89: Dr Fatima Khan: Weaving Eastern traditions with Western medical science

Welcome to Dear Menopause podcast, where we discuss the menopause transition to help make everyday life a little easier for women. This is Sonya, and I am your Dear Menopause . I have a brilliant episode for you today with Dr Fatima Khan. Now, Fatima is a highly skilled perimenopause and menopause specialist. She comes with a very holistic approach to women's physical, emotional and mental well-being during these middle life years. We're going to love getting to know Fatima and the various nooks and crannies that our conversation visits Fatima. Welcome Dear Menopause.

Thank you for having me, Sonya. It's been such a wait to get onto your really busy podcast, I know. I'm so proud to be here.

Thank you, I'm absolutely delighted to have you here. I know we're going to have a really juicy, informative conversation. Why don't you kick things off? Use yourself to the listeners so that everyone knows who you are and what you do.

I work as a perimenopause and menopause specialist. I'm based in Melbourne, having moved here four years ago just before the pandemic. Prior to that, I was working in London in a NHS National Health Service-based menopause clinic, which was a tertiary centre. We saw lots of complex patients. I'm also working in the private sector. I got most of my training in the UK after being certified by the British Menopause Society. They do an advanced certification in which you've got to spend a significant amount of time seeing patients and doing research and other things. My main focus at the moment is looking after women who are experiencing the perimenopause, menopause, premenstrual syndrome to a certain extent, and high-risk patients who have been convention told they can't have hormone therapy. That's my main focus of the area at the moment.

One of the things that we've spoken about is that you very much come from a holistic Western medicine combined with holistic care for your patients. Do you want to go into how that works for you a little bit?

I guess it's just cultural background. I was born in Pakistan and I was one when I moved to Dubai. I was there for about five years, then we moved to England, then I went back to Pakistan and then eventually moved to the US for a bit and then was in the UK from the age of 14. My mom's actually born and raised in Kenya and all her siblings have been in the US and the UK. We've always had that family connection abroad. I guess when I was growing up, my mom's the youngest of three children and three sisters I guess siblings and then my father's got three sisters. I've always been around women and older cousins. We were the youngest. I saw my cousins get pregnant, have babies, look after the kids and age in a very different way to the lens that we might have in Western medicine. One of the things was having this belief that our bodies has this power to repair if you give it the right environment, through lifestyle, food, movement, exercise and also looking at women to a lens which respects them beyond how they look. They added value they add into their wisdom and lived experiences. I think we were talking about lived experiences. I've been very privileged enough not just to read about pregnancy and read about menopause. I've actually seen women live through it and know how they've navigated through it, which I think a lot of women these days don't necessarily have. That because we don't have this community and we're more focused on nuclear families. I guess that's what shaped my upbringing, which is based around modern Western medicine which saves life, but also Eastern medicine where the philosophy is very much eating together family values and going up to your elders for advice and navigation on how you navigate every phase of life and all reproductive phases as well, so incredibly lucky to have been brought up in a family that has these incredible older women that obviously role model for you, as well as being able to witness their lived experience through the different phases of life we were talking about beforehand.

That you mentioned, which I thought was just so beautiful, was that, if you are having a family gathering and you're sitting around the table, that there's this respect for the older members of your family, particularly the women. It's not just respect because they're older, it's respect because of what they've navigated through their life, recognition of the wisdom and the lived experience that you can go to them and ask them for advice because they've lived through it. I think that's something that I know that is lacking in my family background, but I think we talked about is lacking in a lot of more Western culture.

Yeah, and I think that's not necessarily negative things. The Western culture brings lots of opportunities for women. There's education, we can navigate our careers more effectively. You've got financial independence, which means you may need to move away from your home that you grew up in the community. As you grew up, you might go to another city, just like I've done. My family's based in the UK and I'm here on my own because of other opportunities, so I think that's great. But I think we can't underestimate the role that we get from our network or the village, that we need to grow families but also to navigate lives you can. When I was growing up, I guess I didn't really have that many friends because I always had an older cousin or an aunt or someone who's lived through an issue that I might be experiencing, because you can always go to someone to ask advice. But actually having that support network is what we need to aim if we're going to navigate the perimenopause and menopause, whichever society you're in. And I've seen some great communities in Australia, even if they're not focused on family or sisters or aunties, where women come together in communities and support each other. So I think just the cultural background and environment is really important. We know that and if you look at studies where they've noticed how you navigate menopause, it's very different in Asian countries, societies Asia, japan, china the way they navigate is different. It's partly their dietary, their lifestyle, but also what it means to go through menopause. And I think in the West a lot of the connotation is when you're going through menopause you age and when you age you become invisible, because our worth is still based around reproductive ability are we fertile enough? But also on how we look, and that's not necessarily the case. So in Asia, in South Asia, as you get older you get to sit on the head chair of the table. Someone will get up and give you their chair on the bus or in a restaurant or at home. So women are still very much part of their home life and the communities, the workplace. Anywhere they go, they're still very much visible, they're respected, they're valued and their input of their wisdom that they've acquired from living all these years is incorporated in every part of the community. And I think sometimes I don't think the communities in the West do that, I just think we've got this inner narrative in our mind because we've got magazines and everything around, that we're not visible. So a lot of the things. It's about the mindset that women, when they transition to menopause. I always say the mindset's really important. How do you look in the mirror and think of yourself? Does menopause mean to you that you're not relevant anymore? Are you invisible? And actually, with a more stronger mindset, you can navigate this wherever you are in the world.

Yeah, I think that's really important to talk about, more than what we seem to be talking about now. I know I've been in this space now, for this is coming into my third year. You've been working in this space for a very, very long time and I feel and we've spoken about this before that there is becoming a narrative for women, particularly across social media platforms, that has created some fear around aging and menopause and what those mean together, and the fear for, perhaps, the women that are coming into their perimenopausal years of what they are going to experience. And I find that it's a really fine line for us to walk around creating awareness, talking about the fact that perimenopause exists and that there may be some symptoms that you experience and, if you do experience them, that you need to go and seek some help and you don't have to suffer in silence. But we also don't want to be creating fear in the generations that are coming through either.

It's interesting because I started to go in social media in 2020 around COVID and it was very neutral. It was focused on creating awareness and giving women choice. So when you give women choices, there's no fear. We're not going to be polarized towards one way. And now there seems to be these two groups pro-HRT and the HRT haters and I think it can be sometimes based around this fear of if you don't take number one, fear around going through menopause, which is not the purpose of education. It is a natural transition and some women will need support with hormone therapy. That's fine. But the narrative that if you don't take hormones, you will age and get dementia and osteoporosis is fear mongering but also partially not true, because at the moment, they're not licensed for prevention of heart disease and dementia. So when you take estrogen, the short term goal is to manage your menopause symptoms Long term, we know it can treat and prevent bone loss. We know that but there and we know it reduces heart disease by 50%. But we know the other 50% is your lifestyle, which is very powerful, and I know women who take HRT and still get disease, dementia and osteoporosis, and I know women who don't take HRT and don't get any of those diseases, and so I think it's really important to. When you look at women, there is a whole spectrum of women and that's defined fundamentally by their environmental or we call epigenetics, where how, that, the way we live, determines the disease we get to a certain extent, and obviously there's genetic redistribution. So I think just living as taking HRT, you won't get these long term diseases. Very simply, I think you need to make an informed decision and you can respect the woman's journey. As a healthcare professional, my job is to give them information and then they choose a pathway, and HRT is part of it. But it may not be part of it for lots of women, and my personal experience in healthcare is very much lifestyle first and also using a lot more natural botanicals. I had used homopathy in the past. I love using acupuncture. I love using acupuncture. I've used some Chinese medicine herbs. I've never used a contraceptive pill because I've always suffered from severe premenstrual in my puberty years. Then, when I was 19, I was diagnosed with polycystic ovarian syndrome and didn't have peers for six months and I had really severe anxiety and depression and it was the first day of my medical school. I don't really talk much about it, but that was a very clear memory and they wanted to put me on the pill, which they normally do for peacocks and I literally focused back onto my fundamentals of sleep, self-care, eating the right foods and I was first year of university, you don't eat properly, you just get out of baked beans on toast and the lack of sleep, and I corrected it all. We know hormones are really very much affected by sleep, the way we eat and also the way our stress is manifested in our body as well. And then we came to when I got pregnant which was again another challenge, but I did get there and then postnatally I had really severe postnatal depression. Again I didn't take antidepressants for it and again it was a hormone depression. I don't like calling it postnatal depression I had my mom. I had home help, I had immense amount of support and yet I felt really, really flat, really fatigued. I didn't really get the joy that people would get, or women would get, from having childbirth and had suicidal thoughts and I didn't take antidepressants and I had to go back to focusing on the fundamental pillars of health. And also I did use some natural progesterone at that point and again, some women will use antidepressants, that's fine, but for me it was all it was about these hormonal shifts which I'm very sensitive to. And then came my kind of very early perimenopause when I was in my late 30s, which I started to get a lot more anxiety and panic attacks and found myself with palpitations and emergency twice in the space of six months. And this has happened to a healthcare professional and I actually quite didn't know what it was, especially when perimenopause said there was no education around perimenopause and for me, my mental health suffers when there's a hormone shift. I don't tend to get the other things, and I think that's what my advocacy is around. Hormone health is mental health, and we've always thought of hormones as something that helps with reproductive health. Obviously, it's there to create a baby, have a period, ovulate, and it's procreation based. But actually hormones are really important for women's mental health, for our energy, for our mood, sense of joy. It improves sleep and it might seem that we're pivoting to a more pro hormone thing. And what I'm trying to say to you and someone who's very holistic and loves Eastern medicine and complementary medicine there is a role of estrogen for the woman who need them, and that could be for emotional health, mental health and organ health. You know it supports bone health, brain health, health health and also intestinal, gastrointestinal, gut health as well. So I think you've got to look at the individual person and you've got to optimize your fundamental pillars of hormone health, which I talk about reducing stress, sleep hygiene, eating the right foods and movement. Without this, even hormones don't help and in my experience, when I give estrogen to women who haven't focused on these four pillars of health, which are important for healthy aging and longevity, they still struggle. So you have to focus on those, and then I normally add in mindset and social connection with like minded women to navigate the perimenopause and menopause. But for me, when I'm looking at women I if you actually listen to enough women the first complaint they have in the early perimenopause is mental health. They don't talk about hot flush in the night. So I said, talk about feeling of overwhelm, feeling of anxiety, panic, attack, this disconnect from their body, this lack of joy, which are kind of the signs of depression. And we know most women get given antidepressants in their early menopause and then it may respond initially but really it's a hormone sensitive mood disturbance.

Yeah, that's really interesting and that you know I've had Professor Jay Ashrukel Karnion before. I'm a huge fan and it sounds like you most likely are too of the work that she's doing to really bring to the forefront the conversation around that connection between hormones and mental health. And I think it's so incredibly important and probably often overlooked in a lot of cases, whether it is the woman not recognizing or joining the dots between, you know, the onset of the anxiety or the palpitations and that loss of joy to their perimenopausal years. So one of the questions that I have for you because you do, you're not a GP, you don't work as a GP and you do come from a much more holistic space than I imagine a lot of GPs do One of the things that I hear constantly and you know we hear this regularly worldwide, it's not an Australian problem that is that the lack of education for GPs around perimenopausal, menopausal health for women is really lacking. There is not enough of it. And then GPs from experience, on the GPs I've spoken to here in Australia, they're overworked, they're underpaid, they are expected to know a little bit about everything. So women are falling through the gaps when they do go and speak to their GP. How do you see that we can correct this for women, that they don't just get dismissed and put onto antidepressants?

I think first of all you've got to go back to the root cause and number one ask yourself are women number one, accepting that there's a lack of education in this group? So all right, it was never taught about menopause, it was just one little topic. There was no information around it. A lot of the focus in gynecology so when I started off doing my initial career was an obstetric and gynecology, and then I went more to a general practice and went back to doing menopause training. So the focus in all of it in gynecology is fertility based Okay, managing the periods, but I think painful periods, heavy periods, and then how do we get women pregnant, how do we get women, help them stay pregnant, and then those were the kind of main focus and then maybe a little bit of gynecology. The menopause connect didn't really exist when I was training. Clearly there's obviously been a bit of a shift where and that's primary for two reasons now where most women in Australia will live till 85. So that's the way we're living longer. So you're spending 30, 40 years in menopause and so there is a demand for that. Compared to, I think, if you're born in 1920s, your life expectancy was till 48. So that's the first thing. So the curriculum hasn't really evolved with the woman's reproductive lifespan and reproductive lifespan plus aging lifespan as well. The second thing also is that women have been living longer, a lot longer. So how come we haven't evolved to change a medical curriculum? And I think the answer to that is most women, like my mother, was 29 when she had her three kids. Actually there's four of us I'm just skipped my brother there so four of us were three sisters and a brother, and so by 45, I was 17, almost going to university, and so they would have had enough time where they're not doing the school runs, not doing the lunch boxes, not rushing them to dance classes and rugby and all the school sports. They would be by themselves at home, have enough time for self-care. My mom didn't work and a lot of women of that generation were at home being mothers running the household. So there's been a shift in what is a role of a woman where they are contributing economically, they're working full-time and they're pursuing careers, which is great, but then they're having kids later 35, 38. So now the average woman going to menopause is a bit earlier. I would say I see a lot more perimenopause as more pronounced the symptoms in the early 40s and most of them will have three kids under the age of five, up 43, 44. So that's the reason why it's more of an issue now, because the women have got a lot more demands on themselves in terms of their work life and home life and they need to be able to function, Because when you're going through the perimenopause and menopause, this symptoms, which are physical, emotional and psychological they're not just hot flushes you can't function, you can't be a productive human being and you've got to be able to work full-time and also look after kids. And the circumstances have changed for a lot of women. A lot of women might be single parents, they might be divorced, they don't have the flexibility of staying at home and looking after kids or having their financial support from another party to navigate this phase at home. So you've got to understand as to why there's been a change in landscape in how women are experiencing these symptoms. But also the healthcare education hasn't evolved because there's change in the last two decades. Medical curriculum takes decades to evolve. It's that's another big political and what funds the change is another big topic. But now we are having a lot more change in that where they need to be educated. But I think you've got to be a bit fair for general practitioners. They're general practitioners. They will see someone managing their diabetes, which is very complex, to then asthma, to a skin condition, to chronic autoimmune condition, and this is a really specialized field now because it's starting much earlier, at 42, 44 and it goes on for a decade and so to expect general practitioners to be able to manage this, even if they had an education, is really, really hard. I had to spend a whole year to learn about reproductive gynecology and reproductive endocrinology, learning about the hypothalamic axis. What are the other hormones that plays with this prolectant, this estrogen, this progesterone, this testosterone? Then how does cortisol and insulin link with it all? So I think we've got to step back and manage expectation that general practitioners can manage some of it, but they're still not gonna be able to be expert in this and some of the perimenopause there's got complex needs. They might have a thyroid underlying issue. There might be anemic. There's lots going on with a woman in the perimenopause so it needs to be more multidisciplinary. There might be, endocrinologists there might need a gynecologist and a general practitioner. I don't see. I think there probably are modules that GPs can do and we know that, but I can't see a future where every general practitioner would have awareness they'll still need to be referring on. But personally I do see a lot of GPs who have an interest in women's health and they are specializing, and majority of the menopause societies now offer modules and training to specialize further. The Australian Menopause Society has great webinars and educational seminars what they do to educate GPs in this further. So I think the education is there. But the question is are the GPs and the individuals happy to invest time and money into it?

Yeah, because the onus is still on the GP to actually do the training. There's no, yeah, there's no expectation.

It's not government funded, so they have to pay for it themselves. So they're taking out, especially for general practice and yourself contracted, so you're losing money, and then you're paying money to learn a new skill. So that requires a lot of commitment, dedication, time and all the other things. So I think you've got to understand what are the barriers to providing health care and this is why, if you step back, for me when I look at it, it needs to be a public health policy. So we know in Nysart Wells they've got $40 million correct me if I'm wrong, but I'm sure that was the last number I looked at to create four menopause hubs. And that's an amazing government initiative because in Australia particularly, we can't afford to lose this really valuable demographic so it's the fastest growing demographic in the workplace and there's a shortage of skills. So you don't want to have someone who spent 20 years building up a career she's navigated childbirth, navigated raising the kids and then menopause hits her and then she leaves her work at $49. Loses that on super. We know we're losing $17 billion in super. So for me, managing menopause is an economic decision for the government but also reduces the health care burden. We know when you support women in these multidisciplinary hubs where they're looking after women's future health or their heart, brain and bone health and their current health allows women to work, to earn an income for themselves, contribute to economy, but also the health care burden is reduced because we know that menopause can mark for some women the initial kind of steps towards chronic disease heart disease, diabetes, blood pressure, cholesterol, eastrogen can navigate some of them. But I think ultimately we need a multidisciplinary, government funded menopause hubs which are evidence based and then you don't have these individual voices promoting whatever they want to promote and there is a general consensus which is agreed on by world experts and we provide that health care to a government funded, statewide, nationwide clinic and I think that's where the confusion would be reduced and women will have health equity when it comes to having access. So currently for women in Australia to access experienced, adequate health care practitioners to manage their menopause is lottery.

No, and I talk about this constantly on this podcast, and that is I live in a city, you live in a city. We're very privileged. We have access to a number of GP options, a number of expert options, but for the women that are regional and rural, those options just don't exist and it's very, very hard for them to get the care that they need and I agree, but I think one of the good things that you can do now is that Medicare has got a new item number where women all over Australia for reproductive health can access video consults.

Okay, does menopause fall into that?

Yeah, menopause fall into that.

So I've got a lot of interstate. I get a lot of rural women who can be seen. So there's a separate code for that. So the government has acknowledged that. So I think we need to applaud them for the things they're doing. Yeah, it's very easy to say things we don't have and again, we need to provide what NSAC Wales has done, similar funding in Adelaide, western Australia, queensland, northern Territory. It's not shouldn't just be a NSAC Wales lottery to have these four menopause hubs which have got a lot of funding them and what's going to happen to the menopause of women in Victoria and when they leave their jobs. That has a huge impact to basically in the national economic status. It's not just when women are working in NSAC Wales, they're not the only one contributing to the economic pot of Australian government. So I think the way forward is that we need government to create policy for menopause and kind of make sure it's the same nationwide and there's no discrepancy statewide. So at the moment the problem is there is a different statewide and the menopause experience is the same. You know it's not different in New South Wales compared to Victoria.

I feel we need to get a lot more inclusive when we are talking about perimenopause and menopause, particularly here in Australia, to include our Indigenous communities and to include our multicultural society. I feel that we often speak from a very, you know, cisgender perspective, but also our LGBTQI plus community as well. Do you agree that we need to become more inclusive with our language and and serving those populations?

Kind of not just in menopause. I think generally in healthcare it's not just menopause. I think we've always had two defined gender roles and that comes down from our guidelines which stem from studies. Yeah, okay, so it's very gender based. It's either male or female and most of the data from women's health comes from male data. So I mean, before we get to the smaller minority communities which need to be part of the conversation, I think we just we at the moment the data in women's health is based on men's health. So we've just got so much to do when it comes to understanding how, overall, the menopause experience, but also the heart disease, brain health, bone health how does this impact women and communities from, as he said, from multiple diverse backgrounds, and that includes all of them. There's lots more work to be done there, because how can we provide them care without understanding their needs? And we can't provide that care without studying that cohort of people and at the moment it's still very male centric.

Are we starting to see more research and studies done that are women centric, as opposed to taking? You know, what worked for a 20 year old man is going to work for a 47 year old woman?

I think we're getting there, especially around heart disease. We know that heart disease is very different. So if you look at the data for heart disease, so women in Australia lived till 85. The main cause of death is Alzheimer's and heart disease. Until 2016, heart disease was the leading cause of death for women and if you speak to an average 50 year old, they're not concerned about the heart health at all because we always think it's a male dominant condition and prior to the menopause, women don't get much heart disease because estrogen is protective for the heart, it's protected for the blood vessels, it keeps the cholesterol down, it supports blood pressure, so the heart disease parameters do increase, such as cholesterol, blood pressure, and we're more at risk for developing heart disease. But the way we present heart disease is very different to men and so now there's a lot more studies being done. There's a lot more awareness primarily. There's a lot more cardiologists who are women who are conducting these studies. You know it stems down to. I think a lot of the studies were done from a male perspective. If you're a professor who's designing studies, you've got to understand how do we decide policies and protocols and guidelines around treatment plans, and they stem from studies and you've got to understand who's designing the studies and conventionally there have been male professors, so it's not that they didn't study women. I always think we all have blind spots. If I was doing a study for a male, I would have blind spots because I don't understand what their unique biological needs are. So most of the studies have been done from a male perspective because they've probably had blind spots. And now we've got more. It's like an unconscious bias it is, and I think, rather than saying it wasn't a study, but you've got to understand, I probably would, if I had women, all my studies, if I was a professor, I would focus all my studies in women and completely ignore the men. Okay, so now we've got women who are academic positions and they are leading the way in studying women's health. So it stems from there. And then the second thing is we are now seeing publication of data which is now impacting guidelines which are female specific. So for the first time, we're actually understanding what the biological mechanisms of aging are in women compared to men. And once we get that data we're then we're going to expand to these minor oligarch groups. We already know that heart disease varies in, say, indian sub-Asian continent. Their risk of heart disease is very different to, and even in indigenous population. Their risk of heart disease and diabetes is very different to, other demographics and ethnic minority groups. So it comes down to funding. We all want everyone to be represented, but I think at this point in time, as a bigger group of women, we're not even getting women represented. We still don't have enough data on that. So I think we've got to kind of peel the onion, the layers of the onion and then understand, go back to the root cause of why we're in this position, and it comes down to funding, it comes down to who's leading it, and we're seeing changes. I think everyone wants an inclusive conversation around this, but it's going to take time.

Yeah, I think patience is something that we need to be maybe a little bit more aware of, and we do have the center inquiry coming up, which is an opportunity to put forward conversations like this around the fact that this is where the funding needs to go and these are the changes that need to be made to get those impacts that then trickle down into the woman that is going to see her GP and then, as Access to a menopausal multidisciplinary team hub, to be referred back to. I think that would be a great outcome. To wrap things up, we've talked a little bit about how treat your patients and have looked after yourself over the years from a very holistic perspective, and you've got those pillars of health that you talk about, which I absolutely love and embrace myself, which is nutrition and exercise and sleep and stress management. Would you like to leave us with what your top kind of recommendations are for women in those areas?

You've got to understand the demands on an average 45 year old now are very different to the demands 10, 20 years ago. Working full time, having young kids under 10, navigating all that landscape. You've got to give practical tips. It's very easy. We all know we have to exercise and we all know we have to eat healthy. So I actually don't spend my time talking about that, because when you reach that stage in your life, we kind of all know what we need to do. But it's about how we do it and what are the barriers that are causing us to not self care. And for me it goes back to the fundamental things of women carving out time for themselves. They forget the needs of everyone else is there. So they literally start their day and I literally get them to go to their day and they literally have zero time for themselves. And so first thing I asked them to do is I need you for half an hour, half time for yourself every day. It could be a 10 minute workout, it could be planning a coffee three times a week with someone, or the coffee is not always the best thing to have in Perimenopause. You can make things worse, and so is alcohol, so I actually get them to do the basic things of 30, 60 minutes I start with 30 minutes because one hour is a lot by just getting a diary and journaling as to what is it that they want to do. It's an inventory or an audit of their life at that point, and that's when they start finding room, when they start pause, they reflect and they say, ok, I'm neglecting myself in these things, I'm neglecting myself in these things. I can delegate this bit, I can let go of this a little bit, and it's finding time to focus on those four things, and they will find time. A bit more movement three times a week. Social connection is really important because I find a lot of women are very isolated. They're so busy with their work and their children that they stop talking to other women and when they do talk to the woman, it's very quick time by and the experience of anything, including the Perimenopause, is a lot more scary when you're experiencing it alone. But when we experience this collectively, you realize, oh, it's something that everyone else is experiencing. So, having time to meet up with a girlfriend and then you talk about by the way, I'm quite pure, it's also heavy, I'm flooding, or I'm experiencing it and then realize that actually a lot of women are experiencing this. Normalizing the conversation Again brings that stress and worry down in the brain that uses only happening to you, and then you're more likely to focus on looking after yourself and carving time to meal prepping. Even in 50 percent of your meals are meal prep. It's finding time to do a bit of strength training. You don't need a 60 minute cast. 15 minutes or wait three times a week at home is enough. And I think when they start doing that, there's this sense of connection with themselves. And I think it's really important because we find ourselves disconnected we're living in our minds, disconnected from our body and we're just on the go and we keep pushing and we keep going. And I think when we neglect our fundamental needs of our body, which are through food, sleep, rest and that lovely oxytocin in which we get, I always say the antidote to stress, at least for me, is when I meet someone. When I have a coffee with a girlfriend for an hour, I get great. I have conversations about the same thing, we're whinge and moan about the same things. It might be our husband, it might be the kids, it might be the laundry pile, it might be feeling overwhelmed and you realize, oh my God, everyone has experienced the same things. It's OK, I'll survive this, they're surviving it. So that's what I normally recommend, and then, of course, I give them more actionable plans in life. But I think that's a good start, and then that allows you to self care on those fundamental pillars and then you move on to hormone therapy if your symptoms are severe, and also heavy bleeding, which we haven't spoke about. I think we've normalized heavy bleeding, heavy bleeding is common, but it's abnormal the amount of women who are literally exhausted with irons that really should not even be existing. They're solo. I probably want to finish on the fact that that gets ignored and the lack of iron leads to feeling fatigued, breathless. You can't exercise, you're exhausted all the time and then they don't they don't even seek help for that heavy bleeding. They again put up with it.

And I do an episode recently with Dr Teller Oopal and we talked just about heavy menstrual bleeding, which has actually been hugely popular. So I'll link back to that episode in the show notes as well. But I'm really glad that you bought that up because you know Teller emphasized that as well. It is something that has become normalized but it is putting the body under a lot of stress and, as you said, those iron deficiencies that are just going unrecognized.

And a lot of the women that I find in this early period of pause, they can't do those movement and fundamental pillars of health because they're exhausted from low iron. So this is what the connection is you don't have time for self care when you're so exhausted that you can't even. You know, just doing your basic errands is exhausting. So you've got to look at what is the things that you can treat, you know, and iron deficiency is a curative disorder in a way, if you want to call it that. So that will be my four things initially, and, of course, don't be scared of it. There are lots of women who have navigated generations prior to us, this phase. But you need the connection with like minded women. Listen to women, talk to women, listen to different experiences. It's very easy now women to focus on social media, facebook groups, where it's a lot of toxicity, and they come to me really, really scared because they're just getting one narrative. And the women who are on the social media groups, they could just be talking about their negative experiences because they want to share that, but then if that's the only narrative you're familiar with, you're not getting the other positive narrative. And I always say to women with a correct mindset and support. Menopause is actually a liberating experience. It's an experience when you really get to know what you want. You've got 40 years to look forward to. Women have reinvented themselves through different careers, different opportunities, and we see that and I think that's what we need more of in our society role modeling of mature women over 50. And we've got them now, especially in media being represented, that actually life doesn't end at this phase. There's so much more to look forward to. We're not without HRT. We have both role models. I don't think there's one way of doing it. And so find your group, your connection, your community, make sure it's balanced conversation and make sure you're doing the things you can to help yourself in treating the things you can to treat yourself. And most GPs are excellent at measuring iron. I would recommend treating earlier with iron infusions if iron is very low, because I see a lot of women with very low Probably tell it, probably spoke about this. They're just hovering at the lower end and it's still not enough. Iron is so important for our hair, our nails, our stamina, endurance, mental clarity, mental clarity. So you know, those are the things that any woman entering at any stage of life can do.

Absolutely brilliant suggestions. I feel like we've kind of had a conversation about multiple topics.

I hope the listeners find it useful. I mean you do excellent wide variety of conversations focusing on all aspects of women's health. So it's been an absolute pleasure being here today. Thank you for my pleasure, thank you.

Thank you for listening today. I am so grateful to have these conversations with incredible women and experts and I'm grateful that you chose to hit play on this episode of Dare Menopause. If you have a minute of time today, please leave a rating or a review. I would love to hear from you, because you are my biggest driver for doing this work If this chat went way too fast for you and you want more, head over to stellarwomencomau slash podcast for the show notes. And, while you're there, take my midlife quiz to see why it feels like midlife is messing with your head.