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Podcast Episode 10: Physiotherapy and the perimenopause and menopause with practitioner Deborah Thomas

Podcast Episode 10: Physiotherapy and the perimenopause and menopause with practitioner Deborah Thomas

Symptoms of the perimenopause and menopause can impact a person’s physical health and wellbeing in a variety of different ways. Whilst HRT can offer relief for many symptoms, alleviating physical discomfort can prove more complex. The role of the physiotherapist in the ongoing care and treatment of those experiencing pain during the perimenopause and menopause can prove essential.

Joining host Lauren Redfern on the podcast to discuss the role of the physiotherapist in the treatment of perimenopause and menopause is Deborah Thomas. Deborah is a qualified physiotherapist with a special interest in pelvic health. In this episode, Deborah discusses the role of the physiotherapist in empowering patients to adopt a healthy lifestyle and the importance of encouraging patients to exercise whatever their limitations may be. She breaks down the importance of good education and explores the variety of physiological symptoms that can surface during the perimenopause and menopause, paying particular attention to pelvic, bone and heart health. As well as being a certified pilates instructor and mindfulness practitioner, Deborah has extensive experience working across a variety of different physiotherapy departments including musculoskeletal, obstetrics and gynaecology, orthopaedic, neurology and respiratory specialities.

Podcast Transcript:

Lauren Redfern [00:00:06] Welcome to the podcast for the Newson Health Menopause Society, a multi-disciplinary collective of interested professionals passionate about improving hormone health across the world. The society exists to educate and inspire others to raise the standard of menopause care and access to treatment, to facilitate research, collaborations across specialities and countries, and to provide expert advice and guidance to our associates. The ultimate aim of the Newson Health Menopause Society is to improve the lives and future health of women and all who experience the perimenopause and menopause. I’m Lauren Redfern. I’m a medical anthropologist and I’ve been exploring the experiences of those using testosterone as part of their HRT treatment. In this podcast series, I’m going to be talking to guests from a variety of different disciplines in order to share knowledge and ultimately improve our understanding of the perimenopause and menopause.

Lauren Redfern [00:01:05] Debra, the physiotherapist I will be speaking with today, first met Alice following a diagnosis of pudendal neuralgia – a condition that can cause pain, discomfort and numbness in the pelvis and genital region. Visiting her GP to discuss the extreme discomfort she was experiencing, Alice explained that her pain was interfering with both her professional and personal life, highlighting that it was significantly impacting her quality of life. Alice was signed off work for a month but received little advice or support on how to diminish her symptoms. The one piece of advice Alice did receive was try not to sit down, as it will likely irritate the pain and make it worse. Alice was referred to a gynaecologist who in turn referred Alice to Deborah. Deborah tells me that by the time she met Alice she was taking Pregabalin, Amitriptyline, and an SSRI, all in an effort to manage her pain symptoms. She describes how Alice had reached a tipping point and was in the midst of a mental health crisis. Indeed, upon the advice of her primary caregiver, Alice had not sat down in nearly a month as she was petrified that doing so may inflame or worsen her symptoms. After a thorough assessment, Deborah was able to ascertain that Alice was not only experiencing pain in her vulva region, but was also struggling with other joint and muscle pain. She reported fatigue as well as urinary issues. Alice hadn’t previously considered the perimenopause as a possible contributing factor to her symptoms, but told Deborah that she didn’t want to use HRT as she was scared of the possible associations and risk of cancer. Deborah explained to Alice the effects that local estrogen can have on the pelvis and how nerves and nerve pain can respond to chemical irritation. In the case of Alice’s pudendal nerve pain, Deborah highlighted how it may respond to hormonal deficiencies in the pelvis and the stress and anxiety she was experiencing. Ultimately, after adequate advice and support was provided from Deborah, Alice decided to try a localised vaginal estrogen and in time did opt to introduce HRT to her care. Deborah reports how Alice’s symptoms improved dramatically after the introduction of HRT, but that it was only one piece of the puzzle. Alice also underwent manual therapy on her pelvic floor muscles and was given an exercise programme which involved movement and physical activity. She was guided through some mindfulness practices and techniques and Deborah communicated with Alice’s GP and specialist to explain how she may benefit from the vaginal estrogen. Deborah and Alice made a plan how to get back to work on a part time basis, and they discussed coping strategies for flare ups. Ultimately, they went through how to manage both the good days and the bad days. Whilst Alice’s progress highlights the wonderful improvements that can be made with the right intervention. Sadly, Alice isn’t an anomaly, and in Deborah’s words, she’s a typical patient. Here to discuss with me today the role of physiotherapy in the treatment and care of perimenopause and menopause is Deborah Thomas, who we spoke about in the story. Hi, Deborah. Welcome. Would you please be able to introduce yourself to those listening today and just tell us a little bit more about the work that you do.

Deborah Thomas [00:04:20] Thank you, Lauren. Hi, I’m Deborah Thomas. I’m a physiotherapist and I work in private practice in England. I qualified just over 20 years ago and I work in a variety of environments, so most of the time I spend at my clinic. However, I also attend quite a few support groups for women of all ages. I partake in education sessions that either I organise or in the workforce, and again to a variety of populations, to men, to women, all sorts of ages. So I suppose my work is quite varied. Most of my caseload would include what would be classed as musculoskeletal patients and pelvic health. So we’ll probably expand on that in a little while.

Lauren Redfern [00:05:11] I wanted to start by asking a broad general question, Deborah, which is really what physiotherapy is and how it pertains to perimenopause and menopausal care. Because I think for some people listening, they might not necessarily associate the perimenopause or menopause with physiotherapy. So I wondered if you could talk us through that a little bit.

Deborah Thomas [00:05:30] Yeah, absolutely. And I’ll probably address your question by answering it in two parts. And I think we’ll start with what is physiotherapy, because quite often people think that physiotherapy is actually a treatment technique. So physiotherapy is a profession, it’s a holistic profession. And quite often I’ll say to people it’s a holistic with a W because we treat the person as a whole. This is a science-based profession and we use evidence based practice and this is very important in the UK and in many other countries we are governed. We have to work to a very high standard and we’re held up to those standards. It’s very important that we work within the scope of our practice. So that actually means that different physios will have different sets of skills, different experience. We’re not all the same. Okay, so physio is not a treatment technique. It’s actually a profession. Very varied, very exciting and interesting. We focus very much on health promotion, on education, on empowerment, mainly of patients, but also other health professionals, and the public. We aim to restore movement and function. This is one of the most important things in the story of the lady that we just discussed. She developed a fear of movement and a fear of posture. So we can use a variety of tools to be very, very broad here. We’ll use a lot of movement and exercise. Some of us will use manual therapy techniques, acupuncture, biofeedback. We use a lot of education, advice, relaxation techniques, and some physios will specialise, for instance, in musculoskeletal, maybe pelvic health, like we’re going to discuss today, neurorehab, respiratory. It’s almost endless, which is why I love this profession so much. To expand a little bit more how this relates to perimenopause and menopause, many physiotherapists have developed a speciality – and this is, I suppose, why I’m talking to you today – in what we call ‘pelvic health’. Used to be separated Lauren, into men’s health and women’s health. Many of us now actually work with men and women. And so we like to use the terminology pelvic health. And I suppose this is where it’s much more applicable to the perimenopause and menopause, okay. So specifically here we would treat problems, for instance, like incontinence of bowel, bladder, we’ll treat people who complain of pain, a variety of pain like pelvic pain, vulva pain, musculoskeletal pain. People who have a complaint of prolapse symptoms, any sexual dysfunction, vaginal dryness, any issues relating to bone health, falls, balance, osteoporosis. Here we use a lot of education. And you and I know we’re going to talk about this a lot, but education to the men and women we work with, to other allied health professionals, to GPs in the workplace. Like I mentioned, one of the things some of us provide is something called a menopause MOT that you and I might discuss soon. Many of us also teach exercise classes. It might be Pilates, it might be yoga, it might be other exercise classes. Some of us are qualified to fit pessaries, some of us are qualified to use acupuncture as a treatment tool, biofeedback, ultrasound. So again, this is very, very varied, but this is really the area where it pertains to perimenopause and menopause. So kind of pelvic health physio.

Lauren Redfern [00:09:24] Okay. So just to clarify, in terms of with physiotherapy, there are obviously different areas you’re mentioning musculoskeletal, but when it comes to perimenopause and menopause, you’d say it more falls into that category of pelvic floor health. The more likely for anyone listening that might be experiencing sort of perimenopausal, menopausal symptoms, it would be they’re looking for a physiotherapist. They might want to think about someone that specialises in that pelvic floor.

Deborah Thomas [00:09:48] That’s a good point, because as you and I have discussed before, how somebody would arrive at my door varies. So if a woman is looking specifically for somebody who may specialise in this area. Yes, I do recommend that she went to speak to pelvic health physio. However, someone experiencing hip pain may end up seeing another physiotherapist who may specialise in musculoskeletal, and hopefully after this talk we can give a few pointers to those physios what to look out for to make them think, ‘ah, maybe this is a perimenopause menopause issue and not a hip problem’.

Lauren Redfern [00:10:25] And that’s fascinating the way there is that crossover that it might get missed, that perimenopause and menopause as a possible causal factor may get missed due to the fact that it’s not necessarily in in the specific area that we think of.

Deborah Thomas [00:10:38] Absolutely. So, for instance, this week, a woman came to me because, again, she had a different type of pelvic pain to the lady you described here. And as I was chatting to her and screening her, she said, ‘oh, I’m seeing another physio for my shoulder’. And I said to her, ‘Have you considered perimenopause?’ Because by that point it was obvious she had at least five symptoms. And she said to me, ‘Oh yes, but my GP told me I’m not perimenopausal’. And in my head I’m thinking, ‘has the physio treating your shoulder considered the menopause?’ So this is a thought going through my head, Lauren, yeah.

Lauren Redfern [00:11:12] Interesting. Okay. Well, obviously I started today by sharing Alice’s story with you all, which sadly, as we discussed, is for you, Deborah not an anomaly. But in many ways, actually, you’ve said to me a typical patient. And I think what the story highlights for me is, as you mentioned briefly earlier, the importance of education not only amongst patients, but also amongst healthcare professionals. So they’re aware of the importance of considering factors such as the perimenopause and menopause in their treatment and care, and I wondered if you might share with us your thoughts on this and the role of education within physiotherapy and that communication between healthcare professions.

Deborah Thomas [00:11:54] Absolutely. And this is a very broad question, and I’ll try and be specific.

Lauren Redfern [00:12:00] Even if it is a bit specific.

Deborah Thomas [00:12:01] Yeah, you and I could chat for a whole hour. I think about education and to a degree what we’re doing now is education, because whomever’s going to be listening to this hopefully will be able to take points from this to help themselves. So education is a cornerstone of a physiotherapist’s input. Specifically in the perimenopause and menopause field, one of the services I provide to women is I call it a ‘menopause MOT’ or a check-up from the neck up, but it’s not really from the neck up, it’s from the neck down as well, Lauren. So this gives me and the woman an opportunity for a general health assessment. So specifically in this I’d be doing a multi-system assessment. We’d go through lifestyle, we can expand on this in a bit if we want to, a urogynaecology assessment that may or may not include a pelvic floor examination and education is a massive part of this. So she will, like Alice in your story, receive education on how hormones play an effect in our body, what menopause is, how important exercise is. Whatever we’ve identified in her assessment that she requires, it may be me teaching her how to assess her vulva by herself, or breast care, it’s endless. Every woman, almost every woman that comes to my door. A letter will be sent from me to her GP. She will receive a copy and if a specialist is involved here, I will send a letter to the specialist. And in this letter, I will expand on this multi-system assessment and what I’ve identified. And if I feel that the GP may benefit from highlighting a resource that may be helpful for them to help the women or a link to a website or an assessment tool, I’ll put that in that letter. So this is my way of alerting them, highlighting to them resources for themselves, but also letting them know that us physios are part of the team that looks after a woman. So many, many primary care physicians and even specialists won’t necessarily take into account that people will benefit from physiotherapy. So this is one way of communicating with them. Another part of education that I provide as a physiotherapist is providing workshops in workplaces but also in my community for again, promoting awareness, guiding people. For instance, I delivered quite a few talks called the prosecco pelvic floor, so prosecco is a very common drink here in the UK. I’m still convinced most people came for the prosecco, not for the pelvic floor, but they left Lauren, with a lot of information about the pelvic floor and a little bit of prosecco. Okay. I’ve delivered many workshops about the menopause and for instance, World Day for Menopause. World Women Day are great opportunities for us physiotherapists to provide promotion, awareness and education. So I think that’s a very long answer to your question about education. There are many ways to educate, but let’s remember that education is a strategy. It’s a tool to empower people. So I suppose my aim is not to educate. My aim is to use education to help empower people. Is really what I wanted to say.

Lauren Redfern [00:15:20] Yeah, it’s interesting because that leads on to my next point, really, which is on the importance of empowerment because in the I’m guessing from this prosseco and pelvic floor was that aimed at women healthcare professionals or a combination of both?

Deborah Thomas [00:15:33] So I did both actually, so healthcare professionals – I don’t think we provided prosecco. There’s an opportunity there still Lauren!

Lauren Redfern [00:15:41] Let us know healthcare professionals, if you’d like some prosecco with your education.

Deborah Thomas [00:15:45] Absolutely. Do you know, I think because it was easier to get the healthcare professionals here without the prosecco, yeah, because, you know, so many women don’t actually appreciate that there’s an issue that needs discussing. And that’s why the prosecco helped bring them through the door. Not that I’m encouraging drinking too much prosecco here!

Lauren Redfern [00:16:02] I mean, I think completely, as you say, if it can get people in a room and talking about the importance of it and feeling empowered to actually have that conversation, I can see it as a really great way to engage because I think that was the point I wanted to lead onto is, is the importance of empowerment and how we can instill confidence not just in healthcare professionals, but, as you say, in women themselves, to be able to advocate and ask for the care they need, how they can do that. I mean, obviously it would be wonderful if we can all access workshops to do that. But in the meantime, you know, I’d be keen to hear your thoughts on how we can best empower women really to advocate for their needs when talking to a healthcare professional.

Deborah Thomas [00:16:43] Absolutely. And I actually think, again, it’s there’s more than one way here. This is a two-way and three-way process. One way is through podcasts like these. And hopefully women will listen to this and then decide to discuss this maybe with their physiotherapist. Or, for instance, if I can empower other physiotherapists who are not necessarily pelvic health physios and maybe don’t feel too comfortable asking too many intimate questions. But if I can give them a few pointers to say, you know, ‘if you notice the pain isn’t improving after your treatment, if you notice a woman isn’t doing the exercises that you’re giving her, if you ask her a few basic questions. So this is what I’d go through in my workshops with them, and then maybe it’s a good idea for you to refer her to pelvic health physio’. So this is me empowering other physiotherapist to empower women. Many women that will come through my door again, they might come for knee pain, for hip pain, for hand pain, for a breathing problem, will invariably walk out with leaflets with recommendations to read certain books to this website is great. The Menopause Charity website have a really, really lovely, easy to use menopause symptom checklist. So for many physios I’ll say, ‘you’re not sure what to ask? Get your woman to fill that checklist. If it looks like there are a lot of symptoms there, refer her on to pelvic health physio’.

Lauren Redfern [00:18:15] One thing I wanted to ask in the case of Alice, obviously she came to you and at the point she was referred to you, she was on Pregabalin, Amitriptyline and a separate SSRI, all for the management of her symptoms. And I wondered in terms of the role of a physiotherapy, because I don’t think we think about necessarily physios being able to prescribe hormones, but necessarily thinking about hormones as a possible form of treatment. And I wondered, for a physiotherapist at that stage, obviously you would refer back to a GP with the recommendation of possibly exploring hormones. And I wondered what your thoughts were. And I mean, obviously with your experience, that was something that you flagged and were able to go ‘Hmm, I think maybe this could be perimenopause and menopause’, but obviously if someone wasn’t aware of that, what do you think we can do to really give people the tools to feel comfortable referring back to a GP if they’ve referred to you to say, ‘yeah, maybe some hormones here might be a good idea to try’.

Deborah Thomas [00:19:12] I think we need to tread carefully here, Lauren. Ultimately, as physiotherapists, we can’t prescribe hormone treatment, but we do understand how hormones will affect joints, cartilage, soft tissue, pain. And so we do have that understanding. And with Alice, it was a very staged approach because at no point do I want her to feel threatened. She came to me in a high state of threat anyway. I didn’t want her to feel bulldozed. It was very, very staged and I suppose I went with her pace, whereas I suppose to me it became quite obvious that we’re dealing with menopause here. She was actually nine years postmenopausal, Alice specifically. I had to tread carefully because of course she had this concept in her mind of fear of cancer. So we started with her, first of all, with addressing movement and exercise, and that led me on to the fear and the fatigue. And then I think it must have been two or three sessions in then I said to her, ‘Have you considered how the menopause might be part of this?’ You know, I can’t write to her GP about considering hormonal treatment here before I’ve discussed it with her.

Lauren Redfern [00:20:28] Absolutely.

Deborah Thomas [00:20:28] And then we started chatting. I think what happened with Alice, Lauren, actually is we decided to use acupuncture as a treatment tool. And while I was acupuncturing her, I speak to her, I chat to her. So this gives me a lovely opportunity to discuss other issues with her. And that’s when I recommended she read a leaflet and a book, and I directed her to a few websites that are trustworthy and evidence based. And I said, you know, maybe it’s worth you having to think about this. So you start sowing seeds slowly, slowly. And then she came back and she said, ‘Oh, could we have a chat about the menopause?’ And I said, ‘Yeah, absolutely, let’s have a chat’. And then when it became clear, I said to her, ‘Maybe I think it might be a good idea to do a trial of some local estrogen. And I’m happy to write to your GP about this. And when I write to the GP, I can say what I recommend’. And so it was very, very staged. So at no point she feels like she’s being, I suppose, railroaded into something. And at the end of the day it’s her decision. It’s not mine. She can say, I don’t want that, and that’s absolutely okay.

Lauren Redfern [00:21:39] Well, I think also what you’re kind of getting at in that response, which I think is really important, is the creativity that needs to come into practice and the, you know, that sometimes the thing that you’re able to offer as a physio is that care, that consistency of seeing you week by week and having those sessions where the more you have those conversations, the more you learn about the patient and the more you might flag like this could also be going on. So I think that’s really interesting in that response to kind of think through the importance of practice when you’re talking to patients, to really listen consistently over those periods of time they’re seeing you about all the little piecing of the puzzle together I suppose.

Deborah Thomas [00:22:16] One of the main skills that we develop with time is to be good listeners and for people to come in to meet us and to feel comfortable, to feel that you are not threatened here. You have got the time. We will listen. We will discuss. There are no taboos and we’re going to take things at your pace so people might not come every week. It very much depends how often they come. Quite often we will do consultations that actually over a Zoom video phone, whichever, we’re very creative now. But we need to listen to the subtleties, and you develop that over time and especially in pelvic health, you know, we’re dealing with such intimate issues, sexual dysfunction, relationships. I mean, I’m not a relationship counsellor, but how often do I talk to people about their problems with sex and intimacy because it’s all part of this. So the first thing is for people to understand we are on their side. We are here to advocate for them. Okay? And we address the mind and the body. But it’s so important to get people moving and reduce fears of movement and get people exercising, Lauren.

Lauren Redfern [00:23:30] And I think on that, one of the things I wanted to address with you is it’s so important, as you say, to get people moving. But there are barriers that exist when it comes to exercising. If your symptoms include things such as tiredness, fatigue, lack of energy, aches and pains, bowel and urinary issues, it’s probably all going to make exercise the last thing you want to engage in. And I wondered if you had any thoughts on how we could address what seems to me maybe a bit of a vicious cycle, you know, not wanting to exercise because actually there’s fear involved. You know, I don’t want to necessarily go to a class where I jump up and down in case I leak or I don’t really feel like going out jogging because I’m extremely tired. I wondered what your thoughts were.

Deborah Thomas [00:24:13] Very good question and very important question, because it is a vicious cycle, and I am a little bit brutal when it comes especially to this time of life. I will say to people, exercise is non-negotiable now in perimenopause and menopause as in exercise is extremely important. I might term it physical activity, I might term it exercise, but we have to find a way to get you moving, reduce fear of movement. And I do say to people, what do you do for exercise? What physical activity do you take part in? And quite often they’ll say, I don’t because of the reasons you mentioned here, Lauren. And I will say, is that because you don’t enjoy it, is that because you don’t have time? Tell me a bit more about it. What happens? So again, let them have the space to speak and open up. In my head, I am thinking barriers to exercise. Let’s identify barriers and work through them. Incontinence is one of the biggest barriers to exercise and I want to remind all the listeners that we’re talking about incontinence of bowel, bladder and wind. Embarrassment is a very big factor here. Just this week, I spoke to a woman who now isn’t going outdoors at all, so she bought a treadmill to run at home. So essentially what she’s done is she, to a degree, addressed her barrier by now, becoming housebound with her exercise. So rather than solving the problem of the leaking, she just decided to look indoors rather than outdoors. So she is exercising, but now we’re dealing with the leaking as well. Okay. Prolapse symptoms are a huge barrier to exercise. And what we’re discussing now could be a little checklist for physiotherapists who are not in pelvic health or for women, listening, thinking, hang on a minute, this is something that we can deal with and address, musculoskeletal aches and pains, knee pains, back pains, hip pains. Some people will avoid exercise because they think that if it hurts, it means that they are damaging themselves. So they should stop exercising. And that’s actually not true. So come and get assessed and let us help you. Again, fatigue and poor sleep. One of the worst things again. So I as a physiotherapist can say to a woman, do 20 of this exercise three times a day, but she’s not going to do it if she’s shattered. Anxiety is a big issue. Lauren, a lot of people have started developing body image issues. A lot of women do tend to put weight around this time of life. They don’t want to go out and be seen in leotards and what have you. So there’s a big kind of body image anxiety issue that we come across and deal with. Balance changes, and the less people move and exercise, quite often the worse their balance becomes. And this is very important to this age group because we want to prevent falls. I suppose there’s one more point I just wanted to make here quickly, Lauren, if that’s okay. If as a physiotherapist you are noticing that your woman is cooperating with the exercise regime that you’ve given her, but she’s not improving, she’s not getting stronger. So the way her body’s responding to the exercise is not, as you would expect, that in the way she should light a little light in our brain to think, could this be hormonal? Could this be lack of estrogen or even a lack of testosterone? That is part of this, which is a topic for another talk completely Lauren.

Lauren Redfern [00:27:37] I wanted to address something that you said there around anxiety and it was something we mentioned in Alice’s story. And I found really interesting when you chatted with me about that particular patient was that you did do a bit of mindfulness work with her. Now, obviously, I think for some physios they wouldn’t necessarily think about mindfulness or mental health intervention as within the domain of physiotherapy. But I thought it was really interesting that for you, you know, you discuss how these practices kind of go hand in hand, that it’s a holistic approach that, you know, exactly as you say, if you’re feeling anxious, if you’re feeling stressed, if you’re feeling embarrassed, you are less likely to exercise. And yeah, I wondered your thoughts on how you might introduce some of those basic practices into physiotherapy, if there are any healthcare professionals listening who are interested in thinking about that.

Deborah Thomas [00:28:22] So I think traditionally physiotherapy was very much considered a bodily practice. I suppose what I mean by that is that the way we treat the body, we don’t treat the mind. Very happy to say that things have moved on significantly in the past 10, 15 years. We can’t separate the mind from the body and there is ample research and evidence now to show how mindfulness practice can change things physiologically and can help empower people and is a tool that we can use in our practice. Of course, you have to work within your scope of practice, so if you are not trained to teach the skills, you can’t say, I taught her mindfulness, okay, but we all know how to teach breathing exercises and some of us are trained to teach relaxation sessions. So this is still very much part of physiotherapy intervention. Okay, this is a way to address pain, to reduce threat, to get people reconnecting with their body and to give them a tool to help themselves. So this is part of the empowerment we all breathe all the time. Okay, so wherever you are, you’re out in a café, you’re outside exercising, you’re sitting at home and excuse the language, you’re getting your knickers in a twist, because you’re worrying about something. First thing you go to is your breath, calm everything down, get all your ducks in a row, start again. So I suppose all of my treatments include mind and body. You can’t separate it sometimes you’ll start from the mind and not from the body and sometimes the other way round. Sometimes physical exercise helps calm the mind. And then you can do your mindfulness breathing exercises, relaxation, meditation. So there’s no one way that is the correct way here. But we must all remember that people who are in pain, people who are anxious, we have got to calm threat down. Even if they don’t know what the threat is, they’re in a state of threat.

Lauren Redfern [00:30:28] Yes. And I suppose on that, the pain management that can also be assisted and helped through appropriate kind of mindfulness work and paying attention to those thoughts, too.

Deborah Thomas [00:30:39] Yeah, absolutely. And I think specifically in Alice’s case, what frustrated me as a physiotherapist was, and I think it’s the state of where we’re at at the moment, is I think it was the right thing to give her time off work because the work environment was actually adding to her stress and pain. So she needed a pause. She needed a break. However, beyond drugs that she was given and very, very strong drugs. And I’m not a pharmacist, I’m not a doctor, but I would query the amount that she was on, the combination. She was not even provided advice to go and seek talking therapies to move and exercise. To the contrary, she was terrified of sitting and luckily the specialist referred her to me. But I suppose what I would like to develop more and more, and this is why I work on so strongly, is for a GP, for instance, to identify that she’s a prime candidate to be referred to physiotherapy. So the aim would be to gradually take her off the drugs and medication and at the same time increase her ability to self-manage, to have tools to help herself.

Lauren Redfern [00:31:48] Absolutely. I think actually, sadly, that’s all we’ve got time to discuss today, Deborah, which is a shame, because I think there’s so much on this topic and I hope you’ll actually come back and talk a bit more about some of these topics, maybe in more detail. We can do a whole session on pelvic floor or embarrassment and barriers. But I just want to thank you for taking the time to discuss with me the important role of physiotherapy in treatment of menopausal symptoms. And I wondered if we might end today by asking if you had any take home messages for those listening? Any particular messages that you wanted to emphasise?

Deborah Thomas [00:32:21] Yeah. Thank you, Lauren. I suppose my take home message is perimenopause and menopause is a normal stage in a woman’s life. I would like to help women be prepared for this so it doesn’t catch you unawares. It’s not all about HRT. HRT or hormone replacement therapy, in my opinion, can play a significant role. But I want to remind people that exercise is extremely important. Movement is extremely important. Finding ways to manage stress, improve sleep. And really we need to think about the future, not about the current symptoms, of brain health, bone health, heart health. We have to think about women’s health in the future and be proactive and promote these things. And this is where physiotherapists are absolutely a prime position to help. So if in doubt, refer yourself to a physiotherapist in areas that you can or ask a physician or a specialist to refer you to physiotherapy if that’s what’s needed. But we are here to help you and we’re here to advocate for you. And that’s really what I wanted to get across today, Lauren, just to make people aware that we’re here.

Lauren Redfern [00:33:32] Yeah, and it was fascinating chatting today, Deborah, so thanks so much for joining me.

Deborah Thomas [00:33:36] Thank you very much.

Lauren Redfern [00:33:40] We would love for you to join our collective of professionals passionate about the menopause visit and NHMenopauseSociety.org to become an associate. You’ll receive regular webinars and advice from our experts as well as opportunities to network and connect with the latest research from around the world. You can follow us on Twitter at @NHMenoSociety. And don’t forget to tell your colleagues about the Newson Health Menopause Society.

END.

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