June 18, 2024 • 37 mins
"With HRT, it was like a switch. It was in 3 days. My symptoms had improved and I was coping with my life so much better."
If you live in New Zealand and use HRT, you'll be aware there is a shortage, and with no quick solution in sight, I was grateful to speak with Rene Schliebs on the podcast this week.
Rene is a clinical nutritionist and medical herbalist with over 20 years of experience in women's health. She has a special interest in empowering women on their menopause journey. And what I loved about Rene is that she advocates for HRT to reduce symptoms in peri and post-menopause as well as supporting clients with natural medicine.
The topic of our conversation this week is navigating medical treatment options to easily empower women to converse with their GP like a pro.
We cover how to prepare for your GP appointment, the HRT options available in New Zealand, what to do if your needs are not being met, how to navigate the current HRT shortage in New Zealand, and what to do if you have pre-existing health conditions - hint they don't necessarily preclude you from benefitting from HRT.
Join us as we explore the increasing demand for HRT and the need for greater understanding and support for menopausal women's health needs.
About Rene:
Rene Schliebs, a seasoned clinical nutritionist and medical herbalist, brings over two decades of expertise to her practice. Her professional journey intertwines seamlessly with her personal experiences, including struggles with fertility and the heartbreak of miscarriage. Through these challenges, Rene has honed her ability to offer personalised guidance to women navigating similar paths.
As she now traverses the terrain of menopause, Rene draws from her roles as both a professional and a working mother. Her deep understanding and empathy for women during perimenopause and menopause are evident in her approach.
With her guidance, you'll gain the knowledge and confidence needed to tackle this phase of life head-on.
Instagram: @reneschliebs.menopause.expert
Follow Meegan on Instagram here
Join the waitlist for The Midlife Upgrade Course: https://meegancare.co.nz/course/
Please note: The content of this podcast does not constitute medical advice, diagnosis, or treatment. Always seek the advice of your doctor or qualified healthcare provider.
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:00):
Kia ora. Are you a woman navigating midlife, menopause and beyond?
I'm Megan Keir, your midlife mentor and psychosynthesis counsellor and coach.
Join me as we dive deep into the heart of midlife, unravelling the complexities
of menopause and exploring uncharted territories that lie beyond.
Together, we'll navigate through self-doubt, bid farewell to people-pleasing,
(00:22):
conquer imposter syndrome and tame those overwhelming feelings.
It's time to celebrate this vibrant second chapter of life, claiming your authentic
confidence and courage along the way.
Midlife is not a time to settle. It is a time to unleash your purpose,
make an impact uniquely your own, all while prioritizing your well-being.
(00:43):
So buckle up for conversations that resonate with the essence of your midlife
journey. Are you ready? Let's begin.
Welcome to the podcast, Renée Schlebes. Tell us who you are and who you help.
Sure yeah so I am a clinical nutritionist and medical herbalist and I've been
in clinical practice for over 20 years now specifically in the women's health space.
(01:05):
Initially like early on in my practicing career I was helping fertility clients
going through assisted reproductive technologies struggling with fertility and
helping them to have their families so that was a very very rewarding time of my life and it was
also very much mirroring what I was going
through with my husband personally because we were struggling to
(01:27):
have a family and multiple miscarriages and did
IVF as well and you know I could have a lot of
empathy for what families were going
through you know couples were going through trying to conceive at that
time and then I've now naturally moved on
to perimenopause in the menopause space because that's
where I'm at now so yeah it's kind of in clinical
(01:47):
practice your practice kind of often just mirrors what you are going through
yourself and yeah so I'm incredibly passionate now about helping women in this
space get the help that they deserve and you know to mitigate these often very
disabling symptoms that they're going through at this time of their lives.
Yes so good to hear so our topic of conversation today is about navigating medical
(02:11):
treatment options so that women can be empowered to talk with their GP in a
really, well, like a pro, right?
In a really empowered way. So you're a clinical...
Nutritionist and medical herbalist, why is this topic particularly important to you?
Well, in terms of where I'm at, I know what it's like to suffer through these symptoms.
(02:34):
And now that I know what I know, I can look back and see that early intervention
and treatment for myself could have made life so much easier.
And I was suffering unnecessarily through that
time frame my life and when I
really made some concentrated changes by starting
the you know HRT and really focusing
(02:57):
in on on my own diet and lifestyle choices that's
when I noticed incredible changes you know with with HRT it
was like a switch you know within three days my symptoms
had improved and I was coping with my life so much
better so you know I mean HRT might
not be for everybody but I'm very passionate about it
because I know how it's helped me and I know how it's
(03:18):
helped a lot of people that I consult with and a lot of you know friends and
family members as well so it's about educating women so that they can talk to
their GP and get the right advice for them and make a decision that is meaningful
to them to get the help that they need.
Yes similar journeys actually I struggled for many years sort of trying to put
(03:41):
things together to help the symptoms.
And because I went through menopause early, my friends weren't going through
the same thing. So I was sort of a bit out of left field.
And then by the time I actually came to HRT and then the shift it made for me
just to be able to feel like my life was, I had enough energy to do my life
(04:02):
again, was massive and to drop the struggle.
And so I'm a real advocate for Or if it works for you and you're okay with that,
then absolutely have those conversations with your doctor. So I'm glad we can talk about this today.
Yeah, yeah, I agree. And, you know, in the clinic, I consult a lot with corporate
women and I do a lot of speaking in the corporate space.
(04:23):
And the most common thing that I hear from these women is.
I am so afraid of losing my memory. And that is, you know, that's happening,
you know, cognitive decline because of lowering estrogen levels,
it really affects the brain and it affects output.
And when you start putting estrogen back into these women, it's just calming
everything down, cognition improves, sleep improves, you know,
(04:46):
it just improves their lifespan so dramatically.
And, you know, they can continue in their careers the way that they want to.
Oh, so, so good. Good. Now, could you start by giving us an overview of the
most common medical treatment and options available for us if we're in peri
and or post-menopause in New Zealand specifically?
Sure. Yeah. So the most common and the safest form of HRT is estradiol in the
(05:11):
form of estrogen patches, micronized progesterone in the form of a capsule.
So these are 100% body identical. So So they are the exact same hormones that
we are losing in rapid decline that we're putting back into the body.
Topical application has been shown to be very, very safe and effective and the
progesterone in the form of the micronisers.
(05:33):
Progesterone from plants is the most safe and effective treatment.
There are other options though. So some women prefer to take tablets of the estradiol.
They do come with a slightly increased risk in terms of blood clotting if you're
taking it orally because it does have to go through the liver to be processed
by the body, whereas the patches don't have to do that first pass.
(05:56):
So they don't have that increased clotting risk.
So yeah, the patches, the tablets of of estradiol and the progesterone is the most common forms.
If you haven't had a hysterectomy, so if you do have a uterus,
you must take progesterone to protect the lining of the uterus from any unopposed estrogen.
So the uterus can thicken up if you're not taking progesterone.
(06:19):
So we do need to do that if we have a uterus.
If you've had a hysterectomy, you don't necessarily need
to take the progesterone or you can take it for the benefits it
because it's amazing for sleep but you don't
have to have have it for those protective effects on the uterus but
then we also have gels that are available although
not funded and you know they are
(06:41):
also a very effective treatment for for women going through this stage of their
lives but yeah the most common treatment is the patches and the progesterone
together that's right yeah and so do Do I just go to my GP for this or do I
need to see a menopause specialist that can prescribe? What's your advice on that?
Your GP, any New Zealand GP can prescribe HRT, although what I'm finding with
(07:06):
a lot of women is that their GPs aren't listening to them, they're not being heard properly,
they're being denied HRT or they're being told things like, I won't prescribe
this for you unless you have an IED inserted.
Inserted so you know it's about finding the
right GP for you if your GP isn't listening
then I would highly suggest finding a
(07:28):
new GP but yes of course you can go
to your GP and have this prescribed and you can also see
a menopause specialist doctor and there are a few
out there that I absolutely love and you know if there's more kind of complications
going on with cysts or fibroids or concerns around you know endometriosis or
other sort of reproductive disorders you may be referred to a gynaecologist
(07:51):
or an endocrinologist for further clarification and treatment.
And so how would I know if my GP is actually on the ball with menopause,
like current menopause treatments?
Is it kind of hit and miss, I need to show up and just see what response I get,
or are there ways to sort of navigate that?
So I would always speak to the practice manager and just find out who the best
(08:14):
person in the practice is around menopause and perimenopause and specifically
say that that's what you're coming in for.
Leave all other concerns behind because you've got a 15-minute appointment basically.
So you want to be specifically talking about the hormones and the perimenopause
or menopause or whatever you're going through around that menopause space.
(08:35):
So definitely calling in advance to find out who that person is.
If they are advertising that they are menopause specialists,
then usually they have a menopause certified qualification through the Australasian Menopause Society.
And they are the ones that I would highly recommend going to see because they're
(08:56):
up to date with their current research. They know what they're talking about.
It's a 45 minute appointment usually, and you feel very validated and very,
very heard in that space as well.
Right. So are those GPs private though, the ones that are registered with the
Australasian Menopause Society? They are.
They're not specifically private, but you do have to pay, you know,
(09:18):
and in some cases, you know, up to $300 an appointment.
So it's not easily accessible for a lot of people.
But there are clinics that are popping up that are trying to make this more
available to women in the menopause space.
And there's one that's just recently started up called the Kala Clinic.
Oh, I saw that. Yeah, this week. Yes, yes. So that's very exciting.
(09:40):
And she is a woman that went into menopause very young and never was able to
find the right treatment for her and felt very unheard and unvalidated.
So it was her mission to start a clinic that could validate women and was easily accessible.
So I think the consultations are $89. And I imagine they will be booked out very quickly.
(10:02):
So she may be finding... I already saw they were like booked out at least a
month in advance and that only sort of opened this way.
So clearly there's a massive need, isn't there?
There absolutely is. Yeah. And I mean, I've just had a client this morning and
she very clearly, in my opinion, would benefit from being on HRT.
She had been to see her doctor with her symptom score chart and said,
(10:26):
the doctor dismissed the symptoms and said, I don't think that you need this at this point.
You know, but we're looking at mood changes. We're looking at sleep problems.
We're looking at urinary issues.
All of these things are happening because of the declining levels of estrogen in her body.
So she's now going to see a new GP. And funnily enough, she told me that that
GP is actually quitting the practice at the end of the year.
(10:49):
So we are also, you know, we're also looking at burnout, compassion fatigue.
You know, doctors have been under a lot of pressure in the last five years.
And I mean, that doesn't, you know, dismiss, you know, not discussing concerns
with women around HRT, but it's telling you the state of the medical system,
you know, it's pretty bad.
(11:10):
Yeah. So we're struggling as patients and consumers, but obviously there's a
massive load that they're dealing with as well.
So to bear that in mind, I think is helpful.
And what is the checklist you briefly mentioned in there? Can you share a little bit about that?
So there's something called the Greenscale Adapted Symptom Questionnaire that
you can find and easily download on the Australasian Menopause Society website.
(11:35):
So it basically is a symptom score chart that goes through every single system
in the body that's affected by perimenopause and menopause.
And you can grade your symptoms according to not having started on menopause
hormone therapy, three months later, and then six months after starting.
And it's a fascinating score. I think my first score was 46,
(11:57):
and anything over and above 15 is very clinically significant.
So, you know, I was really suffering. And then three months later and six months
later, my score, I think, after starting HRT went down.
To six and then three. So that's how effective it was for me.
I love being able to visually see that for myself as well.
Because when I think back, you know, it's been coming up to three years,
(12:19):
I think, since I've been on HRT, and so much has changed, but it becomes my life.
And so then it becomes more difficult to compare.
So I know that so much has changed for me, but it's hard for me to recall and remember and compare.
And I think that that's a helpful thing for us to do just for ourselves to check
(12:40):
in with how we're doing as women. Thank you for sharing that.
No, I agree. And also what's very interesting about that score sheet is,
and you probably have found this in the perimenopausal phase,
you're swinging on those highs and lows very rapidly, very quickly, and things can change.
So it's also good to have that sheet on hand if you feel like things are changing
(13:03):
a bit and your dose might need to be increased.
So it's a really good measure for women on do they need to go up a level in
their patches and their dosages and how are they going to do that?
And they can take that form to their doctor and say, you know,
this is where my symptoms are at this point. Do I need a higher dose?
And so can you just clarify this for us? We don't need to wait until we're at
(13:25):
menopause, you know, the 12 months since our last menstrual cycle to actually
begin HRT. Can you just speak to that briefly?
Oh, absolutely not. This is all based on symptoms.
So if you ask, you know, perimenopause can start as young as natural,
you know, sort of perimenopause around the age of 35, when our estrogen and
(13:46):
progesterone levels are starting to decline.
It's faster after the age of 40. So if you're around that age and you're noticing,
you know, more severe swings,
you know, know with mood with sleep any hot
flushes I mean it's not just about hot flushes it's
about increased urinary you know frequency
the things for me were like debilitating anxiety joint pain muscle pain and
(14:11):
sleep disturbances nothing to do with hot flushes so if you're not kind of educated
around that menopausal space it's very hard to know what's going on and you know for a lot of women,
they go to their GP with their symptoms and get put straight on antidepressants
without even having had that conversation.
So we need more awareness and more conversations out there with our doctors.
(14:35):
Absolutely. And so what is the limitation of say, because I did go into perimenopause
after my second child and so I was 37.
I had no idea that was what was going on. I just thought I was really fatigued
and irritable and all the rest
of it. Looking back now, I can and see that that was what was happening.
I totally lost my train of thought. I was about to ask you something.
(14:57):
That's menopause. That is menopause.
It was the limitations. We welcome,
yes, that's it. We welcome the memory lapses. We do, we do, we do.
The limitations. So yes, if
you get put on antidepressants, because I've heard that a lot from women.
Can you speak to the limitations of that? So, I mean, in terms of going on antidepressants,
(15:18):
you know, there could be very valid reasons for that.
However, if you're looking at somebody in a perimenopausal phase,
we're also looking at other kind of hormonal symptoms that might be coming into
play there and what else do we need to treat.
So, you know, we need to look at women holistically, not just as one kind of identified symptom.
(15:39):
And I've just lost my train of thought there too.
I was going to say about the antidepressants, you know, there's very clear data
out there and it's quite well hidden in the data sheets that antidepressants
will cause osteoporosis.
So we're already seeing a woman that's got depleting estrogen levels,
(16:00):
which is going to affect her bone health and then potentially being put on antidepressants
for menopause rather than HRT for menopause, further compounding that fracture risk and bone risk.
So it's here. There is a lot to be done in terms of actually just revisiting
the space and educating GPs around it. Yeah, absolutely.
(16:22):
And so blood tests for hormones, right? I think maybe I'm in perimenopause,
can I just go to my doctor and get a blood test? What's the picture around that?
Yep, you can absolutely go and have a blood test. However, as I said before,
you know, the hormones one week could be in the hundreds and then below a hundred,
you know, swinging in those highs and lows in terms of estrogen,
(16:44):
follicle stimulating hormone, progesterone.
So those are the key bloods that you would test.
And, you know, it might be relevant in the beginning to just do kind of a baseline
measure and see where a woman might be sitting, but it may not be clinically significant.
What we really, really want to be doing is listening to her and believing her.
(17:05):
About where she's at and what's going on with her
symptoms and as i said before that's that green scale
score chart is amazing for that but just on the blood tests one that is absolutely
vital to check would be testosterone especially if if the woman has hypoactive
desire disorder so you know really low libido no desire at all for intercourse
(17:27):
we want to be checking testosterone testosterone,
and there is help available for that.
So in New Zealand, we can prescribe a product called Androfen,
and that is a game changer for a lot of women.
However, it's once again not funded, but Pharmac are looking at funding that.
So it's expensive and not all women can afford to go on that.
(17:48):
But in terms of bloods, we must check that because we don't want anything swinging
into a male level of hormones in the body.
We want to make sure that that's maintained within the clinical norms.
Yeah. So asking for a friend, not really, I'm asking for myself.
Someone's using androfen, which I've found to be really helpful.
What would you say is the timeframe of testing? So they do a baseline test and then test again when?
(18:12):
So when I spoke to Dr. Jenny Hill at Dr.
Menopause, she said that, you know, of course there's a mandatory first blood
test and then again at a month and then at three months,
they're going to be continuously checking they're not going to leave you over
a three-month period and not check that because obviously they have to be very,
very safe with their prescribing of it. Yes, exactly.
(18:33):
Yes. And so in New Zealand, and I believe currently worldwide as well,
there is a shortage of HRT patches and it's slowly been getting more and more
significant to a stage now where it's pretty significant.
I've been talking I've been talking to a lot of women who haven't been able
to fulfill their prescriptions and their repeat.
(18:56):
What on earth are we going to do? I'm all right for a couple of months,
but I'm like, what on earth am I going to do after that?
Yeah, it's an unacceptable, absolutely dire situation for so many women worldwide.
So, you know, initially it was blamed on COVID and now it's because there's
been a massive uptick in the use of patches.
(19:17):
But, you know, come on, this is just women's lives that we're dealing with now.
And, you know, suicide rates. I've heard of women actually wanting to commit
suicide over this. So it's dangerous.
It's unacceptable. a lot of women are cutting their
patches into thirds to stretch them
out and make them last a bit longer there is
(19:37):
the option of the tablets if women choose
to go that way but a lot of women don't want that increased risk
with the clotting and some women can't take them because of that risk so you
know but that is an option and then of course as i said before there's the gels
there's two gels available in new zealand but they come at a cost as well so
you know a minimum of 40 sometimes up to $150 a month for that.
(20:02):
So I honestly don't know how this is going to pan out.
Pharmac are apparently tendering for a new supply, a new contract,
but it blows my mind that this is taking so long.
I don't understand why it can't just be done to support these women,
including ourselves, you know?
Yeah, you're so right. It's completely unacceptable, and yet we're not really
(20:26):
surprised by it, right? Because women's health, in my experience,
has always taken a back seat.
And so it's not surprising, although it's outrageous.
Oh, I did hear from a woman this past week who said that her doctor,
she went to the doctor to ask for HRT as a new user patient.
And the doctor said to her, no, I'm not prescribing patches and progesterone
(20:50):
because of the shortage.
We've been told not to prescribe it. And that's different to saying,
yes, but there's a shortage. let's see what we can do still comes in and dribs
and drabs I thought that was just.
Outrageous it is my pharmacist did tell me
that there was a new shipment mid-june and then
another one in august but she was
(21:11):
also quite vague she was like you know and they are suffering as
well they've got women coming in demanding these
things and and honestly they feel terrible about
it you know it's not their fault and you know
the new zealand government needs to do more in
this space but there are a lot of surveys going
on at the moment there's petitions so you know
(21:32):
I encourage women to look at those and fill them out and
you know have a voice in this space that I mean
that's that's what we can do when we can't do anything is to have that voice
and to speak up about it yeah so it's good to be seeing those petitions out
there yeah absolutely so in terms of if I'm I'm going to my GP and I want to
(21:54):
talk to them about HRT or the possibility of HRT for me.
What sort of prep and what sort of steps do I need to take?
What would you say to a client to help them prepare?
Because like you say, you've got that 15 minutes. It's not a lot of time.
It goes really fast and you want to get the best outcome for yourself from that.
So, as I said before, wringing the practice ahead and finding the best consultant
(22:16):
there for you and your condition.
I would also book the very first appointment of the day. So,
you're not waiting around. You're not flustered when you go in.
You're fresh and they're fresh.
So, I always book the first appointment of the day. And then,
you know, keep a symptom diary.
Write down how you're feeling, what's going on. also
be prepared to talk about your family health risks any
(22:38):
other risks that you think might be important and your
own personal health care as well so going
into those appointments as prepared as you possibly can be
to get the best out of that situation and then
you're going to be wanting to ask questions along the lines
of what HRT options are available for me
what's you know perhaps the easiest the safest route
(22:59):
for me to to get this and to have continuity of
care I would also be asking you know at
what point they would like to see you for a follow-up
because I think it's incredibly important for women
to be followed up a month later and then at the three-month point just to make
sure that the dosage is right for her because more often than not it's too low
(23:22):
and they need a higher dose and as I said before you know things are swinging
very very rapidly and they could need need a higher dose quite quickly.
So it's about just really keeping in touch and building a good rapport and that
good relationship with your GP so that you feel very, very cared for.
I have actually, a friend of mine messaged me last night and she said that her
(23:42):
practice had emailed her about the shortage and to offer her the gel.
I haven't had anything like that from my practice at all, but I thought that
was really reassuring and quite promising. It's very proactive.
Yeah. And if I've been talking to my doctor and I feel like they haven't been
taking me seriously, they have just sort of told me to put up with it or whatever the case may be.
(24:08):
What advice do you have for me and how can I sort of advocate for myself and
my well-being and health?
No woman should be denied HRT if that is her choice.
And we need to be giving this choice back to women. It's her body.
She is the only person that knows exactly what is going on for her and how badly
(24:30):
her symptoms are affecting her quality of life.
So if she's in front of a GP who
is denying her that and not engaging in a conversation, just get a new GP.
And the Australasian Menopause Society website has a fantastic list of GPs available
in New Zealand who are menopause certified. And they can be,
(24:51):
you know, those more specialist care ones like Dr.
Menopause or the Menopause doctors or just general GPs.
So if you're not being heard, it's time to get a new GP. Great advice.
And of course, there's always telehealth now.
So that makes us, you know, makes things a lot easier as well.
Yeah, absolutely. That's incredible.
Yeah, for sure. So you're a clinical nutritionist and medical herbalist.
(25:13):
How do you see that integration of both natural and medical treatments?
Months what's your viewpoint on that yeah well i mean
as i said before you know it's it is my you
know wish and desire that we all work together collectively to
support women and this is not just gps this is
you know all sorts of integrative care acupuncturists you
(25:35):
know counseling therapy and that's an important one
as well because i see a lot with women that unresolved childhood
trauma really and you probably see this in your practice rears
its ugly head around this time frame when
we're having these massive massive swings so it's about you know extending that
to all forms of health care for women but you know something that a woman can
(25:58):
ask her GP in consultation is you know do you work with any nutritionists do
you work with any naturopaths any herbalists you know like Like,
who is your extended network of people that you could refer me to?
And a lot of practices do have that now, which is really, really cool to see.
So I think the more that we can advocate for ourselves, be very firm with where
(26:20):
we're at, and also, you know, just talking to your GP and educating them about what's working for you.
You know, I'm taking XYZ supplements and I'm following this anti-inflammatory
diet plan and it's really working for me.
How can we work together for the better, you know, for the better good of my
health? And so for women who prefer not to use HRT or perhaps they can't or
(26:41):
they don't respond to it very well, what alternative or complementary techniques?
Therapies, treatments are available and do you recommend? So diet is amazing.
A lot of women do very, very well from having a proper consultation with a nutritionist
to get on top of their eating, really get an anti-inflammatory diet plan in there for them.
(27:03):
Doing some sleep therapy as well, taking some nutrients that help with sleep are very, very good.
So there's things like, you know, magnesium and kava, 5-HTP,
you know, speaking with a qualified practitioner about how those supplements
could be prescribed for you for your condition.
There are a lot of amazing herbs that help with the nervous system that have
(27:25):
shown some clinical significance in reducing those vasomotor symptoms with hot flushes,
although there needs to be a lot more research in that area, but there is help.
In terms of medical options for not being on HRT, steroids can be prescribed.
Prescribed antidepressants can also be prescribed
(27:46):
and have worked for a lot of women with hot flushes but
once again we're looking at these things don't come without their risks you
know so everything medical can come with a risk and it's about weighing up those
risk benefit situations based on your personal medical profile with your GP
and making the right decision for you Yeah.
(28:08):
And as you say, everything medical comes with a risk.
There's still a lot of conversations that I hear that HRT is dangerous.
You're at risk of breast cancer. It's a very high risk.
I was talking to a friend a few weeks ago and she was considering it.
Then she talked to some other friends. She's like, this is what they said.
And I was like, I wonder where that information comes from. What do you see in that?
(28:33):
So that information came from the Women's Health Initiative study in 2002.
Where they took a section of women.
So they were mostly around 65 years old.
They had been away from estrogen already for a good period of time, so 10 years almost.
So it wasn't a relevant study compared to you know
when we do put women on HRT and the risk
(28:55):
was you know it wasn't even clinically significant so
that's all being debunked now and there's so much
that's coming out around that and how misinformed
that study was but you know there are there
are contraindications for use of HRT
you wouldn't use it in an active blood clot so somebody
with known deep vein thrombosis you wouldn't use
(29:17):
it in active breast cancer and this is not
to say that women post breast cancer treatment can't
have HRT they absolutely can and
that is a conversation that needs to happen with qualified specialists and an
oncologist and a doctor to make the best informed decision for that patient
so yeah liver disease active breast cancer of course pregnancy you wouldn't
(29:39):
use it and an active blood clot but apart from that it's actually incredibly safe to use.
And we need to look at the benefits of HRT rather than talking about these supposed risks all the time.
Do you want to have a long health span?
What does that look like in terms of cardio metabolic disease?
Well, your risk is decreased by 30%, if not higher when taking HRT.
(30:02):
Your bone health, your risk for Alzheimer's, dementia, the list goes on and
on and on. And we're lucky at this time.
And I think, you know, our daughters, our children going to come into the space,
you know, with a lot more education and, you know, power in this situation.
It's a very, very interesting time in the menopause space at the moment.
(30:24):
It is an interesting time and we can really see, you know, even in the last
five years, how much things have swung and how much the demand from when I first started on HRT,
which was probably three years ago to now, the demand has has increased,
but it irritates me that that has been given as a reason, like we're doing something
wrong. Oh, well, you're running out because the demand's increased.
Like there's this inferred kind of, well, you're all wanting far too much.
(30:49):
This is supporting our health and wellbeing over the long term.
I don't think it's too much to ask.
Yeah, I 100% agree with you. And when I look at all of this and I think of other areas of medicine,
there is no other area of medicine where people are going to their doctors and asking for a treatment.
(31:11):
You know, if you've got high cholesterol, you're put on a statin
you know willy-nilly you know drugs are handed
out very very very readily but in
the HRT space we're having to go to our doctors to
demand this it just makes no sense to me
at all and if we look at you know for example a
thyroid disorder you're given the hormone that's going to
(31:34):
support your thyroid so why in menopause
are we being denied hormones that are going to
support these systems it's just crazy it's
wild isn't it it would I would take a good unpacking
to understand that the structures that have
fed into this and the stage we're at now with
it yeah yeah absolutely I did
(31:56):
have a woman speak to me and obviously in no way am I any you know I'm not medically
trained but she was talking about she'd been on HRT and it really really helped
her but she'd had she She didn't know she had fibroids and so that had become
a problem and they'd grown over the last year, that kind of thing.
What's the sort of general protocol around that?
(32:19):
Because a lot of women do have fibroids whether we know it or not,
right? Yeah, absolutely.
So that's a case where I would absolutely recommend a specialist,
a gynecologist or an endocrinologist to look after
the care of that woman and it may be that the dose is just titrated a little
bit for her you know and she needs to be very very clinically monitored for
that and it's not to say she can't have HRT but it's about you know perhaps
(32:42):
pulling back on the dosage under the guidance of a proper specialist for that person.
Yes I think that's the key isn't it it's when you have these added complications
for your own health is to have that guidance from a specialist it doesn't mean
that it's necessarily a no-go area but you need that specialist help.
Yeah absolutely and you know there's amazing doctors out
(33:04):
there there are amazing specialists out there it's just
you know a group that we need to
be kind of educating and bringing along on the
ride with us yeah exactly and I do love sharing resources you know like people
like you like Menno Doctor we've got amazing integrative a couple of amazing
integrative GPs here in New Plymouth that are really up with the the game with
(33:26):
menopause and thank goodness one of them was the woman that I went to see to
talk to her about HRT, and she just laid it all out for me.
She said, you've got this option, this option, and this option.
Things were only partly funded then, and I went away and made an informed choice.
She sent me all the information so I could have a look at it.
It was a very empowering experience. Yeah.
You know, I hope that more and more of us have that experience for ourselves as well.
(33:52):
Yeah, I agree. And I'm so glad that you got the help that you needed.
And my experience is very, very similar with Dr.
Menopause as well. But yeah, as I said earlier, it's really exciting to see
these other little clinics popping up that are cheaper alternatives as well. Yeah, so good.
And so what resource support systems are available in New Zealand for women
who are navigating menopause?
(34:13):
So, you know, that would be about accessing that to complement our GP's advice
to gain a better understanding of what's happening. It's taken me years to understand that.
And I'm out the other side now, but I finally understand perimenopause,
menopause, postmenopause and what was going on for me.
What are the resources available for us?
Yeah, so probably the only one that I would really endorse is the Australasian
(34:37):
Menopause Society website.
It's an amazing directory of everything research-based. So it's clinically up to date.
You can download articles there that you can take to your GP.
There's information there on how to speak to your GP.
There's the quiz that you can do to take to your GP as well.
And of course, the link to all of the certified doctors who will be able to help you in this space.
(35:01):
So that's pretty much the only resource that I really do recommend because it
is certified and I know that the research is up to date.
Te Whare Ora, for example, if you go on there, so this is the New Zealand health
website, if you go on there and type in menopause,
you will get two articles and they are on cervical screening and HPV.
(35:23):
That's it. There is no information available, which is really sad.
So yeah, the Australasian Menopause Society website is where you'll get all
of the relevant and up-to-date information.
Okay, good to know. And yes, that game needs to be picked up quite a bit.
But however, we have the Australasian Menopause Society.
And so any final words of advice if someone was listening and they're sort of
(35:47):
thinking about HRT or they just started, but they're pretty confused,
they're maybe struggling with their health, advice would you leave them with?
I would say, you know, the first protocol is to find somebody who is going to
hear you and to listen to your symptoms because you want to feel validated.
You don't want to feel like you're going crazy. And this is how a lot of women feel in this space.
(36:10):
And I know for me, it was like, what the hell is happening to my brain, to my body?
You know and finding somebody who is going to listen
to you and validate what is going on for you is the most
important thing so my best piece of
advice is if you're wanting to navigate the space if you're wanting to talk
about HRT please find a GP that you feel very very comfortable with who you
(36:33):
feel is listening to you beautiful and if people want to stay connected with
you perhaps they want to just learn more from you or even work with you what's
the best way for them to do that So.
Instagram is the best way to find me and my handle there is reneeschleeps.menopause.expert.
Well, Renee, thank you so much. This has been really, really informative and
(36:55):
I know it's going to be one of those episodes that women come back to time and
time again so that they can get that resourcing that we all need.
Yeah thank you for having me and also you know
thank you for the work that you're also doing in this space i think
the more that we can all band together and you know collaborate
together as you know women helping women the better
it's going to be for the health outcomes of all of us hey
(37:18):
thanks for joining me on the podcast really appreciate you
check out my course where we just go so much
deeper than i can ever do on a podcast over an
eight-week period the midlife upgrade course is a
blend of video and learning modules and weekly live calls where you will discover
a roadmap for psychological freedom in midlife check out all the details on
(37:44):
my website i really really would
love to have you join the course megancare.co.nz forward slash course.
Kia ora. Are you a woman navigating midlife, menopause and beyond?
I'm Megan Keir, your midlife mentor and psychosynthesis counsellor and coach.
Join me as we dive deep into the heart of midlife, unravelling the complexities
of menopause and exploring uncharted territories that lie beyond.
Together, we'll navigate through self-doubt, bid farewell to people-pleasing,
(00:22):
conquer imposter syndrome and tame those overwhelming feelings.
It's time to celebrate this vibrant second chapter of life, claiming your authentic
confidence and courage along the way.
Midlife is not a time to settle. It is a time to unleash your purpose,
make an impact uniquely your own, all while prioritizing your well-being.
(00:43):
So buckle up for conversations that resonate with the essence of your midlife
journey. Are you ready? Let's begin.
Welcome to the podcast, Renée Schlebes. Tell us who you are and who you help.
Sure yeah so I am a clinical nutritionist and medical herbalist and I've been
in clinical practice for over 20 years now specifically in the women's health space.
(01:05):
Initially like early on in my practicing career I was helping fertility clients
going through assisted reproductive technologies struggling with fertility and
helping them to have their families so that was a very very rewarding time of my life and it was
also very much mirroring what I was going
through with my husband personally because we were struggling to
(01:27):
have a family and multiple miscarriages and did
IVF as well and you know I could have a lot of
empathy for what families were going
through you know couples were going through trying to conceive at that
time and then I've now naturally moved on
to perimenopause in the menopause space because that's
where I'm at now so yeah it's kind of in clinical
(01:47):
practice your practice kind of often just mirrors what you are going through
yourself and yeah so I'm incredibly passionate now about helping women in this
space get the help that they deserve and you know to mitigate these often very
disabling symptoms that they're going through at this time of their lives.
Yes so good to hear so our topic of conversation today is about navigating medical
(02:11):
treatment options so that women can be empowered to talk with their GP in a
really, well, like a pro, right?
In a really empowered way. So you're a clinical...
Nutritionist and medical herbalist, why is this topic particularly important to you?
Well, in terms of where I'm at, I know what it's like to suffer through these symptoms.
(02:34):
And now that I know what I know, I can look back and see that early intervention
and treatment for myself could have made life so much easier.
And I was suffering unnecessarily through that
time frame my life and when I
really made some concentrated changes by starting
the you know HRT and really focusing
(02:57):
in on on my own diet and lifestyle choices that's
when I noticed incredible changes you know with with HRT it
was like a switch you know within three days my symptoms
had improved and I was coping with my life so much
better so you know I mean HRT might
not be for everybody but I'm very passionate about it
because I know how it's helped me and I know how it's
(03:18):
helped a lot of people that I consult with and a lot of you know friends and
family members as well so it's about educating women so that they can talk to
their GP and get the right advice for them and make a decision that is meaningful
to them to get the help that they need.
Yes similar journeys actually I struggled for many years sort of trying to put
(03:41):
things together to help the symptoms.
And because I went through menopause early, my friends weren't going through
the same thing. So I was sort of a bit out of left field.
And then by the time I actually came to HRT and then the shift it made for me
just to be able to feel like my life was, I had enough energy to do my life
(04:02):
again, was massive and to drop the struggle.
And so I'm a real advocate for Or if it works for you and you're okay with that,
then absolutely have those conversations with your doctor. So I'm glad we can talk about this today.
Yeah, yeah, I agree. And, you know, in the clinic, I consult a lot with corporate
women and I do a lot of speaking in the corporate space.
(04:23):
And the most common thing that I hear from these women is.
I am so afraid of losing my memory. And that is, you know, that's happening,
you know, cognitive decline because of lowering estrogen levels,
it really affects the brain and it affects output.
And when you start putting estrogen back into these women, it's just calming
everything down, cognition improves, sleep improves, you know,
(04:46):
it just improves their lifespan so dramatically.
And, you know, they can continue in their careers the way that they want to.
Oh, so, so good. Good. Now, could you start by giving us an overview of the
most common medical treatment and options available for us if we're in peri
and or post-menopause in New Zealand specifically?
Sure. Yeah. So the most common and the safest form of HRT is estradiol in the
(05:11):
form of estrogen patches, micronized progesterone in the form of a capsule.
So these are 100% body identical. So So they are the exact same hormones that
we are losing in rapid decline that we're putting back into the body.
Topical application has been shown to be very, very safe and effective and the
progesterone in the form of the micronisers.
(05:33):
Progesterone from plants is the most safe and effective treatment.
There are other options though. So some women prefer to take tablets of the estradiol.
They do come with a slightly increased risk in terms of blood clotting if you're
taking it orally because it does have to go through the liver to be processed
by the body, whereas the patches don't have to do that first pass.
(05:56):
So they don't have that increased clotting risk.
So yeah, the patches, the tablets of of estradiol and the progesterone is the most common forms.
If you haven't had a hysterectomy, so if you do have a uterus,
you must take progesterone to protect the lining of the uterus from any unopposed estrogen.
So the uterus can thicken up if you're not taking progesterone.
(06:19):
So we do need to do that if we have a uterus.
If you've had a hysterectomy, you don't necessarily need
to take the progesterone or you can take it for the benefits it
because it's amazing for sleep but you don't
have to have have it for those protective effects on the uterus but
then we also have gels that are available although
not funded and you know they are
(06:41):
also a very effective treatment for for women going through this stage of their
lives but yeah the most common treatment is the patches and the progesterone
together that's right yeah and so do Do I just go to my GP for this or do I
need to see a menopause specialist that can prescribe? What's your advice on that?
Your GP, any New Zealand GP can prescribe HRT, although what I'm finding with
(07:06):
a lot of women is that their GPs aren't listening to them, they're not being heard properly,
they're being denied HRT or they're being told things like, I won't prescribe
this for you unless you have an IED inserted.
Inserted so you know it's about finding the
right GP for you if your GP isn't listening
then I would highly suggest finding a
(07:28):
new GP but yes of course you can go
to your GP and have this prescribed and you can also see
a menopause specialist doctor and there are a few
out there that I absolutely love and you know if there's more kind of complications
going on with cysts or fibroids or concerns around you know endometriosis or
other sort of reproductive disorders you may be referred to a gynaecologist
(07:51):
or an endocrinologist for further clarification and treatment.
And so how would I know if my GP is actually on the ball with menopause,
like current menopause treatments?
Is it kind of hit and miss, I need to show up and just see what response I get,
or are there ways to sort of navigate that?
So I would always speak to the practice manager and just find out who the best
(08:14):
person in the practice is around menopause and perimenopause and specifically
say that that's what you're coming in for.
Leave all other concerns behind because you've got a 15-minute appointment basically.
So you want to be specifically talking about the hormones and the perimenopause
or menopause or whatever you're going through around that menopause space.
(08:35):
So definitely calling in advance to find out who that person is.
If they are advertising that they are menopause specialists,
then usually they have a menopause certified qualification through the Australasian Menopause Society.
And they are the ones that I would highly recommend going to see because they're
(08:56):
up to date with their current research. They know what they're talking about.
It's a 45 minute appointment usually, and you feel very validated and very,
very heard in that space as well.
Right. So are those GPs private though, the ones that are registered with the
Australasian Menopause Society? They are.
They're not specifically private, but you do have to pay, you know,
(09:18):
and in some cases, you know, up to $300 an appointment.
So it's not easily accessible for a lot of people.
But there are clinics that are popping up that are trying to make this more
available to women in the menopause space.
And there's one that's just recently started up called the Kala Clinic.
Oh, I saw that. Yeah, this week. Yes, yes. So that's very exciting.
(09:40):
And she is a woman that went into menopause very young and never was able to
find the right treatment for her and felt very unheard and unvalidated.
So it was her mission to start a clinic that could validate women and was easily accessible.
So I think the consultations are $89. And I imagine they will be booked out very quickly.
(10:02):
So she may be finding... I already saw they were like booked out at least a
month in advance and that only sort of opened this way.
So clearly there's a massive need, isn't there?
There absolutely is. Yeah. And I mean, I've just had a client this morning and
she very clearly, in my opinion, would benefit from being on HRT.
She had been to see her doctor with her symptom score chart and said,
(10:26):
the doctor dismissed the symptoms and said, I don't think that you need this at this point.
You know, but we're looking at mood changes. We're looking at sleep problems.
We're looking at urinary issues.
All of these things are happening because of the declining levels of estrogen in her body.
So she's now going to see a new GP. And funnily enough, she told me that that
GP is actually quitting the practice at the end of the year.
(10:49):
So we are also, you know, we're also looking at burnout, compassion fatigue.
You know, doctors have been under a lot of pressure in the last five years.
And I mean, that doesn't, you know, dismiss, you know, not discussing concerns
with women around HRT, but it's telling you the state of the medical system,
you know, it's pretty bad.
(11:10):
Yeah. So we're struggling as patients and consumers, but obviously there's a
massive load that they're dealing with as well.
So to bear that in mind, I think is helpful.
And what is the checklist you briefly mentioned in there? Can you share a little bit about that?
So there's something called the Greenscale Adapted Symptom Questionnaire that
you can find and easily download on the Australasian Menopause Society website.
(11:35):
So it basically is a symptom score chart that goes through every single system
in the body that's affected by perimenopause and menopause.
And you can grade your symptoms according to not having started on menopause
hormone therapy, three months later, and then six months after starting.
And it's a fascinating score. I think my first score was 46,
(11:57):
and anything over and above 15 is very clinically significant.
So, you know, I was really suffering. And then three months later and six months
later, my score, I think, after starting HRT went down.
To six and then three. So that's how effective it was for me.
I love being able to visually see that for myself as well.
Because when I think back, you know, it's been coming up to three years,
(12:19):
I think, since I've been on HRT, and so much has changed, but it becomes my life.
And so then it becomes more difficult to compare.
So I know that so much has changed for me, but it's hard for me to recall and remember and compare.
And I think that that's a helpful thing for us to do just for ourselves to check
(12:40):
in with how we're doing as women. Thank you for sharing that.
No, I agree. And also what's very interesting about that score sheet is,
and you probably have found this in the perimenopausal phase,
you're swinging on those highs and lows very rapidly, very quickly, and things can change.
So it's also good to have that sheet on hand if you feel like things are changing
(13:03):
a bit and your dose might need to be increased.
So it's a really good measure for women on do they need to go up a level in
their patches and their dosages and how are they going to do that?
And they can take that form to their doctor and say, you know,
this is where my symptoms are at this point. Do I need a higher dose?
And so can you just clarify this for us? We don't need to wait until we're at
(13:25):
menopause, you know, the 12 months since our last menstrual cycle to actually
begin HRT. Can you just speak to that briefly?
Oh, absolutely not. This is all based on symptoms.
So if you ask, you know, perimenopause can start as young as natural,
you know, sort of perimenopause around the age of 35, when our estrogen and
(13:46):
progesterone levels are starting to decline.
It's faster after the age of 40. So if you're around that age and you're noticing,
you know, more severe swings,
you know, know with mood with sleep any hot
flushes I mean it's not just about hot flushes it's
about increased urinary you know frequency
the things for me were like debilitating anxiety joint pain muscle pain and
(14:11):
sleep disturbances nothing to do with hot flushes so if you're not kind of educated
around that menopausal space it's very hard to know what's going on and you know for a lot of women,
they go to their GP with their symptoms and get put straight on antidepressants
without even having had that conversation.
So we need more awareness and more conversations out there with our doctors.
(14:35):
Absolutely. And so what is the limitation of say, because I did go into perimenopause
after my second child and so I was 37.
I had no idea that was what was going on. I just thought I was really fatigued
and irritable and all the rest
of it. Looking back now, I can and see that that was what was happening.
I totally lost my train of thought. I was about to ask you something.
(14:57):
That's menopause. That is menopause.
It was the limitations. We welcome,
yes, that's it. We welcome the memory lapses. We do, we do, we do.
The limitations. So yes, if
you get put on antidepressants, because I've heard that a lot from women.
Can you speak to the limitations of that? So, I mean, in terms of going on antidepressants,
(15:18):
you know, there could be very valid reasons for that.
However, if you're looking at somebody in a perimenopausal phase,
we're also looking at other kind of hormonal symptoms that might be coming into
play there and what else do we need to treat.
So, you know, we need to look at women holistically, not just as one kind of identified symptom.
(15:39):
And I've just lost my train of thought there too.
I was going to say about the antidepressants, you know, there's very clear data
out there and it's quite well hidden in the data sheets that antidepressants
will cause osteoporosis.
So we're already seeing a woman that's got depleting estrogen levels,
(16:00):
which is going to affect her bone health and then potentially being put on antidepressants
for menopause rather than HRT for menopause, further compounding that fracture risk and bone risk.
So it's here. There is a lot to be done in terms of actually just revisiting
the space and educating GPs around it. Yeah, absolutely.
(16:22):
And so blood tests for hormones, right? I think maybe I'm in perimenopause,
can I just go to my doctor and get a blood test? What's the picture around that?
Yep, you can absolutely go and have a blood test. However, as I said before,
you know, the hormones one week could be in the hundreds and then below a hundred,
you know, swinging in those highs and lows in terms of estrogen,
(16:44):
follicle stimulating hormone, progesterone.
So those are the key bloods that you would test.
And, you know, it might be relevant in the beginning to just do kind of a baseline
measure and see where a woman might be sitting, but it may not be clinically significant.
What we really, really want to be doing is listening to her and believing her.
(17:05):
About where she's at and what's going on with her
symptoms and as i said before that's that green scale
score chart is amazing for that but just on the blood tests one that is absolutely
vital to check would be testosterone especially if if the woman has hypoactive
desire disorder so you know really low libido no desire at all for intercourse
(17:27):
we want to be checking testosterone testosterone,
and there is help available for that.
So in New Zealand, we can prescribe a product called Androfen,
and that is a game changer for a lot of women.
However, it's once again not funded, but Pharmac are looking at funding that.
So it's expensive and not all women can afford to go on that.
(17:48):
But in terms of bloods, we must check that because we don't want anything swinging
into a male level of hormones in the body.
We want to make sure that that's maintained within the clinical norms.
Yeah. So asking for a friend, not really, I'm asking for myself.
Someone's using androfen, which I've found to be really helpful.
What would you say is the timeframe of testing? So they do a baseline test and then test again when?
(18:12):
So when I spoke to Dr. Jenny Hill at Dr.
Menopause, she said that, you know, of course there's a mandatory first blood
test and then again at a month and then at three months,
they're going to be continuously checking they're not going to leave you over
a three-month period and not check that because obviously they have to be very,
very safe with their prescribing of it. Yes, exactly.
(18:33):
Yes. And so in New Zealand, and I believe currently worldwide as well,
there is a shortage of HRT patches and it's slowly been getting more and more
significant to a stage now where it's pretty significant.
I've been talking I've been talking to a lot of women who haven't been able
to fulfill their prescriptions and their repeat.
(18:56):
What on earth are we going to do? I'm all right for a couple of months,
but I'm like, what on earth am I going to do after that?
Yeah, it's an unacceptable, absolutely dire situation for so many women worldwide.
So, you know, initially it was blamed on COVID and now it's because there's
been a massive uptick in the use of patches.
(19:17):
But, you know, come on, this is just women's lives that we're dealing with now.
And, you know, suicide rates. I've heard of women actually wanting to commit
suicide over this. So it's dangerous.
It's unacceptable. a lot of women are cutting their
patches into thirds to stretch them
out and make them last a bit longer there is
(19:37):
the option of the tablets if women choose
to go that way but a lot of women don't want that increased risk
with the clotting and some women can't take them because of that risk so you
know but that is an option and then of course as i said before there's the gels
there's two gels available in new zealand but they come at a cost as well so
you know a minimum of 40 sometimes up to $150 a month for that.
(20:02):
So I honestly don't know how this is going to pan out.
Pharmac are apparently tendering for a new supply, a new contract,
but it blows my mind that this is taking so long.
I don't understand why it can't just be done to support these women,
including ourselves, you know?
Yeah, you're so right. It's completely unacceptable, and yet we're not really
(20:26):
surprised by it, right? Because women's health, in my experience,
has always taken a back seat.
And so it's not surprising, although it's outrageous.
Oh, I did hear from a woman this past week who said that her doctor,
she went to the doctor to ask for HRT as a new user patient.
And the doctor said to her, no, I'm not prescribing patches and progesterone
(20:50):
because of the shortage.
We've been told not to prescribe it. And that's different to saying,
yes, but there's a shortage. let's see what we can do still comes in and dribs
and drabs I thought that was just.
Outrageous it is my pharmacist did tell me
that there was a new shipment mid-june and then
another one in august but she was
(21:11):
also quite vague she was like you know and they are suffering as
well they've got women coming in demanding these
things and and honestly they feel terrible about
it you know it's not their fault and you know
the new zealand government needs to do more in
this space but there are a lot of surveys going
on at the moment there's petitions so you know
(21:32):
I encourage women to look at those and fill them out and
you know have a voice in this space that I mean
that's that's what we can do when we can't do anything is to have that voice
and to speak up about it yeah so it's good to be seeing those petitions out
there yeah absolutely so in terms of if I'm I'm going to my GP and I want to
(21:54):
talk to them about HRT or the possibility of HRT for me.
What sort of prep and what sort of steps do I need to take?
What would you say to a client to help them prepare?
Because like you say, you've got that 15 minutes. It's not a lot of time.
It goes really fast and you want to get the best outcome for yourself from that.
So, as I said before, wringing the practice ahead and finding the best consultant
(22:16):
there for you and your condition.
I would also book the very first appointment of the day. So,
you're not waiting around. You're not flustered when you go in.
You're fresh and they're fresh.
So, I always book the first appointment of the day. And then,
you know, keep a symptom diary.
Write down how you're feeling, what's going on. also
be prepared to talk about your family health risks any
(22:38):
other risks that you think might be important and your
own personal health care as well so going
into those appointments as prepared as you possibly can be
to get the best out of that situation and then
you're going to be wanting to ask questions along the lines
of what HRT options are available for me
what's you know perhaps the easiest the safest route
(22:59):
for me to to get this and to have continuity of
care I would also be asking you know at
what point they would like to see you for a follow-up
because I think it's incredibly important for women
to be followed up a month later and then at the three-month point just to make
sure that the dosage is right for her because more often than not it's too low
(23:22):
and they need a higher dose and as I said before you know things are swinging
very very rapidly and they could need need a higher dose quite quickly.
So it's about just really keeping in touch and building a good rapport and that
good relationship with your GP so that you feel very, very cared for.
I have actually, a friend of mine messaged me last night and she said that her
(23:42):
practice had emailed her about the shortage and to offer her the gel.
I haven't had anything like that from my practice at all, but I thought that
was really reassuring and quite promising. It's very proactive.
Yeah. And if I've been talking to my doctor and I feel like they haven't been
taking me seriously, they have just sort of told me to put up with it or whatever the case may be.
(24:08):
What advice do you have for me and how can I sort of advocate for myself and
my well-being and health?
No woman should be denied HRT if that is her choice.
And we need to be giving this choice back to women. It's her body.
She is the only person that knows exactly what is going on for her and how badly
(24:30):
her symptoms are affecting her quality of life.
So if she's in front of a GP who
is denying her that and not engaging in a conversation, just get a new GP.
And the Australasian Menopause Society website has a fantastic list of GPs available
in New Zealand who are menopause certified. And they can be,
(24:51):
you know, those more specialist care ones like Dr.
Menopause or the Menopause doctors or just general GPs.
So if you're not being heard, it's time to get a new GP. Great advice.
And of course, there's always telehealth now.
So that makes us, you know, makes things a lot easier as well.
Yeah, absolutely. That's incredible.
Yeah, for sure. So you're a clinical nutritionist and medical herbalist.
(25:13):
How do you see that integration of both natural and medical treatments?
Months what's your viewpoint on that yeah well i mean
as i said before you know it's it is my you
know wish and desire that we all work together collectively to
support women and this is not just gps this is
you know all sorts of integrative care acupuncturists you
(25:35):
know counseling therapy and that's an important one
as well because i see a lot with women that unresolved childhood
trauma really and you probably see this in your practice rears
its ugly head around this time frame when
we're having these massive massive swings so it's about you know extending that
to all forms of health care for women but you know something that a woman can
(25:58):
ask her GP in consultation is you know do you work with any nutritionists do
you work with any naturopaths any herbalists you know like Like,
who is your extended network of people that you could refer me to?
And a lot of practices do have that now, which is really, really cool to see.
So I think the more that we can advocate for ourselves, be very firm with where
(26:20):
we're at, and also, you know, just talking to your GP and educating them about what's working for you.
You know, I'm taking XYZ supplements and I'm following this anti-inflammatory
diet plan and it's really working for me.
How can we work together for the better, you know, for the better good of my
health? And so for women who prefer not to use HRT or perhaps they can't or
(26:41):
they don't respond to it very well, what alternative or complementary techniques?
Therapies, treatments are available and do you recommend? So diet is amazing.
A lot of women do very, very well from having a proper consultation with a nutritionist
to get on top of their eating, really get an anti-inflammatory diet plan in there for them.
(27:03):
Doing some sleep therapy as well, taking some nutrients that help with sleep are very, very good.
So there's things like, you know, magnesium and kava, 5-HTP,
you know, speaking with a qualified practitioner about how those supplements
could be prescribed for you for your condition.
There are a lot of amazing herbs that help with the nervous system that have
(27:25):
shown some clinical significance in reducing those vasomotor symptoms with hot flushes,
although there needs to be a lot more research in that area, but there is help.
In terms of medical options for not being on HRT, steroids can be prescribed.
Prescribed antidepressants can also be prescribed
(27:46):
and have worked for a lot of women with hot flushes but
once again we're looking at these things don't come without their risks you
know so everything medical can come with a risk and it's about weighing up those
risk benefit situations based on your personal medical profile with your GP
and making the right decision for you Yeah.
(28:08):
And as you say, everything medical comes with a risk.
There's still a lot of conversations that I hear that HRT is dangerous.
You're at risk of breast cancer. It's a very high risk.
I was talking to a friend a few weeks ago and she was considering it.
Then she talked to some other friends. She's like, this is what they said.
And I was like, I wonder where that information comes from. What do you see in that?
(28:33):
So that information came from the Women's Health Initiative study in 2002.
Where they took a section of women.
So they were mostly around 65 years old.
They had been away from estrogen already for a good period of time, so 10 years almost.
So it wasn't a relevant study compared to you know
when we do put women on HRT and the risk
(28:55):
was you know it wasn't even clinically significant so
that's all being debunked now and there's so much
that's coming out around that and how misinformed
that study was but you know there are there
are contraindications for use of HRT
you wouldn't use it in an active blood clot so somebody
with known deep vein thrombosis you wouldn't use
(29:17):
it in active breast cancer and this is not
to say that women post breast cancer treatment can't
have HRT they absolutely can and
that is a conversation that needs to happen with qualified specialists and an
oncologist and a doctor to make the best informed decision for that patient
so yeah liver disease active breast cancer of course pregnancy you wouldn't
(29:39):
use it and an active blood clot but apart from that it's actually incredibly safe to use.
And we need to look at the benefits of HRT rather than talking about these supposed risks all the time.
Do you want to have a long health span?
What does that look like in terms of cardio metabolic disease?
Well, your risk is decreased by 30%, if not higher when taking HRT.
(30:02):
Your bone health, your risk for Alzheimer's, dementia, the list goes on and
on and on. And we're lucky at this time.
And I think, you know, our daughters, our children going to come into the space,
you know, with a lot more education and, you know, power in this situation.
It's a very, very interesting time in the menopause space at the moment.
(30:24):
It is an interesting time and we can really see, you know, even in the last
five years, how much things have swung and how much the demand from when I first started on HRT,
which was probably three years ago to now, the demand has has increased,
but it irritates me that that has been given as a reason, like we're doing something
wrong. Oh, well, you're running out because the demand's increased.
Like there's this inferred kind of, well, you're all wanting far too much.
(30:49):
This is supporting our health and wellbeing over the long term.
I don't think it's too much to ask.
Yeah, I 100% agree with you. And when I look at all of this and I think of other areas of medicine,
there is no other area of medicine where people are going to their doctors and asking for a treatment.
(31:11):
You know, if you've got high cholesterol, you're put on a statin
you know willy-nilly you know drugs are handed
out very very very readily but in
the HRT space we're having to go to our doctors to
demand this it just makes no sense to me
at all and if we look at you know for example a
thyroid disorder you're given the hormone that's going to
(31:34):
support your thyroid so why in menopause
are we being denied hormones that are going to
support these systems it's just crazy it's
wild isn't it it would I would take a good unpacking
to understand that the structures that have
fed into this and the stage we're at now with
it yeah yeah absolutely I did
(31:56):
have a woman speak to me and obviously in no way am I any you know I'm not medically
trained but she was talking about she'd been on HRT and it really really helped
her but she'd had she She didn't know she had fibroids and so that had become
a problem and they'd grown over the last year, that kind of thing.
What's the sort of general protocol around that?
(32:19):
Because a lot of women do have fibroids whether we know it or not,
right? Yeah, absolutely.
So that's a case where I would absolutely recommend a specialist,
a gynecologist or an endocrinologist to look after
the care of that woman and it may be that the dose is just titrated a little
bit for her you know and she needs to be very very clinically monitored for
that and it's not to say she can't have HRT but it's about you know perhaps
(32:42):
pulling back on the dosage under the guidance of a proper specialist for that person.
Yes I think that's the key isn't it it's when you have these added complications
for your own health is to have that guidance from a specialist it doesn't mean
that it's necessarily a no-go area but you need that specialist help.
Yeah absolutely and you know there's amazing doctors out
(33:04):
there there are amazing specialists out there it's just
you know a group that we need to
be kind of educating and bringing along on the
ride with us yeah exactly and I do love sharing resources you know like people
like you like Menno Doctor we've got amazing integrative a couple of amazing
integrative GPs here in New Plymouth that are really up with the the game with
(33:26):
menopause and thank goodness one of them was the woman that I went to see to
talk to her about HRT, and she just laid it all out for me.
She said, you've got this option, this option, and this option.
Things were only partly funded then, and I went away and made an informed choice.
She sent me all the information so I could have a look at it.
It was a very empowering experience. Yeah.
You know, I hope that more and more of us have that experience for ourselves as well.
(33:52):
Yeah, I agree. And I'm so glad that you got the help that you needed.
And my experience is very, very similar with Dr.
Menopause as well. But yeah, as I said earlier, it's really exciting to see
these other little clinics popping up that are cheaper alternatives as well. Yeah, so good.
And so what resource support systems are available in New Zealand for women
who are navigating menopause?
(34:13):
So, you know, that would be about accessing that to complement our GP's advice
to gain a better understanding of what's happening. It's taken me years to understand that.
And I'm out the other side now, but I finally understand perimenopause,
menopause, postmenopause and what was going on for me.
What are the resources available for us?
Yeah, so probably the only one that I would really endorse is the Australasian
(34:37):
Menopause Society website.
It's an amazing directory of everything research-based. So it's clinically up to date.
You can download articles there that you can take to your GP.
There's information there on how to speak to your GP.
There's the quiz that you can do to take to your GP as well.
And of course, the link to all of the certified doctors who will be able to help you in this space.
(35:01):
So that's pretty much the only resource that I really do recommend because it
is certified and I know that the research is up to date.
Te Whare Ora, for example, if you go on there, so this is the New Zealand health
website, if you go on there and type in menopause,
you will get two articles and they are on cervical screening and HPV.
(35:23):
That's it. There is no information available, which is really sad.
So yeah, the Australasian Menopause Society website is where you'll get all
of the relevant and up-to-date information.
Okay, good to know. And yes, that game needs to be picked up quite a bit.
But however, we have the Australasian Menopause Society.
And so any final words of advice if someone was listening and they're sort of
(35:47):
thinking about HRT or they just started, but they're pretty confused,
they're maybe struggling with their health, advice would you leave them with?
I would say, you know, the first protocol is to find somebody who is going to
hear you and to listen to your symptoms because you want to feel validated.
You don't want to feel like you're going crazy. And this is how a lot of women feel in this space.
(36:10):
And I know for me, it was like, what the hell is happening to my brain, to my body?
You know and finding somebody who is going to listen
to you and validate what is going on for you is the most
important thing so my best piece of
advice is if you're wanting to navigate the space if you're wanting to talk
about HRT please find a GP that you feel very very comfortable with who you
(36:33):
feel is listening to you beautiful and if people want to stay connected with
you perhaps they want to just learn more from you or even work with you what's
the best way for them to do that So.
Instagram is the best way to find me and my handle there is reneeschleeps.menopause.expert.
Well, Renee, thank you so much. This has been really, really informative and
(36:55):
I know it's going to be one of those episodes that women come back to time and
time again so that they can get that resourcing that we all need.
Yeah thank you for having me and also you know
thank you for the work that you're also doing in this space i think
the more that we can all band together and you know collaborate
together as you know women helping women the better
it's going to be for the health outcomes of all of us hey
(37:18):
thanks for joining me on the podcast really appreciate you
check out my course where we just go so much
deeper than i can ever do on a podcast over an
eight-week period the midlife upgrade course is a
blend of video and learning modules and weekly live calls where you will discover
a roadmap for psychological freedom in midlife check out all the details on
(37:44):
my website i really really would
love to have you join the course megancare.co.nz forward slash course.
Popular Podcasts
On Purpose with Jay Shetty
I’m Jay Shetty host of On Purpose the worlds #1 Mental Health podcast and I’m so grateful you found us. I started this podcast 5 years ago to invite you into conversations and workshops that are designed to help make you happier, healthier and more healed. I believe that when you (yes you) feel seen, heard and understood you’re able to deal with relationship struggles, work challenges and life’s ups and downs with more ease and grace. I interview experts, celebrities, thought leaders and athletes so that we can grow our mindset, build better habits and uncover a side of them we’ve never seen before. New episodes every Monday and Friday. Your support means the world to me and I don’t take it for granted — click the follow button and leave a review to help us spread the love with On Purpose. I can’t wait for you to listen to your first or 500th episode!
The Breakfast Club
The World's Most Dangerous Morning Show, The Breakfast Club, With DJ Envy And Charlamagne Tha God!
The Joe Rogan Experience
The official podcast of comedian Joe Rogan.