97: Progressive Menopause GP Care with Dr Ceri Cashell

Transcript

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Welcome to the Dear Menopause podcast.

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I'm Sona Lovell, your host Now.

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I've been bringing you conversations with amazing menopause experts for over two years now.

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If you have missed any of those conversations, now's the time to go back and listen, and you can always share them with anyone you think needs to hear them.

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This way, more people can find these amazing conversations, needs to hear them.

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This way, more people can find these amazing conversations.

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Welcome to today's episode.

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I'm absolutely delighted to bring you a conversation that has been a long time in the making.

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You are going to meet Dr C Cashel.

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Kerry is a GP.

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She started her career in 2004 in Edinburgh, Scotland, but when you hear her accent, she's actually a good Irish lass.

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C has a special interest in women's health, including menopause, mental health, adolescence and child health.

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She is an author and she is also the co-founder of a fantastic new platform called Healthy Hormones, which you'll hear more about as we chat today, and Ceri is part of the team that is bringing to Sydney in March 2025, an incredible event called So Hot Right Now being held at the Sydney Opera House with an incredible lineup of global and local doctors and researchers.

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I will share a link to that event in the show notes so that if you're interested in coming along, you can grab your own ticket.

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Enjoy today's episode.

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Ceri is such a delight to chat to.

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I know everyone is going to get something out of today's episode.

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Thank you so much for joining me today.

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Thank you for having me.

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I think a really good place for us to start would be why don't you give everybody that's listening a little intro as to who Dr Ceri Cashell is?

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I'm a GP in the Northern Beaches of Sydney who was tootling along quite happily doing regular general practice.

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I think it's three years ago now when a lovely patient, who you know well, came in and asked me to prescribe her testosterone, which had been started by another doctor, and I realized I knew nothing about prescribing testosterone and she suggested that I go and upskill because it had changed changed how she was doing and she thought it would be great if other women could experience those benefits where appropriate.

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So it took me a little while but I did.

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I went off and did the course that she also recommended.

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Very good patient, full of information, which I love.

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I'm very happy with that.

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So I did the Confidence in Menopause course by Louise Newson and then listened to her podcasts and really over very quickly, over a few weeks, I realized there was this whole chunk of medicine that I'd never been taught that either as a medical student or as a doctor in training and really hadn't picked up over the years that you know these, these things called sex hormones, are really integral to the whole of our body's physiology.

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You know, from our brain, which impacts our mental health, to our heart, to our bones, bones to our gut, you know, as, like, menopause isn't just this stopping of periods, it's, it's a whole other transition which really has impacts right across the spectrum of the individual health, well-being, ability to work, etc.

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Etc.

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So much so that was I, you know, like so many people who sort of find this medicine, you become a bit evangelical because you start to see women, you know, getting their lives back, and, as a doctor, that is amazing.

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So, yeah, so that's really been my journey and you know, and since then I've just it's gone from strength to strength, just from strength to strength, and meeting people like you and you know, and getting you to come and present at the talk that we did last year, and then getting on that stupid, crazy advent calendar that meant, by the time chris christmas day came around, I was a broken woman.

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I never have enjoyed wrapping presents so much and it's usually a chore.

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So, yes, and then, and then just, yeah, better than social media, better than social media, god, yeah, um, and and just it's growing, hasn't it, sonia?

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It's just a, it's just a wonderful space to be in because there's so many awesome people trying to deliver better outcomes for women.

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It really has.

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I was reflecting now.

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One of the things we're going to talk about today is the recent International Menopause Society Symposium.

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I really enjoyed it and we all got together in Melbourne recently.

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Was this incredible group of absolute powerhouses that all were together for the first time in one place.

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Like we've all had this amazing online connection, you know we've all been within different groups advocating and championing different parts of our causes, but to have everybody together in one space was just absolutely phenomenal.

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And that was definitely, you know, the highlight of those few days was meeting all those people in real life and you know they lived up to their online persona.

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And then some just and that's because there's a lot of there is a kind of sense that you're, as a doctor, you're a wee bit out on your own and patients are often saying you know, we just can't find anybody to give us this care.

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But you really got a sense that there is this new wave of clinicians and advocates who really are wanting to learn more, who are wanting to change the status quo, who want to deliver better, better health care to to women and those born with ovaries in this phase of their lives, so that they live the second half of their lives in the best health possible.

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You know, it's so much more than just it's not not a phase, it's like it's the second half.

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It really, really is.

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It's huge Because I think the average expected lifespan for a woman now is 83.

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Is that right?

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But then there's a percentage and I always forget what that actual percentage is that lives to 100.

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So you know, if 51 is the average age of menopause, this literally is the halfway point for many, many people, and we are all beginning to live longer and live healthier for longer, which is you know why it's so important that we really kind of take the bulls by the horn, if you like, at this point in life and really get on top of making sure that we have our best health possible.

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Now, one of the things that I have heard you say in response to talking about the impact that Jules had on you know, you as a doctor and what you learnt and how you've changed how you practise as a result, is that you felt at times that almost like you needed to apologise to some of the patients that you had seen prior to this shift in your approach to menopause patients that you had seen prior to this shift in your approach to menopause care, because you really could see how poorly their their menopause care was handled yeah, I mean, don't be trying to make me cry again, because you sure I cried in front of all the senators talking about this.

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I decided it was a strategic cry just to show that I was human.

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But really, I mean it really genuinely is something that I can only, just, I think only just now talk about without getting upset.

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You know, looking at all of those like we're talking, I mean I've been a GP for 25 years.

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So really those first 22 years tootling along, you know I always prescribed a bit of hormone replacement therapy but I just had no sense of where it sat and the women that would have come in.

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You know, I worked in Edinburgh for a long time and women from South Asia used to complain about all over body pain and we used to say it's just such a thing.

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But really to this day it's still the best description of perimenopause and menopause, like everything hurts, everything's falling apart, you know.

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And then there's all the women whose real primary symptoms, which we know are extremely common, are, you know, are psychological symptoms, you know, the kind of mental health, the anxiety, the insomnia, the depression and the suicidal thinking.

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I feel very lucky that I haven't lost any patients to suicide as a result.

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But certainly I've had some women who have really had a prolonged period.

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We're talking years of really serious mental health issues that seem to be actually really responding to hormone replacement therapy.

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But you're talking about years of somebody's life and how the brain changes in that time.

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So it's not that you can really undo that you certainly make improvements.

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So, no, I feel terribly responsible.

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I mean, we do as doctors that's, you know, part of why doctors are nervous about, um, you know, nervous about prescribing HRT is because of that breast cancer fear.

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We're like we're always trying to balance out, you know, doing good and not doing harm.

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So that that that is something you know, that you know.

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Those of us, you know, especially in general practice track, we look after whole families, you know.

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So we um, yeah, we're, it's really important to us that we, we provide the best care, and when you realize that it's been really poor, you're human, you feel a bit bad about it yeah, and you know I think that's one of the things that I've enjoyed so much is, you know I've been embraced by this incredible fold of amazing practitioners and, you know, specialists and GPs and researchers.

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Is that at the heart or at the core of each and every one of you is this incredible heart that really does want the best for their patients, and for me, that's been really eye-opening to experience this empathy and, you know, the beautiful care that you guys do have for your patients, which is really wonderful.

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Okay, let's talk about the International Menopause Society Conference.

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I'd love if you can give everyone listening a bit of an overview, from a GP's perspective, of what kind of was talked about on a global level when it comes to menopause care.

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So I mean the things that you know.

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I suppose I was looking for the learning points or the consolidation points that are really going to impact my care.

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You know real world medicine and real patients and there was a you know there was a real diversity of quite academic stuff and then stuff that was quite practical and then stuff that would apply to big populations of women, if not all women, and then you know other topics that were that were, you know, for very small groups.

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So I think there was definitely a feeling that were well, it was mixed to me.

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There was a focus on a lot of novel treatments and that is a concern to me.

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This is just how our healthcare system works.

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You were very reliant on the pharmaceutical industry in terms of sponsoring research and sponsoring conferences.

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Where MHT and HRT sits in.

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There is difficult.

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So I was looking for the places you know where you know the lectures which were focusing on HRT and I think everybody's sort of looking for different bits.

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So you know, certainly the lectures on, you know, bone health and cardiac health and mental health really were, were really useful, and you know the big thing with bone health which you know Australia is a wee bit of a leader in that and that our guidelines are very much promoting using MHT-HRT as first-line drug therapy for preventing osteoporosis and even treating it, which doesn't exist in other guidelines and it's a bit stricter in the UK and much stricter in the US.

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And that lecture was phenomenal.

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You know Professor Bronwyn Stuckey, who's an Australian endocrinologist out in Perth, was.

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You know, oestrogen is nature's gift to bones.

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Like we don't have another drug that does what it does.

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It, you know, it builds bone up, it stops it breaking down, but it also keeps it sort of flexibility, which is important, whereas the other drugs that we use can make bones, although they keep them strong, they can be a bit stiff, they don't bend as much, and that these small risks attached to them and that we're really under using mht as a treatment for, especially for younger women.

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I have inherited quite a few younger women who've been put on what she calls weapons grade drugs.

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You know, for the bones when they, you know, and they're hard to come off, there's sort of it's difficult.

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It's difficult to stop some of these drugs because they work.

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So that was a, that was a really.

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I think that was a really big audience in that lecture.

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So a lot of doctors will have gone away going right.

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Okay, mht it's a good option for preventing bone loss in women and we know that it helps the muscle and the tendons and the joints and your energy to exercise.

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So it sort of delivers the whole shebang when you're looking at mobility and musculoskeletal health as a whole.

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And so that definitely was a you know, it was a really good, you know a good thing to take away.

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But it wasn't new research.

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Some of the a lot of the newer research was is very much focused on these novel treatments.

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So I'm sort of going, you know, just bring, and that's kind of disappointing that there's not so much research and you know happening into the hormones that we have, and I think that is, you know, just a financial thing.

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It's research is extremely expensive but there are.

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There's good studies happening.

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You know professor susan davis down in monash is looking at the role of testosterone in preventing heart failure and bone and muscle loss in women.

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So that's really exciting work because we don't have many and many randomized, controlled trials looking at that.

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We do have observational data from, you know, from quite a few studies, including use in health, showing that you know improves musculoskeletal symptoms.

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We've got older data showing it improves testosterone, can improve bone health, and her one was um.

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She presented an older study of hers, a few years old and about immediate recall, and I think that's really that word finding, and so that there is.

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There is, you know, good randomized control data showing that women can remember things a bit more quickly, and I'm sure that's the verbal fluency, but and that's with testosterone well, that's with testosterone, yeah, and you know what again.

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But a lot, all of the research into the majority of the research into testosterone has been into hypoactive sexual disorder or hsdd, or, as we know, at low libido, and so most of the evidence is in that area.

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So 75% of research looks at that, which I really would love to see more research, because it is the most biologically active female hormone and, again, that's another big message.

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That's obviously how my journey started.

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So there's a lot of people, a lot of clinicians, who would still be very nervous of prescribing testosterone, and so that was brilliant to have that put in in there, even if it's just for, even if the sort of awareness, just for low libido.

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That's a start, you know.

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So that's, that was good.

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Um, then there's, you know the whole kind of medicine 3.0, peter adia of medicine.

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You know longevity medicine and preventing disease.

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So there was hints of that, not a lot.

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I would have liked to have seen a bit more.

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You know this kind of idea of you know health span, not just lifespan, but it was alluded to in the in the cardiovascular disease lecture, and you know MHT as what we call primary prevention, so preventing disease.

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Lovely professor from the UK, professor John Stevenson, and he said you know, people keep trying to make you, you know, keep saying the MHT is bad, but I'm afraid it isn't.

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He was like it's, it works and and there's good data showing, observational data again not, and that image.

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Timely use of mht so close to menopause, with sort of within the 10 years, does reduce your risk of cardiovascular disease and improves your lifespan, and, but they still won't recommend it to you, know, as a preventer of cardiac disease.

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But it's okay because we're going to have it for our bones, you know.

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So we'll take, take, take the wins when you can get yeah, take it for your bones, and add-on is that you may get some heart health protection in there as well, absolutely and then we had that and we had that great debate on mental health between Professor Jayashri Kulkarni a wonderful australian professor and the US neuropsychiatrist, professor Pauline Mackey, and that was really interesting.

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You know, professor Kulkarni has been an advocate for sort of really understanding, researching, applying hormones in female mental health, which we know are hugely important right across the life cycle from adolescence right through.

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But I've been really ignored and it was a wee bit.

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I think the debate been really ignored and, um, it was a wee bit.

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I think the debate maybe was.

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I think it was a wee bit unfair because I think the opposed got to put up lots of slides and prof kulkarni was told she wasn't allowed any and so she argued her point very well she did.

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You know, she's both a researcher but she's also a clinician who sees real women she's amazing and for anybody listening that you know is not familiar with Professor Jayshri Kulkarni.

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She's been my guest on here a couple of times already To date.

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Always the most downloaded episodes are when I have Jay on and we talk about mental health and hormones.

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And you know, yeah, it's a fascinating field and you know you alluded right at the very start of our conversation about you as a GP and you you know the impacts that you do see on mental health with women.

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You know, through this midlife phase.

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So, yeah, I very much enjoyed sitting in on that debate with um with with them.

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That was awesome yeah, no, she's.

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I mean people who don't know who she is.

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I'm like where have you been?

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She's like just the bomb, you know.

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It's just like really is.

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She's an amazing human.

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Yeah, yes, and she's so yeah, yeah, she's.

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I don't know she deserves.

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I don't know what your top award is in australia, you know, like the victorian she's already, hasn't she?

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I think she's already got an order of australia medal, so I think the next one would be, perhaps, queen of australia.

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Yeah I feel that's the kind of that's the kind of accolade she deserves, because she really, you know she's.

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Australian of the year.

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Actually, that's where that would probably be a great accolade for her Australian okay, well, that'll be our.

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That'll be our next campaign, sonya, you know absolutely well.

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When we've nailed this the whole perimenopause and menopause thing we'll move on to um for um.

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Australian of the year.

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Sure, I think it's going to be a while before we're finished here, though, kerry.

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Yeah, all right, I would really like you to also give us all a little bit of insight into the company that you have co-founded recently, called Healthy Hormones.

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Yes.

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So a few of us got together on WhatsApp and we're sort of sitting discussing complicated cases and sharing resources, and it became really obvious that we needed an Australian based platform, that we could do this more formally, because if the five of us were doing it or the six of us were doing it, the seven of us all think great.

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Well, there was clearly a lot more doctors who would really benefit from it, and Louise Newson has done something similar in the UK.

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But we need something that is specific to Australia and both for Australian clinicians but also for Australian women.

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So it's ended up being two of us, because it is a lot of work and so it's the second full-time job in the evening after the stories have been read or not.

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I've not done my fair share of stories recently.

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So it's a platform for clinicians really, not just doctors.

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So it's very much we want to bring in this or to really de-silo medicine.

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So we've got psychologists, psychiatrists, endocrinologists, rheumatologists, urologists, nutritionists, dietitians, nurses you know really everybody who looks after the health of women, which is pretty much anybody that works in health care.

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There's very few people who don't see women in any sense.

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You know most, even if you only see men.

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Most of a lot of those men will have female partners.

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So really to bring that collective brains trust through, to get those different perspectives, there's quite a lot of quite a lot of it is based on difficult prescribing because there's a lot people, human beings, don't read the textbooks before they get their problems, you know.

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So we don't fit into these kind of check boxes.

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You know we've got.

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You know you know condition x, z and you know that's a bit messy so you can't always work down the nice wee guidelines that we get.

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So it's really useful to share, you know you, to share um experience, knowledge and and also resources.

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We also provide sort of an up-to-date research platform there which is available both to our clinical community but also to our public community, and I think that's the big change that we've had in medicine.

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You know, with social media, doctors is really that I can never say a democratization of information, you know, so that it's not behind paywalls.

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You've and you don't need to have a medical degree or a statistics.

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You know understanding, you get somebody translating this information, because so much of the information has been sort of held a wee bit in ivory towers and you've really relied on other people, it's been gate kept, hasn't it very much?

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so from doctor, from gps as well, you know so not just for the public, and it's and I think that's wrong.

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You know, how on earth do you make an informed decision when you it's really, you know, delivered to you in such a convoluted, you know, changed?

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You know it's really important to get information at source.

00:19:11.965 --> 00:19:13.107
So we do that.

00:19:13.107 --> 00:19:14.509
So it's it's been great to love.

00:19:14.509 --> 00:19:19.759
We've got about um 900 doctors on there now and about 500 in our public community.

00:19:19.759 --> 00:19:27.648
So it's really grown and it's growing every week and it's just that kind of collaboration, other people sort of getting more confident in CGPs going.

00:19:27.648 --> 00:19:28.817
What about this, what about that?

00:19:28.817 --> 00:19:31.161
And it's a real peer support group.

00:19:31.260 --> 00:19:33.125
Yeah it's fantastic, brilliant.

00:19:33.125 --> 00:19:35.108
Thank you so much for sharing about healthy hormones.

00:19:35.108 --> 00:19:45.644
I think that that's, you know, such an important vehicle for both the public but also for your, you know, supporting other GPs and practitioners and all of that so amazing.

00:19:45.644 --> 00:19:49.539
Hats off to you for adding in yet another job into your day.

00:19:49.539 --> 00:19:50.683
You know your busy life.

00:19:50.683 --> 00:19:56.840
You're a mom, you've got kids, you're running a business, you run your own practice as well as being a GP and seeing all these amazing clients.

00:19:56.840 --> 00:19:57.826
You have a lot going on.

00:19:57.826 --> 00:19:58.489
Kerry Cashel.

00:20:00.434 --> 00:20:01.900
Yeah, sometimes I get a bit tired.

00:20:02.762 --> 00:20:03.894
Yeah, a bit Well.

00:20:03.894 --> 00:20:05.622
At least you know how to get the good drugs when you do.

00:20:05.622 --> 00:20:14.267
Let's talk really quickly about the Senate inquiry, because you were very heavily involved in that, alongside myself and a number of others.

00:20:14.267 --> 00:20:18.746
And then I've got one last question that I'd like to touch on you with.

00:20:18.746 --> 00:20:24.521
In regards to you know what we might see in the future when it comes to menopause care, so let's talk about the Senate inquiry to you.

00:20:24.521 --> 00:20:27.694
Know what we might see in the future when it comes to minerals per year, so let's talk about the Senate inquiry.

00:20:27.694 --> 00:20:34.789
What was your biggest takeaways from the recommendations that were tabled and what you hope will be the final outcomes from you?

00:20:34.789 --> 00:20:35.595
Know those recommendations.

00:20:36.035 --> 00:20:50.945
Oh, I mean, I just thought when I saw that, you know, after all the work we put into all of us you know there's hundreds of submissions we'd all worked really hard and then we all went and did our verbal evidence, which was, you know, stressful and you know, and you know it was emotional, especially for people with lived experience like yourself.

00:20:50.945 --> 00:21:00.561
You know again there's me crying for me in a rubbish gp and so but I really did not expect to see like it was, like a santa wish list.

00:21:00.561 --> 00:21:04.075
You know what came out from their report the recommendations.

00:21:04.075 --> 00:21:04.915
I thought I couldn't have written those better myself.

00:21:04.915 --> 00:21:05.059
They were.

00:21:05.059 --> 00:21:05.506
You know what came out from their report the recommendations.

00:21:05.506 --> 00:21:06.825
I thought I couldn't have written those better myself.

00:21:06.825 --> 00:21:07.606
They were brilliant.

00:21:07.606 --> 00:21:19.587
You know they really covered things that will make a real difference to, as I say, like real doctors, real people, real women in the real world, you know, in their jobs, you know as part of society.

00:21:19.587 --> 00:22:18.640
And you know, and ultimately you know, really changing the status quo so that women do have equity in health care and achieve better equity in the workplace, and that includes pay and superannuation and the whole things they focused on, I would say very achievable changes such that, partly that the government can deliver, but also things they can support in terms of funding, and that is really, you know, improving awareness at a population level for all women and those born with ovaries, that you know understanding menopause and how sex hormones impact your body, really from the, from adolescence, because there's, you know, it's not just menopause, it's the, it's the whole life cycle, so that you know awareness that the government is very well placed to do and can deliver through multiple avenues through school, through health care and, very importantly, as I say, you know, in the workplace, which is really sex education for grownups, because that is the place you're going to reach the most adults, both male and female.

00:22:20.101 --> 00:22:32.366
I do think, you know, at the minute I almost think we have a wee bit of an imbalance between informed women and, you know, ovary owners or ex-ovary owners, and doctors, you know.

00:22:32.366 --> 00:22:34.468
So I think, a lot of women are struggling.

00:22:34.468 --> 00:22:39.069
We know that from Facebook group, you know, trying to access, you know, good quality menopause care.

00:22:39.069 --> 00:22:55.172
So we really need to upskill doctors and that's really where I would love to see, obviously, a bit of support from the government to, you know, keep healthy hormones running free, because it's, you know, it's a big task and you know doctors want to learn but it's really hard to know what you need to know and to recognise the things that you don't know.

00:22:55.172 --> 00:22:59.282
That's a hard thing in medical education, so it needs to be part of the curriculum for medical students.

00:22:59.282 --> 00:23:09.095
They need to understand that sex with sex female versus male is does determine so much in health, whether that's heart disease, bone disease you know things that happen in your brain, but it includes menopause.

00:23:09.657 --> 00:23:30.358
And the other thing is, you know, for the people who want to take hormone replacement therapy or menopause, hormone therapy or whatever you want to call it, it should be affordable to the masses, because it's one of the cheapest ways to reduce chronic disease and make people feel well and keep them in work so that they can make good lifestyle choices and choose to exercise and eat better and sleep better and cut back on their alcohol or stop drinking and see their friends.

00:23:30.378 --> 00:23:31.141
So all those things.

00:23:31.141 --> 00:23:45.955
It's part of a whole package, but it very much is an enabler of a lot of important things in both lifestyle but also in society, so that women can stay and work if they want to, and that just on the back of a packet.

00:23:45.955 --> 00:23:54.528
The maths of that is so obvious that if you made, you know as I you know, would like and certainly should be cheap, but it'd be brilliant if it was free.

00:23:54.528 --> 00:24:02.237
You know that, so you know all women could choose to take it if they want to and not be prevented on a cost basis, because I think that would be a game changer.

00:24:02.237 --> 00:24:14.903
I think we'd really see a huge yeah, I think Australia could just become a world leader in so many domains if we kept our wise women in work and I think there's, I know, is it.

00:24:15.023 --> 00:24:25.008
As of January, ireland makes all HRT MHT available free of charge to everyone, or you know anybody that's eligible for taking hormone therapy.

00:24:25.008 --> 00:24:25.496
Is that right?

00:24:25.596 --> 00:24:32.124
I think so I'm not sure if it's just attached to one health insurance company, but certainly a significant number of women will be able to access it free.

00:24:32.124 --> 00:24:32.905
I have to check it.

00:24:32.905 --> 00:24:45.085
I'm not sure if it's everybody, it's certainly a significant number and you know, coming from the nhs in, you know in the uk, you know in northern ireland and scotland our prescriptions have always have been free for quite a lot of years, and England.

00:24:45.085 --> 00:24:49.050
Now they have a one-off fee per year of £20 or $40.

00:24:49.050 --> 00:24:53.686
Hormone therapy in the UK is already either free or extremely cheap.

00:24:55.335 --> 00:25:03.335
That's so different to what we know that women are paying here in Australia, with, you know, prometrium not being on the PBS yet we're.

00:25:03.335 --> 00:25:04.044
You know it's on the way, but it's going to be time before that's.

00:25:04.044 --> 00:25:06.880
You know Prometrium not being on the PBS yet, where you know it's on the way, but it's going to be time before that's.

00:25:06.880 --> 00:25:08.683
You know the costs.

00:25:08.683 --> 00:25:17.625
The out-of-pocket costs for a lot of people almost become prohibitive, I think, particularly when we're you know, in this financial crisis that we're all kind of living with at the moment.

00:25:17.914 --> 00:25:23.125
And we know that women will always put themselves last, so they'll pay for something else instead of their their HRT.

00:25:23.125 --> 00:25:24.188
You know that, you know.

00:25:24.188 --> 00:25:24.689
We know that.

00:25:24.689 --> 00:25:27.970
You know they suck stuff up all the time, or we suck stuff up all the time.

00:25:27.970 --> 00:25:42.141
We will always find money for somebody else in our world's needs instead of putting ourselves first and I think we are the hub of so much, whether it's family or the workplace or society in general it's really important to just maybe apply a little bit of good self-care.

00:25:42.141 --> 00:25:44.527
Whether you call it selfishness or not, it's.

00:25:44.527 --> 00:25:46.398
It really pays dividends.

00:25:46.398 --> 00:25:50.678
We know I can't know what the figure is when you invest a dollar, a pound, in a woman, I think it's like.

00:25:50.678 --> 00:25:52.403
Or you know you get five dollars back.

00:25:52.403 --> 00:25:56.405
You know it's like we're we're good investment yeah, absolutely.

00:25:56.968 --> 00:26:00.720
Any other final takeaways from the senate inquiry no I'm just really excited.

00:26:00.759 --> 00:26:02.865
I just felt from the senators themselves.

00:26:02.865 --> 00:26:04.155
You know they were very much.

00:26:04.155 --> 00:26:15.484
I think all of them bar one were were actually taking MHTHRT and I never want to say that it's all about that, but it was a real sense of they understood what it meant to be, you know, a woman trying to work.

00:26:15.484 --> 00:26:25.996
You know, in this phase of their lives, maybe juggling children and parents and really wanting to be able to continue to do all of those things as effectively as they had previously.

00:26:25.996 --> 00:26:31.647
And you know that all women should have that option to do so and we should make it.

00:26:31.647 --> 00:26:49.405
We should make it accessible, you know, in all aspects, but even just being aware, I think, just being you know, so many women just want to be validated in their experience, irrespective of what treatment path they choose, to know that you're not getting dementia or you're not a failure or X, y, z.

00:26:49.405 --> 00:26:52.675
It can be so helpful just to understand the why.

00:26:52.817 --> 00:26:59.517
Yeah, absolutely, and I think we've already touched on this a little bit when we've talked about the cost of MHT and hormone therapy.

00:26:59.517 --> 00:27:14.332
But if you had a glass ball or if you had a magic wand and you were able to, you know, predict or create the future of menopause care in Australia, what do you think that we should expect?

00:27:14.494 --> 00:27:21.864
Well, I mean, I suppose I'm still practicing as a regular GP, so I still see both men and women and people of all genders right across the life cycle.

00:27:21.864 --> 00:27:48.287
I think you know there's certain cases that are complicated, that probably do need to be seen by a menopause specialist, but I really believe that menopause care should just be part of normal care and that really means that all doctors, all clinicians and not just GPs need to understand how sex hormones work in the female body and probably need to understand how they work in the male body a bit better, because it's one area that both sexes do badly in terms of care.

00:27:48.287 --> 00:27:53.125
I think, right from the get-go we need to understand female physiology.

00:27:53.125 --> 00:28:12.315
So understanding how the female body works, that should be taught through all curriculum, whether it's medical or allied health, and I think if we do that we will absolutely shift the landscape and then maybe we'll start to get more funding into R&D, into the female body, which in many companies is like 1% of their budget.

00:28:12.315 --> 00:28:14.617
So really understanding it's the health of women.

00:28:14.617 --> 00:28:21.385
Menopause is one part of that and for me it was the window into understanding the whole life cycle of females.

00:28:21.385 --> 00:28:25.896
But it doesn't matter where your entry point is, we just need to understand that.

00:28:25.938 --> 00:28:28.026
So I think that would be a huge change.

00:28:28.026 --> 00:28:38.519
I think prioritizing, I think making certain drugs affordable to everybody, whether that's the safest contraceptives and or MHT, I think that would be a big change.

00:28:38.519 --> 00:28:39.923
So certainly, education.

00:28:39.923 --> 00:28:43.941
You know, we need to sort of really look how we educate our young people on health.

00:28:43.941 --> 00:28:47.769
I think we need to probably pivot a wee bit to being a bit more clever using social media.

00:28:47.769 --> 00:28:55.669
The way we've traditionally delivered education maybe needs to flex a little bit, because there's multiple tools that we really could probably use more effectively.

00:28:55.669 --> 00:29:02.625
And letting people you know, just understand how it all works, you know early on, so that you know they get validated, they know how to seek help.

00:29:02.625 --> 00:29:08.442
I think those are basic principles that would improve menopause care, but would just improve care full stop.

00:29:09.175 --> 00:29:19.855
Yeah, I think that's a really good point and I think one of the things that I would like to see and you know we touched on this really really briefly just before, but that is to remove that gatekeeping of certain information.

00:29:19.855 --> 00:29:24.020
Obviously, a patient doesn't necessarily need or want to have access to all of their information.

00:29:24.020 --> 00:29:26.384
Obviously a patient doesn't necessarily need or want to have access to all of their information.

00:29:26.384 --> 00:29:41.057
But an example that I can quote my husband's medical clinic doesn't allow him to see the results of his pathology reports when he has his blood taken for checking how he's going on certain medications at the moment, because they're testing a whole heap of baseline stuff.

00:29:41.057 --> 00:29:47.787
And I'm like can you get your copy of your report so we can have a look and we can compare what your results were six months?

00:29:47.866 --> 00:29:48.027
ago.

00:29:48.887 --> 00:29:50.130
Yeah, but they won't let him.

00:29:50.130 --> 00:29:53.383
He rings and they just go no, you can't have those, they're ours.

00:29:53.383 --> 00:29:55.396
And I'm like actually, no, they're yours.

00:29:55.396 --> 00:30:15.106
And you know, and I know I've had conversations with my own specialist about this and it's like it shouldn't be like like this, like you should have access to your information that's relevant to help you make healthy decisions and not get be gatekeeping all of this information absolutely I mean that and I suppose that is through that awareness and education, you know.

00:30:15.214 --> 00:30:18.863
So, educating everybody so that you are informed.

00:30:18.863 --> 00:30:26.789
I think that means doctors have to upskill and I do think there's certainly a lot of our technology that will enable that in terms of ai, because patients will just come in and go.

00:30:26.789 --> 00:30:30.558
No, that doesn't cut the mustard for me, sorry, like what it says here.

00:30:30.558 --> 00:30:36.579
So really it should be a partnership and so that we still, hopefully will still be necessary as doctors.

00:30:36.579 --> 00:30:38.886
But it is a partnership between patient and doctor.

00:30:38.886 --> 00:30:43.365
It is not me telling you this is what you must do or this is what you must not do.

00:30:43.365 --> 00:31:00.506
It's well, here's the, here's the risks, here's the benefits, here's the options, what's going to work for you, because everybody's an individual and it needs their individualized you know care plan, but absolutely being a partner, not really moving away from that patriarchal sort of paternalistic medicine of you know.

00:31:00.506 --> 00:31:05.682
Here you go, there's your tablets, pat you on the head, you, that's not going to cut it anymore.

00:31:06.584 --> 00:31:08.145
Yeah, perfect, Kerry.

00:31:08.145 --> 00:31:13.103
Thank you so much for all of your time, your wisdom, everything that you are doing in this space.

00:31:13.103 --> 00:31:15.597
Is there anything else that you'd like to leave us with before you go?

00:31:15.858 --> 00:31:18.905
No, I just think this is a dawn of a revolution.

00:31:18.905 --> 00:31:21.663
So I feel that you know there's exciting times ahead.

00:31:21.663 --> 00:31:22.907
I really think that our you know's exciting times ahead.

00:31:22.907 --> 00:31:39.661
I really think that our we've had 20 years of living in the shadow of the study, that kind of demonized hrt, hrt one part of menopause care but I think, just really recognizing that women can be masters of their own destiny, and I think we really need to step away from this idea of protecting the little women.

00:31:39.661 --> 00:31:40.782
Women are strong.

00:31:40.782 --> 00:31:49.828
Give them the tools to make the right decisions and choose their own destiny so they can live the second half of their lives in the best health possible.

00:31:49.828 --> 00:31:52.743
That's all that we want and I think we deserve that.

00:31:53.675 --> 00:31:54.880
It's not too much to ask, is it?

00:31:56.403 --> 00:31:56.826
I don't think so.

00:31:57.734 --> 00:31:59.818
Awesome, kerry, thank you so much for your time.

00:31:59.818 --> 00:32:15.739
Time I'm going to link through in the show notes to healthy hormones so that anybody that's interested whether they're a practitioner or a member of the public that would like to jump on board and have a little look at what you're doing and, obviously, through to anything else that we've discussed tonight as well.

00:32:16.019 --> 00:32:17.104
Thank you so much for having me.

97: Progressive Menopause GP Care with Dr Ceri Cashell

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