Menopause. It’s a word that still carries far too much stigma and confusion, despite being an entirely natural life stage for half the population. In the latest episode of Skin & Within, host Clarie Gray sits down with menopause specialist Dr Fiona O’Donoghue to demystify this often misunderstood transition and offer a calm, clear perspective on what women can expect – and how to manage it.
Fiona brings both medical expertise and a refreshingly human touch to the conversation. Together, Clare and Fiona explore the full scope of what menopause means – from the early signs of perimenopause through to post-menopause – and, crucially, how it impacts more than just hormones.
More Than Hot Flushes
While hot flushes tend to dominate the headlines, Fiona is quick to point out that menopause affects every system in the body. From joint pain and sleep disturbances to brain fog, anxiety and changes in libido – these symptoms are not “in your head” and they’re certainly not trivial. It’s about time we stopped brushing them aside and started addressing them properly.
Menopause typically hits around age 51, but perimenopause – the hormonal rollercoaster leading up to it – can start in your early 40s or even late 30s. And because symptoms can vary wildly between individuals, too many women are left second-guessing what’s actually going on with their bodies.
HRT: Facts, Not Fear
The episode dives deep into Hormone Replacement Therapy (HRT), clearing up outdated myths and misinformation. Fiona explains the differences between older synthetic hormones and today’s body-identical options, which are much safer and more tailored to individual needs.
HRT isn’t for everyone, and Fiona makes that clear – but it can be life-changing for many women when used appropriately. As always, informed decisions are key, and speaking with a knowledgeable GP or menopause specialist is the best first step.
Beyond Prescriptions: Lifestyle Matters
For those who prefer or require alternative support, Fiona also explores holistic strategies. Nutrition, movement, stress management and quality sleep are all powerful tools for managing menopausal symptoms. Supplements such as magnesium and Vitamin D can also play a supportive role – though, as Fiona points out, it’s essential to choose well-researched options rather than jumping on the latest wellness bandwagon.
Crucially, Fiona encourages listeners to access reputable resources such as the British Menopause Society and Menopause Matters. These platforms are there to inform, empower, and ensure that women don’t feel lost in a sea of misinformation.
Take Back the Narrative
This episode isn’t just about managing menopause – it’s about reclaiming confidence and control. With candid conversation and actionable advice, Clare and Fiona offer a new lens through which to view this life stage: not as something to be endured, but as an opportunity to reset, reflect and re-centre.
Whether you’re already experiencing symptoms, supporting someone who is, or simply want to be prepared for what’s ahead, this episode is a must-listen. Because when it comes to menopause, knowledge really is power.
🎧 Listen now on your preferred podcast platform and subscribe to Skin & Within for more honest, expert-led conversations about wellness, womanhood and everything in between.
TRANSCRIPT:
Skin and Within helps you find your inner glow with insights from wellness experts
>> Claire Gray: The Big Light presents.
>> Claire Gray: Welcome to Skin and Within, where I help you find your inner glow with insights from wellness experts. I'm Claire Gray, founder of Ermana Natural Skincare and passionate wellness warrior. In this series, I'm exploring how to find radiance that's not just skin deep, but leads to a healthier, happier you from the inside out. In today's episode, we're going to discuss menopause and its impact on women's health. I've just had a very informative conversation with menopause medic Fiona O'Donoghue. We talked about the various phases of menopause, HRT and women's health issues. Listen out for why balancing hormones isn't actually a thing and how HRT might not be the silver bullet for everyone. Let's go. Fiona, thank you so much for coming along today to talk all things menopause, and hopefully we can cover quite a bit in the half hour that we've got.
Can you give me a bit of a summary about what menopause is and what age, on average, it occurs?
>> Claire Gray: Yes. Thank you so much, Clare, for inviting me. I love talking about all things menopause and there's so much to know about it. so menopause effectively means, cessation of periods. There's a lot of definitions and sometimes they matter, but in essence they don't matter too much. Menopause means when you. It means cessation of periods. postmenopausal means a year after the last period. the age of the menopause can vary greatly. In the UK, the average age of the menopause is 51, but it can be anywhere between 45 and, 55. And we don't consider it to be a premature, menopause unless it's under 40.
>> Claire Gray: Right. Okay.
>> Claire Gray: So I think the message is it can happen at any age, but round about 45 to 55.
>> Claire Gray: Okay. So would you say if you are 45 at the moment and you're seeing changes, whether it be in your periods, in your general health, then it's more than likely you are perimenopausal?
>> Claire Gray: I would say so. It's certainly likely that your hormone changes are having some influence on your physical or psychological symptoms at that stage.
>> Claire Gray: Okay. Okay. And how long does perimenopause last?
>> Claire Gray: Well, that's probably going to be the theme of our discussion because there's no right or wrong answer to that. perimenopause. Some women's periods will stop completely and they'll have no Symptoms? we reckon about, 25% of people will have quite bad symptoms and 50% of women will have tolerable symptoms.
>> Claire Gray: Got you. Okay. Okay.
Hot flushes are the typical menopausal symptom
So probably one of the ones, well, the one I was familiar with long before I had, I entered into perimenopause was hot flushes. That's the one that everybody used to talk about from my parents, from when my mum was going through it. Can you explain what hot flushes are and how they can be managed?
>> Claire Gray: Yes. So that is the typical menopausal symptom. And in fact, years ago, if you didn't have a flush or a sweat, we didn't really think you were menopausal.
>> Claire Gray: Oh, right. Okay.
>> Claire Gray: So that's changed quite a lot. We now realise there are many, many other symptoms of the menopause. But, a hot flush is just a symptom where the decreasing oestrogen levels are fluctuating. Oestrogen levels affect the thermoregulatory centres in your brain and cause a hot flush. it's usually worse when you're in a sort of very fluctuating, very, erratic up of hormones. And, that's what tends to cause, flushes and sweats.
There are lots of common symptoms associated with the onset of menopause
>> Claire Gray: Okay. And you mentioned there, you touched on the fact there's lots more symptoms too. Do you fancy entering in or letting us know what other kind of symptoms you can expect?
>> Claire Gray: Absolutely. There are so many symptoms and, sometimes it's easy when it's flushes and sweats because we know that, you know, hormone replacement will help. Flushes and sweats. With some of the other symptoms, it's a bit more difficult because sometimes we don't know how much other factors are contributing to them or not. But the kind of things that you could expect to find would be, some other physical symptoms. So joint pains are, common, genitourinary symptoms of menopause with vaginal dryness and, itching and, sometimes discomfort during sex, dry eyes, skin changes. other very common symptoms are anxiety and, interestingly, anxiety of all descriptions, which often leads to poor sleep. flushes and sweats can cause poor sleep. But, you can have poor sleep for other reasons in the menopause. And it's not necessarily flushes and sweats. Really interesting one that a lot of women report is car anxiety.
>> Claire Gray: Yeah, I've had that big time.
>> Claire Gray: So, it's only really by women talking about these symptoms that, you know, we've got to realise that these are particular issues. So things where people would, previously have Happily driven at nighttime or happily driven somewhere where they didn't know and followed their sat nav, they'll find that they suddenly become a bit more anxious about doing that. So that kind of anxiety, brain fog, forgetfulness, irritability, there are just so many symptoms. Often women will say they just don't feel themselves or they just don't feel like they can cope with things the way that they used to. they maybe nothing else has change in their life, maybe their periods have become a bit irregular or a bit, bit different. But you can still have regular periods and still have perimenopause. But they'll say they're in jobs where they've been very able to deal with people, deal with situations and they just don't feel like they're quite in control of things.
>> Claire Gray: Yeah, you just don't feel quite yourself and you can't. It took me a long time to work out what it was. You can't quite put your finger on it, but that and I had the joint pain.
>> Claire Gray: Horrendous anxiety, crippling anxiety when driving, like panic attacks while driving. So I can, yeah, I can relate to that. It's not, it's not pleasant at all. And can you. There's obviously there's different lifestyle changes that we can make to help alleviate some of the symptoms.
I thought it was worth touching on HRT first of all
I thought we could maybe talk about them in a bit, but I thought it was worth touching on HRT first of all because I don't know, we've not had a discussion before here. So I don't know which way you, you swing, what your opinion is towards HRT and lifestyle, whether it's one or the other or a bit of both. Can you talk to me and explain what, tell me what different types of HRT are available out there?
>> Claire Gray: Yeah, very much so. I very much believe that most of the symptoms of the perimenopause and menopause, can be dealt with or should be dealt with, by first, of all lifestyle factors. So looking at the nutrition, looking at the exercise, looking at the mindfulness, all of those things. But also HRT will help. If your symptoms are because your ovaries are producing less oestrogen, then giving back what your body used to produce, but in much smaller amounts, then that will help symptoms. It depends what symptoms we're looking to help. So if we're looking to help flushes and sweats and you're perimenopausal, then hrt, will help that. But not everyone wants hrt. So we'll talk about some of the other approaches that we can take, and, we'll try and reassure, woman about hrt. and what we're doing is going backwards really, with that because, as you probably know, in 2002 there was a big study that came out, the WHI study which said that HRT was quite dangerous and that it caused heart attacks and strokes and caused breast cancer. And, so for many, many years, women just suffered with symptoms and were frightened to take hrt. And, the advice was that if you had to take hrt, you would take the small dose possible for the shortest possible time.
>> Claire Gray: Right. Okay.
>> Claire Gray: So that has made a lot of women, especially perimenopausal women now, whose mothers were probably in. That's my mom was.
>> Claire Gray: Yeah. Remember the scare?
>> Claire Gray: So they, they would have been either taken directly off their HRT or if they had symptoms, it would have maybe gone to their doctor. And the doctor said, well, look, you can't have HRT and you'll just have to find other ways to. To deal with it. So. So a lot of women are, have, you know, misconceptions about it and understandable concerns.
An interesting word comes up a lot in menopause is balancing your hormones
So we'll have that conversation about how HRT, especially the HRTs we use now are body identical. HRTs, mostly, and how they, they don't have an association, they don't have the bad associations that they used to have and that we're replacing what your body used to produce with smaller amounts.
>> Claire Gray: So body identical. Just to clarify, they're most like. Or they're closer to our body's own. Hormones are more natural, aren't they?
>> Claire Gray: Very much so. So HRT is oestrogen and progesterone. Progesterone. If you, haven't had a hysterectomy or you don't have the Mirena coil, then you need progesterone to protect the lining of your womb. And there are lots of different types of progesterones. the oestrogen is what we call the business part, excuse me, of the hrt, in that the ovaries are not producing as much oestrogen. So we need to replace the oestrogen, and then we only need the progesterone to protect lining of your womb. So it's not really helping your symptoms. It's the oestrogen.
>> Claire Gray: It's balancing things then. Or.
>> Claire Gray: Well, that's an interesting, an interesting word that comes up a lot in menopause is balancing your hormones. And I'm not quite sure for me what that actually means okay from a medical perspective, with hrt, balancing your hormones doesn't really mean anything to me.
>> Claire Gray: Okay.
>> Claire Gray: But it sounds quite nice to balance things.
>> Claire Gray: Right?
>> Claire Gray: It's an okay word, but it sort of conveys an idea that the progesterone dosage depends on the oestrogen and the oestrogen depends on the progesterone. In some ways it does, but not in a balancing way.
>> Claire Gray: Ah, okay, that's interesting.
>> Claire Gray: Okay, so the way they depend on each other, but it's not really balancing, is that, you know, you don't need progesterone if you've got a Mirena coil or you've had a hysterectomy. But everybody needs the oestrogen, and the oestrogen is 17, beta estradiol, which is identical to the oestrogen in our bodies. And, all HRTs contain 17 beta estradiol. So the oestrogen is the same, way back in the studies that caused all the concern, it was a different type of oestrogen. It was, what we call conjugated equine estrogens. So they were made from pregnant mare's urine.
>> Claire Gray: That's what I heard. Is that true?
>> Claire Gray: Yeah, yeah, yeah. So that used to be what HRT was, and it was very effective and it worked. and it was the HRT at the time. But we've now moved on to 17 beaded estradiol. And you can get that in the forms or slight modifications of the 17 bead estradiol. And you can get that as a tablet or as a patch, a spray or a gel. So those are your forms of oestrogen. And then you then have the different varieties of progesterone. And so we have body identical progesterone, and, we have synthetic progesterone. The important part about all of that is that HRT is very different from the combined oral contraceptive pill, which is the other hormone that most women will know about. And it's very different because the combined pill adds in extra hormones on top of your body's own hormones. You're in the pre menopausal, phase where you've got lots of your own natural hormones. And then we're adding extra in. we're adding synthetic, oestrogen, ethanol estradiol, which is totally different from the estradiol in hrt. And we're adding different progesterones. So, and we're adding something in that is taking over the control of your cycle and adding extra in to what's Already there. Okay, so it's different.
>> Claire Gray: So it's different again. So you've got your HRT body, identical form of progesterone, but if you're on the pill or like a mini pill as well, would that be that you're adding a synthetic progesterone?
>> Claire Gray: Yes. So the mini pill is a synthetic progesterone and the combined oral contraceptive pill is synthetic estrogens and, progesterone.
>> Claire Gray: Right. Okay. And see, going back to oestrogen, is it correct that you are better or your body absorbs oestrogen better if it goes. If it's transdermal and it's taken through the skin in that form rather than a tablet form?
>> Claire Gray: No. Great question, Clare, because that's something that people, ask about. The difference between transdermal and oral HRT is that, transdermal HRT has no association with increased risk of blood clotting, whereas oral HRT does. Now, the risk of blood clotting with oral HRT is very low. The risk of blood clotting with the combined contraceptive pill is much, much higher, and the risk of blood clotting with pregnancy is much, much, much higher as well. So if you get it all into perspective, oral HRT is still good and it's still okay to use it.
>> Claire Gray: Okay.
>> Claire Gray: but we usually start with transdermal because it's got no risk blood clotting.
>> Claire Gray: Right. Okay.
>> Claire Gray: But there's absorption is totally different, depending on the person. So some people will absorb well transdermally and some people won't absorb well transdermally. So it's an individual thing.
Different people will be on different dosages of oestrogen
>> Claire Gray: Okay. And in terms of dosages, so when you talk, when you. We touched on that as well. So different people will be on different dosages of oestrogen. For example, will the doctor just try you on a low dose and then gradually put it up if your symptoms aren't being alleviated, how, does the doctor determine what dosage to put you on?
>> Claire Gray: So there's a standard, dose of HRT and then there's what we consider lower dose HRTs and the higher dose HRTs. So we'll normally start off on a standard dose, unless we're starting off in someone who is older and being without hormones for a long time. Because sometimes we'll still start HRT in women in their 60s things. And, you know, it's a much gentler approach to start them on a lower dose.
>> Claire Gray: Right.
>> Claire Gray: and then, so. But usually a standard dose and then sometimes we have to build up or sometimes we have to step down.
>> Claire Gray: Okay, so what you're saying there is that if you are. So say you have been, say you're menopausal, post menopausal, and have been, and you're in your 60s or even your 70s, could you still go into HRT?
>> Claire Gray: You can do, There is no rule that says you can't. It depends on the symptoms you have and it depends on your medical history. But, there's no age limit to when you can start it. And, there's no age limit to when you've got to stop it.
>> Claire Gray: Okay, good to know. Okay.
Clara: Am I missing out on testosterone? How do I know
And then, so we've mentioned progesterone and oestrogen. We've not mentioned the third one that is getting a lot of coverage at the moment, which is testosterone. So a lot of people out there like Davina McCall and have talked about how important that is. So I'm only on oestrogen and progesterone. Am I missing out? Should I be on testosterone? How do I know if I need it?
>> Claire Gray: Well, another great question, Clara, and a common question that we get asked. And yes, Davina's programme did stimulate a lot of interest in testosterone. And I would say that at that time a lot of women came to ask about testosterone. And the testosterone is licenced. Well, it's not actually licenced. There's no product for women in the uk, but, British Menopausal Society guidelines say we can use it in women in the uk, but only for, decreased libido, or what we call medically as hypoactive sexual desire disorder. So that's the medical terminology that we've got for that. And so it's really only, recommended for use for that alone. So the other things that, Davina talked about and that other people talk about are, helping brain fog, helping memory, helping muscle tone, helping energy. It's not supposed to be used for that and it doesn't really seem to have the benefits for that. So there are a few women who I've found testosterone very, very useful for. And, they're the women who do have hypoactive sexual desire disorder. They're on, their optimum hrt. So they're on a good combination of hrt. They don't have any genitourinary symptoms of menopause, because if you have vaginal dryness and you're sore down there, you know you need treatment for that. because you're not going to be interested in sex if it's sore and dry. So we treat that. And then if you have, you know, if you have a good relationship, you've got you know, nothing major stresses in your life, you've got nothing else going on that could be causing all those issues. Then we'll think about testosterone.
>> Claire Gray: Right. Okay. I did wonder, was I missing out? That sounds crazy, but when you see all this publicity about it, you start to think it's something else. And I think women are. Now we're so angry, I think about what we haven't had access to or what. Certainly my mother didn't have access to that. I think people automatically just want it more at principle, don't they? But that's really interesting to see that if you, you would only, only put somebody on it if they were, if they tried everything else, if they've tried, they've gone, they've got their maximum oestrogen, progesterone and things still aren't working for them in there.
>> Claire Gray: Absolutely. If, if we do it otherwise it doesn't really work. So if we have a good conversation and eliminate all the other potential problems and, and women understand what that's all about.
>> Claire Gray: Okay.
>> Claire Gray: Then that's when it works. but and otherwise it doesn't really work.
>> Claire Gray: Okay.
HRT can help prevent heart attacks and strokes in women when they're older
And are there other advantages to going on to hrt? You know, they talk a lot. There's been talk about linking lack of hormones to dementia and heart disease. Is that where HRT would help?
>> Claire Gray: Absolutely. you know, HRT is useful. So I break it up into the symptoms that you've got and then the long term health benefits. So we know that hrt, will help prevent heart attacks and strokes in women when they're older. We know that women get some protection from heart attacks and strokes in the sort of pre menopausal stage. women tend to suffer heart attacks and strokes at a later age than men because they've had the protection up to the menopause. And then when they get older they that's when they, if they haven't been on hrt then that's when they start to develop heart attacks and strokes and angina. It's very, very interesting as well. The heart disease that women experience is very different from the type of heart disease that men experience. And again, this is going off on a slight tangent, but it's very interesting. Men tend to get atherosclerosis and you know, furring of the arteries in the big blood vessels in their heart. Women tend to get it in the small blood vessels so it often presents in different ways and there are different treatments. But ultimately we know that HRT has a cardio protective effect for women, but only if they take it in this window of opportunity that we call, which is perimenopause. So in that sort of 10 year period, round about 45 to 55, if you take HRT, then you will decrease your risk of heart attack and strokes when you are older. A really important factor about that is heart attacks and strokes are the commonest cause of death in women. You are at least four times more likely to die from a heart attack, or stroke than you are to die from breast cancer. Which in our, in our menopause conversations, we talk a lot about breast cancer because that's one of the things that women are scared of. But, you know, getting everything into perspective and thinking about the whole picture. You do need to be worried about heart attacks and, strokes.
>> Claire Gray: But HRT can lessen the chances of the risk of that bone disease and osteoporosis as well. Am I right in saying?
>> Claire Gray: Absolutely. We've known for a long, long time that, hrt, protects bones. I first started working in the menopause in the late 90s, with a lovely man called David Mackay Hart, who people consider the grandfather of hrt.
>> Claire Gray: Right, okay.
>> Claire Gray: And, I worked with him in the Western. And, we called it clinic, the Osteogen Clinic. We didn't call it HRT clinic, it was osteogin. Because at that time, you know, early menopause or surgical menopause was all thought to be associated, excuse me, with, with bones and trying to protect people's bones.
>> Claire Gray: Right.
>> Claire Gray: So we talked a lot about bones because we knew that women with early menopause would suffer from osteoporosis, and we were trying to prevent that. So that's a very long established thing that we know. But in among everything else that has happened with hrt, it's kind of got forgotten about a bit. but HRT beneficial for bones also, factors that are important for that are, nutrition and exercise. So a bit like we kind of talked a wee bit about earlier, it all comes together and none of the things work if you don't do the lifestyle bit as well.
>> Claire Gray: Yeah. I was listening to a talk last week and that's what somebody said, like, HRT isn't a silver bullet. There's all the other pillars of your lifestyle that you have to. I think there's five different pillars. I think Louise Newson talks about. Isn't she. And that's just what you've mentioned there. Diet, exercise, you also touched on earlier on low stress, and HRT and sleep. That's such a, kind of five pillars that she talks about. So not one thing in isolation is going to make you feel.
>> Claire Gray: Exactly. And I think, you know, yeah, if you just take HRT and don't do anything else, I don't really think you're going to get the maximum benefit from it.
>> Claire Gray: Yeah, yeah, I've certainly, I've seen, seen that. And friends that have gone on to, they're just taking the HRT and expect amazing results, but it's not happening. They're wondering why. Okay, so as well as helping with all the symptoms of perimenopause and menopause, HRT will also help prevent bone disease, heart disease and Alzheimer's as well. And dementia.
>> Claire Gray: Yes. So dementia. I don't think, we have an absolute positive about dementia just yet. I think the evidence is gathering and I think it's pointing towards hrt probably, is, going to be shown to have a benefit. But there are some studies have shown not much benefit and there's some studies have shown some benefit. So although the jury's still out, I think it probably will develop. And that's really interesting thing about, excuse me. Is that, things are always developing. There's always new evidence, there's always new studies. So things change all the time.
>> Claire Gray: Yeah, I guess there's a whole new generation now of people that are making sure that they've got the hrt. So it's going to take time to find out.
The treatments that women get for breast cancer can cause bad menopause symptoms
So what about people who can't go on to HRT because they've had, breast cancer, for example? What, what do you say to them? What advice can you give them?
>> Claire Gray: Yeah, so we reckon that, well, we know that the treatments for breast cancer are so successful, and that we know that more and more women are, having breast cancer and, and, you know, living the rest of their lives happily. Maybe not happily, because the treatments that they get for breast cancer cause quite bad menopause symptoms. So they're living in a situation where they're having horrendous flushes and sweats, horrendous genitourinary symptoms of the menopause. And you know, I think it used to be that these women were just told, well, you know, you just have to get on with it and that's that. But, you know, that's not correct. And, there are things that we can do, things that we can do to help the first obvious thing is, genitourinary symptoms of menopause. So women who are on, you know, aromatase inhibitors or tamoxifen. The side effect is severe vaginal dryness. And, so these women, you know, aren't able to have, you know, they aren't able to have sex comfortably. Maybe, you know, they're looking at this for the rest of their lives because the medication they're on because the medication has caused it.
>> Claire Gray: Okay.
>> Claire Gray: they'll often have awful joint pains because that's a side effect of medication as well. and also recurrent urinary tract infections from dryness down below. So that's a big issue. And, vaginal lubricants and, moisturisers, are a first port of call really, for those kind of symptoms. can depend on the type of breast cancer as well that they've had. Most women will have receptor positive breast cancer, some women have receptor negative breast cancer. And, there are slightly different ideas about what treatment treatments for them. But first stop is moisturisers and, lubricants. And this is the kind of thing that sometimes women don't think to ask for treatment because they think that they've survived the breast cancer treatment and they've just got to get on with it. We can use vaginal estrogens as well in women who've had breast cancer and that can depend on the type of treatment they're on. but, vaginal estrogens are not generally absorbed into the bloodstream, so we can use those. What we'll often do is have a discussion with their oncologist and, you know, about what they think about that. But we know, and I've got a very, very good, colleague, menopause colleague who specialises in menopause treatments after breast cancer. And, you know, we have these discussions a lot in WhatsApp groups and other colleagues in the UK and, we're happy to give vaginal estrogens to most women who've had breast cancer. So it's a conversation to be had and it's something to add, ask about. And, it's not something to think that you've got to put up with.
>> Claire Gray: Yeah. And that's the case with so many women, isn't it? In the past they've just put up with all these symptoms, no matter what, and.
>> Claire Gray: Exactly.
>> Claire Gray: And not ask questions or gone to the doctor about it.
>> Claire Gray: And it very much, we very much think as well now that quality of life is important. So you know, some women will, their, their lives will be horrible. You know, they, they, they're a long time after their breast cancer treatment and they're really struggling. So we can treat the vaginal symptoms. And sometimes these women, after really careful consideration, will start HRT because their lives are such a misery without it. And we'll not just say, no, you can't have it. And that's it. You know, it'll be a careful discussion, a measured discussion. And there are lots of research papers we can look at. Not a lot of research has been done obviously, because it's difficult to do the research and give women, you know, HRT who've had breast cancer. And some of these studies have been stopped early. and some of the studies have been flawed. So this is something that is definitely going to develop.
>> Claire Gray: Okay, but that's people that maybe at the end of their, literally at the end of their tether then.
>> Claire Gray: Exactly. And there is a new drug that has come out recently that helps only flushes and sweats, none of the other menopausal symptoms. And it's not a hormone. It's I mentioned earlier about, when you asked about what causes a, hot flush. They're neurokinin 3 receptor blockers. So they, they block the receptors in the hypothalamus which controls thermoregulation. And so it's a non hormonal thing that can help flushes and sweats. And it's licenced, it's not licenced for NHS use at the moment. It's just private and nicer looking at it. But for women who don't want to take HRT or maybe can't take HRT for different reasons, this might be something in the pipeline and also it might be something. There are, are studies going on in women who've had breast cancer with us. So it might be something that might be suitable for them.
>> Claire Gray: Yeah, so I mean there's definitely a shift, isn't there, towards more research going into women's health, but for so long.
>> Claire Gray: There hasn't been very much so. Very much so. So that's all positive. I'm really happy about that. that things are changing and it's interesting for me, having been around in the menopause all that long time ago and to see, you know, see it being, being used and then nobody using it and now it's, it's increasing. But I think that that's also because, you know, because of the WHI sort of re evaluation of that study as well as the Mirena coil, the transdermal hrts, and the, you know, body identical hrt. So things have all changed.
>> Claire Gray: Yes. And you've seen massive changes in that space of time. M. So what about people, so what about women that are going through horrendous menopausal symptoms and the HRTs not working for them, the lifestyle changes aren't working for them. Can you give them any kind of reassurance that it, will get better or how long it's going to last? You know, I've got a friend that suffers from horrific migraines really bad and is on HRT but just getting no relief at all.
>> Claire Gray: Yeah, so that's, that's what I like in the menopause, a challenge like that. So I would go right back to the start and look at what the symptoms are, clarify what could be hormonal symptoms, what could be to do with other things as well. Look at the kind of HRT, they're on. So sometimes, transdermal HRTs or patches of HRT with more constant levels are very good for people with migraines or with headaches. I would look at the lifestyle issues. I would go over things again because sometimes people say, I'm doing all the lifestyle issues and they might think they are, but there might be other things, other routes to explore with that. Then I would look. So. So I'm not all about HRT and, I'm not all about menopause. I'm all about the whole thing.
>> Claire Gray: Okay.
>> Claire Gray: So I would look and see what, you know, clarify the diagnosis of migraine, look and see if they are, ah, on particular medications to prevent migraines. You know, there's obviously medications to take if you have a migraine, there's medications to take to prevent migraines. I would then look at, thinking, do they have side effects of hrt? Is there something in else apart from HRT that would be useful? Because it's not all about HRT and HRT is not for everyone.
>> Claire Gray: Yeah, exactly.
>> Claire Gray: And we can look at the other, other options, depending on the combination of symptoms that they have.
>> Claire Gray: I see.
Some antidepressants have a side effect of helping menopause symptoms
>> Claire Gray: So there are different, antidepressants, that actually have a side effect of helping, menopause symptoms, and that's relevant to the breast cancer patients as well.
>> Claire Gray: Okay, so people have. So because we've heard this in the past that people are putting on antidepressants because they're depressed because of menopause symptoms, but what you're Saying is some of the side effects of those antidepressants are helpful.
>> Claire Gray: Exactly. Exactly. So antidepressants got a bad press a while ago, as did cbt got a bad press because people thought that doctors, were dismissing their symptoms and giving them antidepressants or giving them cbt, but that's not what it is. so, for instance, venlafaxine is an, antidepressant that has a side effect of helping flushes and sweats. So we're not giving it as an antidepressant. And often that's a difficult one to explain because women do then think that really you're just kind of pretending that it's an antidepressant, but it's not. There's evidence that it decreases flushes and sweats. another medication called oxybuty, which is used for, irritable bladder, it has, a side effect of helping flushes and sweet sweats. and there are a few other things, medications that, have other side effects and things that I don't use too often, but those would be my top two that could help. So for the lady that you're talking about, I would be looking at, some of those other options. I might think of the new Neurokinin 3 blocker, but only for flushes and sweats. It doesn't help, brain fog or insomnia or anything like that. That, So though that would be the avenue I would think about CBT because,
>> Claire Gray: And that's cognitive behaviour therapy then.
>> Claire Gray: So. So cognitive behavioural therapy has been shown that to help reduce flushes and sweats. and, you know, it probably helps people manage the flushes and sweats better. But, you know, studies and evidence have shown that it does have an impact. And I think, I think CBT is a great, great skill for probably everybody anyway.
>> Claire Gray: Yeah. To have in just general life.
>> Claire Gray: Yeah.
>> Claire Gray: As a coping mechanism. Interesting.
How long do the symptoms last? Perimenopausal and menopausal symptoms
Okay, so in general terms, how long do the symptoms last? Perimenopausal and menopausal symptoms. How long are we going to be like this?
>> Claire Gray: That's a really difficult question to, answer. So if you are on hrt, then you might be on it and you might really be getting any benefit from, or flushes and sweat and symptoms, but you'll still be getting your benefit for, you know, your cardiovascular disease, your bones, your skin, all of those, your joints. So, you know, if you, if you want, you can try stopping the HRT if you want to, and see what happens. Okay. There's no there is no hard and fast rule about how long the symptoms will last, how long you will need to go through them. Some women who have never been on HRT will still have some symptoms when they're in their 70s. Some women who don't go onto HRT will you know, not never have any symptoms. Some women will have, you know, medium, you know, copable symptoms, maybe well into their 60s. So it's not really possible to give an answer to that question.
>> Claire Gray: Okay, I kind of thought that's what your answer would be.
>> Claire Gray: It would be good.
Are there any supplements you would recommend? Yes. But then you've got to be careful what harm they can do
>> Claire Gray: So just a couple of quick questions here because I feel like there's so much ground to cover, not enough time. But are there any supplements you would recommend?
>> Claire Gray: Yes. So that's a good question because there are so many supplements, advertised and you know, there's not a lot of evidence for most of them. There's probably, you know, anecdotal. Anecdotal, sorry, evidence for a lot of them. But then you've got to be careful, you know, do you know what harm they can do? I know, you know, if it was a matter of trying them and you knew it wasn't going to be harmful, fine. It's also really important to know the benefits that you won't be getting from them. So if you do that you've got to realise that, you know, you're not going to get the benefits for your heart or your bones. And that's important especially for people with premature ovarian insufficiency because you could really make a difference to their cardiovascular health and their bones and their genitourinary symptoms and their urinary tract infections as a consequence of that. So you've got to be aware of what you're going to be missing out on. And you've got to, I think you've got to find good resources, good reliable resources that you can look at. The, the supplements that I'm most that are top of my list.
>> Claire Gray: Okay.
>> Claire Gray: And that I do take.
>> Claire Gray: Yep.
>> Claire Gray: Are vitamin D. Vitamin D is a no brainer really. We know that the evidence is good for that and we're looking after our bones and our muscles. we live in the northern hemisphere so everybody's vitamin D levels are low, especially in this winter autumn. The other one, that's getting more and more evidence is magnesium. And so magnesium is thought to be good particularly for anxiety and insomnia. It maybe has some benefits in cardiovascular protection as well. And I think there's reasonable Evidence for that. And I'm not concerned that we would cause ourselves any harm. Harm by taking it. So those are my ones that I'm good with. There are a lot of other products that are used in other countries and have been used in other countries for a long time. And they're in combination products that are sold here. Things like ashwagandha and turmeric. And they've been used in different countries for a very long time. evidence. I'm not sure the evidence is there. probably don't cause any harm, but I don't know.
>> Claire Gray: Yeah, yeah, I don't know. I mean there's certainly a lot of menno washing out there at the moment, isn't there? And people putting menno at the beginning. There was something I saw the other day and it was a bar of chocolate with almonds on it. Menopause, I've seen that or something like that. It's getting crazy now. But yeah, I'm glad you said that. That's the only two supplements I take, vitamin D and magnesium. So that's really good to know. It's also worth touching on that it does affect the immune system, doesn't it? Menopause or does it?
>> Claire Gray: Well, I'm not sure about that. I think I've not come across any medical evidence to say that. I think that, from the immune system point of view, you know, I'm looking at the nutrition and the exercise and I'm looking at the gut microbiome and I think that's probably got a much bigger m effect on our immune system and there's some evidence around for that as well. so yeah, I think that, the menopause probably doesn't affect our immune system, but our sense of well being, if we replace the hormones that we have not had and if we do our exercise and are happy and healthy, then I think that's going to make our immune system, boost up. Like I kind of said before, it all kind of links in. But I wouldn't say that the menopause cause it depresses your immune system.
>> Claire Gray: Okay.
>> Claire Gray: But boosting everything probably helps.
>> Claire Gray: Okay, good.
So have you got any advice for listeners about how to approach their doctor
So have you got any advice for listeners about how to approach their doctor? Because I think for a lot of women that's the most daunting part. And I've had so many people say to me, oh, I don't know what to ask, you know, or they've been to the doctor and the doctor said, no, you don't need this or whatever. If people are at the end, if people feel that they need hrt, how would you recommend they approach their doctors?
>> Claire Gray: Yeah, I think it's difficult because, you know, at ah, the moment, it can be quite difficult in primary care, M to access your gp. And I work in primary care so I understand the stresses and the busyness. so it can be quite stressful to get there, I suppose. also there's a big variation in the knowledge of gps about menopause. So I think that my advice would be to, inform yourself, really well about menopause and HRT from really good resources so that you know that the information that you are looking at is reliable. And then if you can, you know, go to your GP with, you know, with your symptoms and they feel like you. It's very difficult in general practise. We have a 10 minute consultation and it's impossible. I mean we're here talking about menopause and we could probably talk for hours and hours and hours about it. So if you arm yourself with the best information, you know, that you can and you have an idea about our list of the symptoms that you have, then that is probably the best way to get the information, and the help from your GP. But, it can be difficult in 10 minutes. I don't, you know, I do some NHS work, I work a lot in the NHS and I do some private work and it's a luxury to me to have all of that time to explain things properly. So it's difficult.
>> Claire Gray: Yeah, I'm sure.
Fiona says people should make lifestyle changes to deal with menopause
So can you give me, just to round off, can you give me three tips or three lifestyle changes that people can make to help them deal with menopause to make things a bit easier for themselves.
>> Claire Gray: So the first thing I would say, and which we've probably, probably discussed already, is that it's such a wide range of symptoms and that everyone is different in the way they experience the menopause. Which also means that everybody's, treatment plan or our management plan will be different. So it's. It's not one size fits all is the phrase that we use a lot in menopause. And that, that is, is very true. also probably recapping and what we have spoken about, I can't emphasise and enough how important lifestyle issues are. I can't say how important nutrition is and getting good, information about nutrition and doing the right type of exercise will work along with your HRT or whatever you decide to use. I also think that it is really important to arm yourselves with the, with really good resources. There's so much information and it can be really, really hard to know what's right and what's wrong. So I think you need to find some good resources to use.
>> Claire Gray: Can you recommend any of these?
>> Claire Gray: I absolutely can. so the British Menopause Society, which I'm a member of, is a very good organisation. We've got lots of colleagues and we talk about things with each other. We have forums where we discuss things and they produce really good guidelines and they have ah, a patient section called the Women's Health Concern. Okay, so I would look at the Women's Health Concern. I would also look at Menopause Matters, which is a very good website and they have a very good magazine, that with lots of things, you know, that they'll talk about hrt but they'll talk about all the alternatives, they'll talk about sleep problems. So, you know, it's not confined to the hormones and the medical aspects. It's everything. So Women's Health Concern and Menopause Matters would be good resources that I would use. And you know, if, if you're thinking of trying alternatives or things on social media that are advertised, just be, be very careful and go to those two resources that I mentioned and see what the opinions are, M and you know, work it out from there.
>> Claire Gray: Okay, thank you very much. That's really good advice. Thanks a lot, Fiona.
>> Claire Gray: You're welcome.
>> Claire Gray: Thanks so much for joining us on Skin and Within, where I help you find your inner glow. Stay tuned for more conversations and wellness wisdom for a healthier, happier you.
This episode was brought to you by Hermanna Natural Skincare
Next time, I'm joined by GP and alternative health therapist Dr. Veronica McBurney M, a visionary practitioner with a holistic approach to, to patient care. Don't miss this one. Thank you for listening and please share the podcast onward to anyone you think would benefit from it. Don't forget to rate, review and subscribe. This episode was brought to you by Ermana Natural Skincare. For more information go to hermana.co.uk and follow @ermanaskincare. on Instagram. see you next time.
>> Claire Gray: From the Big Light Studio.