21: Managing Perimenopause? With Gabby Logan

ANNA: Hello gang, Anna here. A quick warning before we begin. Whilst this episode is useful and informative around the menopause, we do briefly discuss suicidal thoughts. So bear that in mind as you decide when and how to listen. As a woman in her 50s, I have to say that this week's topic is one that I've been itching to delve into for months on this podcast. It is, of course, the menopause. Now, I don't know about you, but no one talked about the menopause when I was growing up. And if they did, then it was a bit of a joke, as in your mother's a bit upset because she's going through the change, whatever that meant. And it was definitely a way of implying that a woman was unattractive, unemployable and past it. Attitudes are thankfully changing, but the shift is gradual and there's still too much shame and stigma attached to menopause symptoms. So I'm grateful to be able to do a little something this week to remind all of you currently navigating this life stage that you really are not alone. So let's get into it. This is It Can't Just Be Me. LISTENER: Hi, Anna. Hey, Anna. Hi, Anna. Hi, Anna. Hi, Anna. Hi, Anna. Hi, Anna. LISTENER: Hi, Anna. It can't just be me who's really struggling with staying faithful. LISTENER: I definitely got menopause brain. I really want children. And he doesn't. I had feelings of jealousy. LISTENER: It's just all around the middle. LISTENER: I feel like a Teletubby. And then I hated myself for feeling that way. If you've got any advice? I would really appreciate any advice. It can't just be me. It can't just be me, right? ANNA: If you're a fan of watching major sporting events, then my guest today needs absolutely no introduction at all. She is the glamorous, glorious, global Gabby Logan. Gabby competed as an international gymnast in 1990 before making her career jump into broadcasting in 96, where she soon established herself as one of the nation's biggest presenters on Sky Sports. Since then, she's hosted some of the UK's greatest sporting events including the Olympics, the Six Nations, and both the Men and Women's Football World Cup. She's a seriously good sports broadcaster and is now a household name. I've always admired Gabby for her broadcasting expertise, her beautiful voice, but it's her brilliant podcast, The Midpoint, which I think shows a side to her that most people are unaware of. The Midpoint is a celebration of midlife, and of course, one of the discussions that comes up time and again is the menopause. something Gabby has no difficulty discussing, so I knew that she'd be the perfect person to help out with this week's dilemma. Here she is everyone, it's Gabby Logan. Gabby, Logan, I feel as though I should really be inducting you into TV's Hall of Fame. But for now, I can merely welcome you to our little podcast, It Can't Just Be Me. How are you? I'm very well, thank you for that lovely introduction. GABBY: How are you? ANNA: I know you sound amazing, don't you? GABBY: It's always weird kind of like hearing- You don't normally hear those introductions kind of being recorded, you know, because obviously people put them on afterwards. So you sit here going, oh gosh, I'm cringing, I'm cringing. ANNA: We're sitting there also thinking, hang on a minute, I've done loads more than that. GABBY: Well, I wouldn't have said that. No, it wasn't at all. Thank you so much. ANNA: Well, obviously, I mean, your career is extraordinary. So thank you very much for being with us today. Also, our dilemma today is from a woman who's going through something I know we've both talked about a lot, which is obviously the perimenopause. She's having a really tough time. She's struggling with a whole host of very difficult symptoms and is asking why it seems to be so much easier for some women than others. But before we get into that, every week I ask my guests to share their very own It Can't Just Be Me dilemma. So, go on, what have you got for us? GABBY: I imagine this is a bit niche. It can't just be me that wishes there was an Olympics for the over 50s. ANNA: No, that would be amazing if that isn't just you. GABBY: I did a little bit of research in preparation for this argument as to why there should be Olympics over the age of 50. And it won't surprise you to know that there have not been many Olympic winners over the age of 50. Our very own Nick Skelton won the show jumping in 2016 at 60 years old or 59. But most of the over 60 winners and 50 winners were shooters back in the early 1900s, right, when it was a very elitist thing, the Olympics. In fact, my favourite one was from the 19, somewhere in the 40s or maybe the early 50s. It must have been the first Olympics after the war. and it was a 60-year-old bloke who won a medal for drawing. I didn't even know drawing was in the Olympics. Is that an Olympic sport? It was something like drawing crafts, yeah. So that's gone, obviously. That's long gone, that particular event. However, it remains the fact that the only other event, really, that has anybody over the age of 40 tends to be a horse event. So dressage does have quite a few. There's a Japanese guy who was 71, I think, in the Rio Olympics. But that's it. ANNA: But even so, I think there's a place for just saying we're going to do the Olympics for people over 50. Just have a crack. Sprinters, gymnasts. Back in the day, this might surprise you, but back in the day I was actually quite the gymnast myself. Were you? Oh, so I think I could do a little bit of tumbling, floor work, maybe with a ribbon. GABBY: Oh, so you've been a rhythmic gymnast? ANNA: Oh yeah, I mean before the 34F boobs grew, I was all about the tumbling. I could do a pike, I could do a dismount, I could do everything. What would you do? GABBY: Well having done gymnastics in a former life, I think I'd like to change sports and I've been really enjoying road bikes and getting out and doing like big rides. I've never been in a velodrome, though. I've never actually cycled in a velodrome. I've been in one, but I'd quite like to give that a go. That looks quite death-defying almost sometimes, doesn't it? It looks steep. It looks steep, it looks scary, but why not? Let's give it a go. Let's give it a go in the velodrome. ANNA: So you'd go velodrome and I'd be in a leotard on the floor. GABBY: Just across the way, in the gym, and I'll be in the velodrome. ANNA: I think that's an absolutely brilliant idea, and you heard it here first. However, back to our dilemma, which actually, if we did do the Olympics for people over 50, would include women going through the perimenopause. And this week's question is from a member of the Menopause Matters Forum. If you don't know already, Menopause Matters is a brilliant magazine with a great online community. Personally, I found it actually incredibly helpful when I've needed answers around my own symptoms. So for anybody listening, I'd strongly recommend that you check them out if you're struggling. We'll make sure that we leave a link in the show notes. We're also joined today by one of the best known doctors out there when it comes to women's health, Dr Ellie Cannon. As well as being a practicing GP, Ellie writes the health pages for the Mail on Sunday. and is also the on-screen doctor for BBC Breakfast and ITV News. So we're delighted that she's found time to be with us. Ellie, thank you so much for coming into the studio. Seriously, thank you. I know you're busy. DR ELLIE: No, it's fabulous to be here. Really, really good to be here. ANNA: Thank you. So, girls, this dilemma is from Sarah, who is 56. She emailed it in, so I've asked a friend of the show to read it out. Here goes. LISTENER: Hey, Anna. I wonder why is it so hard for some women during the perimenopause? For some it seems to take years to try to get some level of stability whilst others don't even notice that their periods have stopped and realize that they're postmenopausal. I'm 56 and still getting period symptoms every four weeks without fail. I'm on 1, 2, 5 estradiol patch, a low dose antidepressant and use the Mirena so thankfully I've not got any bleeds. However, I am suffering from crippling anxiety, tearfulness, I feel vulnerable, I struggle with mood swings and have cyclical thoughts of suicide. I deal with horrendous joint pain also and muscle fatigue and exhaustion. The good news is I'm getting a bit of it under control. Yet others who seem to have very mild symptoms, I feel look at me as if I'm mad or weak. And I just can't understand why it's so bad for some and not for others. Can you help please, Sarah? ANNA: Okay, before we get into this, Sarah, I want to reassure you that your symptoms are very common and you are absolutely not alone. So, according to a 2021 government study of 2,000 women aged between 40 to 60, 53% reported low mood or depression, 50% reported anxiety, 58% reported a lack of energy, and 9% of those with perimenopausal symptoms had contemplated suicide, which is Absolutely shocking. Ellie, I want to start with you as our medic in the room. For those who may be unsure, when we talk about perimenopause, what is it that we actually mean? DR ELLIE: So what we're talking about is the time around the menopause, so either before a women's period stops or after. And we say that a menopause is between the ages of 47 to 53, I mean that's the range. Then let's remember that ranges are just that, they're not sort of absolutely set in stone, different people may have different times. And then the perimenopause is all the time around that. So of course, if you're going to start your menopause at 47, it might be that your hormones already start to change. Aged 43, 44, your cycles might change, your periods, your mood. And likewise, at the other end of the spectrum, after 53, people can still be having those symptoms. And perimenopausal symptoms are akin really to menopausal symptoms. They're those hormonal changes that we're very familiar with that affect our mind and brain fog and depression and anxiety. Obviously the physical changes to do with the weight and your cycle changes. A lot of people I see before their menopause and a lot of women have no idea that A big part of the perimenopause is actually that your periods get heavier and more frequent. Actually a big feature of perimenopause is that you have two periods a month for a few years and they're very heavy, which is, you know, shocking really for a lot of women. So it's its own time, it's different from the menopause, it can last a long time and as we've heard from your dilemma it can cause a lot of symptoms. ANNA: Why is it that it's so much harder for some women than others? DR ELLIE: So I think that is a really great question because that speaks to so much within health and medicine anyway. So if we look back to when we're kids and we have chickenpox or in the last few years when people have COVID, look, we all get things in a totally different way because we're all individual and we're all made up of our family history and our genes and our lifestyle and there's a lot of things that make up ourselves, genetics, environment, So you're absolutely right, one person will suffer or experience one way and one person will experience a completely different way and that seems incredibly unfair but that is just the spectrum that we always see in health. ANNA: And we're talking about a period potentially of a decade. Yeah. Which is, you know, a huge chunk of our lives, really, as women. But, Gabby, you first thought that you might be experiencing symptoms when you recorded an episode of your podcast with Mariella Frostrup, who, of course, was really the first journalist to highlight menopause. Tell us a bit about that. How were you feeling and what gave you that lightbulb moment where you thought, hang on a minute? GABBY: I think Mariella's about 10 years older than me. And as you say, she had written and she was on to talk about books she'd written to do with menopause and she'd been quite outspoken and quite unusual in that landscape. I think there are a lot more voices now. And she started talking about things that she had experienced and I was sitting there thinking, hang on a minute. recognize a few of those. I'd noticed that I was more anxious. I'd noticed that I was a bit kind of edgier and it was 2020. So we were in the middle of a global pandemic and I was thinking it was to do with that. But then I was also kind of thinking, no, it's not that, it's something else. And just physical symptoms would be skin feeling more dry, you know, not feeling like I could kind of get myself going as quickly in lots of ways. I did feel my libido kind of slipping as well, but not, it was all a bit kind of low level. Do you know what I mean? And I was thinking, is this just aging? And if so, gosh, this is, you know, pretty This is crap. Yeah. And I've got a long time to go. I've got a lot of longevity in my life. I've got five people who live to a hundred, you know? So I was thinking, gosh, I'm not going to live another 50 years in this kind of state. And so I hadn't really given it a great deal more thought because first of all, I'd hardly ever heard of the word perimenopause. I'd heard of menopause, which I assumed was the kind of sitcom version of it where you've got really hot flushes, which I didn't have. So I didn't recognise that. I'd never had massively problem period. So when they started to kind of disappear slightly, I hadn't really noticed. I know that sounds ridiculous, but you know, I just hadn't. So after the podcast recording, I said, do you recommend any particular doctors to go and chat to? I didn't want to go to my local GP because it was COVID times and you could barely get an appointment. So I just started my own kind of journey. And I didn't even, at that point, come straight off and say to my husband, you know what I was saying to you about? I just thought I'll just have a do a bit more reading. And yeah, lo and behold, it was a perimenopause. And after that initial conversation, I think I had two more periods. Like literally. So I was deep into that period of my life. ANNA: How did you know? Because obviously blood tests aren't routine. GABBY: Well, I did have blood tests and I know that's, you know, you don't have to have blood tests to find out, but it did show that my hormone levels were on the floor. We were saying before about why some women have really bad menopausal symptoms and others don't. Well, I had really bad fertility issues and some women don't. So I had IVF to have my children. Other than having IVF, I'd never had any gynecological issues. And even when I had my tests, they couldn't work out why I wasn't getting pregnant. So I was in that 20% band of unexplained infertility. So I never really troubled any doctors about my kind of workings until I went to have IVF and fertility treatment. And this is the thing that makes me kind of sometimes a bit cross as well, that women's health is so neglected in so many areas. Nobody had asked me anything about my health since I gave birth. There were no checkpoints to say what's going on. So it led on then to me to have so many more conversations and reading. I could have skirted through that period, as my mum claims to have done, and not noticed anything and just stopped having periods. But I wasn't happy feeling like I was 25% of myself. I didn't want to live the rest of my life feeling like that. And I was also focused massively anyway on what I ate, exercise, all those things I was doing. I was really focused on my health. So I knew there was not much more I could do. Do you know what I mean? I was like, I can't really eat any better. Can't work out anymore. Because my younger self would think a good run will sort it out. And the thing about perimenopause, a good run never did seem to sort it out. So what did you do? So I decided to, on the recommendation of the doctor, try HRT. I was taking gels, which you can do, you know, a kind of a bigger dose or a smaller dose, depending on how you're feeling. And so I started with a very small dose of the gels and noticed massive changes to me. And I won't lie, it was a lovely feeling to feel like myself again within a few weeks. So yeah. ANNA: So you were going for the gel and what about your progesterone? GABBY: I had progesterone as well, sorry, in tablet form. Yeah. And any testosterone? Yes, a little kind of chickpea of testosterone. my libido came back within a week. I felt definitely a massive improvement there and that was important to me. I had a very healthy relationship with my husband and I loved him and fancied him and I couldn't understand why I didn't want to have sex with him as much or why it was something that I felt I was going to have to have. It was almost like, is this going to become dutiful? ANNA: Which is what so many women say, don't they? GABBY: Yeah, and I wanted to keep enjoying having sex, not feeling that I was just doing it because it's part of the marriage contract. ANNA: Yeah, yeah. I mean, I can absolutely identify with a lot of things that you're saying and also what Sarah is saying as well. I think I started my perimenopausal journey probably when I was about 44, 45. So it's what you're saying Ellie. And as it went on, I really started to feel really quite unwell. And it was more psychological symptoms for me. I never got a hot flush. totally didn't get that. It was more anxiety, fear, brain fog, all the things weirdly that my mum had gone through at the same age. But like your mum, Gabby, my mum's like, oh, I can't remember, darling. I think it was fine. It wasn't fine when she was going through it. So I felt that I was going mad. And then I think the penny dropped, that my periods are starting to get a little bit erratic. I need to do something about this. But I've really struggled to find the answer in terms of making me feel better. Actually, which brings me to talk about HRT with ULE, because there's been a lot of emphasis put on HRT recently. And I know that it's very helpful for a lot of women. It has been helpful for me, but I find like I'm having to constantly fine tune it. But I think we think of it as a panacea. And it isn't. So how do you feel about it? DR ELLIE: Well that's exactly it really, I mean no medicine, and obviously I'm a doctor prescribing medicine on my little green pads of paper every day in clinic, but no medicine, whether we're talking paracetamol, whether we're talking chemotherapy, there's no such thing as a panacea, there's no such thing as a magic bullet, there's always pros and cons, there's always side effects. And again, this goes back to what we were talking about the spectrum. So absolutely, HRT is fantastic as part of, I suppose, the armory, if you like, in the same way that the contraceptive pills are fantastic as part of the armory in contraception, but there are also other options. So, a lot of women will really benefit from HRT. Oestrogen, progesterone, testosterone as well, as Gabby has mentioned, particularly for the sexual symptoms of the menopause, 100%. But there are also women who can't take HRT or who don't want to take HRT. And we have to make sure that they're included in this conversation. women who've had young breast cancer who can't take it, there's women who feel awful on it who can't take it. There aren't a huge number of other options but there are people who will feel better taking an antidepressant for example or from just the lifestyle and we shouldn't really say just the lifestyle changes because that can actually be sort of quite amazing if you've not exercised before and you change into that or you start doing something like yoga. But I think we have to see these things as sort of like a patchwork and a jigsaw where we stick a few things together. There isn't a great answer. For some women they will do really well on HRT with some other things. But as long as we're all sort of realistic and we look at the individual about it. ANNA: Because I think it's really complicated. You know, your hormones, you've got an orchestra of hormones going on. And we tend to go, take oestrogen, progesterone, testosterone, you'll be fine. And certainly in my experience, it hasn't been fine. And trying to get the dosage right and the ratio between them is just almost impossible. DR ELLIE: Yeah and I think what we have to remind ourselves if we sort of look back to teenage years or our 20s and 30s when we're sort of you know some of us are looking for contraception, we'll sit in a room with our friends and some of us will be great on the pill and some of us will hate it and we'll get spotty and some of us will love the implant and some of us won't. And that's the same with HRT, because we're dealing with exactly the same hormones and what we're adding in. We can't sort of diagnose this with a definite number on a blood test. So it's a bit of a suck it and see approach. ANNA: Which can be very difficult, I think, for women. I mean, look, without question, HRT can be massively beneficial. I have found it beneficial. Gabby, clearly, you have. I mean, you feel great, presumably. I definitely do. GABBY: I understand what you're saying about the exact science is impossible, isn't it, for women? And everybody's different. I guess being aware of your body, understanding yourself, maybe even making a diary of your symptoms. There has to be a bit of responsibility, I think, from the individual here and saying, right, I'm going to really kind of monitor this myself. I know white wine makes me feel horrific now. And I used to be able to drink white wine in my, you know, I can have one glass and over three hours and feel terrible, right? So everything changes in your body as you, as you get older, you notice it because you're kind of aware of it and what makes you feel good 20 years ago. doesn't anymore. So I guess it's the same kind of thing, isn't it? Noticing your changes, noticing how you're feeling. ANNA: I need to ask, does that go across the board for all alcohol or is it just wine to wine? GABBY: No, it seems to be just those kind of like, you know, gin and tonic isn't so bad. I'm not really good with wines generally, I think, anymore. I kind of feel like it doesn't, you know, I'll try and have a glass and then it's... It just doesn't work? Yeah, I feel like I'm getting the hangover before I've even finished a glass. ANNA: Well, as I understand it, actually, menopausal women, we can't metabolise alcohol as well as we used to. Is that right, Ellie? DR ELLIE: Yeah, so there are changes that occur so obviously we metabolize alcohol through our liver and that can change and that can change because of, I'm sorry to say, fat around the liver and things to do with that and obviously there are changes with weight during the menopause and changes with where the fat in our body sits and that can affect how our liver functions and it's funny now listening to Gabby and saying about how she was listening to Mariella Frostrup and then thinking Oh gosh, is this my perimenopause? Because now I'm thinking to myself, oh gosh, when I drink white wine, I also don't feel very well in my mouth. And how old are you now? I'm 47. ANNA: So, I mean, this is really interesting. DR ELLIE: I know, you're Mariella. But that's really sad about white wine. ANNA: But are you now thinking genuinely, are you thinking, oh, hang on a minute, perhaps I'm starting to eke into perimenopause now? DR ELLIE: Yeah, I mean for me I'm very, very aware of mental health symptoms and sort of mental illness and I've always been very open about the fact that I suffer with anxiety and I've taken medication over the years for anxiety to deal with that. It's very, very hard to separate that now. in my mid to late 40s, that sort of anxiety and what's going on there with actually, is this to do with the perimenopause? It's impossible for people to work that out. And it ends up being down to you thinking, is this me and how I've always been? And why is it worse now? GABBY: Do you know what else, though, I think, when you say it's down to down to us, I think it's really helpful if you've got people in your life, whether it's your partner, your children, your mum, what kind of relationships you have around you, had to have open and honest conversations with people because when I told my kids and husband what was happening, I could almost see like they literally were like, hallelujah, because they'd obviously all noticed this change in me and were kind of, I think, slightly nervous to broach anything or I remember there was this one morning where it was a Sunday morning and I was particularly disappointed with the fact that nobody had cleared up after breakfast on a Sunday morning. That'd be livid. And the pots were everywhere. I came into the kitchen and I just went mad. And I sat at the table and I told them all that I'd been looking at flats in Beaconsfield. I hadn't. And I was thinking of, you know, going off until they could all sort themselves. I mean, I was literally planning this escape where I was going to leave them all. You know, nobody was more surprised than Kenny. And I think right now my daughter is like, you know, pretends that she's traumatized by it and she goes, oh, I was just so distraught. And she had tears kind of like falling down. Of course, none of them had done anything particularly unusually bad, but I was obviously just feeling like, I just can't cope with you all right now, you know. And then I had Penny Lancaster on my podcast, The Midpoint, and she talked about throwing a chicken dinner on the wall, Rod Stewart's chicken dinner at the wall. And she said, Rod took the boys out the kitchen and then came back and sat down with her. And I love Rod Stewart for this because I mean, he's had some practice. I think there were five wives before, but he sat down with her and just talked about kind of how she was feeling. And then she went off and spoke to a doctor and found out that these were perimenopausal symptoms. ANNA: Well, I mean, we know that divorce rate actually increases for couples when women are going through their perimenopausal years. Yeah, communication is essential, isn't it? To say, you know, I'm feeling really crap. And then your other half goes, yes, yes, yes, you are. So it is about communication. But just actually, I'm just picking up on your anxiety, Ellie, because again, for me, the mental health symptoms were just appalling. And I ended up going to see the only gynaecologist psychiatrist in the country. But I went to go and see him and I was saying, I feel really, really shitty. And we discussed about taking HRT and oestrogen. And I remember him saying to me very clearly, have you ever taken antidepressants before in your life? I said, yeah, I have. Through other periods of my life, periods where I've been struggling with fertility, for example. I had an ectopic pregnancy, so after that I was really very unwell mentally. And he said, did antidepressants help you then? And I went, yeah, they did. So he said, so why don't you just take them now? Because they can help you. And it did. It did. DR ELLIE: And I think that we owe it to ourselves and we owe it to all women to have that pragmatism, you know, that an antidepressant is going to help you. That's an absolutely brilliant thing to pick up on, you know, other times in your sort of reproductive life, if we want to call it that, you know, after something as traumatic as an ectopic pregnancy, when hormones were all over the place and the physicality of that and the emotional side of that. you found antidepressants helpful. So that's really good to then sort of mirror that through the menopause and think, well, actually, maybe even though this is hormonal, maybe also an antidepressant is going to help. GABBY: Might help, yeah. As a doctor, I'm taking you here as a doctor, so I'm going to use you. Brilliant. Do you think the conversations become almost too binary? DR ELLIE: Absolutely. I mean, yes, no doubt about it. And I think all conversations now are too binary. You're absolutely right. There isn't black and white, but humans love certainty. We love to know this is good, this is bad. We can't cope with grey. We can't cope with uncertainty. So we want to be told it is HRT. ANNA: So for those women who are on HRT, and obviously Gabby and I both are, here's the age old question. When do we come off it? DR ELLIE: I wish I had the answer to that. So the current guidance is, and this is not helpful, but I'm going to say it out there because this is, as I say, the guidelines, is that you are on the lowest dose for the small amount of time as possible. I mean, that's the sort of official, nice guidelines British menopause. A bit like any other medication, you take the minimum that you need to take to do the job that it needs to do, and then you wean yourself off. Now really, if we look, we have thankfully done a lot more research in the last few years into HRT and actually women taking HRT in their 40s and 50s are really not adding to their risks of whatever we look at. So let's say we're looking at breast cancer or blood clots, that type of thing. If you're having a normal prescribed, a regulated level of HRT in your 40s and 50s, you're not adding to your risk. And really then towards the end of your 50s and in your early 60s, you might be starting to think, is this the time to come off? How do I feel? Do I wean it? Goes back to what we just said, totally up to the individual. I have patients in their 60s and 70s, as they should be, starting new relationships, starting new jobs. People don't want to be told to stop their HRT if they've got a new boyfriend, you know, and they shouldn't be. So it's really individual. ANNA: And I've heard from plenty of women who are post-menopausal that actually they feel great now. So do you hit a point coming off HRT as you get older into your 60s, 70s, 80s, that actually you end up going, I feel really good. My energy's come back. I feel fine. DR ELLIE: Yeah. And again, it's going to be a spectrum. So you're going to have women who feel great in the same way that, you know, it sounds like all of our mums told us that they sailed through the menopause. GABBY: My mum looks amazing and she's got unbelievable energy. You know, she's 73 with incredible energy and she's never been on HRT. So at my 50th birthday party, she went around saying to my friends things like, it's not an illness, you know, it's not an illness. And one of my friends came up to me and said, your mum's doing a great job of just totally going out there telling all these 50 something women that, and I said, yeah, but she forgets what she was like in that period. She might think she sailed through it. I would say not. Because she has different memories of that. Now she's in a great space now, you know, with her health and everything, and she looks great and she's enjoying life. But I think, as you say, Ellie, it is a completely individual, isn't it? So her sister was kind of famously in the family of the hot flush one, you know, Auntie Jane's hot flush. She's having a very obvious menopause that kind of, you know, where she's having to fan herself all the time, which was my kind of understanding, as I said before, of what the menopause was. That's all I thought it was, just people kind of fanning themselves. DR ELLIE: Well, that's also it. So I wonder as well, if your mum and that generation of women, they only knew the menopause as stopping periods and hot flushes. So if she actually had 10 years of the menopause dreads and feeling anxious, it wouldn't have been labelled. So that's, you know, she would think she sailed through it. GABBY: Yeah. With herbs, as she says. ANNA: I mean, there's so much to discuss with us and so much more I could say, but I'm just wanting to bring us back to Sarah. Her symptoms are clearly awful, awful. As a doctor listening to those symptoms, Ellie, if she were your patient, how would you be treating her? Because listening to her, there's a bit of me, obviously I'm not a doctor, but I'm thinking, are you on too much HRT or what's going on here? DR ELLIE: First of all, is this just menopause? Are there actually other things going on here? That's what we really need to do. That's important with any diagnosis. That's so important. We have to be very careful with women that we don't just label things menopause and miss something else very crucial as well. So I would say that she needs somebody to look at her really holistically and pragmatically. Whole host of sort of blood tests, investigations, see what's going on. Does the HRT need tinkering with? Up, down, change? Does she need a bit of testosterone? Would she benefit from talking to somebody? I think the sort of the top line is that she shouldn't just accept feeling like this because this definitely shouldn't be somebody's experience of the menopause on HRT. ANNA: Sarah says that she sometimes feels weak or mad. for experiencing such severe symptoms. Do you think, Gabby, that we've still got a long way to go when it comes to understanding the menopause and actually there's still that shame that's attached to it? What would you say? GABBY: Yeah, and I hope that listening to this she realises she is absolutely not alone and that there are actually now some great resources out there some brilliant podcasts, some interesting books that have been written, people going through similar things that you can realise that, you know, this is not just you. Because that makes me feel so sad that, you know, something that is actually just part of your progression as a human being on the planet is making you feel that way and actually other people can share their experiences. So I really hope that she takes some kind of solace from that and seeks out those resources. ANNA: I have to say, I really do sympathise with her. My mum had a really bad menopause and mine's been tricky. And just in terms of that depression, the anxiety, the low mood that she's experiencing, when you're in the midst of it, it feels awful and like it's never going to end. And so I guess we all want to reassure Sarah that it does get better, it will get better. We checked in directly with her as well, and she's told us that she is feeling a bit better, which is great. Normally, I'd ask for some concrete advice for Sarah, but this week, I'm going to ask you to direct that advice to anyone listening, and that includes partners, family members, colleagues, and so on. So, Ellie, if someone is dealing with severe menopausal symptoms, what should they do? DR ELLIE: have a look at the Menopause Matters, British Menopause Society, make sure you are completely aware of what is going on and whether your symptoms really are to do with the menopause alongside doing a symptom diary because it's very difficult sometimes when you do speak to a healthcare professional to even remember what you wanted to say. Knowledge is power. And then go and seek help. Start off with your GP. I really believe that patients know themselves better than anybody. And if you are not happy with what that doctor says to you, you go and speak to somebody else. You go to another GP within that GP surgery, or you are very entitled to leave that GP practice and start again in another GP surgery. Feel empowered to do that and to ask for the help that you need. ANNA: And Gabby, how can family partners or colleagues help, do you think? GABBY: I think with family, it is really important to have those conversations. I've got two children. They're 18 at the moment. They were about 14, 15 when I started to realise that I had symptoms. I probably had symptoms for a few years before that. They probably saw it all coming. Probably knew before me, but didn't know what to call it. But having those open conversations just makes everything so much easier then to deal with. It's almost like you lift a little bit of the weight off your shoulders. So I think have those conversations if you can. And for the workplace, I think there's a lot that can be done actually. I talk to a lot of businesses and a lot of companies are really now kind of becoming aware of this and having menopausal kind of counsellors in their businesses. I think industry and corporations are realising that they want these women. They don't want to lose these women from their workforce. They've trained them for 20 years or they've seen potential career paths for them and they want them there. So what can we do to retain them? ANNA: So Gabby, obviously other than HRT, which sounds like it's really working for you, and I think that we've also got to be positive about the menopause. It can be a really liberating time in life for women. But what else has worked for you outside of that medication? GABBY: Yeah, when you say liberating, I'm not one of those people that was emotionally attached by periods. Apparently some women really hate the end of periods. I was like, hallelujah. I've found my female friendships have been so important in the last few years and they've kind of energised me. I love going to a lake near me on a Sunday with a couple of girlfriends. And you know, it's part community as well. So that's really important, cold water and cold showers. And anytime I can get into cold water anywhere, basically. And always being mindful of diet and what I eat and enjoying really good food. And I think Having loved exercise my whole life, I think it's one of the best gifts I was ever given really, I suppose, starting sport at an early age because I've never had to find sport, it's always been there. I just like moving and I want to keep moving. ANNA: Sarah, I really hope that you've been listening to this, and for anyone else that might need support out there, I also hope that this conversation has been useful for you. If anything resonated with you today, we'd love to hear it. Please do get in touch with us, either by leaving me a voice note at itcan'tjustbeme.co.uk, or you can email your dilemma to itcan'tjustbemeatpodomo.com. Now, Gabby and Ellie, you've been so brilliant that I'm going to chuck two more quickfire dilemmas at you. They are also based around the topic of the menopause, which frankly we could talk about all day. And they're from two women that we met at the Postcards from Midlife live event. This first one is from Laura. LISTENER: Hi Anna, I'm Laura and I'm 56 years old. I have a 21-year-old daughter and at the moment we're both going through our hormonal stages. So how can we meet together in the middle and understand each other? ANNA: This sounds like hormonal hell. So a 56-year-old Laura with a 21-year-old daughter who may be struggling with periods by the sounds of things. Gabby, you've got a 17 or 18-year-old daughter. I imagine this is something that you can relate to. too. GABBY: I mean, she's, she's an absolutely brilliant girl. Love living with her. You know, she's amazing, but I've noticed some sharp changes in mood in the last couple of years that didn't happen in the early stages of her periods. And then there's my sharp changes in mood that were happening with perimenopause. Well, get two of those on the same day and not great for anybody in the house. So I think one of the things that I've loved about midlife is acceptance and just going, you know, I was wrong there. I shouldn't have, I shouldn't have jumped to that conclusion. I should have just, and I go in and say, Really sorry, I shouldn't have said that. And we're back to being mates again. But I think it is hormonal as opposed to just deep, intrinsic problems. And I think if you can just address things very quickly and try and find things to do together that you enjoy. You know, your daughter is your friend. She's not a rival in the house. You know, sometimes I look at my daughter and she's so beautiful. She's got so much in front of her. And you think, oh, and I'm on the other side of the midlife and I'm kind of heading towards the end. And it'd be very easy, wouldn't it, to think, oh God, I hate you. But actually, it's wonderful to have that relationship and be on each other's side. ANNA: Ellie, what would you recommend to help Laura and her daughter understand each other as they're going through these biological changes? DR ELLIE: So I'm also speaking from experience because I have a 20 year old daughter and I would say recognize it and name it and don't be afraid to say what it is. I've never been afraid with my kids to actually sort of name things and you know mention anxiety, mention menopause as you said Gabby it's so important to talk and have these conversations. And also remember that we can't really remember what it's like to be that age. I was 26 when I had my daughter, which is relatively young, but still, I can't really remember what it's like to be 20. We don't know how they feel, really. We can't remember. And their world is so different to ours, isn't it? ANNA: Very different. OK, girls, thank you for that. So this next one is from Libby, and I'm desperate for the answer on this one. LISTENER: Hi Anna. So how do we deal with the weight gain as we go through menopause and midlife? It's not that I'm shallow. It's a fact that you feel your clothes getting tighter and you see your body changing and you feel you don't have any control over that even though you're trying to change weight. So any suggestions would be really helpful. ANNA: Oh Libby. I really, really hear you on this one. Now look, Gabby, you look amazing. You're 50. You exercise a lot. You eat super well. Is this something that you can relate to with Libby? GABBY: I totally relate because I think your body, you know, does change, doesn't it? You know, it's not the same body that I had when I was 25, 26. I know there are certain foods that just don't make me feel great anymore. And they seem to attach themselves to me in a different way, you know, an abundance of potatoes. They don't disappear, you know. So I'm much more mindful about what I'm putting in. I love food and I want to make sure I get good nutrition from it. So I'm mindful about food. I'm mindful about alcohol. I do love training and resistance training is so important in midlife and beyond and even earlier. And so make sure I do that. And I'm a big fan of Pilates and, you know, getting outside and cycling and walking. And I've had a lot of experts on my podcast from the fitness industry who basically say the bad news is you've got to do more, not less. You've got to keep up and actually extend what you're doing. Not just, Oh, I'm 50 now. I'll do half as much. You've got to eat half as much more. ANNA: Oh, that's fascinating. Ellie, from a doctor's perspective, is there anything that we can do to stop ourselves looking like a lemon stuffed into a dress? Just talking about myself. DR ELLIE: Well, I think we have to accept that there has been a change because our bodies have changed and hormones, oestrogen particularly, is very, very much intertwined with fat and where the fat sits in our body. So you have to accept there's been a change and look for what that change is. It might be that things you have metabolized absolutely fine your whole life, like Gabby's potatoes, now just sit underneath your belt. And, you know, those things have to change. And I am very, very against fad diets and, you know, special, you know, amazing miracle diets that are going to sort of be the answer. there will not be a miracle diet and there will not be an answer. GABBY: And those things like you say in your 20s where you might have followed something for three weeks and thought this is it's not that body anymore. DR ELLIE: No and that's it and that's what you have to accept and you don't have to accept that you can't do anything about it but you have to accept exactly it's not that body anymore. ANNA: So you're saying accept and adapt. DR ELLIE: Accept and adapt and evolve. Okay I love that. ANNA: Girls, what a joy it has been to have you both on the show today. Gabby, thank you for all of the work that you do to raise awareness around the menopause and of course for talking about it so openly and honestly on the show. Thank you. And Dr Ellie Cannon as well, thank you too for bringing your invaluable medical expertise to this subject today. I know how busy you are with your own patients, so thank you for taking the time to be with us in studio. I'll be back next week with a new episode of It Can't Just Be Me. In the meantime, if you find yourself with a dilemma and really need some advice, then visit itcan'tjustbeme.co.uk to leave me a voice note or email your dilemma to itcan'tjustbeme atpodomo.com. And if a weekly delivery of this podcast into your ears just isn't enough, You can also find us on Instagram, TikTok, YouTube and Facebook. Just search for It Can't Just Be Me, because whatever you're dealing with, I promise you, it really isn't just you. From Podimo and Mags, this has been It Can't Just Be Me, hosted by me, Anna Richardson. The producers are Laura Williams and Christy Calloway-Gale. The editor is Kit Nilsen and the executive producers for Podimo are Jake Chudnow and Matt White. The executive producer for Mags is James Norman Fyfe. Don't forget to follow the show or for early access to episodes and to listen ad-free, subscribe to Podimo UK on Apple Podcasts.