Menopause Matters - Understanding symptoms, wellbeing and your options.

Cheri Huggins: Welcome to the Nursing and Midwifery Health Programme Victoria podcast series, where we will be diving into issues that impact the way nurses and midwives navigate today's changing world. I'm Sherry Huggins, a registered nurse and senior clinician at the Nursing and Midwifery Health Programme Victoria, and host of this podcast. The Nursing and Midwifery Health Programme is a support service which provides care and assistance to nurses, midwives, and students by experienced nurses and midwives. NMHPV provides a space where our colleagues can bring with them any sensitive health issues impacting their wellbeing. It's free to access, confidential, and independent. Today we're exploring a topic that affects half of the population and yet, until recently, has often been misunderstood, underdiscussed, or even considered taboo: perimenopause and menopause. For many women, this stage of life can bring significant physical, emotional, and psychological changes that can affect relationships, wellbeing, and work. At the same time, increased awareness has led to more conversations, more information, and sometimes more questions about how best to navigate this transition. And this morning, I'm delighted to be joined by Dr. Sonia Davison, an endocrinologist with a specialist interest in women's health. Good morning, Sonia, and thank you so much for joining us this morning.

Sonia Davidson: It's a pleasure, and I can't wait to get through the nitty-gritty of women's health and perimenopause and menopause.

Cheri Huggins: Fabulous. So let's jump in then. Perhaps we can start with, just for our listeners, can you explain the difference between perimenopause and menopause? So when does it occur, and what's happening hormonally during these stages?

Sonia Davidson: Sure. So from puberty, so from when periods start, from average age 13 years in Australian women, our pituitary and our hypothalamus are programmed to send messages to our ovaries. The ovaries then make eggs, the eggs make the oestrogen. And if everything is well, we're not on the pill, breastfeeding, pregnant, or otherwise unwell with other things, or have had surgery, etc., that will happen. And every month we are designed to drop an egg, and really it's about biology and, I think, reproducing. But of course, many of us don't have children, and many of us have one or two, and some of us have lots. The scary bit. In the 40s, typically, we start to run out of eggs, and that is normal and natural and programmed. But the poor pituitary wants that amount of oestrogen to continue. It's sort of into a set pattern and really just wants to have that oestrogen feeding back to the pituitary all the time so it knows that the body is fine, normal, and reproductive. So the pituitary really ramps up the messages. The pituitary is here in the brain to the ovaries when it feels that the eggs are running out, again, typically in the mid-40s. So it will send more messages to the ovaries: please make some eggs, please make oestrogen. And sort of it goes into overdrive as we're sadly losing our eggs, again, typically in the 40s. And the median age of perimenopause is 46 or 47, but it can vary widely and wildly. So what happens is that some months will be just absolutely normal in perimenopause. The pituitary will signal nicely to the ovaries. The ovaries will make an egg, will have normal amounts of oestrogen. And then, of course, progesterone is a different part of the cycle for different purposes, but not as important for symptoms, usually, in perimenopause. And what will happen then is we will get an overshoot and have a huge increase in oestrogen. So the oestrogen can be high, the oestrogen can be normal, but sometimes, because we are running out of eggs, the oestrogen can be very low as we're heading towards menopause. So perimenopause is a very wild and widely fluctuating time in hormones, in oestrogen specifically, and progesterone for women as they're heading towards a natural, normal event, which is menopause. And of course, we'll talk about symptoms in a minute, but I'll talk about the biology first. So menopause is from the Greek, menopause. I'm probably saying that very wrong, but it's the cessation of the monthlies, and it really means the last natural period and the last egg. But sometimes we lose menopause because we might be on the pill, we might have had a hysterectomy, we might have a Mirena or another IUD and not have periods anymore. So sometimes, for some women, it's difficult. But it's just the last egg, the last period. And unlike perimenopause, when hormone levels can go wild and wide and go all over the place, menopause is associated with a very low level of oestrogen. We still have a little bit, but on average, throughout reproductive life, our level is about 400 pmol/L of estradiol, the main oestrogen we have, and we don't need to measure it. If it's a typical story at menopause or perimenopause, we don't need hormone levels. That's a big message that people get a bit unstuck with. But after menopause, that level will be about 20. So a 20th of our average level and a 70th of our peak levels, because oestrogen when we're ovulating can peak up to 1,500 or 2,000. So women will feel different when they have that very, very, very tiny amount of oestrogen. And of course, menopause is associated with loss of fertility, which for some, they're happy. Some, they're also sad about it. But it is also a change in life biologically, where we know other things, other health problems start to happen after menopause in increased incidence. And of course, women are really hot for information about menopause at the moment. We're suddenly chatting a lot.

Cheri Huggins: That's great. That's what we want, isn't it?

Sonia Davidson: Absolutely.

Cheri Huggins: It absolutely sounds like a wild time. I really love the way that you've described it as being wild, because I think wild can also equate to being quite scary, I guess. So you talked about symptoms. So I guess asking you, how do symptoms of perimenopause differ from those experienced during menopause? And are there particular signs that women are often surprised to learn can be related to hormonal changes?

Sonia Davidson: Sure. Menopause is pretty easy. I'll go there first and then we'll backtrack to perimenopause. And the typical age of menopause, the median in Australia, is 51 to 52 years, but it is normal from 45 to 55 years. And some of my ladies actually sneak in a little bit older than that, 57 or 58 or so. It's all set in our genetics, set in the pituitary, and we tend to do, and families do. But a very important thing is early menopause is menopause earlier than 45 years, and premature menopause is menopause earlier than 40 years. And we really do want to identify those women because they are sort of robbed of their oestrogen that will protect their heart, their bones, their skin, their body, etc., and their brain. So we really want to identify those women and make sure that they're treated. And we want to treat anyone with bothersome symptoms. People criticize me and say, "Why are you going on about menopause? It's a natural life event. Just get on with it. Just let women do it." Women are at the peak of their careers. They're often looking after dependents. They're in relationships. They're looking after elderly parents who are getting unwell. And it's tricky to be in this difficult world that we're in.

Cheri Huggins: Yeah, yeah.

Sonia Davidson:: So just because you're in your 40s or 50s and you've got a major hormonal change then making you maybe not sleep or whatever, so we need to really focus on that. But menopause is typically, with that very low oestrogen, associated with hot flushes, which tends to affect the chest and upper body, not generally the whole body. It's very unusual. Night sweats, but it can be sweats during the day. They can be drenching. Some of my women can sleep on beach towels, wring them out, and get another beach towel. So it's very disruptive. Sleep is a real issue. Mood can be a real issue. So anxiety, irritability, and low mood. Some of my women, for example, in the pandemic, were too anxious to drive their cars anymore. So just this irrational anxiety that you wouldn't expect just comes out of the blue, typically in 40s and 50s. Some will get crawling or itching under the skin. It can drive them a little bit batty. Some will get restless legs. Some will get joint and muscle aches and pains and think, "Oh God, I've got some terrible arthritis." And some will have vaginal symptoms, so dryness. They might have some discharge. They might have burning urine. They might have urinary frequency, urgency, or leakage. And they might feel very tired, and they might have brain fog, and they might have every issues. It's not all doom and gloom. There are strategies out there, and not everyone gets everything. Some just sail through it. So 20% are severe, and 20% are just nothing, and then everyone else is in the middle and has some bothersome symptoms. So we target the symptoms that bother that woman. We don't do a blanket, one-size-all-fits approach. But perimenopause is really tricky because sometimes we will be designed to lose an egg, but actually an egg is recruited because the pituitary is trying so hard to keep the oestrogen up. And sometimes we will ovulate twice in a month and have a great big, enormous surge of oestrogen that might go up to something like 3,000. So that's a really tricky time. So in addition to the menopausal symptoms they might be having, they might also have breast tenderness, bloating, fluid retention, and they just might have quite extreme mood disturbance, and of course, sleep disturbance. So I always say they don't know if they're Arthur or Martha. They're used to having regular cycles, if they're regular and if they're happening, or if they're not bleeding, of course, they'll be probably aware of what's normal for them. But the wheels start to fall off in perimenopause, but it can be a very bumpy ride. And menopause is not easy, but at least we don't get those enormous fluctuations.

Cheri Huggins: Sure. It sounds like a lot of suffering. So I'm really glad that you said that it's not all sort of negative, and it would be really nice to hear about the upside, what we can do to reduce that suffering. Quite often, we have women of perimenopausal or menopausal age come to our service, and they do describe symptoms that you've just spoken about. So irritability, low mood, depression, poor concentration. They don't always equate that with hormonal changes. And I think you touched on this as well, but if you could speak a little bit more to it, Sonia, about why is there such a wide disparity between the symptoms? Some people, some women sail through menopause, and others really have a lot of challenges. Can you say a bit more?

Sonia Davidson: It's about genetics, sorry, and our own biology. So there is a wide variation in biology. Twins will generally do what the other twin will do, so it's very interesting when we look at twin studies. We don't really understand that very well, but there are other circumstances. So those that have had past trauma in their lives, they're more likely to have a mood disturbance. And those who've had challenges throughout their life, maybe those who might have had a complex gynecological history, such as endometriosis, if they've had previous surgery, etc., they might be also on the disadvantage. So it really depends on the person, their genetics, their individual circumstance. For example, 3% of women, or 3.7, I think, to be exact, have premature menopause, so menopause before the age of 40 years. A lot of that is genetic. A lot of that we don't understand. But some of it might also be treatment for cancer or for endometriosis or for radiotherapy or someone who got terribly unwell, for example, if they had lymphoma, etc. So there's lots of things out there which can alter symptoms. And some people will also be on another medication. So there are groups of medications that we sort of serendipitously found could treat, for example, flushes or sweats or sleep or mood. So, for example, the SSRI group, the things like sertraline, Zoloft, fluoxetine, paroxetine, those medications for anxiety and for low mood can actually treat sweats and flushes. So that's why one woman might sail through a little bit easier. But those medications can also increase flushes and sweats in some people.

Cheri Huggins: My goodness.

Sonia Davidson: You can see it's instead of just being like diabetes with a high blood sugar, well, we treat it. Menopause is a variety of symptoms for individual biologies, and we just have to really understand that woman in front of us and try and target our approach, given her background, her history, her risks, and what she wants to do and what the symptoms are doing.

Cheri Huggins: Yeah. So treating women as individuals is essential in order to target treatment. So in nursing and midwifery, the work we do can be physically demanding and emotionally challenging. Do you recommend any strategies that can be used to support women in their well-being and manage menopausal symptoms while they're working in these high-pressure health environments?

Sonia Davidson: Well, the other thing is, I mean, if they're a theatre nurse or in hospitals, for example, they're usually hot environments, aren't they? They do that in hospitals on purpose because then they cut down on the blanket laundry costs.

Cheri Huggins: Yes, absolutely. Absolutely.

Sonia Davidson: So I often feel sorry for place women because they're in those big inclusive garments, like theatre nurses, those who work in hot environments. They are going to make flushes and sweats and all those things seem even more unbearable. And of course, if you haven't slept going to work, and if you're feeling low in mood, going to work and doing all those sort of things. So I think it's about being aware of your capabilities. Secondly, being aware of shifts. Sometimes I write letters for shift workers saying, "This woman just needs a consistent shift so that she won't she needs to sleep if she's to be a productive worker." I know that's hard to say when others then you're going to do those tricky shifts. But if you're a nurse or a midwife who's done this job for 20 years, sometimes you need to be looked after a little bit, and sometimes you might need to do a consistent shift. That's what I think, but whether the managers think that is another issue. Also, thinking about your hours, what can you manage? I know some people need to work full-time for money and their retirement and for just staying afloat, but thinking about maybe reducing hours if that's a possibility while you get through this difficult phase. Making sure you see a health practitioner talking about the symptoms that bother you. There are lots of different treatments for flushes and sweats and sleep. It may be hormone therapy. It may not be hormone therapy, but there are lots of issues there. And some people in perimenopause will have terrible, disastrous, heavy bleeding. So that's a real tricky one if you're a nurse or a midwife. You're attending to other people's needs, and you might have torrential flooding or whatever. Heavy bleeding is never normal. Women just put up with it. They sort of get into a pattern, and perimenopause can be associated with that. Get some help. There's always something we can do for bleeding, sweating, sleep, those things. And let your family know, because often women will cope at work, get through work, but then sort of trudge home. And then someone, they've left you with the bins to put out. They've left a mess on the floor. There's a pile of washing there. The toilet seat is up, and you have to then go home and do all of those things as well. And that's where the straw on the camel's back can break, and you can really lose it when you get home. And I sort of think that that's normal, but of course, that's difficult. And women don't ever want to do that, but they're just trying so hard to do everything in life, and sometimes it just becomes a bit too much.

Cheri Huggins: It does. And looking after ourselves is quite often really low down on our priority. But it sounds like from what you're saying, Sonia, it's really important for our self-care to be a focus, not to be an afterthought.

Sonia Davidson: Do something for you. I know it's so hard to do, but just even if it's walking the dog for 30 minutes and leaving the family behind and just clearing your thoughts. And of course, exercise. So the ones that manage better do some exercise. And of course, weight tends to increase around perimenopause and menopause. That one extra biscuit per day without ensuring exercise to burn it off will put on a kilo in a year. That's 10 kilos in 10 years with one extra biscuit.

Cheri Huggins: Oh my word.

Sonia Davidson: So women just have to be very mindful of keeping moving. They may have to change their diet. I've got many women who say, "I eat the same. I exercise the same, but I'm gaining weight on my tummy." So just be very aware of that. Our body, we lose our metabolic rate as our oestrogen levels go down. So that's another thing to fight at midlife, and we want to be nice and healthy for our hearts, for our brains. Smokers have an increased incidence of early menopause and have more flushes and sweats. So that's another important thing. I'd love women who are smoking or vaping to try and give that away. And women who are sort of at a disadvantage in socioeconomic terms, so maybe not nurses and midwives, I hope, but maybe their patients they might see might also be struggling with more symptoms just because of a bad beginning in life.

Cheri Huggins: So Sonia, are you saying that women don't have to accept weight gain? They don't have to accept sometimes that tire that comes around the middle of our tummies. It's not inevitable.

Sonia Davidson: It's not, but you have to work at it. I say to my women who are struggling with weight, "You've got to want the food, or you've got to want the body." And you have to learn what your body needs. Because it's very hard if you're cooking for a family, especially for a teenage son, or they apparently eat a whole loaf of bread at one setting.

If you're cooking a big dinner for them, you can't have that dinner typically in midlife. Some will because they've got a good metabolic rate and doing the exercise. But for those who are gaining weight, they need to eat smaller portions. They need to reduce carbohydrates as well, the things like bread, pasta, rice, all the white things, potatoes, noodles, etc. The things that fill up a plate are the things that are going to put weight on women typically. So it again depends on the woman and her strategy and her family history, of course, but keep moving. Also, breast cancer is part of it. So we know that breast cancer increases. If we are overweight or obese, that actually doubles the breast cancer risk much more than hormone therapy does. And the women who do two and a half hours of moderate exercise per week have a substantial reduction in breast cancer risk, and that's 21 and a half minutes per day. So my challenge to your listeners: keep active, keep healthy, do your 21 and a half minutes per day on average, try to tackle weight gain if it's happening, and do all the other things. Your blood pressure check, your blood sugar, all those things, cholesterol. We need to stay healthy, and midlife is a really good time to actually look at all of that and plan for the future. You might have stuffed it up until midlife, but to actually get it together as you're getting older.

Cheri Huggins: Oh, that sounds really hopeful. And it's really good to hear about the health concerns, but what we can do about them in real terms. So I really like the way that you've kind of underlined that. So many women will be asking what seems like a simple, but I guess is also a complex question. Should I take HRT? So how do you approach that conversation?

Sonia Davidson: Well, HRT is hormone replacement therapy, but someone got upset about that term. So nowadays you might be seeing MHT or HT. So that's menopausal hormone therapy. But everyone knows there's an HRT. So I just hate it when they change words and nomenclature for no good reason. So just be aware out there that it might also be called HT hormone therapy. This is essentially giving back oestrogen, and if they have a uterus, it's giving back progesterone. The oestrogen helps the symptoms. The progesterone makes sure that the womb lining remains nice and thin. And some will also add testosterone for lowered libido causing distress. But I usually would treat with hormone therapy first, which is oestrogen plus or minus progesterone. So everyone is very interested in hormone therapy because I think the pandemic made us talk about health a lot more. It made us talk about quality of life. Women really started to speak up, and a lot of celebrities started to talk about their own experience with menopause. So Naomi Watts, Michelle Obama, and Oprah Winfrey started to talk about menopause big time, and others, and the role of hormone therapy and how they felt well and how it was good for them. So of course, women listen to those sort of leaders and want a positive role model. So hormone therapy got a bad rap after a big study called the WHI, which was the Women's Health Initiative study. This was the biggest study of hormone therapy in the US looking at oral hormone therapy, a different type than we use now, in 26,000 women. And they were average age 63, didn't really have menopausal symptoms, and it was a focus on the heart. They were trying to see if hormone therapy would decrease the risk of heart disease. So our knowledge of hormone therapy is mostly based on that study, but there was a big dive bomb. A lot of women were on hormone therapy until 2002 when that study was released, and it said hormone therapy causes breast cancer, so stop taking it. So it was a very tricky journey, but after that, we've sort of realized the reasons to take hormone therapy, and we do it for bothersome symptoms that are causing distress. We would mostly use body-identical hormone therapy. That means the same oestrogen as our body makes estradiol, and most of the oestrogens in Australia are estradiol-based, and the same progesterone that our bodies, our ovaries would make. And there is a body-identical progesterone. But I'm not saying that all the other different types of hormone therapy products are wrong. There are lots of different products. They don't all suit one woman. One might be great on them, another might struggle on them. And of course, then there's doses and factoring in bleeding if they're still bleeding, if they're perimenopausal. So it gets tricky. So it's important to see someone for advice about hormone therapy. There's some beautiful information at Gene Hales for Women's Health about hormone therapy, perimenopause, and menopause, and also at the Australasian Menopause Society. There's a beautiful info sheet there called, I think it's something like MHT, Risks and Benefits, which goes through very beautifully the benefits and the risks, and it needs to be very considered and tailored to that individual. For example, some have had clots in the leg or lung before, or some might have existing heart disease. So you need to think very carefully. And sometimes it's not about hormone therapy. Sometimes the best option might be a non-hormonal option. It might be a non-hormonal medication. And again, there's some information on those websites about those as well, but I'm happy to talk about them. And sometimes doing something very different, such as cognitive behavioral therapy or hypnotherapy, can be very useful for symptoms. And both of those strategies are useful for sleep, mood, and for controlling flushes. They don't reduce flushes, but they control the way we deal with flushes. And there's a beautiful self-help book on cognitive behavioral therapy by Myra Hunter, a UK author who's very interested in this area if your audience want to have a look at that. But a good hypnotherapist can help as well. And again, you can see that it's targeting the person, knowing about her symptoms, knowing about her health risks, doing her screenings such as mammograms, Pap smears, or cervical screens, and all those sort of things, and then targeting the exact concoction or the exact strategy to that woman. And then even then, we don't get it quite right. I always try something for three months, and then after three months, have a look at see how things are going, adjust the dose, change the product, or whatever. It's very much trying to just sort it out very gently to start with.

Cheri Huggins: So it sounds like a combination, but it might be a combination of treatments and approaches that might be right for that individual, but a process of elimination also. Fabulous. I'm really glad that you mentioned about screenings because I know there is research to support the fact that nurses and midwives aren't always the best at keeping up with their screenings. So thank you for mentioning that, and we can underline that as well. One of the questions I was going to ask you, but I think you've kind of touched on it, was that we know menopause is a natural biological transition. And so how can we support women in a way that validates their experience without pathologizing what is a normal stage of life? Is there anything else that you would like to add to that, Sonia?

Sonia Davidson: I think women can handle perimenopause or menopause if they understand what's happening. So I think a big amount of this is, "I was this for this amount of my life. Now I've got very different symptoms that I'm not quite happy, and I didn't really realize that they were going to happen." And I think a lot of the understanding for some of my women come in perimenopause and say, "I'm actually okay, but I just want to know, is this perimenopause, and what do I do for the next bit?" So they're organized. And I know nurses and midwives are very organized, but I get it with the self-care bit. It is a tricky thing when you're in your 20s, you're generally studying. I think this is my summary. Maybe meeting someone, trying to form relationships. In your 30s, you may still be studying, but you're trying to solidify your work life. You might be doing extra study. You might be having children. In the 40s, again, you are probably looking after dependents, whether it's parents or your children or your relationship or your dog, cat, or whatever. You're reaching the peak of your career, and the last thing that you're thinking about is your own hormones leaving the building. Because you've sort of got used to things, and you're sort of getting in control, and then wham, the hormones start playing up, and you think, "What's going on?" Some of my women give up work. They won't go for another job. They want to get another job, but they can't be bothered, or their symptoms are so terrible that they don't sleep. So just think in life, if you've got bothersome symptoms, they can be treated. And I don't want a woman to give up a good relationship or a good job or whatever just because of her menopausal symptoms. That's just what this is not about.

Cheri Huggins: That's really encouraging because it can feel hard, can't it, just to keep going, to feel motivated, interested in things.

Sonia Davidson: They can lose their mojo. Some of them say, "My get up and go got up and went." And they feel tired. And do you know what? It's also not all about perimenopause and menopause because some of the women in their 30s, there's a big wave on social media. So be very careful about social media. There is a lot of mixed messages. Always try and get your information from an expert source such as Gene Hales for Women's Health or the Australasian Menopause Society or Better Health. That's a good one as well, or the Mayo Clinic overseas. Because there are a lot of people saying, "In your 30s, you are perimenopausal, and it's all about hormones and whatever," whereas they're probably working, having the care of young kids, trying to get their life in order. And often it won't be about perimenopause because it's a little early, although some might start to be perimenopausal. There's a big wide of variability. So you can be perimenopausal for 11 years. And if menopause is 51, it could start from the late 30s, but if menopause is 45, it could be in the 30s. But PMS is a more likely thing in the 30s when women are just getting those terrible premenstrual bloating, fluid retention, mood disturbance. And that is normal, but it's an abnormal body response to normal hormones, and that's more likely in the 30s. So you might be perimenopausal in the 30s. Just backtrack a bit, get some good advice and information, tease it all out. I've also heard of women in their 30s going to doctors and saying, "I'm perimenopausal," and the doctor's saying, "Well, I don't think you are," and them getting very upset about that. And we don't need to check hormones. So I know that women will be busting their guts to know what their hormones levels are. I would only do that in premature menopause. So menopause, I'm suspected below the age of 40, or if there are atypical symptoms or unusual symptoms. And we might be testing testosterone levels, for example, because that's very important if we're looking at testosterone treatment for women, but not for oestrogen.

Cheri Huggins: Oh, thank you for clarifying that. Social media can be a good thing, but also an unhelpful thing.

Sonia Davidson: Just make sure that the person you're listening to is evidence-based, scientific. And the other thing is I don't like about the new wave of menopause is lots of people are selling products, whether it's a cooling pillow or special pajamas that you won't sweat with at night or face creams or whatever. A lot of people have got on this anti-aging and menopause bandwagon. And I think it's a little bit tricky when they've targeted sort of a very vulnerable group in terms of trying to possibly sell a product. So just be very aware of those things as well.

Cheri Huggins: Yes. Exploitation is something that's happening a lot these days, isn't it, as you say. So look out for that. You did mention earlier about some women decide to leave work. And research does suggest that it happens a lot in nursing when they just give up because of menopausal symptoms. Is there anything that healthcare organizations can do to create workplaces that better support women during menopause and perimenopause? I know we talked briefly about what individuals can do, but what about the organizations?

Sonia Davidson:: There's some beautiful guidance for workplaces, and workplaces have become very interested in not only menopause, but also reproductive issues, heavy periods, and those sort of things. It's hard when we target one part of biology, and women might be quite shy of saying, "I've got flushes, sweats, and sleep disturbance," and whatever, talking to a manager about that. I always like the thought that there's leave available for a health reason rather than targeting it to one or the other. But having adequate toilets if there's heavy bleeding, if they're perimenopausal, etc., and access to those toilets. And some women may not feel comfortable with a mixed-gender toilet as well. I think that's very important to have a protected female toilet. I'm a big one on that. Sorry about others if you don't like me saying it.

Cheri Huggins: I'm with you on that one.

Sonia Davidson: I think women just feel safer, and this is hard stuff. Having heavy bleeding as a woman is a tough gig, I think, a biologically tough gig, and some will really struggle. But there are some beautiful statements out there that workplaces can gather. It's usually nice for a manager to be aware of the menopausal sort of symptoms, and if someone reaches out to them to have a strategy in process, it might be about supporting, again, their shifts that I talked about, their uniforms. I have sort of tried to campaign for different uniforms for some. I know that's hard in a workplace. Temperature control is another thing, having maybe them in a different office with a fan or whatever, because most people want to be warm, but some people want to be a bit cooler with air circulating, having access to other things such as leave if they need to. Working from home might be another important thing as well. So there are some beautiful statements and strategies out there. So we're getting a lot better about menopause at work, which has been sort of in the last five years, people have sort of opened their eyes up.

Cheri Huggins: Yeah, great. Oh, that's really encouraging to hear that. I wasn't aware that there were those sort of possibilities within the workplace. So again, it's great that you've brought that to the awareness. So look, we're coming to the end now, Sonia, but I have to say that you are a wonderful, wonderful advocate for those of us that are going through, approaching, or have even been through the menopause because sometimes even then we have questions that have remained unanswered. So I've really appreciated our conversation today. But what I would like to ask you is, do you have a message that you would like every woman approaching perimenopause or menopause to hear? What would your message be?

Sonia Davidson: It's your body. It's what you make of it. Don't put up with bothersome symptoms. There's always a strategy out there. Try and be healthy. Our good God, or whoever gave us this body, whatever you believe in, designed us to move, and it's very easy to not move. We need to do our exercise, whether it's just brisk walk, whether it's something more than that. We need to reach out to someone who is an expert. And there are some beautiful GPs and specialists at the Australasian Menopause Society. There is a Find a Doctor web page there. And they're not all doctors. There are nurse practitioners who are excellent as well. So they are listed by locality and their specialty as well. So even though your trusted GP might be someone that you love and admire, they might not really get it with perimenopause and menopause. I'm not saying jump camp. I'm just saying get some women's health advice, stay with your GP, and then try and figure it out between the two. You just definitely need the weight is really important. Don't just keep getting bigger.

Cheri Huggins: Yes.

Sonia Davidson: Easy to say, hard to do. It is your body, and no one else is going to reach out and just say, "You need some help here." It does need to come from within, which is really hard. If you're tired, not sleeping, terrible mood, flushes and sweats, have to drag yourself to work, drop the kids at school, then go and pick up the pieces with the elderly parents. It is definitely a meat-in-the-sandwich experience, but there is help out there. You can make a good go of it. And when I see women and they come back to me and whatever strategy I've given them, and there's three lovely words I love to hear them say, and that's, "I feel normal." You don't have to feel amazing. You don't have to be swinging from the chandeliers. When you're not feeling well, "I feel normal" feels really wonderful. So there is the possibility of feeling normal. Don't put up with terrible periods. That's a nurse and midwife thing. We can switch that off really easily. Lots of things we can do there. Don't put up with flushes and sweats and sleep disturbance. Mood, we can do lots of things with. The thing that you need to do is do your screening. Mammogram every two years after 50. You may need to have it before that if you're at risk. Cervical screening every five years. You can do a self-collect now and do your blood pressure, your cholesterol, your blood sugar, and get some help. I know you wanted a very simple statement there. I've given a big one.

Cheri Huggins: No, I really love the big one because you have just highlighted everything, and it's fabulous. We need to hear all of this. Thank you. So look, as we come to the end, I'd really like to thank you, Dr. Sonia Davison, for sharing your experience and helping us better understand the realities of perimenopause and menopause. For nurses and midwives, these conversations are particularly important because not only are we caring for ourselves as women whilst experiencing these menopausal or perimenopausal symptoms, but many of us will be caring for other people who are navigating menopause and perimenopause. So this helps us to feel informed, supported, and empowered. Thank you.

Sonia Davidson: Brilliant. All good. Good luck, everyone. Now, don't forget, get some help.

Cheri Huggins: Get some help. Wonderful message. Thank you.

Sonia Davidson: Big pleasure.

Cheri Huggins: For any nurse, midwife, or student of these professions who might need support after today's podcast, you can access our service on 9415 7551 or by going to our website and completing the contact page. Thank you for listening.