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Podcast Episode 6: Recognising the perimenopause and menopause in patients with existing health conditions with Dr Sarah Ball

Podcast Episode 6: Recognising the perimenopause and menopause in patients with existing health conditions with Dr Sarah Ball

In this episode of the NHMS podcast, host Lauren Redfern is joined by Menopause Specialist Dr Sarah Ball to discuss the ways in which the perimenopause and menopause may be missed in patients with other long-standing health conditions. Drawing upon her own experience as a GP, Sarah outlines how a commitment to asking simple and straightforward questions can prove important in helping to distinguish between the re-emergence of an existing condition, and the onset of perimenopause and menopause. Using a number of interesting examples, this episode urges clinicians to keep menopause on their minds, even in instances where it seems an unlikely culprit.

Dr Sarah Ball is a GP and Menopause Specialist currently consulting as part of the Newson Health team. Dr Ball has extensive experience in working with perimenopausal and menopausal patients. She finds the process of empowering women to understand their menopause journey and access appropriate care and treatment highly rewarding.

You can follow Dr Sarah Ball on Instagram and find her on Twitter.

Podcast 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 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] Sofia was 51 when she first met her GP, Sarah – an insulin dependent diabetic – Sofia had been in good control of her diabetes for over 25 years. When she came in to see Sarah, however, Sofia was anything but balanced. Clutching a piece of paper from the DVLA, Sofia was in tears and explained to Sarah that her driving licence had been suspended due to the repetition of supposed ‘hypos’. Sofia was naturally distraught. At the time of Sofia’s visit GP, Sarah, was working on an audit for the surgery in which she was asking women of perimenopausal and menopausal age about their periods. Though Sarah was aware that Sofia’s presentation likely pointed toward the management of her diabetes, she still reserved herself to ask the question to still enquire about Sofia’s periods. To Sarah’s surprise, Sofia responded that they were actually indeed irregular. Enquiring more about the supposed hypos, Sofia explained to Sarah that there had been excessive night sweats, palpitations, all accompanied by poor sleep. It was from these symptoms that Sofia had concluded she was struggling with regulating her diabetes. Sarah, however, in staying true to the audit, realised that Sofia may in fact be struggling with the perimenopause. As such, Sarah decided after a thorough assessment that Sofia may be perimenopausal and prescribed her HRT. Within a few short weeks, Sofia had vastly improved and her symptoms had all but subsided. She was able to regain her licence and in doing so, her independence. I wanted to share with you Sofia’s story as a way to begin today’s discussion in which will be thinking about the ways in which the perimenopause and menopause can often be missed, particularly in patients who are being treated for other long term conditions. To help me tackle this topic is the wonderful Dr Sarah Ball, who was mentioned in Sofia’s story. Sarah is currently consulting as part of the Newson Health clinical team and as well as being a GP, Sarah has a particular interest in reproductive health and a postgraduate qualification in obstetrics and gynaecology, family planning and practical contraceptive techniques. Hi Sarah, thank you so much for joining me today. I wonder if we could start with you, just introducing yourself to those listening and telling us a little bit more about the work that you do.

Sarah Ball [00:03:21] Yes, of course. Thank you, Lauren. So yes, I’ve been a GP for over 20 years and my career, I suppose, changed to the one that it is now by meeting Louise Newson about five years ago now. So now I am a menopause specialist and I also contribute to the Newson Health Menopause Society really as part of the ripple effect because of what I learnt triggered by Louise, and what that’s set off. We really want to ripple that on to all healthcare professionals and the public across the country, but also across the world, which is why it’s amazing that we now have this platform to do it.

Lauren Redfern [00:04:00] Thank you for sharing that, and I wondered if we could begin really with thinking about how in the story we started with, I mentioned that you were undertaking an audit and that that was perhaps part of the reason you were able to spot Sofia’s presentation of symptoms as something that could maybe be more than her diabetes management. And I wondered if you tell us a) little bit more about the audit and what moved you to undertake it, but sort of b) what you felt you managed to achieve as a result from that?

Sarah Ball [00:04:31] Yeah, it turned into something huge, actually from a silly little thing, almost so I’d always been into women’s health. I always felt reasonably confident with contraception and menopause and anything to do with kind of female healthcare, really. But maybe and probably definitely in retrospect with all the furore after the Women’s Health Initiative study and all the seeming complete confusion after that, I don’t think probably anybody had ever as a healthcare professional, got back to the point where they felt completely and utterly as confident as we had sort of before the Women’s Health Initiative study. But then in 2016 when the NICE guidelines came out, I think that was probably the catalyst which sort of propelled Louise back into really going forward with menopause care. And I happened to meet her for the first time ever at a lecture, and it was literally that one hour of my life, which was mind-blowing because it was just simple, straightforward, understandable, empathic, but with evidence behind it. And basically, the message that I got at the end of that lecture was actually the menopause is everywhere. And once you see it, you can’t unsee it. And I just thought, Oh my goodness, I thought I was doing this, OK? You know, I thought I was keeping up and actually go, Oh, actually, I haven’t really thought of that, hadn’t thought about that side of the symptoms. And so I thought, right, I have to do something about this. I can’t just, you know, you don’t just write this up for your CPD and then don’t do something about it. You know, we used to get points in our appraisal for impact if there was impact from something you’d heard. So I went back into my surgery and I decided that for the next two weeks, for every booked patient I saw, and most of my patients at that point were booked rather than on call emergencies, that I would make the presumption that if they were between the ages of 45 and 55, that their problem was to do with the menopause unless proven otherwise. And also, as another sort of add on to that, I would decide that if they were postmenopausal and they had anything to do with their urinary tract or their genital system, that I would also presume that was menopause until proven otherwise. So I suppose over that two weeks, I used to see about, I suppose, about 100 patients a week. So if we knock off about 20%, which were the on call days, you know, I was still seeing I don’t know about 150 patients and I actually saw very few men by that point anyway, because women predominantly sort of chose me. It was mind-blowing, absolutely mind-blowing, so I would not let a consultation go by without thinking ‘Have I asked about the periods or considered their periods or thought about their hormones’ and Sofia, who you talked about, there’s a sort of a handful that have completely and utterly stuck in my mind all these years later. But she was, that really, really kind of shook my foundations of what it is to be a GP and what it is to embrace the menopause because my heart slightly sunk when she came in because I didn’t know her before. She normally saw one of the partners who was the diabetes specialist. I know about diabetes. I’m not rubbish at diabetes, but it’s not my absolute expertise. And I just thought, Oh gosh, you know, she’s lost her licence. This is serious. She’s having these nocturnal hypo’s where she’s getting a racing heart and she’s sweating, and she remembers that that’s what hypo is. And so she’s reported it to the DVLA bless her, and her licence is gone, and that’s her livelihood taken away. And I said, Oh my goodness, I’m going to have to think about insulin and look at her blood sugar. And I did have a cursory look at her sugars, and actually they were fine and I was like, this is strange, oh, what am I going to do? And I thought, hang on, I’m doing an audit, and I thought, Oh, have I got time to do this audit? You know, this is serious. This woman’s just lost their licence. Have I really got time to do this? And I thought, no, just stick with it. And I said, you know, what’s happened to your periods, and she’s like ‘oh they changed’. And then you know asked a bit more and I said, ‘I think this is your menopause’. And, you know, let’s try some HRT because, you know, we know that HRT is really safe. And yeah, like you said, got better really quickly. She got her licence back within six months, which is about the quickest you can get it back in those circumstances. And not only that, obviously, she benefited from all the symptomatic improvement and the future health. And I mean that to me was mind-blowing. And I think what I realised was that if a patient came to me and put menopause on a plate for me and said, ‘I think I’m menopausal and I would like HRT’, well, OK, I could deal with that. You know, I was happy with that. I was never going to be sending them away or telling them it was rubbish or that they couldn’t have it or whatever. But actually, most menopause does not present itself on a plate. It hides in the weirdest places and in people. And I suppose what’s really important about the audit is that the people I was asking was actually far too narrow. But I realised that quite quickly and within a few months of me having doing that audit, I wasn’t doing it an audit because it was an exercise that I promised to do and I had to tick some boxes. It was because I realised that that’s what everybody should be doing. And I’d expanded the age range, so basically any women from her late 30s onwards was going to have the presumption it was their hormones until I proved otherwise.

Lauren Redfern [00:10:10] Okay.

Sarah Ball [00:10:11] And I didn’t need to restrict it to when I was just doing booked appointments because actually patients that present as emergencies in general practice, it’s often, whether they’re having palpitations or whether they’ve got a urine tract infection over and over again or they’re having anxiety, panic attacks or whatever. You know it is everywhere. We used to think of, I think, menopause and women’s hormonal issues as the last thing on the list. You know, let’s exclude, this.

Lauren Redfern [00:10:36] Yes.

Sarah Ball [00:10:37] Let’s exclude that. Let’s exclude this. And when we’ve got rid of all the ‘important’ things in inverted commas, then oh, well, if it’s none of them, maybe it could be your hormones. But actually, I realise so fundamentally, you’ve got to flip that on its head because it’s normally hormones.

Lauren Redfern [00:10:52] Yeah. And I mean, I think it sort of brings me on to the next question that I really wanted to ask you, which is exactly on that. Why it is important to be asking patients of perimenopausal age about their periods? And I guess an extension to this, you mentioned that you would be asking women from their late 30’s onwards. I was curious, actually, whether questions about menstruation or cycles could apply earlier than that as well and really what your thoughts were about that and the importance of asking about periods, why it’s important and really when we should be doing that.

Sarah Ball [00:11:21] Yes, I suppose, you know, periods are often thought of as a kind of a narrow part of gynaecology, if you see what I mean but actually our periods, are actually a huge barometer of our overall health. You know, if you’ve got gluten intolerance or you’ve got an iron deficiency or something, even at the age of 20, your periods will probably not behave very well because it’s just it’s a bit like our hair quality is often a sign of other stuff going on underneath it. So actually, we should always consider female hormones from the minute they start at puberty all the way through. And it might not be perimenopause or menopause. It might be because of, like, PMDD, you know, or fertility issues or things like that, but certainly where mental health is concerned, hormones often have a strong link. And again, I’m generalising, and I was having to set some boundaries because I had to start somewhere with the audit. But you know, as we know, although most people’s perimenopause and menopause happens from mid-thirties or later, actually, it’s not impossible for it to be earlier and something that happened also that has always stayed with me since that audit was a lady came in, who was too young for my audit so, I’d you know, temporarily for a few minutes, taken it off the radar and she was only 29, and she was also a new patient to our clinic, and she came in with a buggy, double buggy. She’d got three kids under the age of five. She was sobbing. The kids were kind of running riot, and she just said, ‘Please, please, I’ve got to have a sick note. I’ve got a full time job, I adopted these three children in the last five years. I can’t think straight. I don’t enjoy anything. I can’t function. I feel awful. I can’t possibly go to work. I can’t sleep, I feel awful’. I thought, Oh God, blimey, there’s a lot to unravel here. You know what’s going on? And then I thought, I don’t know why something just made me think, ‘Well, while you’re doing the audit, why not?’ And I said, ‘You’re probably going to think I’m mad asking you this, but can I ask about your periods?’ And she said, ‘Oh God, I don’t have them anymore. I had a hysterectomy and my ovaries removed 18 months ago’. And I was like, ‘what? Like at the age of 27?’ ‘Oh yes’, she said ‘I had awful endometriosis, so they removed everything. Hence, why I’ve adopted these children’. So I was like, ‘OK, so you’re on HRT, then?’ And she went, ‘What do you mean?’ She said ‘That’s for old people’. And I was like, ‘No, no, no, no, you don’t have your ovaries, so you really have to have HRT you have to replace what your ovaries’. And she was like, ‘Oh, no one ever mentioned it’. And again, it was like, Oh my god, again, it’s there, right bang slap in your face. But unless you ask the question, you don’t do it. So again, start her on HRT and her life changes.

Lauren Redfern [00:14:12] Yeah, and I think that’s that’s what’s interesting is it’s, and I loved hearing about the audit that you did is in many ways, it’s simple. It’s just asking a question about periods, but in other ways, it sort of astronomically shifted your way of thinking. But also, I thought about that and god, imagine how different that would be if it was just a routine thing, which we were training clinicians to think about doing as part of an intake questionnaire or even consultation.

Sarah Ball [00:14:37] Yeah.

Lauren Redfern [00:14:38] One thing I wanted to ask you is when we’re thinking about treating patients with multiple conditions, what do we really need to be thinking of? Because obviously, in the case of Sofia, it did turn out that, you know, her presentation was the emergence of perimenopause. But obviously it’s a complex field to navigate when you’re working with patients with ongoing conditions that need treatment and management. And how do you think about that as a clinician, I guess it’s really my question is more about chicken and egg. How do you identify what is what you know in that?

Sarah Ball [00:15:06] Yeah.

Lauren Redfern [00:15:06] And I’m not sure there’s a straightforward answer to it.

Sarah Ball [00:15:09] Yeah. Well, I think again, it’s that awareness that people do have other long term conditions, be that diabetes, epilepsy, arthritis, multiple sclerosis, for example, and it gets very easy, especially in general practice, where you know, time is short and continuity of care unfortunately has deteriorated a lot in recent years, and the pandemic obviously has made things even worse, is that it’s very easy to just keep blaming the condition that they’ve always had. ‘Oh, well, that’s obviously your diabetes’, ‘well, that’s obviously because you’ve got multiple sclerosis’. And actually, as long as we keep that very simple fact in our head that actually, if you are female or you were born with ovaries, then you are not going to escape the menopause. It is going to happen at some point. You know, unless you sadly died beforehand. But obviously, that’s not a very frequent occurrence. And therefore, just keep it on the radar because, you know, another lady this is, I suppose, a much simpler example but again, it’s really crucial. Another lady who was 55, she came with eczema, she’d had eczema her whole life and her whole family had eczema so actually, she was really, really good at managing it. She was like an expert, professional patient. She was brilliant with all her cream. She had a really good regime. She’d managed it fantastically all her life. But in the past few years, the control of her itching had just gone crazy. She couldn’t sleep at night. She was itching the whole time, and she could not understand what had changed because she was still being good as gold with all her medications and everything. And again, I just went, ‘Have your period stopped?’ She said, ‘Oh yeah, they stopped two years ago’. And I said, ‘would that tie in with about the time that your eczema became out of control?’

Lauren Redfern [00:16:57] Mm.

Sarah Ball [00:16:57] Oh yeah. I didn’t even begin to think that the two were linked. And again, we treated her menopause, her eczema all got better, you know, simple. But it happens, you know, and it happens with all these other conditions. I mentioned even things like multiple sclerosis and epilepsy and anything where stress is going to compound another pre-existing condition. If you deal with the menopause, you’re going to get even more bonuses than just treating the menopause in someone without pre-existing conditions.

Lauren Redfern [00:17:27] Absolutely. I wanted to ask as well, obviously, and that’s a really wonderful example for that. I think I wanted to extend that a bit further and really think about instances where this can become confusing. And I’m going to use myself as an example in this, but I remember when I kind of early on in beginning my research and observing in the clinic, you know, I found myself actually querying how as practitioners, you make the distinction between what is a perimenopausal symptom when it comes to things like low mood, anxiety, suicidal ideation, even to take it to that sort of more extreme level. And what is the mental health condition or concern of pre-existing and how you make that distinction about treating it? Because that was fascinating to me. I mean, first of all, I had to take a second to really look at my own knowledge to go, ‘Wow’. I didn’t know low mood and impact to mental health was even a symptom of perimenopause and menopause. And actually, in my observations, I noticed it as probably one of the most reported. So really, I suppose what I’m asking in that is how when it’s coming to sort of those complex circumstances like that with patients, how do you make that judgement call as a practitioner? I know we’ve talked a bit about previously on the podcast about, you know, first line treatments, often being SSRI’s or perimenopause being misdiagnosed as a mental health condition. But obviously, I suppose practitioners are in a complicated circumstance if they are not understanding or well educated in knowing those distinctions. How you make that call?

Sarah Ball [00:18:54] Yeah, I think again, there’s lots of facets to that in that if we understand the basic physiology of how our hormones start to change when we start the perimenopause and we understand that often the first change that happens is actually that our progesterone levels drop down whilst our estrogen levels actually go up at the beginning of the perimenopause. And that in itself is quite a promoter for anxiety. So very often at the very beginning of perimenopause, when it’s not on people’s radar, usually you get these changes with sleep tends to decrease a bit because progesterone helps sleep and anxiety tends to creep in. And that’s often the only thing. And the patient may not have noticed that their periods are changing because, you know, if you’re still having periods, you might have seen that the patterns change. But actually, a lot of women out there these days have contraception on board, which disguises it because they’re not having periods so they may not have their periods on their radar. So we should always have mood on the radar if we’re talking about anything which could relate to hormones, but it’s also it’s about pattern recognition. So it’s about getting the menopause symptom questionnaire out or getting the balance menopause app and tracking your symptoms and just seeing are there other things going on? Yes, actually, I have had a few more migraines. So yes, actually my joints have been a bit achy or I’ve been weeing a bit more often or been a bit more irritable, or my PMT has been a bit worse. So there’s that which can help. And it’s also about talking to the individual and getting their experience. So we’ll quite often say to someone, ‘Oh, I understand that you did suffer with depression 10 years ago’, for example, ‘how do you feel in comparison to that?’ And actually our patients are often our biggest help, and they’ll often say, ‘Oh, yes, I do remember that that happened, maybe in the aftermath of’, I don’t know, ‘I had a miscarriage’ or something. And ‘I remember how I felt then, and this feels not dissimilar, but it is different. I can feel that this isn’t true clinical depression, you know, it’s variable. My mood is very low at some point and I feel flat and disinterested. But then other times I feel fine and then I think I’m going a bit mad’. I think there’s a lot of that, but at any point it’s always OK as well, to say, ‘Well, I think this could be your hormones, but I can’t categorically prove it. But we could have a trial of treatment, and three months of replacing your hormones is probably going to give us the answer that either this is going to help or isn’t’, so that’s the whole point. There isn’t often a cast iron diagnosis, it’s pattern recognition. It’s a clinical diagnosis. It’s having an individualised consultation where you’re involving the patient as you know, that they know their selves best.

Lauren Redfern [00:21:55] And I suppose on that, something I wanted to ask is, I mean, you mentioned certain conditions earlier where there are crossover symptoms in presentation, for example, you know, things like fatigue, brain fog, they can be there for people if they have a chronic condition for quite some time, you know, that could be a side effect of the long term medication they’re on. Or it could be a side effect of the condition that they have, you know, someone with chronic pain or fibromyalgia, for example fatigue can be a big part of that. Would it be a similar case in terms of looking at factors such as well actually, you know, it’s worsened or they’re reporting more of it or they’re of that age? Is that sort of the idea?

Sarah Ball [00:22:32] Yeah, absolutely. I think any other underlying condition that has changed warrants a thought about hormones, but also and you mentioned fibromyalgia, for example. Now this is obviously a whole nother conversation, and everyone has their own opinions about this. But my personal opinion is that there is no such thing as fibromyalgia in terms of it’s a symptom I consider, not a diagnosis. So actually, for a lot of people with fibromyalgia, they’ve been misdiagnosed and actually they should have been diagnosed with the perimenopause/menopause, or it relates to testosterone deficiency, which often can pre-date the menopause as well. So actually, it can be helpful sometimes to then – you actually may treat the condition that they’ve not had properly treated for years.

Lauren Redfern [00:23:17] That’s fascinating. And actually on that, Sarah, I’m probably at the end of this going to say, please come back and do an episode on that because I mean, I’ve had conversations with people about this, and I think it is that that thing that’s happening where it’s are we treating the condition or are we treating the symptom because those things are different, right?

Sarah Ball [00:23:32] Yes, they can be different, but sometimes they’re one and the same thing, if you see what I mean. So.

Lauren Redfern [00:23:37] Absolutely.

Sarah Ball [00:23:37] Long COVID. Chronic fatigue syndrome, fibromyalgia. There’s a massive overlap. Great big porridgey soup in there with the menopause. And actually, usually if you treat one, you end up treating all of them because they’re all part of a spectrum of a hormonal deficiency which has been mislabelled, misunderstood, whatever.

Lauren Redfern [00:23:58] Yes.

Sarah Ball [00:23:59] That also kind of made me think about, because in my when I’m talking about my experiences, learning about menopause, I have to say, although I’m trying to explain to all healthcare professionals, I’m a GP at heart and we have all – I’m sure everyone’s heard the term heart sink, which usually refers to patients that we have in general practice that usually attend frequently, that usually have unexplained or symptoms going on and on – and no one quite knows what to do with them. And they’ve maybe had lots of referrals and they’ve often on lots of medication and you kind of dread them coming. Not because you don’t care about them as a person, but because you’ve run out of options and they make you feel inadequate because you haven’t been able to help them and they’re frustrated and then you get frustrated. And then often relationships with heart sinks can be very difficult and GP’s try and pass them off around their other colleagues because they don’t want to deal with them. And actually, menopause, fibromyalgia, chronic fatigue syndrome, all those things often fall very neatly into the basket of heart sinks. And again, doing this audit, I had a patient who was in her early fifties and was very much considered a heart sink. She attended at least twice a week to the surgery. She had sort of borderline learning difficulties. She was extremely overweight. She had high blood pressure. She had depression. She was extremely anxious. She was very irritable. Her and her husband were always falling out and having arguments in the waiting room much to, you know, sort of public view. And no one really knew what to do with – and she had a diagnosis of fibromyalgia as well – and again, she came in, not surprisingly, four times while I was doing my audit. But I realised that I said, ‘Right, OK, let’s talk about your periods’. She said, ‘I haven’t come about that. I’ve come about the fact that I can’t live with my husband anymore and I need you to help me’. And I said, ‘No, tell me about your periods’, and she’s said ‘oh god they just get heavier and heavier and closer together and closer together’. And I said, ‘Right, OK, just hear me out here. I think we need to think about the menopause’. And yes, I did have to get her back a few more times, – and I need to come back to this point in a minute – to talk about, because if it is a, if the patient wasn’t ready for you to mention it, they’re not there waiting, ready for you to just go, ‘Oh yeah, I’ll take HRT, fine’. You know, I then have to explain a few things about it. But again, she was transformed and actually, she then stopped consulting. She just needed to come every six months then to get her HRT again, it transformed her and her blood pressure had settled down. She started to lose weight. She became active again. You know, her and her husband got their relationship back on track. You know, her joints stopped aching. You know, it was, well, that sort of thing. And I think that probably is the other thing I didn’t want to omit saying, if you’re going to do something like this and actually, I would love it if every GP did it and then told us about it at the society, that would be amazing, is you just need a little bit of backup in terms of one, you need to be confident in then actually talking about HRT and prescribing HRT, there’s no point in finding the answer to the problem if you don’t know, then how to treat it, if you see what I mean. So doing the Confidence in the Menopause course, you know, it’s not difficult being confident about HRT, but obviously don’t go into it completely blindly, and you need some information to give to the patient, because yes, we are time restricted in general practice. And if you’ve just brought up their periods in a ten-minute consultation and then thought, ‘Oh, I think you’re actually menopausal and that’s not what you came about’. You need an escape valve to be able to deal with it properly. So I would at that time, I used to have a leaflet, which – now there’s lots of leaflets on the balance menopause website – that was a general overview of menopause and HRT, which I could give to the patient. Or you can now signpost them to the balance app, for example. And then I would always try and then say, I want you to go away and actually think about what we’ve said and have a look at this resources that I’ve given you. And then would you come back in a week or twos time so that we can talk about it again? Because otherwise I don’t want to put GPs off if they feel absolutely like, ‘Oh my gosh, I’m not really at all clued up about menopause’. And then you’ve got to throw yourself in and then feel overwhelmed, but to do it in a way that you’ve got a bit of protection.

Lauren Redfern [00:28:10] And I think that’s an important thing to mention as well is that something I’ve talked a lot about on this podcast, actually is how there is obviously the added component of time that we have to think about. You know, in an NHS setting, it would be lovely if GPs had 20 minutes, 25 minutes to spend with the patient, but often that’s a big restriction for them. And it’s not necessarily, I think that perimenopause or menopause is overly complex and complicated once you feel confident, but it does take time to explain that to a patient to explain the role and function of different hormones, to explain why they deplete, to explain how you’re reintroducing them. And I think that’s a lovely bit of advice is really thinking about, OK, how do I book this in in a sequential, you know, future for the patient to kind of introduce that in a manageable way?

Sarah Ball [00:28:53] And I remember and sometimes this does happen in GP surgeries, especially not always, but between the different genders of GPs. Women often have lengthier consultations because we’re often dealing with hormonal issues, mental health issues, gynaecological issues because of the reasons that we’ve been talking about. And often there would have been a little bit of tension with the male partners going, well, ‘do you need that long? You know, couldn’t you see more patients?’ And I think, yeah, and I never, ever felt any. I was like, ‘Well, I’m going to talk to this women about menopause in 20 minutes. She’s got information to go away and prepare herself. I’m going to see her for 20 minutes, and I can categorically promise you that that 20 minutes will save our surgery, the patient, us as individuals, the NHS, the economic status of the country, a fortune. You know, even that lady I described who was a heart sink, she became not a heart sink so that, you know, two consultations a week became two a year. That’s a massive saving for the NHS, and that’s before we consider that she’s reduced her risk of heart attacks and breaking her bones and dementia and obesity and diabetes and arthritis, and getting COVID and all those sorts of benefits, yeah. So yeah, I’m not worried about the time. It’s just making sure you’ve maximised what you can get out of that time by giving them some resource to start with.

Lauren Redfern [00:30:19] Yeah. And I think feeling confident for yourself in knowing is about thinking about the long term picture, as you say, and going because obviously I think we can firefight a bit in that circumstance and actually add it all up. As you say, that patient that you were seeing it reduced the burden, I suppose, on the practice enormously.

Sarah Ball [00:30:34] Yes.

Lauren Redfern [00:30:35] I’m really sorry to say that I think we’re actually out of time Sarah. I had a number of questions more that I wanted to ask you. So I will have to beg you to please come back. And I think there would even be an interesting conversation, as we said earlier about presentation of things like fibromyalgia and how you manage that. Something I wanted to ask you. I’ve been asking people when you finish the podcast if they have any particular take homes they’d like to stress from the conversation we’ve had today. But even on this, you know, whether it’s any take homes or any best practice bits of advice for people working with patients with long term conditions when it comes to being aware of the perimenopause and menopause.

Sarah Ball [00:31:07] I think really probably all I would say might take home line would be ‘once you see it, you can’t unsee it’. And just.

Lauren Redfern [00:31:14] Yes.

Sarah Ball [00:31:15] You know, if you’re stuck for something to do for your next appraisal and I know GP’s are completely under the cosh at the moment, I’m not belittling the havoc that the pandemic has wreaked, but I promise you that doing something like this, although you think, ‘Oh my God, that just sounds really time consuming and oh god, how am I going to fit that in?’ You know, it completely transformed how I practice and it’s ended up transforming my career. And even more importantly than what it does for you as a professional, what it does for the lives of your patients, you know, you will never look back I don’t think, so go for it, basically is what I’m going to say.

Lauren Redfern [00:31:52] Amazing. Thank you so much for joining me, Sarah, and I’ll catch up with you soon.

Sarah Ball [00:31:57] Thank you, Lauren.

Lauren Redfern [00:32:00] We would love for you to join our collective of professionals passionate about the menopause visit 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.

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