Dr Marita Long: How to talk to your doctor about menopause and perimenopause

[00:11] Sonya: Marita, thank you so much for joining me today.

[00:13] Marita: Oh, thanks for having me on. It's a real pleasure to be here.

[00:17] Sonya: The pleasure is most definitely all mine. And I also know this is going to be such a valuable chat for my listeners. Now, Marita, why don't you go ahead and introduce yourself and then we can let the conversation flow from there.

[00:34] Marita: Excellent. Great. So I'm a GP. I work three days in a clinical setting. I work in the northern suburbs of Melbourne, and then I do one day a week. That's medical education, and that's been primarily in the area of dementia education, three days in clinic. So I see everyone from brand new babies to people in their 90s. So we call that cradle to grave, essentially care. So that's a big job for GPS. We have to know a lot of stuff about a lot of things. When we have registrars coming into practice, I tell them, as a GP, you need a good working knowledge of 187 conditions, so it's no mean feat to get your head around. And of course, menopause is one of those 187 conditions, if you like, even though it is a natural state in our sort of reproductive stages in life. But it's a really important turning point for women. And so it's something, I guess, that I've become very passionate about, not just because of menopause, because it is such an important turning point for women. It's where there's a real change in life and it's a great opportunity to get women to engage in health care and start to think about themselves, because we spend so much time thinking about other people, whether that be children, partners, parents, our workplace, our community. We're always giving out to other people. And I think menopause is a time when women need to be able to say, now it's time for me.

[02:01] Sonya: Absolutely. And I love everything that you said just then. And one of the messages that I really try and get across in my podcast is that, yes, the perimenopausal menopausal transitional period can be a bit bumpy. It can feel pretty ****** at times for some women. Not all for some, but what comes on the other side of that can be so much freedom. And like you say, it becomes our time with although parenting never ends, working that out, the parenting and caring for younger children is predominantly over for most women by that point. Yes, we're caring for aging parents. We're often holding down jobs and careers and relationships, and it's a messy time, but at the same time, it is an opportunity to really stand up and go, okay, what do I want my life to look like now? And be in control of that path?

[03:01] Marita: Exactly. And we know as women we're going to live longer than men, but we also know that we tend to live sicker than men.

[03:08] Sonya: Yeah, I haven't heard that before.

[03:10] Marita: Yeah, it's terrible, isn't it. And things like women have bigger strokes than men, less investigations, so worse outcomes. Generally, you think of heart attacks they're often missed in women. So our classic education around how someone's having a heart attack is chest pain going down the arm, up to the jaw. We know it's very different for women.

[03:32] Sonya: That's right, yeah.

[03:33] Marita: So that can be missed while we're.

[03:36] Sonya: On that topic, so we don't forget to come back to this because it's actually really important. Can you talk us through what those symptoms are so that women can be educated on that?

[03:45] Marita: Yeah, so I guess it's one of those things where it can be very subtle and women also can often downplay their symptoms. It was really interesting. I had a patient the other day who came in with symptoms of stroke. And when she came in, she said, I'm really sorry to bother you. I know you're so busy, Doctor. I've just had this funny thing happen, and she started telling me, and it was some tingling in her arm and a little bit in her leg. And when I started asking her questions anything in your face? She said, oh, my lip was a little bit tingly. And I was like, I think you might be having a stroke. Oh, no, surely not. No, it couldn't be that. So it's this sort of downplaying of symptoms. I think we've had quite a lot of education about stroke, and stroke does often appear, I guess, in that classical stroke way, heart attacks for women can be as simple as nausea and fatigue. Women go, I'm a bit overweight, that's why I'm a bit puffy, I haven't been exercising enough, I'm letting myself go a bit, I'm carrying ten kilos. All those things that they will downplay it. And because we're not educated to think about it in different ways, we may not be as alert to it either. And we know post menopause, our risk starts to match up to the same as men because we lose the protection of oestrogen. So, again, a really important opportunity to be able to educate women about that and to say that these are the things that we're going to look at. We're going to look at what risks you might have and do our very, very best to modify them, but also educating them on what sort of things might be worrying signs and giving women that confidence to come in. And insist if they're feeling not right. If something's not quite right to insist on turning over all the stones to see what it could be.

[05:37] Sonya: Absolutely. And that's a topic, again, that I talk a lot about, and that's that self advocacy and that having the confidence and the I suppose it also comes down to, like, self belief that you are important enough to say, hang on, sorry. Actually, no, I don't feel comfortable with you passing it off as that. I'd like to investigate this a little bit further and often that is what needs to happen. I mean, are you guys as GPS, I know that you're so pressed for time, you run with short appointment times, you've got overloaded clinics and I know that Dr. Karen McGray, who is the president of the AMS Australasian Menopausal Society, which you're a board member on, is that correct? Yeah. Awesome. Which is another area that I want to talk to you about. But I know I've read a lot where Karen has really been very vocal about how those short appointment times really put women at a disadvantage because it takes so much longer to sit down and unpack what's going on in a woman's life to then be able to join the dots about what could be going on for her. Is that something that you agree with and that you find in clinic?

[06:51] Marita: Exactly right. So for me, the way, and I guess I'm fortunate where I work, that it is in a clinic that supports slower medicine, despite the fact that Medicare really doesn't support slower medicine, which is part of the big problem. And again, that is a gender bias. So that's working against women. So I'm in a clinic where it does support slow medicine. So for me, when someone makes an appointment, and often they will tell the receptionist it is to see me about menopause, it's always at least a half hour for the first appointment and often say to women when they come and see me for that first appointment, that over the next couple of months we're going to become best friends. As in, we're going to see a bit of each other, because this is going to take a bit of time and a bit of work. Work? But then once we've sorted through all that, you probably won't need to see me for twelve months in such base how things are going. So it is about, I guess, being upfront about that and I guess to your listeners if they're thinking of making an appointment to see their GP about menopause, a few things I would say is one, when they ring to ask the reception staff, are there any doctors there who see a lot of women or do a lot of women's health? That's the first thing because as we said before, GPS have to know a lot. So if someone booked in to see me, for example, for a skin check, they'd be very disappointed because I would say it's not really my strong point. I can certainly pick out something very nasty and pick out something very benign, but I might struggle in between times. So I would often refer to another in my clinic. Yeah. So when you ring to make the appointment, don't be embarrassed to say what it's about and ask, is there a doctor there in the practice who sort of has a special interest in women's health? Because that's going to be the best.

[08:26] Sonya: Person to see, I think that's great advice.

[08:30] Marita: Yeah. And then ask for a long appointment. So just say I'd really like to book in a long appointment and then it's amazing. With the advent of social media and Facebook and probably podcasting, to be honest. I think there's been lots of education information sharing with women. And I've had some women who have been on the menopause Facebook group, which I'm not even sure what it's called, but they've obviously been told a really good thing to do is to get onto the AMS website, have a read of some of those information fact sheets, fill out the AMS scorer, the Symptom tracker. Yeah, great tool medications and take all that with you when you go to CGP. So I've had a few women do that. I'm like, how did you know how to do all this? Prepare so well that's what I tell.

[09:19] Sonya: All of the women that I come in contact with to do. I'd like to think they're all my listeners. Yeah, no, absolutely. On my website I've got links to literally download the symptom tracker from the AMS site, links through to different I send anybody that says to me that they're either having issues with their current GP because that does happen and like you say, GPS have to such broad topics you need to be across that. One of the things that I love about the AMS downloads are that they're all researched and they're all linked back to their reference documents. And I've always told my listeners and my clients that if you go into your GP with a documentation that's from the AMS and it's linked back to the scientific research, it's going to be really hard for them to fob you off.

[10:13] Marita: Yeah, exactly. They'll be like, oh wow, this is amazing. Oh, I might just get on this website. Oh wow. It actually tells you almost step by step what to do. Which is great. I guess the thing that I've learned, the more and more women I see who present in that perimenopausal and menopausal phase, like everything, there's no one size fits all. So it is very nuanced because it depends on what else is going on in women's lives and what other medications they might be on. As great as the AMS is and as useful as it is, it's not always going to to mean it's going to be really easy or it's going to be a really easy consult or it's going to be really a quick fix to figure out what to do. Because everyone is so different and everyone's unique needs are so unique. But it is a fantastic resource.

[11:03] Sonya: It's an amazing resource and I'd like to once we kind of move on with the conversation a little bit touch on the AMS so that people and the women that are listening can actually really understand exactly what the body is and what you do. And I have a friend and she's been a guest on our podcast, Dr. Ardell Piper. She's an OBGYN in Canada, and she told me that the AMS was her go to the AMS is just streets ahead in a lot of other international bodies when it comes to this information and the availability of it.

[11:41] Marita: Well, I'll have to take that back to the board meetings.

[11:43] Sonya: Yeah, do. She's a huge and she does a lot of social media. That was actually how we met. And she would often be doing a talk on ***** Health on Instagram Live, and she'd be holding up an AMS sheet and saying, Go get this download. So, huge amount of resources and brilliant resources available. And I think the thing that came to my mind that I wanted to kind of get across was one of the things that does complicate the whole perimenopausal symptoms and that transition period is that many of the symptoms can also be symptoms of other conditions. So we have to be really careful, obviously, why it's so important to go and sit down and sit down with your GP or find a GP that you can sit down with to talk through what you're experiencing. Because the last thing that we want is for everyone to just put everything down to perimenopause when, like you said, there's heart conditions that need to be considered. There are so many other things that could be going on that are underlying, that lead. Even changes in periods should always be checked out by your GP. You tell me that.

[12:55] Marita: Exactly. So you've got to think about things. Could there be some thyroid dysfunction? Could someone be iron deficient because their periods have become so heavy? What else is going on that we need to look at? What other organic contributing causes could there be? What medications are they on? There's lots of medications that can exacerbate or cause night sweats, for example, or with night sweats. Is there something a little bit more sinister going on? So it is really important that it is a comprehensive assessment. And that's not to scare women at all. That's just informing women that don't just think everything's perimenopause or menopause because there could be something else going on. And again, that's the beauty of that timely consult to really be able to check out things in its sort of entirety.

[13:45] Sonya: Yeah. So I love those tips. Find the right GP to speak to, whether that's in the clinic that you're used to going to. Or the other thing I like about the AMS site is the search function to actually search for an AMS registered GP in your area and then asking for a long appointment.

[14:03] Marita: Now, can I tell you a little story about that?

[14:06] Sonya: Please do.

[14:07] Marita: Okay. When I first went to the AMS conference, which would have been a long time ago now, and I joined, paid the conference fee, and then somehow I paid for three years membership. I don't know how I did. I was rushing. Just put it three years. Anyway, all of a sudden, it was really my first foray into any formal education in menopause. Because that's another thing we don't get taught about menopause.

[14:33] Sonya: Yeah.

[14:34] Marita: We come out on the back foot as doctors because we're not taught about it. Maybe we'll talk.

[14:40] Sonya: And that's a globally recognized education gap now, isn't it?

[14:43] Marita: Yeah. I mean, there are so many education gaps, but this is an important one. And anyway, so all of a sudden I started having all these perimenopausal menopause or women coming to see me in my clinic. This is when I was in Hobart. And about after the 10th woman I said, I'm just curious to know how come you came to see me for this? Oh, because you're an expert. Okay. Why did you think I'm an expert? Oh, you're on the website. I was like, oh, my, there I am. I am on there. So people are going to think I'm an expert. So it was a great way to actually get patients, but it was also this thing of, oh, all of a sudden people are thinking I'm an expert. So, again, just be mindful that you're choosing a doctor who's interested in menopause. They're on that website. It doesn't mean they're necessarily an expert expert. It means that they're interested and they're going to do their very best. But it has to be that thing again, of a two way thing. You can't walk in to see a GP and just expect they're going to know the answers to everything straight away. But what you do need is someone who's interested and who can say, gosh, this one's a bit tricky. I'm not really sure what to do. Let's have a look at this. We might try this. If this doesn't work, we might have to get an expert opinion from maybe an endocrino chronologist might need to be involved, or maybe a gynecologist might need to be involved. So it's the thing of, I guess, having the expectation as a GP, as I said, we're dealing with lots of different stuff and we may not know everything, but a doctor who's on the website is likely to have an interest and to be able to pursue the answers if they don't have them. Look, it's great going to see a doctor who specializes in menopause. That is fantastic. Especially when you don't have access to anyone. My only proviso with that is there's a little bit of risk there of disjointed care. So if one of my patients was to go and see another doctor and they treat them, and then all of a sudden they come back to me for, say, a blood pressure check, and all of a sudden their blood pressure is high. And there hasn't been any knowledge to me that someone started some hormone therapy, perhaps, and that might have been contributing to the blood pressure. It can get a little bit messy and a little bit disjointed. So a lot of the services or a lot of the doctors out there who are doing specialist stuff they do generally tend to feed back. So I say to women, another tip is if you're seeing a doctor outside of your practice, it's always useful to ask for a little bit of a summary, a summary letter to then take back to your regular.

[17:29] Sonya: That's a great tip.

[17:31] Marita: So that everyone's in the loop so we're not missing potential issues by not.

[17:37] Sonya: And it provides that continuity of care that totally makes sense. Yeah. Good tip. Love that. So let's talk about some of the more, I suppose, talked about symptoms, the higher profile symptoms, if you like. You touched on night sweats, we often talk about hot flushes which tend to be more during the day. Night sweats tend to be the devil that get you at night, which then impacts on sleep quality, which then impacts on a whole heap of other things. I'm really interested to talk a little bit more about cardiovascular health.

[18:14] Marita: I would say that you often will see women with palpitations and that often is sort of, I guess, a bit of a trying to pick out how much of this is a bit of anxiety, which of course often comes from a lot of the symptoms. Poor sleep, hot flushes, feeling like you're not managing at work anymore, feeling like you're forgetting things all the time and people are commenting, oh, I told you that. And that often brings about a bit of anxiety.

[18:43] Sonya: Another area that becomes an area that we really need to pay much more attention to and that is our bone health as well in those years. And that is a direct link to the depletion of oestrogen in the body. Could you maybe talk us through a little bit around what your knowledge is when it comes to osteopenia? Osteoporosis, yeah.

[19:05] Marita: So I think that's another area that's probably we're not switching our minds to enough. So the Medicare rebate for having a bone mineral density doesn't kick in until women are 70 unless they have some other condition, kidney disease being a heavy smoker, a heavy drinker, liver disease, an overactive thyroid, for example. So there's a few conditions if they've had kneeing disorder, there's a few conditions that you can get a bone mineral density done earlier under the Medicare rebate. Really for lots of women. When I'm doing that, menopause consult, I'll go into their risk factors for osteoporosis or have they ever had a low trauma fracture. If there's anything there that piques my curiosity, any strong family history, then I would be talking to them about would they like to have a bone mineral density done, that there will be a cost associated with that if they don't have any of those established risk factors. It's not a huge cost generally, but it's often a really nice baseline because if there is any evidence of osteopenia, which is the space between healthy bones and osteoporotic bones again. It's a great opportunity then to look at, well, what do we need to do here? And that might help someone make some decisions around whether they did want to have hormone therapy, for example, because we know that the oestrogen will be protective for those bones. But there's lots of other things women can do as well. And just even knowing what sort of dietary requirements of calcium they should be having or what sort of supplementation they may need and what sort of exercise they should be doing again. They're educated, informed, and then they can go out and make those changes and we can keep an eye on things and hopefully keep their bones strong and healthy and prevent the scenario down the track of a fractured hip and land hospital. And it's over, over kind of thing.

[20:58] Sonya: Those falls and the injuries associated with those falls. I think we've heard so many stories of grandmothers and great aunts and all of those that always seem to be having falls, which obviously is linked to all sorts of things, but then the injuries that are caused as a result of those falls which do become the broken hips. And a lot of the time I would imagine that that is directly linked back to bone health.

[21:30] Marita: Yeah. And I think there's so many things that we can do to prevent everything. So a lot of the things we're going to do to prevent bone health deteriorating are also going to keep our heart healthy, it's also going to keep our brain healthy. So it's really being able to inform women the big difference that these engaging in these activities will make for their longevity.

[21:58] Sonya: And what are the lifestyle changes that you would recommend?

[22:01] Marita: Pretty simple, because I remember actually listening to it, was a chief health officer, I think years and years ago. I was just in the car and basically he said there's four things people need to do to basically eliminate most cancers. And I thought, okay, what's that? Don't smoke, don't drink more than the recommended level of alcohol, which really more and more we hear about it, it's coming into the fact that there probably is no safe level. Stay out of the sun in high UV times and stay in the healthy weight range. And those four things really if you think about that, if you're thinking about heart health. So not smoking, not drinking, staying in the healthy weight range. So staying in the healthy weight range generally means eating good diet and exercising. And so that's going to look after our heart, that's also going to look after our brain. If we're looking at how we want to prevent something like dementia, particularly in midlife, being in the healthy weight range is really important. Not smoking is really important. Not having high blood pressure is really important. Not drinking more than the recommended amount is really important. So all these things, you get incredible bang for Buck and none of that's medication. So the starting point is pretty basic. Now, I'm not saying that that's easy to achieve and for post menopausal women, weight is an issue. That's a big one. That and a lot of women, as you know, have been grappling with weight on and off all their lives and that's a whole nother podcast and a whole nother.

[23:44] Sonya: We could go way down the rabbit hole of societal pressures and where that's come from and the chaos that it's created for women of my generation in particular.

[23:55] Marita: So whilst we don't want to get into that blaming game with women, I think again, it is that stuff of being able to inform them, give them the accurate information, the evidence around it, and then helping them with the strategies, how they might achieve that. And there's lots of really good strategies around that now and we're learning again more and more every day about ways we can support people to not only lose the weight, but keep the weight off. And I think the good news for post menopausal women is at this point in time you don't have to be in that 20 to 25 BMI. Being a little bit above that BMI is actually probably a little bit protective. So we're not saying that you've got to be skinny, it's not about being skinny. We're thinking of health at all sizes, healthy body. We do know that being in the Obese range is going to have significant impacts on your health. When we're thinking about all these things, well, we might have to tweak it. So for bone health we really want to make sure we're doing some resistance training. Overall health, we want to make sure we're doing some vigorous cardiovascular. I think the thing that's becoming clearer and clearer to me and that's through being interested in menopause and going to the congresses and listening to the latest evidence, is that we are getting a much clearer picture on what we can be really confident in advising women.

[25:17] Sonya: So can we touch on a moment the impact that the Woman's Health Initiative had on women's care through their perimenopausal and menopausal phases for women that aren't familiar? Women's Health Initiative was a report that was done on HRT back many years ago that came out with some findings that were later found to actually not be grounded. But it caused a whole period of misconception and misinformation and misunderstanding about hormonal therapy. Are we seeing change not only in education but also the way that symptoms are managed from a prescription medicine point of view?

[25:58] Marita: So I think there is still a big hangover from that. So from what I hear from women who come to see me is that they've been to other GPS who have just said, no, you can't go on MHT, you'll get breast cancer and go to the chemist and ask the chemist for something to help. So I think there is still that misconception that it is unsafe sometimes that can cause people to not want to engage, and this is too hard, and I don't want to be sued for someone getting breast cancer and becomes all very sort of frightening and scary. Look, it's really interesting. I had a woman come and see me a while ago who had been on MHT, and she went to have her breast screen. Sorry, she didn't have a breast screen. She was going to have a well, it was a breast screen, but she was doing it at a radiology center. The radiologist said to her, you should get off that stuff, because everyone wow cancers on that. And of course, he's seeing a very skewed population, a lot of people with breast cancer. He's not seeing the people going to breast screen, walking in and out. And he said, I should be off this, you've got to go, oh, here we go, back through this discussion. But equally, I had a friend who is a really good mate of mine, and she was ringing, we ring, we talk often, and oh, my God, I'm so hot and sweaty. This is true, I can't sleep, this is awful. On and on and on. I said, Go and see your GP, just go and see your GP. There's really good treatment now for you don't have to put up with this, blah, blah, blah. So off she went, dutifully. Followed my instruction, went off to the GP, GP was great, got it started on hormone therapy. She felt a million dollars. So she went out for lunch with the girls, and the girls all said to her, have you had work done? Have you had a few injections? A bit of botox. Something going on, you look great. And she said no. And they said, well, something's changed. What's changed? And she said, Well, I've started hormone therapy because I've been having terrible night sweats now. She was shot down by everyone. Why would you do that? You're going to get breast cancer. It's just natural. Like, you just got to go through it. You just need to toughen up. It's not going to kill you. This will kill you. And I thought, okay, this is a group of women who her peers I thought to myself, Jeff, we still have a long way to go.

[28:17] Sonya: We do. And it really feels like that sometimes, doesn't it? That there is so much work that still needs to be done. And when people say to me, Why are you doing what you're doing? Why are you having these conversations? Because if we don't have the conversations, women don't know. They literally don't know. They're either carrying the hangovers from the previous generations, what they saw their mum go through, what they saw their grandmother go through, the Women's Health Initiative. Even if people aren't aware of what that is, they're carrying the hangover of that. And we really need to raise our voices and make. As many women as possible understand that times have changed and that we are in a completely different space and phase and that there is so much help available to them and that they need to have these conversations.

[29:08] Marita: I guess it's that thing of everyone understanding, too, that every woman has a lifetime risk of getting breast cancer. If you're a woman and you've got *******, you've got risk, and that's irrespective of whether you're on MHT or not. So the difficulty comes, I guess, when someone you assess, someone everyone's assessed on their individual risk, and it's safe to go ahead with MHT and you start and that woman develops breast cancer. Now, is that because of the MHT got nothing to do with MHT? Well, it's always going to be that thing of oh, they're on MHC, you got to stop that straight away. Which of course you have to stop it straight away but then there's always that lingering thought and then they tell their friend and their friend tells their friend and then I don't want to go on that because so it is a tricky one. And I think, again, it comes back to, I guess, as medico is being comfortable and understanding the latest evidence. And that's why it's really important, as we said earlier in the podcast, to try and find a GP who does have an interest and can go and have it. Because if you go and look on the Australasian Menopause website, it's pretty easy to figure out how to work out risk. And the biggest risk factor that we have for women is obesity. And so trying to, again, can be a little bit of a difficult conversation. But I remember one of my specialists who would say to people, you're probably casting a slightly bigger shadow than you should, which was quite a nice way of saying you're probably carrying a little bit of extra weight, and that actually is probably your biggest risk. And so what can we do to help you with that rather than hearing all the white noise that's out there? And I think the biggest take home message I had one time was sitting again at one of the congresses and someone pointing out that MHT is essentially safe for everyone for five years. And then there's different lengths of times and different combinations and slightly different risk. But after that five years, the risk of developing breast cancer with MHT is equivalent to having two glasses of wine a night. How many people are having two glasses of wine a night exactly?

[31:22] Sonya: Plenty. Yeah, it's a great parallel to draw. I like that.

[31:27] Marita: Yeah, it's a real take home message that, okay, what are we talking about? I mean, the risk is very low. It's a risk, but it's very low. But again, looking at the different formulations and combinations, that risk can be longer than five years, or it can be perfectly safe for five years. And if you're doing all the other things to look after yourself, then you're reducing your risk anyway. And the likelihood is, if you've got bothersome symptoms from Oestrogen deficiency, by treating those symptoms with Oestrogen, the likelihood is you're going to be able to address all those other risk factors much better because you're not going to be tired, cranky, hot and sweaty when you exercise. You'll be able to look at your diet because again, you'll have more mental.

[32:18] Sonya: Capacity and you're sleeping better, so therefore you've got more energy. Yeah. Amazing. So one of the last topics, and we've alluded to this a little bit that I'd like to kind of touch on with you is around the AMS. So can you give us a little bit of background on who the Australasian Menopausal Society actually is, who are members, why and what your purpose is?

[32:45] Marita: Yes, I suppose we're made up of a board and it's all volunteers, so it's all volunteered time from health professionals. So it's a mixture of Gynecologists, general practitioners, endocrinologists, we are currently an all female board and there have been men on the board in the past. At the moment, it's an all female board, all very passionate about women's health and women's well being. We meet on a fairly regular basis. I joined just as COVID hit, so most of our meet, my meetings have been Zoom meetings, but we're just getting back to some face to face now. Our mission is, I guess when you look at the overall mission, it's to optimize women's health and well being, particularly through that perimenopause and menopausal phase, and to support professionals in that space as well, to look at providing the best evidence based guidelines and the fact sheets. Look, it's a big undertaking, particularly as a volunteer role, so people are limited in what we can achieve because it is a voluntary role. But everyone on the board is incredibly generous with their time and commitment and energy and experience and knowledge. And it's great as a GP and I'm sure it's great for the Endocrinologist and the Gynecologist to have that two way conversation between where we both fit in this space because we have different roles in the space. The AMS also works with all the other international menopause societies as well, so they're very closely linked in with North American Society and the British Menopause Society and the European Menopause Society. So there's a lot of shared knowledge, shared resources, shared information. They drive a lot of I guess they support a lot of the research out there between a lot of work well with a lot of the other women's health organizations as well, so that they're sort of all talking to one another.

[34:58] Sonya: Considering that it is a volunteer organization, the amount of resources that are on the site for both and I've gone and looked at both sides of things. I think on the site it's called Consumers, but for women patients that want to go and do some research and get some fact sheets, but also the information that's available on there for practitioners, for GPS is amazing.

[35:21] Marita: It's so good. I would open up their website probably three times a day.

[35:27] Sonya: Amazing. And I think I also saw that there was recently run some educational webinars for GPS to try and bridge that educational gap on menopause health for women, which is just amazing to know that those are being held.

[35:42] Marita: Yeah, it's fantastic. I think they do a brilliant job, even if I do say so myself. I feel like I have a very small role in it. But again, it's an important role because it's important to be able to share the information that I get. Then I can share with my colleagues and share through our organization and share with my registrars if I can educate.

[36:05] Sonya: Them around as they're coming through.

[36:10] Marita: And they're always looking for ways that can make their life easier to look after their patients, because it is a big ask that they're getting their head around in training space.

[36:23] Sonya: I can only imagine. Marita, I have absolutely loved everything that we've talked about today. I'm so incredibly grateful to you for your time. I know that as GPS, you are stretched for time most days. So thank you. Thank you for this. I know my listeners are going to get a lot out of just hearing what a GP has to say and all the tips and advice that you've shared have just been absolutely so valuable. So thank you very much. I wrap up all my conversations by asking my guests one question, and that is, what are you listening to, reading or watching right now that is bringing you joy?

[37:01] Marita: Well, this is going to be embarrassing, watching Game of Thrones for about the third time.

[37:06] Sonya: Oh, yes. Wow. The third time. That's impressive.

[37:10] Marita: It was close to the third time. I just sat down the other night and said to my husband, do you feel like a bit of Game of Thrones? It's like, God, yes, he missed Game.

[37:20] Sonya: Of Thrones so much. So I can totally understand why you would sit down and go through it again. I just get sidetracked by everything else new that comes out. But I think that's amazing. Yeah. And it would be brilliant to sit back. Sit down and go back through it all.

[37:35] Marita: Yeah, it is, because you pick up all different things and it is really interesting watching the women and I was watching last night, one episode, and the Queen who ended up I'm terrible at remembering names, the one who ended up marrying Joffrey in the end. And I was looking at her outfits and stuff and I did sit back and think how they manage menopause. I suppose they didn't live that long. Right?

[38:09] Sonya: Well, maybe not.

[38:10] Marita: So maybe they didn't.

[38:11] Sonya: That's a good point. Certainly not in Game of Thrones anyway.

[38:14] Marita: Definitely not. I've been really loving that and I do look to balance off that. I do wordle every day. Does that count for something?

[38:23] Sonya: So do I. Love Wordle. I tell myself it's good for my brain health. Yeah, I think wordle and I love the fact that it's just once a day, you don't do one and then you go down the rabbit hole of, oh, I'll do the next one. Oh, I'll do the next. It's just once a day.

[38:40] Marita: And everyone says, have you done quirtle? I'm like, no, I'm just sticking with wordle.

[38:44] Sonya: You're like me, you're arrest it's like, no, I don't want to know about any of the other options.

[38:47] Marita: Just going to stick with wordle.

[38:49] Sonya: And I had to laugh the other night. We were sitting around on the lounge watching TV as a family and my two young men still live at home and I was really stuck. I was really stuck. And I'd been looking at it for hours, on and off, and they were like, okay, give us a go. And I think they thought that they were going to solve it in a second and be so much smarter than Mum. And it was really funny. We were passing it around the lounge and everybody was having a go at putting it an option. In the end, it was still me that got it in the very last row. But, yeah, I kind of liked the fact that my 22 year old and my 18 year old were just as invested in trying to solve it as I was.

[39:25] Marita: I send it every day, my son and I, he's, he'll be 36 this year, but we send it to each other. We're sort of in this competition every day, who gets it out sooner, and so, yeah, it's not a bad way to engage with them, actually.

[39:38] Sonya: Yeah, first time I've had wordle and I think that it's an absolute winner because I love it just as much.

[39:44] Marita: Excellent.

[39:45] Sonya: Marita, thank you so much for your time and you have been an incredibly gracious and highly informative guest.

[39:52] Marita: Excellent.

[39:56] Sonya: 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 Dear 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 Stellarwomen.com Au 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.