer in
(23:23):
that Conservatory. I'm in my, I'm in my house.
This is my home clinic here. Yeah.
So in my Conservatory, I have a Pilates reformer machine now.
I mean, it doesn't get much harder than that, I have to tell
you. So it's really the choices that
we make with these movements. I use rubber bands like you're
(23:44):
going out of fashion. We, we use hand weights now.
We're not doing heavy hard weights, but we are loading the
tissues. We are using all those
mechanical principles that we learn as physiotherapists, Long
lever, short lever, you know, tomake it as hard single leg
focus, you know, so you can makethis stuff difficult if if you
(24:08):
really want to, if you're reallythinking about it.
And yoga and Pilates are for me,integral in movement and
function preservation for the future.
So you can be a runner, you can be a cyclist, you can be a
triathlete. I've done these things.
But if you want to carry on after 50 and into your 70s,
(24:29):
which I do, I know that these movement approaches are integral
in a a body insurance policy andthat's what I call it that's.
Great. No, that's a great, great line.
I hope you didn't think I was being dismissive of.
Not at all, no. I.
Think one of the things we can sometimes do as well is then
interchangeably use low intensity with.
(24:52):
And that's. Not right.
Whereas I suppose you know, in it when I was thinking about hip
training or or say a cardio or going for a run and it's, it's
at least a different approach and we need to try.
And I mean, there was a great piece and I'm sorry to plug in
MSK mag piece here. It's a bit cheesy, but Sue
Julian's wrote a great piece about stretching in an MSK mag
recently where she was explaining about the research
(25:14):
she's increasingly pointing towards that having real
interesting vascular elements toit, whereby actually that
facilitates cardiovascular growth and gain.
So. Well, yes.
And I, I, I exposed myself to that same sort of principle
that, you know, with yoga, really the strong stretching
does condition muscles. It it doesn't just make you
(25:37):
bendier, you know, so. Sure, and that's something that
no, I remember as a team, we were reading the suit piece and
in the editing suite and thinking, wow, this is really
confronted us with against the bias and against the grain.
And so you then end up sort of reintroducing it into practice
and realizing that that can really attenuate better results.
So you regret having turned yourback on certain things.
(25:57):
So you know, it's it's definitely interesting.
One thing I really wanted to sort of I'll pick up with you if
I could is we've talked a lot about what MSK clinicians should
be bearing in mind and what theymight consider both in terms of
assessment and treatment and management.
But I've been thinking increasingly spoke to Jennifer
James, who's appearing on a on aphysio matter special soon.
(26:18):
And it's not been published yet.But in that conversation, I
ended up in a situation where I was talking about obesity with
her and we said about the fact that there are there are factors
affecting musculoskeletal conditions that we need to
consider when considering obesity.
But there's also this idea of primary weight loss services.
What is physiotherapy and MSK clinicians role in that and what
could we do better? Is this another space in which
(26:41):
instead of just considering withcoming to see you primarily for
pain and injury and police factor this in?
Is there a space for us as sort of health coaches that happen to
be physiotherapist by backgroundhaving primary services where
people are struggling with the menopausal symptoms, are keen to
understand their body as it changes and that's the primary
reasons for them coming in? Yes, and this is the work that
(27:03):
I've been pursuing over the lastfour years.
Really, I haven't got to that point yet because I, I keep
coming upon the stumbling block of not having a doctor that I
can work with at the moment to refer people on to.
And I and I really want to have that pathway hammered out if you
like. But but yes, it's you know,
(27:24):
physiotherapists are so well placed because we have all the
professions are the ones that will take this helicopter view
of people's physical capacity. This, you know, exercises in
with the bricks as physiotherapists.
And, and I really, you know, I've really endeavoured in my
(27:45):
career to be able to straddle that boundary between
rehabilitation and physical conditioning so that we can take
people all the way through that journey.
And even if you just save yourself for the rehabilitation
part and have some trusted source that you hand them on to,
you know, but so running these Pilates group classes, yoga
(28:07):
group classes in and alongside the private individuals that I
work with is, is a really helpful, you know, it flows both
ways. They come to the group classes.
I'm not saying that I break them, but things happen, don't
they, you know, life happens. Yeah.
And so then I'm, I'm there and on hand and I can deal with
(28:29):
those. And to be honest, that what I
find is because they come to me so quickly, you know, we, we get
things back on track and, and they're, and they're back in the
group sessions and, and firing on all cylinders.
And then for people who are coming from nowhere with no
movement experience, we work as in with individuals.
I work with them as individuals.And then they, you know, I'm
(28:51):
very happy for them to take a bit more agency and, and come
along to a group session, meet other people, offer that
community of, of people. Primary menopause symptoms.
I think what I would suggest is,and actually, this is not my
term at all. Vonda Wright is an American
(29:12):
orthopaedic surgeon, and she hascoined the term the
musculoskeletal syndrome of menopause.
And I, this is something that I feel physiotherapists are very
well placed to to approach because it is women with
multiple joint aches and pains, tendinopathies.
(29:35):
Yeah, arthralgias. And then put that together with
fatigue, put that together with mood disturbances where women
are getting anxious and depressed and, and feeling like
this is the start of the end really.
You know, for some women, that'show it feels.
But but the, you know, these elements, the sarcopenia, the
(29:58):
osteoporosis, if we can get ahead of this stuff and provide
women with that information, that and permission really to
push the envelope and to understand that pain is not
always about damage and that thethe more we think about our
(30:20):
pain, the worse it's going to feel, you know, And so to equip
them with all these tools and you mentioned health coaching
and it's really, you know, goingdown that Ave. of supporting
people to explore movement as medicine to tackle what are, I
mean, this is costing the healthservice a lot of money, women
(30:41):
falling over and breaking a hip.You know, ultimately it's
costing the health service a lotof money and people a lot of
pain and and heartache. And and so to arrest that
functional decline that that occurs, you know, that some
people think is inevitable. And you know what it isn't, This
(31:03):
is the thing that I am selling. If you were buying by any
chance, but you know what I mean.
Let's, let's help. Physiotherapists are so well
placed to prevent this physical decline and frailty and empower
people to live this long active lifestyle and should they wish
to and and not feel like there'san inevitability around ageing.
(31:29):
That's right. It's that fatalism, isn't it?
That when you can get people thepenny to drop, that that needn't
be the case. And that they needn't, needn't
just manage decline and they cankick on and they can feel like
themselves again. They can feel younger again.
This is such an exciting premiseand and something that I think
physiotherapy is a really well placed profession to do so.
(31:50):
So you're excited, excited by that?
Well, you know, and the other thing is, and this is true that,
you know, from all the research that I've done, I thought it was
true. And now I'm no more certain than
I could be that it is true that there is not one symptom of
menopause, that physical activity will not improve.
So our thermal regulation is improved by exercise, sleep,
(32:17):
stress management, you name it. There, there isn't a tissue, a
structure, a cellular process that isn't somehow enhanced by
movement and exercise. So, you know, with that, OK, HRT
is an option. It's a choice.
It's, it's not for everyone. Not everyone chooses it.
I do. I feel it's important, but you
(32:38):
know, if if not, if that's not possible or it's not a choice,
movement is the next best thing.You talked about nutrition.
Of course, they go hand in hand.You know that they're bedfellows
that live together and so they should.
But but but movement is medicinefor menopause.
That is that there is absolutelyno doubt for sure.
(33:00):
And it's so it's so therefore important for us to find an
appropriate tailored dose to that individual for what might
suit them both in terms of type and intensity.
Excuse me. So thank you so much for
catching up with me today. Could you tell people where they
might find out a little bit moreabout you and, and, and what
you're active on in social media?
(33:20):
Oh well, I'm precision.co.uk online.
And you know what? That's always the one question I
failed to prepare for. So I'm Precision UK on
Instagram. I'm on all the platforms because
I really am keen to spread the message.
I've got my Precision Moving through Menopause podcast, and
that's on Spotify and Apple Podcasts.
(33:43):
And I'm on YouTube. I've got my YouTube channel Move
with Philippa Precision UK. So Precision.
Oh, and guess what? I did a clever thing.
I spelt it with AZ. With AZ, I'm going to say, I was
just going to say I know it's with AZ.
In fact, I can see it in behind you as well.
Precision it. Is.
With AZ you. Love it.
No, it's makes it memorable. No thank you so much for your
(34:06):
time. Really appreciate it and thanks
for banging this drum so proudly.
It's an important area and one that it's quite exciting to see
how it's all developing and, and, and that the immense
suffering that we can decrease and the, and the clarity we can
bring, We are perfectly placed for, for helping with that.
And it's such a positive area of, of practice at the moment.
(34:26):
And thanks for your contributions to.
It Oh, you're very welcome. Thank you so much for having me.
No problem at all. Take care.
Here are physio matters. We think physio matters.
Become a member today and accessthe biggest MSK library on the
(34:48):
planet. Access at home, work or in the
gym to make sure your CPD conditioning is elite.
Physiohyphenmatters.com More content that will fit on a
deadlift bar.
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