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HELLO! has teamed up with Wellbeing of Women to present a series of short webinars in support of our Menopause Workplace Pledge
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00:00Hello, I'm Rosie from Hello Magazine. I'm also a proud ambassador of Wellbeing of Women.
00:06It was an important moment for us all when Hello of Wellbeing of Women teamed up in 2021
00:11to launch the Menopause Workplace Pledge, a drive to see women going through the perimenopause
00:17and menopause stage of life better supported in the workplace. The campaign was a huge hit
00:23and to date we have almost 3,000 UK companies signed up. But it doesn't end there. We know
00:29there's a willingness to improve things but what does tangible and meaningful support for women
00:34going through the menopause in the workplace actually look like? And how can we ensure that
00:39both managers and employees are able to access the help they might need? If these kinds of questions
00:46have been on your mind too, you're in the right place. In this short video series in the lead up
00:51to World Menopause Day, I will be meeting three game-changing women to hear all about their
00:56experiences in this area to ask for their tips and gain some brilliant insight and advice for us all.
01:02So whether you're a manager, an employee or a woman going through this time of life, stay tuned.
01:08My first guest is Dr Negat Arif. She's a GP based in Buckinghamshire and you'll probably recognize her
01:16face as she's the resident doctor on ITV's This Morning and BBC Breakfast. Not to mention a prolific
01:22TikTok and Instagrammer where she uses her platform to advocate for better women's health
01:28and especially for those from underserved communities. Her first book, The Knowledge,
01:33An Essential Guide to Female Health was published earlier this year and she's also an ambassador for
01:39well-being of women. Dr Negat, thank you for joining me.
01:43Dr Negat Arif. Good morning, Rosie.
01:44Good morning. Let's start in your role as a GP. What trends are you seeing in your clinic with
01:51regards to perimenopause and menopause? When it comes to trends, the biggest issue
01:55that we're seeing are the psychological symptoms because women find either they're too scared to
02:00talk about them because it's such a taboo to talk about mental health anyway and not associating that
02:05with their cycle. So is it a mental health condition that you're dealing with or is it perimenopause?
02:10Dr Negat Arif because women come and see me and say well I'm still having periods but I'm having
02:15anxiety, loneliness, tearfulness, irritability, anger that I never used to have before Dr Harif.
02:20I'm getting brain fog, I'm forgetful, my confidence is really impacted. I'm going to meetings
02:25and it's completely, I've lost my train of thread of thought and I feel that my self-esteem and I'm
02:31undermined by colleagues who are much younger than me in board meetings. So I think that when you look
02:38at that and you think about the psychological symptoms related to say anxiety, clinical anxiety
02:43or clinical depression, there is an overlap but we still need to be able to differentiate the fact
02:49that our hormones, oestrogen and progesterone that are fluctuating can cause psychological symptoms of
02:54the menopause. It's not just the vasomotor symptoms. So the vasomotor symptoms are the physical symptoms
03:00such as hot flashes, night sweats, palpitations, formication which is like the feeling of pins
03:07a needle or spiders calling out your legs, headaches or migraine as well that can happen,
03:12you can get tinnitus, a burning sensation in your mouth, there's a whole load of physical symptoms,
03:17aches and pains, so something known as arthralgia. So the trend that I find most when I sort of do
03:24my
03:24clinic is that it's that differentiation and the nuances of what is perimenopause but what are other
03:31diagnoses that I need to consider as a doctor. So that's one thing. The other trend that I see a
03:36lot
03:36is libido. Women are now happier to come in and talk about the fact that intimacy of their libido is
03:42lower and I think that's got a lot to do with the fact that we are openly talking about sex,
03:48we are
03:48openly talking about the fact that our libido does decrease and also women now feel that they don't have
03:53to put up and shut up about it which is lovely, that's music to my ears as a doctor. The
03:59things that
04:00were hidden about talking about your sexual desires, because women aren't meant to say that they love
04:05having sex or they want to have an orgasm, now that is coming to the forefront in my consultations and
04:12they're bringing it to the doctor to say could you help me with this.
04:16So with so many symptoms, I mean it's quite mind-boggling really the amount of symptoms that you could get
04:22that could be related to the perimenopause or menopause or could be related somewhere,
04:27something else. Where should a woman start to actually get that diagnosis?
04:33The first question I always say before I answer that is what symptoms warrant me when going to the
04:39doctor? So a lot of women say, do I need to go and tell the doctor that I'm perimenopausal because
04:45if I fall pregnant, that's the other time in their life, there's a life event that happens. I don't
04:50go to the doctor and tell them I'm pregnant, I just then wait to get my 12 weeks down because
04:55I contact the midwife and then bypass the doctor altogether. The symptoms that are affecting your
05:00activities of daily living and your ability to carry on things, that's when you go and speak to
05:04the doctor. And so the question arises is what symptoms then warrant you coming through the door
05:09and what do we do further? So that is really based on, again, how much those symptoms that
05:16you're experiencing because there's about, as you know, Rosie, 42 and they're growing, aren't they?
05:21Every single time I speak to a new patient, I'm adding a new symptom. It's what is stopping you
05:27from doing what you want to do and if they are really impacting your quality of life. We are built
05:32for
05:32survival. Our bodies are built to survive this phase. Just like when we started our puberty years
05:38and we had hormone fluctuations, our boobs were forming, our hips were developing and then our
05:44periods had started. Our body was built for survival then. It's exactly the same on the opposite side of
05:49our life when we come to our midlife years or as the Chinese call it, the second spring. So you're
05:54rejuvenating, you're regenerating again and your body's built for survival. But it's about whether you
05:59are now looking for survival and that's where I, as a doctor, step in.
06:03Yeah, so you would say don't put off making that health disappointment if you feel that something's
06:09off. What about women from different cultural or ethnic backgrounds? Are you seeing an increase
06:14in those women coming to your GP clinic? You mentioned talking about libido and there are so
06:20many topics that feel quite difficult within certain communities to discuss openly. Are you seeing an
06:26increase in women feeling confident enough to come forward to address those?
06:30I'm definitely seeing a trend and that's because women are now feeling that they're part of the
06:35conversation. But we've got to look at marginalised communities as a whole because the ethos around
06:40those communities is the fact that actually you shut up and put up with a lot. And that's because of
06:45historic internalised misogyny that we have. We do have institutionalised racism. We have medically
06:51gaslit women for quite a long time, regardless of whether they're from marginalised communities or not.
06:55So when a woman goes to the doctor and says, I've got aches and pains and brain fog and hot
07:00flashes
07:00and palpitation, but I'm still having periods, the doctor, depending on their knowledge, will say,
07:05oh no, no, no, no, no, that that isn't actually brain fog isn't real. And I've genuinely sat when
07:10I was a junior doctor in clinical consultations with a gynecologist who told a woman that her brain
07:16fog isn't real. And so I think we've got to, yeah, we've got to think about how much these marginalised
07:22communities from Black and Asian communities are researched. So we've got one study, one effective
07:28study, but that actually is done in America called the SWAN study in 2020. And that showed that when
07:35women from Black and Asian communities, they actually probably present earlier with, say,
07:40perimenopausal symptoms, so hot flushes and night sweats. So the average age, we say, is about 40 to 45
07:46in white Caucasian populations. For Black and Asian communities, it's about 38, 39. And it could
07:52even start with symptoms of, say, vaginal atrophy, where you get dryness or that itch that doesn't go
07:58away that repeatedly. When the woman from, say, a South Asian heritage goes to the doctor is told,
08:03oh, it's thrush, here's some canistone. She goes away and it gets better a little bit because what's
08:08in canistone, there's a little bit of steroids in them that's going to take the itch away. But the underlying
08:12issue of vaginal atrophy isn't spoken about. And if you look at consultation notes, my data,
08:18when I first started talking about menopause in Black and Asian communities, was that only about
08:2410% of consultations ever documented vaginal atrophy. Whereas I know as a doctor, about 85%
08:31of my consultations are those women experiencing vaginal dryness, painful sex, they have difficulty
08:37having smears. And then that has added all consequences that they don't come in for, say,
08:41cervical screening. And then also recurrent neural tract infections. So then on top of that, to talk
08:47about your libido, oh, that's even more of a taboo, right? So you're not going to offer those symptoms
08:51up to the doctor. Because what happens is, is that when it comes to Black and Asian communities,
08:57they're more likely to offer up things that they feel are less taboo, so the physical symptoms.
09:04So I get aches and pains. So I usually will get women, Pakistani women who are coming to my clinic,
09:09who say, which is translated as everything hurts from my head to my toe. And that I know is a
09:17thralgia. But actually, that is a symptom of perimenopause as well. But if I say to them,
09:22do you have any psychological symptoms? And the first thing they're saying, no,
09:25I'm not depressed, or I don't have a mental health disorder, don't label me with this,
09:29because it's such a taboo within our culture, because we don't have a word for, say, mental
09:35health. The word that we have is madness or pagalpan. So when you use that word, which is translated as
09:42mad, obviously, you're not going to use that. Which leads me to the next thing about communication
09:47within Black and Asian communities. If you look at a lot of the languages, we don't have direct
09:52translation for, say, the menopause. In Punjabi, we have kapre khatamuge, which is translated as
09:59you're off the rag. And in Urdu, it's banji. Banji is translated as you're barren. So again,
10:07not direct translation of, say, menopause or perimenopause. And so when you don't have the
10:13lexicon to be able to even within your group of women, within your community, to be able to
10:18communicate by using the words, you think that it doesn't exist, or it doesn't, it's not pertinent
10:24for you. So you actually gaslight yourself within your own community. So I see a lot of women at the
10:30mosque who are saying, I think what you're describing is, and I use the English word, menopause,
10:35and they'll literally laugh at me and say, no, no, no, no, Dr. McGann, that doesn't happen to us.
10:41Menopause is a Western phenomenon. And I'm aghast when I hear that, because essentially what they're
10:47doing is that they're nullifying their own experience within themselves. And then they
10:52say, well, it's not important enough to offer up the symptoms of hot flashes, because the context
10:58of my symptoms is you stand in the Pakistan heat, and you'll know what a hot flush is.
11:03So the context of my symptoms aren't enough to warrant to go to the doctor, because the doctor's
11:08appointment is so precious. He or she has got cancer to deal with. Why would they be bothered
11:13about my sort of menopausal symptoms? So we have this sort of area, this gray area,
11:19where women are suffering, but won't be able to go to the doctor to support. And the doctor
11:25might not understand the cultural nuances, won't be able to prise apart those symptoms and educate
11:31them and say, this is really important. But with the medium of social media, I produce content in
11:37Punjabi and Urdu. And now women are saying, oh, actually, there's a doctor that looks like
11:43me, so if you can see it, you can be it, who's saying to me that these symptoms are significant
11:47because they're linked to, say, down the line, I'm at risk of osteoporosis, down the line,
11:52I'm at risk of heart disease. And then they're saying, right, I need to not just survive,
11:57I want to thrive and prepare myself for the future.
12:01There are other resources like your book, The Knowledge is so valuable. And that's a very
12:06inclusive book. Some of the diagrams that are in that book are very graphic. And they,
12:11you know, depict women from all different kinds of nationalities and cultures,
12:15which is so critical in opening up this conversation. And how could a woman then advocate
12:21for herself within the healthcare system?
12:24I think firstly, we've got to look at women are busy, right? Regardless, I've never seen a woman
12:29who is not busy. And to be fair, men are busy as well, but women are multitaskers. So what a
12:36woman
12:36does is she'll look after everything else in the household, and then her health is right at the
12:40bottom. So even her awareness of her health only happens when that problem presents to her. So if you
12:48are looking through the lens of privilege, that you've never had heavy periods, or you've never
12:54had painful periods, then your assumption is, well, everybody is like this, and I don't need to pay
12:59attention. And I don't need to do anything about it or have these conversations. But if your lens is,
13:04I suffer from PMDD, I've had fibroids, I've had a hysterectomy, and now I'm in surgical menopause,
13:10then your outlook on life and your investment in your health is going to be completely different.
13:16The awareness that comes is that we as women need to make sure that we're opening up these
13:21conversations, which historically have been taboo. Why have they been taboo? Because our bodies have
13:26never been our bodies. I mean, in 2023, we're still talking about Roe versus Wade and the fact that
13:31the government decides, you know, whether I can have an abortion or not. Well, we know abortion is
13:36health care. So when you've got governments across the globe, and the patriarchy is at play to make
13:41sure that your body isn't yours, because your breasts are sexualized, your vaginas and vulvas
13:46are sexualized, even just your whole body as a whole, your face is sexualized, cover it up. Then
13:52having those conversations gets even harder. But that only comes from empowering each other. So as women,
13:59the idea is, is that we stop seeing colour or creed or class or hierarchy or doctors versus, you know,
14:07we're the ones with the knowledge and these are people who do outreach groundwork. We need to break
14:13that down and to be able to have open dialogues and have ambassadors and people who look like you
14:19to be able to give the message out in the nuances that your culture understands. So I'll give you an
14:24example, Somalian women in New and Tar Hamlets. If I go in there as a Pakistani woman wearing a hijab
14:31and say, here's a picture of the boobs. Look at my book. This is how breasts should be examined.
14:36They'll be appalled by that because that is so away from their cultural nuance where things like this
14:42are hidden. But if I make some bread and make them into dough balls and then put in some frozen
14:47peas and
14:48say, right, I'm going to teach you how to examine bread. Imagine this is your breath. And this is what
14:54a lump would feel like because this is the frozen pea. They will reciprocate that message ten-time
14:59fold because they never keep that information to themselves. And it's given in a way that respects
15:05their cultural way of doing things. I think that when we say, how do we open up this conversation?
15:12I'm always aware that we must be really careful that we don't come in with this savior complex. I will
15:17come in and educate all these women because they need to know about their bodies. Take my book,
15:22the knowledge you need to know about your body. And this is my savior initiative for you. When
15:28actually women know themselves really well, they know their bodies and my 15 years as a doctor will
15:34never replace a lived in experience. Even my book doesn't replace a lived in experience. But where the
15:40magic happens is when you get women who have that lived in experience, you empower them enough to
15:46amplify and do what they're doing already without realizing where they're doing it. And then get
15:51it out there to others. And then others watch her doing it and they replicate it. And so the domino
15:57affects us. And we've seen that, I mean, with Darina, you as well at Hello Magazine. We've seen that
16:03with Lisa Snowden, The Menopause Mandate. We've seen that with incredible women. Neelam Hira at Sisters
16:10talking about her PMDD as a sequel with endometriosis. This is what we need. We need to
16:15champion those grassroots organizations. Yeah, you're so right. There is so much power,
16:22isn't there, in sharing our stories. Let's talk a bit about the workplace, another place where women
16:27can perhaps support each other in sharing their own stories around menopause. But what does tangible
16:33support for a woman at the menopause or perimenopause stage of life look like in the workplace,
16:39in your opinion? I do a lot of work with lots of huge businesses. I've recently started working
16:45with Google and YouTube and Alison Lomax is the MD. So I asked me precisely this question,
16:51how can we support the women because I don't want to lose these highly skilled women. It's estimated
16:56that if we don't support women in the workplace, we're going to lose at the perimenopausal phase of
17:00their life. We're going to lose about a million women, which to me breaks my heart because you think
17:06this is something that's correctable and fixable and also manageable that we shouldn't allow women's
17:11biology to make them step away from a career path that they work so damn hard for. So tangible
17:17support to me looks like the first that you open up the conversation and that starts at leadership.
17:22And that doesn't mean that that starts at the MD level. That could be leadership right at the
17:27bottom where actually the workers are doing their work and somebody putting up their head above the
17:32parapet and say, do you know what? I've got hot flashes and never having a shame or taboo attached
17:37to that. Menopause cafes are happening. So I know that the BBC, I've worked with World Mail as well
17:43and Tesco and Sainsbury's, you know, huge businesses like this, understanding that the woman is the one
17:49that they need to cultivate and protect because she will give 10 times fall to that business and look
17:54after your business. Then the other thing is looking at the clothing. So Tesco's have this amazing
17:59thing already where they're looking at the fibers that they're using in regards to the uniform that
18:04they wear. So it could be breathable. It could be one that absorbs your sweat and there's loads of
18:09work happening with that. There's also a lot of conversations happening around femtech as well. So
18:15wearable technology that allows women to understand what their heart rate is doing, what their palpitations
18:21are doing, what their sweats are doing. And then also thinking about her now cycle in regards to her
18:26hormones. So if she's suffering from hot flashes and insomnia and you've created an environment in
18:32your workplace where she's able to go to her male boss and say, look, I'm not sleeping very well because
18:37of my hot flashes, that she has workable adjustment hours because then she's in at the time or even now
18:44since the pandemic working from home as a possibility rather than physically being in a space all the time.
18:50And I also find that the other tangible effects that can really help is simple things that we never
18:55think about sanitary products in workplaces. Like, honestly, my heart sings whenever I go into
19:01a toilet and there's no NHS hospitals that I still go into that still have sanitary products for free.
19:07But it makes such a huge difference because if you think about it and you're perioretical
19:11woman and you're caught off guard, to know that you can then just, you know, get the products that you
19:18need to stop your flooding at that moment, it makes a world of a difference in the workplace as well.
19:24Um, and I think lastly, we've got to be able to create the culture where other communities,
19:30so black and Asian women in workplaces are also part of the conversation and they're not excluded.
19:35Ask them, what can we do to support you so that you can carry on? In my culture, we have
19:41a saying
19:41that you give a woman some seeds and she'll build you an orchard. And then I think if businesses thought
19:47that way, that if we support the woman, my economy and my business will thrive, then that's an incentive
19:53to make sure that you have tangible things in the workplace to keep that woman there because she will
19:59build you an orchard. It's such a simple phrase, isn't it? But it is so powerful that what can I
20:05do
20:06to support you? It's such a brilliant question. So if a manager is watching this and perhaps there are
20:12lots of midlife women at the company that they work at and they're, perhaps they're a male manager,
20:17um, and they want to improve the environment for the women that work for them so that, you know,
20:23productivity goes up, everybody's happy. When a woman is real, it feels like they're listened to,
20:30you know, they feel fulfilled and they do go that extra mile. As you've said, what could be the first
20:35step that that sort of manager could do? So they've signed up to the wellbeing of women workplace pledge.
20:40They want to take things to the next level, but they don't know what that first step could be. What
20:46could that be? So you, as you put the rail on the head, listening, listen to the women in your
20:52group.
20:53It's such a simple thing to do. So if you've signed up a workplace pledge and you can have an
20:57individual
20:58like me as a doctor to come in and help assist the medical aspects. So the knowledge that you can
21:03have
21:03in order to just support yourself in regards to the symptoms. But, um, I would say firstly,
21:10male or female, because this is not a gender issue at all. This is not a woman's issue. This is
21:15everybody's issue within the workplace. And as a male colleague, I would just reach out to all of
21:20your workers and say exactly that. What can I do to support you if you are having perimenopausal
21:26and menopausal and educate yourself first about what the perimenopause is. And that is so simple to do
21:32now with so many online resources or women sharing their stories. Then the next thing is, is build an
21:38environment in your workplace where women do feel that they can talk about things confidentially and
21:43not feel penalized down the line. And that I know is very variable depending on HR and all different
21:48sort of politics that go into workplaces. And then thirdly, allowing women to have a space where they can
21:54have that space to have those confidential conversations. So that could be setting up a
22:00menopause cafe or a training day that they can go on to learn from each other, how they manage
22:05their symptoms, as well as get healthcare professionals or say menopause advocates or
22:11physical exercise and nutrition, because we know that it's not just always a doctor that you need.
22:16There's loads of other holistic lifestyle things that can be offered. And I know it's going to be
22:20very variable on the amount of budget that a company has or the size of a company as well.
22:25But this doesn't mean that this is a woman's issue. This is everybody's issue. Because if your
22:31end point is, I want my business to thrive and survive in the current economic climate,
22:37it has to start with you investing in the women and girls that are working in your business.
22:41I've heard some great success stories of menopause cafes, as you suggested,
22:46menopause groups, perhaps finding a menopause ambassador or an advocate within the company.
22:52You know, all of this conversation can be opened up by simply a manager going to
22:57the workforce and asking them what they need. And as you say, then the women sharing their stories
23:02within that group is absolutely priceless information. What about on the other side,
23:08if an employee is feeling that they're not coping in their work environment, they love going to work,
23:15work. But perhaps, you know, what they're going through, perhaps starting to try HRT,
23:20or they were experiencing some symptoms, which can be quite debilitating from the brain fog that you
23:26mentioned. I mean, I've had moments myself where I completely couldn't remember the name of a colleague
23:31that I'd worked with for years. And she was sat across the office from me. And I had to go
23:35and look
23:36up the phone list to jog my memory. I mean, it's terrifying. That was before I went on HRT.
23:42And it absolutely changed my life. But how could somebody like that open up a conversation
23:48with their manager in the workplace? Is it an HR question? Is it something to discuss
23:54with your colleague? What could you do? So I always say that I'm very aware that I look at
23:59things from a lens of privilege as a doctor. And I'm like, and I'm quite vocal. I have some medical
24:06knowledge. I'm like, yeah, just talk about it. But I completely understand for some women,
24:09it's not that easy or that simple just to go and talk about it. And I think this is where
24:14finding
24:15advocates or allies is, you know, the magic sweet spot. Again, so those individuals,
24:23and it doesn't have to be somebody from HR or your line manager, it's somebody who can advocate you,
24:27that could even be a friend outside of work, who doesn't understand your work situation. Because
24:32sometimes you can be in the eye of the storm and not understand the dynamics that are happening,
24:37but actually getting another viewpoint from a second opinion from outside actually really helps.
24:42Or somebody who might be in a different line of work who goes, oh, have you ever thought about
24:46doing it this way? Because when we're working in our trajectory, we've got our blinkers on.
24:51And then the question is, but we've always done it this way. And this is what I hate about medicine,
24:55because we sometimes as doctors have our blinkers on and never sort of think about the wider view.
25:00And that's why a second opinion really does help. And this is a really quick tip for anybody that wants
25:07to go to the doctors. If you go to the doctor and you feel that you're not listened to, there
25:11is no
25:11shame or stigma attached to getting a second opinion. I mean, I say this as an NHS doctor who constantly
25:18asks for second opinions, because you never know everything, you know, all the time. And there are
25:24some patients who are slightly more trickier. That's not their fault. It just means that they don't fit
25:30the medical textbook because they have a completely different lived in experience and circumstances.
25:36So that works really well. So allies, second opinion, writing things down. I think journaling
25:43and jotting things down and keeping a symptom diary would really help your manager to understand how
25:50you're affected, especially if you have difficulty verbalizing it in person, because we downplay.
25:56There's a lot of modesty that goes on and you downplay. And I always say that
25:59some of my patients are incredibly stoical. And it only helps when the husband says,
26:04actually, no, she hasn't been sleeping every night, Dr. Arr. And she's just being stoical
26:08in front of you. And that really helps when you go to the doctor as well. So if you want
26:12to then go to the, the other thing is, is that with your workplace, you need to get a combination
26:19of help from your doctor, especially if they're debilitating, as you were saying, Rosie.
26:23And they need to go hand in hand. And I say to my patients, I have a five point plan.
26:27If you're going to go and see your NHS GP regarding support, number one is please keep your symptoms
26:33and find that ally, whether it's work or whether it's a home or somebody who can advocate for you.
26:38Number two, phone the surgery and book a double appointment, speak to the receptionist and tell
26:43her, I want to talk about my perimenopausal symptoms and they're debilitating for me.
26:48The reason you do that with the receptionist is because then she can triage you to the best
26:52person in the surgery. It might not be your registered doctor. Number three, when you go
26:57to the doctor, take your symptom list with you, take your ally with you, and then have that open
27:02conversation. Bring your family history, make sure that you have a latest blood pressure reading.
27:06If you know that your blood pressure goes up when you see the doctor, have a height and a weight,
27:10because we need to know what your body mass index is. And any other thing, like if you had a
27:15history
27:15of breast cancer or strokes or coughs, we need to know about that. And also your experiences with
27:20a, say other hormones like the contraceptive pill or the mini pill. Then number four, be prepared.
27:27And number, yeah, number four, be prepared that on the first consultation, you will not need the
27:32consultation with hormone replacement therapy as a prescription. It is actually rare, even for me
27:37as a doctor, to on the first consultation to say, here you go, HRT for your brain fog, your night
27:43night sights, because I want to rule out other conditions. I need to make sure that it's not
27:47because you've got a thyroid condition or anemia or diabetes or any, you know, God forbid,
27:53some cancers that I need to think about that can also mimic the symptoms of the menopause. And then
27:59lastly, if you've had a good consultation with that doctor, as you leave the consultation room,
28:04book on all your investigations, and then speak to the receptionist on your way out and say,
28:08can I pre-book with Dr. Arif, say it's me, who's brilliant. And I want to see her,
28:14I want to see her in six weeks time because most NHS GP practices that open their diaries six weeks
28:21in advance. So it's really important that you have continuity and to get continuity,
28:26you need to be the person in charge of that. And you need to be the person in charge chasing
28:30your
28:30blood results. And that's how you have a combined holistic and also a partnership with your GP.
28:37It's not your GP doing everything and telling you what to do. You have to work in partnership.
28:41And you have to advocate for yourself. Some brilliant advice there. Thank you so much.
28:47That was super helpful. Is there anything else that you want to add just quickly at the end about
28:53any other way that you could get support within the workplace? Within the workplace,
28:57one of the things that women never talk about is vaginal atrophy. And I know that because I get
29:01women from the workplace talking to me about it. So that's itching, soreness, dryness and also
29:06painfulness in their work clothes or the uniform that they're wearing. And that's such an embarrassing
29:11topic to talk about because some places they just advocate trousers and they don't allow you to have
29:16skirts, etc. So I think that has to become a mainstream conversation and not keep it hidden anymore.
29:23So speak to, like I said, your allies, your advocates, and think around the fact that it's not just,
29:28as one manager once said to me, who was actually a man who goes, it's just a bit of hot
29:33flushes, isn't it doc?
29:35And I'm like, actually, no, it's not just a bit of hot flushes. That's probably what some of the women
29:41have
29:41told you or your assumption has been that it's just hot flushes. But you do realize that if you're wearing
29:47really hard fibers, because remember, some women have really physical jobs, they might work in a
29:53factory line, and the fibers are synthetic, and they're rubbing against their vulva and their
29:59vagina, you need to really think about the fact that how can we implement better change for these
30:04women, so they're not having worsening symptoms. So this is where vagina moisturizers are really
30:08important. So I say to women, if I had my sort of wish list as a doctor, is that any
30:14friend or patient
30:15over the age of 40, I would say to them, just start using vagina moisturizers. So prevent
30:20vaginal atro from happening, because we know that about 85% of women, vagina moisturizers are full
30:26of hyaluronic acid, which is this lovely chemical, which just absorbs water and moisturizes really
30:31well. There's no estrogen in that at all. And you just apply it twice a day. I'm 39 and I
30:37use one
30:37that's called Yes, but there's loads of different brands out there and Hylofem as well. And you can buy
30:43those and use that to prevent vaginal atrophy, because you'll probably notice just around your
30:48periods that you are getting some vulval skin changes. And so that's the other thing, examine
30:54yourself and lock down there as well. We are very good at examining our boobs, but we don't examine
30:58our vulva and vagina. And then if you need to, then go and speak to your doctor about vaginal estrogen.
31:05And this is where that open conversation about holistic approach in the workplace,
31:10and then the medical team being able to oversee vaginal estrogen is where that magic happens.
31:16The education in the workplace is so important for everybody, you know, whatever age the woman is,
31:23and for our men folks too. And it's not enough to just put up a poster around the building,
31:28although that's very helpful as well, to allow us to the symptoms. But there are much more meaningful
31:33ways that you can create a work environment that is going to have a positive impact on everybody
31:40and support women through this time of life. So some amazing tips there, Nigat. Thank you so much.
31:46You're such a mine of information. And of course, your book, The Knowledge is a great place for people to
31:51go to,
31:52to start off getting that kind of thorough understanding of what happens to our bodies,
31:57from menstruation to menopause. The Hello Hub as well online all about the menopause has
32:03lots of credible information. And of course, the Wellbeing of Women website will continue to keep
32:09both employers and employees updated on how they can provide support in the workplace.
32:14So thank you so much for joining me today. I found that really fascinating. Thank you.
32:19And it's positive as well. There's hope for all of us, which is a really great message to end on
32:25as well. There's so much we can do. Absolutely. And I always say that one of the things that women,
32:30like 20, 30-year-olds on my TikToks or social media say, oh my goodness, I'm dreading the menopause.
32:36And I'm like, oh no, really don't be, because we don't dread puberty. We don't really dread pregnancy.
32:41And this is just another life biological journey that we go on as women. We transition. And
32:47transition brings new hope, opens new doors, opens new conversation, even new relationships.
32:53Absolutely. Help is out there as well.
32:57Help is out there. All the information and help is out there.
33:00And I feel now that there's been a real shift in the conversations around our bodies,
33:06and we're reclaiming our bodies as our own. And there's a real sisterhood that's formed. And I
33:13think that's an underestimated or unrecognized superpower, because once you find the right
33:19group of girls around you that you can talk about stuff like that, then you're on the right road to
33:26happiness. Yes. And it's very empowering. So that's a really lovely, positive note to end on. Thank you
33:32so much for joining me. And happy Menopause Awareness Month. Of course, as well.
33:38Happy Menopause Awareness Month. Thank you, Nigat. See you soon. Bye.
33:42Bye.
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