Podcast Episode 17: Early interventions in the perimenopause and menopause with PhD candidate, Nichola Walker

Increasingly we are recognising that the symptoms of the perimenopause and menopause can be easily overlooked, both by those experiencing them and by general practitionePhrs. Being able to appropriately ‘prepare’ for the onset of symptoms is important and evidence suggests that adopting lifestyle modifications early, can prove to be a key component of symptom management. Joining host Lauren Redfern on the podcast to discuss her ongoing PhD research exploring the benefits of early non-pharmacological intervention is Nichola Walker. Nichola is a Registered Nurse who has extensive experience of working with at risk and vulnerable groups. Together, Nichola and Lauren discuss the importance of recognising that we are never too young to begin preparing for the perimenopause and menopause. Drawing upon her own research and other academic literature, Nichola highlights how simple sustainable changes to a person’s lifestyle can make a dramatic difference to their experience of the onset of perimenopausal symptoms. She urges healthcare professionals to consider the importance of and take the time to discuss these modification alongside HRT.

Before undertaking her PhD, Nichola completed an MSc degree in Health Studies & Clinical Research and an MSC degree in Pain Management. Nichola is a member of the NHS England & NHS Menopause Improvement Stakeholders committee and a member of the Staffordshire and Stoke-on-Trent CCG GPN Evidence into Practice Group. She is also a world traveller and has recently summited Mount Kilimanjaro!

Episode Transcript:

Lauren Redfern [00:00:06] Welcome to the podcast for the Newson Health Menopause Society, a multidisciplinary 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 specialties 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.

Lauren Redfern [00:00:43] 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] I often begin these podcast episodes with a story, an account shared by a particular person that’s been kind enough to, in their own words, communicate their experiences of navigating treatment for the perimenopause and menopause. These stories are selected because they relate to the particular topic being addressed in each episode. Whilst I wish I could say I spent hours searching for these accounts, sadly, it’s simply not the case. Whether it’s physiotherapy or pharmacy, there’s been no shortage of anecdotes detailing the specific struggles many are facing when trying to access care and support. In many of the accounts I’ve shared with you, you’ll hear me detailing a myriad of symptoms that may feel familiar to you. Perhaps you found yourself nodding along and recalling how you too went through that. Or merely relating to the experience of struggling to feel like you’re able to function normally or at the level you once did. Increasingly, I find myself considering the question, what if that didn’t have to be the case? What if, when it came to the perimenopause and menopause, we knew what was coming and were able to prepare accordingly? In doing so, it’s likely that I would no longer have to collect stories that detail the unbearable sensation of being hit by a freight train of symptoms that have the power to strip individuals of their autonomy. The primary method, of course, to look at making such a possibility a reality is to start with education and consider adopting early interventions in a person’s perimenopausal journey. Here to talk to me about just this is current PhD. candidate at Keele University, Nic Walker. Hi, Nic, thank you so much for joining me on the podcast and taking the time to discuss with us all the really interesting research you’re currently undertaking, exploring the benefit of early intervention. I wondered if we might start with you, just introducing yourself to those listening and telling us a little bit more about the work that you do.

Nichola Walker [00:02:58] Well, hi, and thanks for having me. I’ve listened to many podcasts from Newson Health, so it’s a great honour to be here today. So I’m Nic Walker, and I think I always introduce myself by saying I have menopaused and been through this journey and sort of got the idea to embark on this PhD to improve the way that we care for women in perimenopause. I think it’s very exciting to see the journey and the education regarding menopause and that end game, if you like, and knowing that we spend so much more time in our post-reproductive sort of stages of life. But I was really very interested in initially probably my journey and what happened at the very beginning for me. I’m a nurse. I’ve been a nurse for many years, I’d worked in sort of gynae, etc. and I found it very difficult to access the right information and treatments. When I started my sort of perimenopause very early. I was 40, 41, so I was quite young in that sort of journey. And even for me I was quite fortunate, I was referred to a gynae professor at the local hospital. I kind of went to the GP and said, ‘look, you know, I don’t really come here, but things aren’t quite right. Things aren’t going right for me’. I couldn’t sleep. I was fatigued. It was the muscle aches, the migraines, and I’d already done this kind of mapping of symptoms and times. So I was quite informed to do that originally. I went to the GP and said ‘I don’t come to you very often, but I’m really at this point now that I’m really quite desperate’. I was about probably 41, 42 then. And got offered antidepressants, which is unfortunately I think still what happens today. And I said, ‘look, you know, I’m not depressed. I know I’m quite down, but I’m not depressed. I don’t need to be even more dampened in symptoms’. And I went through this with probably a couple of years, and I was fortunate to get referred to this consultant, this professor in obstetrics and gynae, and went to see him and he said, ‘you know, my dear, you can pop this patch on and come back to me if you want to’. So it was kind of this thing that was… I was like, ‘Oh, okay, this patch is going to be great’. And he said, ‘And for those times, my dear that you’re tired, you just sleep, you have a rest’. And I was a mother of two and I was working and at that time I was studying for a master’s degree at the time as well and was like –

Lauren Redfern [00:05:33] When am I going to rest?

Nichola Walker [00:05:35] I can’t really do this, I can’t take a week or ten days out. So I had all faith in this HRT patch that I put on and it was a big patch and it kept coming off. And this was ten years ago. You know, we’ve moved on quite a bit now with patches and gels, which is really great news. And I really didn’t get on with them very well and I kind of got to like three months and said you know, ‘can I go back to see the Prof again because my GP doesn’t really know what to do with me’. And off I went to see the consultant or attempted to see him and had six appointments cancelled and moved. So I was now nine months without review and then I really started to look at how I could improve lifestyle modifications at that point, would it make any difference to any symptoms? And then it kind of went on for a few years and it was only probably 18 months ago, two years ago that I was looking at starting a PhD. But really what was I going to do that in? I wanted it to be very useful. I know that’s probably cliché. Everybody wants to, you know, you want to make a change. You want to, you know, impact millions of people’s lives, it does sound very cliché. And I kind of linked it, one or two sort of PhDs that I was interested in and then attended an evidence-based practice group at Keele University and this group is full of nurses and there’s GPs and ANPs etc. from primary care. And came this conversation about managing menopause and when do we start to talk about it. And I sat and said, ‘Well, what about perimenopause? Because I feel there’s a lot of work and a lot of people talking about menopause. But what are the most difficult times that we manage in our reproductive cycle for women is perimenopause because of those fluctuation of hormones’. And from there then it was just really ‘well Nichola, can you put something together? And I said, ‘Well, it’s so simple what I’m suggesting. And it’s something that when I’m just doing my systematic review for my PhD, that when I look at studies, it’s always like I’m not going to include them because they’re over 20 years ago. That as early as sort of 1990s people were talking about lifestyle modifications to manage perimenopause. But where did we lose that? Where has that gone? Because we were talking about it in the eighties and nineties. Research was being done in the early 2000s and then it just seemed to drop off a little bit. And then of course, came the NICE guidelines in 2015, the original. So yeah, so I kind of put this proposal together of when do we start to have this conversation with women? We need this conversation earlier with women. We need to identify it earlier. And there’s a foundation we can put in much earlier, as in lifestyle modifications to improve that journey through menopause and then beyond. So I’m certainly not anti-HRT at all, and I’m very much advising my friends to go get it and, you know, speak to healthcare providers, etc. But I’m really very passionate about if we put the foundation of the building blocks in early, you’re going to be very strong to go through that journey and you’re not going to be as desperate state and then hopefully by doing that, that when you do get to that point of probably looking at some of the pharmacological interventions, that you’re actually doing this with a more steadier mindset, you can make a more informed decision because you put everything else in place.

Lauren Redfern [00:09:08] And that’s so interesting and it’s lovely to hear your own personal story of kind of moving through the perimenopause and having that experience yourself. And I mean, I’m curious, I know people do do that change from, say, working in medicine and then moving to do a PhD. But for you specifically, was it your own experience of going through the perimenopause that kind of prompted that inspiration to change direction into kind of a more academic pursuit of actually feeling like, as you said, yeah, I really do need to make a change in this environment.

Nichola Walker [00:09:40] Yeah. And it was a really tough one as well because from a financial point, it was quite a hit, I was a Band 8, to go to a stipend…

Lauren Redfern [00:09:47] Yeah.

Nichola Walker [00:09:48] So I was hoping that would prove that I was quite dedicated to the cause. But I think initially you think it’s just you. And you think you’re being a nuisance. And I was a healthcare provider. And so definitely going from a very established nursing role to come into education and to coming to do a PhD was definitely fueled by what my experience was. But I think it was one of Louise’s podcasts a while back and she said she kind of started her sort of journey in menopause care by wanting to help friends. And I think you said she put some chairs out, and leaflets and these kind of things and all the friends came in. She wanted to make things better for her friends. And I – there were so many people around me that I was thinking crumbs yeah, this person was running a marathon and now all of a sudden she’s gained weight, she won’t train anymore, she doesn’t want to go out, she’s depressed, she’s not sleeping. And this wasn’t just one person, it’s a lot of people around. And I think I got to feel a bit more angry about it perhaps.

Lauren Redfern [00:10:51] Yeah.

Nichola Walker [00:10:52] So I definitely… when I sort of … it was sort of a platform of evidence based practice group at Keele was a platform. And when I started to talk about it more and then started to write things down and have a look, and I thought, I’m actually wondering if I can make quite an impact. You feel quite small yourself at the time. You’re not quite sure what impact you can have and where you can have it. Kind of see a few women that attend clinics that I run, and that’s the only impact I was probably having. So yes, it was definitely my experience. But then listening to a lot of people around and seeing that things don’t really seem to be… it’s getting there but it’s very slow, not improving probably as much for still that perimenopause sort of time.

Lauren Redfern [00:11:35] And you mentioned lifestyle modifications and early interventions and I’m wondering if you could just tell us a little bit more about your PhD research, specifically what you’re going to be looking at and how you’ll be conducting the research over the next few years.

Nichola Walker [00:11:48] What we initially looked at as an idea was non-pharmacological interventions, improving perimenopause symptoms in primary care. So that was really quite broad at the beginning. And then I did the literature search and 72,000 papers later for non-pharmacological intervention…I was trying to switch and changes and it was coming down to 36,000 and I remember the look on Rachel at Keele, great librarian there who was working with me, and she was like, ‘Nichola, we’ve got to do better with this’ and I was like ‘Well there’s just so much out there’. And so we started to really refine that and I said, ‘Well, you know, we could look at non-pharmacological, but we’re now going to be pulling into that hypnosis every kind of element of non-pharmacological’. And so I said ‘We need to refine this probably to non-pharmacological, but looking at the impact of lifestyle modifications’. So stage one really of the research, I’m just two thirds of the way through the systematic review, we’re just on full text screening at the moment. And the systematic review we’re really trying to answer the question now where I am is ‘Can non-pharmacological interventions such as lifestyle modifications improve perimenopause symptoms?’ So we want that information to almost then fuel the next stage of the research. The next stage will be, I think, it’s going to be qualitative interviews, qualitative research. And that may be… I may just do that as open interviews where a number of women experiencing the perimenopause, and then we’re going to get those ideas and pull those together. And then we’re going to look at the healthcare professionals and probably do Adelphi consensus of what they think the information that we’ve got and say, ‘Well, look, this is what systematic review has pulled out, for what we need for lifestyle modifications and the way that we would educate women about this. This is what the women that I’ve interviewed say that they want in perimenopause intervention. And what do you think? How do you think you can apply this?’ And get that consensus of what would be potentially a model consultation. It may be that there’s a consultation out there that people are using and we marry those together. We’ll look at rolling that out probably in the final year and trialing it to see if this model of consultation, the one that’s there is working or that we’ve developed one or I’ve developed one from there. So that’s really in a nutshell.

Lauren Redfern [00:14:26] And I’m wondering if you could tell us in the context of early intervention, why you think it could prove beneficial and helpful not only to women experiencing the perimenopause, menopause, but also to our medical system more broadly, because you sort of just touched on that, right? Sort of a model consultation. But yeah, what it is that you feel about this approach and really getting that early intervention, that would be beneficial?

Nichola Walker [00:14:49] I think one of the things that we probably underestimate, I think particularly for women, is that we don’t think this is going to be as bad. We think we’re going to probably approach the menopause, have a few hot flushes. We all have those images that float round on Facebook, you know, this woman with the fan and everything’s lifted and she’s fanning herself down and it’s oh she’s having a moment. I don’t think we’ve realised the huge impact it has on us as women, everybody around us, the impact on general living and just getting through the day. And I’m not sure if that’s from a woman’s perspective, but equally from a healthcare professional, we underestimate this early intervention. So when a woman turns up and she might be 35 or 40 years old, we need to get the intervention in early. This woman might not be menopausal then or having symptoms to that degree. But getting the interventions in – and I still think we in the medical profession follow that medical model, there wants to be a prescription and a lot of the time women want a prescription, they want to make this better. When actually we’re looking at long term effects of this. By us identifying it earlier and just talking about it just generally earlier, has to be done because we are now looking at preparing women physically and mentally for what’s coming, because I think that’s one of the biggest failings as we grossly underestimate that until we’re really sort of quite desperate when you think oh crumbs, I probably should’ve done something. And I think one of the difficult things about perimenopause it seems as though it’s quite difficult to diagnose when you’re a healthcare professional. You know, this woman comes in, she’ll say, you know, she might be 41. And there’s almost this little bit of skepticism about diagnosing that early, not wanting to miss something. It’s different when you’ve menopaused and you’ve not had a period for 12 months. Oh, great, the evidence is there. But it’s a little bit more difficult – over the age of 45, we don’t need to do FSH hormone tests, we know that – but between the age of 40 and 45, it’s one of those that, we can still investigate all the elements of the symptoms if we think there’s something to investigate, but we’ve got to be talking about lifestyle modifications earlier and prepping earlier and not almost making women depressed that come to see us. That would be something. You know it’s almost like ‘happy 40th birthday!’, and on your 40th birthday, we’ll send you this leaflet of ‘Do you know what’s about to happen? You get to have a miserable ten years and then beyond and…’. So we’re kind of going to look at how we capture these women as well. You know, there’s obviously these ideas about sort of group consultations, you know, that we’ve seemed to have stumbled on through sort of COVID, etc., and, you know, video consultations, you can get groups of people. So we know we can get large numbers through. But we do have women that attend any healthcare provider, and it’s an opportunity to say, ‘Well, how are you doing? Have you thought about these? And what potentially, now you’re going to be on this journey of…?’ So how we do that is going to be interesting. Finding out what women want, when they want, like discussing how they want it discussing, because I think it’s very hard as well, say a lady’s come in for some other symptom, perhaps a rash or whatever on a leg, you know, and then all of a sudden you start talking about perimenopause because she’s 40. But we know that there needs to be a platform for this early.

Lauren Redfern [00:18:40] Yeah. And I think even just creating I mean, I thought it was really interesting talking about the possibility of a group consultation, you know, so even just facilitating environments where women have access to speak to other women that are going through the same things that they are because I think it’s something that we’re really growing through the society and seeing is that we can be a wealth of support for one another, you know, to feel that there is access to care, even not through your primary practitioner.

Nichola Walker [00:19:04] Yeah. And it does. I think one of the things that COVID has done is that it’s we’ve got into this digital age now where actually it’s quite normal now, I think, to have this phone call from your GP or… but I think particularly when we looking at, probably putting those platforms out that GP surgeries are already stretched and they say, ‘Well we want to identify this early, we want to be proactive, not reactive’. And that’s really what we’re trying to do. We’re always trying to do that in healthcare, always. But I think particularly in perimenopause, knowing this journey that is potentially going to be ahead, the impact that’s going to have on everything around it, that actually a group consultation may be a way forward. It may be platform when actually in an hour you can probably have ten women sitting on a video call. That wouldn’t be for everybody. But it’s a way that could be explored, I think, as well. Yeah.

Lauren Redfern [00:20:02] I wanted to ask you as well, so you mentioned that you’ve had a pretty amazing journey through the perimenopause. And actually, when we first connected, you were unable to speak at that time because you were hiking Mount Kilimanjaro. And I wondered if you could tell us a little bit more about this and specifically what moved you to take this amazing adventure on and yeah, I know that you still continue to travel and it’s a big part of your life. And yeah, I just wondered if you could tell us a little bit about that because it’s really interesting.

Nichola Walker [00:20:32] Yeah, well, I’ve kind of started the sort of perimenopause when I was sort of 40. And I remember it was my 40th birthday and I thought, crumbs, I don’t want a party. I don’t want people all around. And I think I was probably at the beginning of this because I wasn’t like that before, but I just had this whole overwhelming feeling of being 40 and everybody coming. So I hiked my first mountain, which was Snowdon for my 40th birthday, and I remembered feeling really exhausted. And I came down and said, ‘Oh crumbs, you know, that was amazing’. So every year from then I set a challenge and that was really to keep my mental health good. It kept me focused, kept my mental health good. So I tackled really…I went and trekked with my son, so we did Mount Fuji, Great Wall of China, so we started to potter around and then I took on Everest base camp.

Lauren Redfern [00:21:27] Wow.

Nichola Walker [00:21:28] So it was a big one, I’m not going to lie, but it was an intense 12 months of training that I really dug into doing, and I realise now how exhausted I was because I was obviously perimenopause. The menstruation was very difficult. I could be on a period for 20 days and I remember being so annoyed because I’d got this bag that I could take up to Everest base camp and half of it was packed with tampons and these kind of things. And I was just like, I haven’t got the space for this, by the time my sleeping bag was in there… and that was the logistics of trying to do something like this and it was January and we were in a trek team going up and it was incredibly cold about –30. So there was all the logistics of being on a very heavy sort of time of month and obviously it comes at this time. But I quickly realised that albeit I was incredibly exhausted, it kept my mindset very good and very focused. So yeah. So I went off then and did Machu Picchu, trekked through the Sahara Desert and then went to Mount Toubkal in Morocco and then just summited Kilimanjaro. And it really does work to keep you very focused, and for me it was this journey of knowing I’ve got the symptoms I’ve got, through the perimenopause, but it was a form of distraction. My diet had to be good, I had to train. But the sense of achievements as well. Even if I didn’t summit, I’d always got this in my mind, look, if you don’t submit, Nichola, you’ve got on the aircraft and you’ve got there and then when you do and you’ve not slept for days, then you know there’s people in their twenties and you’re here, you know, you think you’re getting on a bit and you think well actually no I’ve actually worked hard and I’ve achieved that. So it was definitely the mountains… and last year I took on my first ultra marathon and I’m just not a marathon runner and that was because of COVID. It had stopped my mountains and travelling. So I signed up for Hadrian’s Wall Ultra Marathon, which was 72 miles and I did it just over 21 hours. And again, it was keeping the focus, putting something in place for me to aim for because you show up for your family and you show up for everybody else. It’s different when you sit back and say I’ve got to show up for myself because I’ve set these targets. And it’s been an incredible ten year journey. And the next one is K2 Base Camp Pakistan, next year.

Lauren Redfern [00:24:03] Amazing. I’m going to have you back to tell us about it as well. It’s a slight departure from what we’ve been talking about, but I know that you’ve previously done some work in in prisons. And I wanted to take the opportunity to talk to you a little bit about health inequalities that are kind of deeply embedded in any conversations about the issues with perimenopause, menopause. You know, as we saw earlier this year, getting hold of HRT is not always easy. We have women, you know, swapping HRT in car parks. And I wondered in your experience of working with populations without routine access to healthcare, where they might be able to get, you know, HRT and things that they need. In your opinion, what do you think we need to think about with these issues around access and in many ways whether this is a breach of rights really to our citizens in not being able to access treatment that they need.

Nichola Walker [00:24:54] Yeah. I mean, I’ve worked in a female prison estate for about ten years and I’m actually on out of hours there this evening. So I do a couple of evenings still a week. I do have to say that I think the care provided to women, certainly in my GP surgery and it is still NHS and it’s still HMP– so Her Majesty’s Prison – so it’s not privatised, so I can’t really say for those, but we have a prison estate with over 300 women. Some of the problems we experience is that we have a revolving door. Patient, prisoner licensing laws changed a couple of years back, so women would be sentenced for a lot longer terms, whereas with licensing laws we can now have women sentenced for just two weeks or ten days. So there’s this one element of the patient population, the prison population, and this is the revolving door. They’re always in and out, but they’re in for such short times that if we initiate any treatment, particularly for perimenopause, menopause, the GP has to follow that up. Some of these girls don’t even go to the GPs. There’s a lot of drug addictions, etc. So what we start isn’t always communicated with GP surgeries and attendance to healthcare providers doesn’t really happen for probably a third of the population that I work with. Then we have, what we call, the lifers. We have the women who are with us for many years. And I think what we’re finding is and we’re not quite catching up yet, is that women that have been with us for perhaps 10 years, 15 years, have got older. So they weren’t what we had ten years ago. They have actually gone through this journey and they aren’t informed about perimenopause. They have a television, but there’s no sky TV. You know, despite what people think about some prison estates, ours hasn’t got that. So unless it’s kind of seen on a programme, perhaps Davina, then they’ve got to watch it, so they don’t always get access to that information. We do have very good healthcare, general healthcare clinics that are run Monday to Friday. So if that woman’s got symptoms, she can turn up saying, ‘look, you know, I’ve got these symptoms’. And I would say that we would start treatment and this may be a blood test. People still seem to want to do this. That continuation of that treatment, I think is followed up quite well. Referral into secondary care doesn’t seem to happen. I think it’s quite funny at the moment and really quite sad that what we’ve got at the moment is posters around and it’s in the reception area of what we class as our GP surgery and there’s some posters and it generally says, you know, menopausal symptoms, hot flushes, night sweats, migraine, and there’s a few symptoms dotted. So if any women are sitting in that waiting area, this is what they look at and they’re just like, ‘oh, my goodness’. So it’s almost like we’ve… there’s this information there, but we’re going to give you very little information. We’re just going to put posters around and eat a healthy diet. That’s very challenging in a prison. Now, women can access the gym, but there is still this element of… there’s less than £2 to feed a prisoner every day. So there will be a lot of beige on the plate. So there’s chips and there’s beans and there’s all these things. So I think there’s different categories of women within the prison service. We’re failing one group because they’re in and out. Starting treatment is very difficult managing that after our withdrawal programmes. The second element is we have got an ageing population within the prison now, more so than we’ve ever had and I think probably what would be good is to actually run menopause clinics within that environment. And it’s almost as if there’s a few women that come in from the GP surgery from the community who are prescribed HRT and we will continue that and that just seems to go on. So that seems okay. But there’s quite a group that have aged and we’ve not really caught up. I don’t work during the days at the prison anymore, I stopped that a while back obviously starting my PhD. I do out-of-hours so I just continue with scripts etc. But that’s the areas and that was the challenge that we’ve got I think at the moment is informing women, really letting them know what options are out there, be more aware of the symptoms, being aware how to access. So yeah, so there’s a lot of work to be done, a lot of work.

Lauren Redfern [00:29:52] Which I think also really echoes the importance of the research that you’re doing around early intervention and non-pharmacological interventions that you can try and implement early. Because if this is information… I know at the society, we’ve been talking more and more about implementing education actually within, you know, secondary schools as well to go this should be learning that we have at a young age to know what we’re expecting. And I think within that, you then have an informed population that knows what to expect when it’s coming, as you say that it doesn’t hit them out of the blue. I wondered if you had any advice for anybody listening today that might be considering a shift from their sort of current role in a medical field to undertaking research. Yeah, how you found that and any advice that you might have to offer really about that, how that’s been for you and what you might say about that?

Nichola Walker [00:30:38] Yeah, I think for me, because I was a little bit of an older student, I had some challenges, a couple of universities, because I couldn’t produce my CSE’s from 1987, albeit I’ve got a degree and two Master’s degrees. And so yeah.

Lauren Redfern [00:30:54] That’s a whole topic for another one.

Nichola Walker [00:30:56] Yes, yeah, that was very challenging. I was kind of this age where I could… I was like, this is the research I want to do. But I think generally, the advice is you can do it. We can all make a change and do it when you think about. Don’t keep putting it off thinking I can’t step up to the plate. I heard a lot of people say, ‘Well, I did a degree in nursing or I did my degree in medicine and never again. I’m never going to study again’. And I just think it gets so much better, as you progress through the academic journey because you do your Master’s and I went on and did another Master’s because I was still a bit scared of PhD and that it kind of got to this point that I thought, I have to grow up a little bit now. And then I had a lot of doors shut because it was COVID, and there was one university who accepted my research proposal and there was funding. And then I got advice to add a COVID slant to the research and I said, ‘I’m not adding COVID to perimenopause’. So I think the advice really is not to give up, you know, continue to do what you want to do and don’t be afraid to be knocked back because we can make a difference. It’s cliché, and that’s why I still keep going back to it’s we can make a difference. This is a field that is growing rapidly and this is really something that I wanted to be involved with.

Lauren Redfern [00:32:22] Yeah, absolutely. And I think even just the conversations, the topics that we’ve touched on today, you know, it’s so important to remind people that if they have an idea about ways to improve the lives of over half the population that are dealing with, you know, symptoms that are affecting their quality of life, you know, go for it. I think, sadly, that is all we have time to talk about today. Nic, thank you so much for joining me. I just I’m ending these podcasts really with asking guests if they have any take home messages for those listening. So anything on early intervention, anything on non-pharmacological interventions you’d like to share with that as a take home message, really.

Nichola Walker [00:32:57] So I think the take home message really is start as early as you can. Don’t wait until you get to this later age of 40 years and your symptoms are now desperate. Put the foundation in early as you can. And it is a very simple take home. Eat as well as you can. Still enjoy your time but eat as well as you can, exercise, it doesn’t always mean running an ultra marathon. It means going out for a walk with the dog.

Lauren Redfern [00:33:28] We’ll all be expecting you to hike Kilimanjaro.

Nichola Walker [00:33:31] So when I always say take exercise people are like ‘Oh my goodness, really Nichola?’. It’s a walk, it’s being consistent, reducing your alcohol, stopping smoking, drinking water, hydrating. One of the best things we can do is drink 2 to 3 litres of water a day but early and prepare for it. Be proactive so we don’t have to be reactive. And I think that’s probably the take-home.

Lauren Redfern [00:33:58] That’s great. Well, thank you so much, Nic and I look forward to speaking to you next year when you’ve done your next summit.

Nichola Walker [00:34:04] Yes. Thank you!

Lauren Redfern [00:34:09] We would love for you to join our collective of professionals passionate about the menopause visit 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.