Nicky Lowe [00:00:06]:
Hi, it’s Nicky Lowe and welcome to the Wisdom for Working Mums podcast show. I’m your host and for nearly two decades now I’ve been an executive coach and leadership development consultant. And on this show I share evidence based insights from my coaching, leadership and psychological expertise and inspiring interviews that help women like you to combine your work, life and motherhood in a more successful and sustainable way. Join me and my special guests as we delve into leadership and lifestyle topics for women, empowering you to thrive one conversation at a time. I’m so happy that you’re here and let’s get on with today’s episode. Over the last few years, perimenopause has been a real roller coaster for me. It’s also been a steep learning curve into hormones, female health and just how little many of us really understand about what’s happening inside our bodies. As someone with a a strong family history of breast cancer, I felt deeply conflicted about hrt.

Nicky Lowe [00:01:11]:
I was trying to weigh up my quality of life against concerns about risk and at times it just felt overwhelming. Last year things reached a point where I felt like I was trying to balance my sanity with my safety. I knew I needed support to understand my options rather than stay stuck in fear and uncertainty. And that’s when I found today’s guest, Dr. Charlotte Gooding. Charlotte is a GP, a BMS accredited menopause specialist and someone with deep expertise in supporting women with complex breast cancer histories and concerns. She works in an NHS breast clinic and has built a specialist service supporting women navigating menopause after breast cancer as well as those at higher risk because of family history. Over the last year, Charlotte has guided me so compassionately through my own HRT journey, helping me understand whether HRT could be an option for me and how to approach it safely in the context of my own risk factors.

Nicky Lowe [00:02:17]:
It was also through that process that she helped identify that I had a large fibroid, which ultimately led to me having a total radical hysterectomy about eight weeks ago. I feel deeply grateful for Charlotte’s support and I also know how privileged I am to have had access to that level of specialist care. And that’s one of the reasons I wanted to have this conversation, to make her insights, expertise and reassurance more accessible to other women who may be feeling confused, frightened or alone in navigating all of this. Now, I do want to say, before we begin, that this episode reflects my personal experience and this conversation is not a suitable substitute for individual medical advice. Every woman’s Situation history and risk factors are different. So it’s really important to do your own research and speak to a qualified health professional about what’s right for you. But in this episode, we’re exploring perimenopause, health, HRT and breast cancer risk and having the kind of honest, nuanced conversation that I know so many women are desperate for. And my hope is that this episode helps you feel more informed, more empowered, and less alone.

Nicky Lowe [00:03:38]:
So I won’t keep you any longer. Let’s welcome Charlotte. Welcome, Dr. Charlotte. Thank you so much for joining me on the podcast. I can’t wait to dive into this conversation because, of course, we’ve been working together for nearly a year now. So I’ve got to know you and all your expertise, and I’m just really delighted that you’ve agreed to come and share that on the podcast with my listeners.

Dr. Charlotte Gooding [00:04:00]:
It’s absolute pleasure to be here. It’s lovely. Thank you for inviting me.

Nicky Lowe [00:04:03]:
So, obviously we’re going to be talking about today perimenopause and the menopause. And I am sure people have heard lots of that because you can’t go anywhere these days without hearing those terms in some way, shape or form. But for many of us, we may not actually have heard the definitions of these and truly understand it. So for those that don’t, can you just describe what we mean when we’re talking about perimenopause and menopause?

Dr. Charlotte Gooding [00:04:28]:
Yeah, sure. So menopause is just really one day in a woman’s life, which sounds a bit disappointing when you think of all the hype around it. It’s when you’ve had no periods for 12 months or more. Now, obviously that definition slightly shifts. And obviously someone who’s had a surgical menopause, that’s going to be slightly different because they’re going to go into a sudden men. And there’s some other situations where people might go into what we call a chemical menopause. So people who perhaps are having certain breast cancer treatments or who might be using things that turn off their ovary for, say, treatment of endometriosis or premenstrual dysphoria. So there are other ways which women can go into menopause, you know, either suddenly or perhaps surgically.

Dr. Charlotte Gooding [00:05:12]:
But generally when we talk about menopause, we’re talking about someone, a woman, who has not had periods for 12 months or more. And that is the sole definition of menopause. Anything after that is postmenopausal. So you’re kind of postmenopausal for the rest of your life and then more. Now we’re hearing about this kind of perimenopause phase and that’s the time leading up to the menopause. And it can be anything from about 10 years before natural menopause takes place. So menopause usually happens in women. Average age in the UK is about 51.

Dr. Charlotte Gooding [00:05:45]:
So if you think 10 years before that, it’s quite feasible that women in their sort of early 30s, even late 40s, late 30s, early 40s, might be experiencing some perimenopausal symptoms. Anything from the age of 45 onwards is considered a normal menopause. So if you have it from 45 onwards, it’s normal. And anything before that is an early menopause. Perimenopause is a bit, kind of. It’s a bit of a buzz at the moment. People are talking about it more. When I sort of first started at med school, no one had ever heard of perimenopause.

Dr. Charlotte Gooding [00:06:17]:
I don’t think anyone was really talking about women’s health, to be honest. But it’s brilliant that we’ve kind of starting to look at that transition phase. And that’s basically what I would liken it to, really. It’s before the ovaries kind of pack their bags and give up all together. They have a little, I call it to patients, a bit of a final hurrah where they just go a little bit erratic and all over the place. And actually that’s pretty much how women feel in that time as well. So they feel quite erratic and up and down. And symptoms can be very variable.

Dr. Charlotte Gooding [00:06:46]:
In that early perimenopausal phase, women might experience some changes to the menstrual cycle. The periods don’t have to have stopped or to have like lengthened in their cycle time, but they might just feel like they have, they’re a bit heavier, they might be coming more frequently, they might be getting some bleeding in between periods. And so it’s characterized by those changes, but they don’t always happen in early menopause. And sometimes we see more of the kind of psychological symptoms coming through, you know, rather than menopause. We associate it with the hot stuff sweats that, you know, the night sweats. Actually, in that early perimenopausal time, women are more coming toward, coming to us with kind of, you know, the mood type symptoms, I would say, than those kind of hot flushes, night sweats.

Nicky Lowe [00:07:32]:
And I think that’s really important for people to hear because I know in my own perimenopausal journey. I didn’t realize that, like, I was expecting to have, as you say, the hot flushes or the hot sweats. That was the. Or people talked about perhaps aching bones or kind of aching, kind of almost limbs. I was expecting. I was looking out for that. So when I was experiencing this emotional turbulence, I. And it come.

Nicky Lowe [00:08:06]:
It crept up on me so gradually that I didn’t really notice until I was like, I don’t feel myself anymore.

Dr. Charlotte Gooding [00:08:14]:
And that’s quite common. So I often say to people it’s a bit like, you know, when you go for a walk and it’s quite misty and a little bit misty and foggy, and the visibility is not great. So that’s like a few of those symptoms coming in, and then you’re carrying on your walk, and then all of a sudden you’re just going along your walk, along the path, and you look up and you’re like, oh, my goodness, I can’t see anything around me. I feel completely lost and disorientated. I think that’s a bit like what perimenopause is like, because. Yeah, because the symptoms are kind of gradual and they’re sometimes subtle. And then if you’re not open and recognizing them and kind of alert to what’s going on around you, then you can find yourself kind of in this deep fog that it feels a bit harder to find a pathway out of. So I kind of like that analogy.

Dr. Charlotte Gooding [00:08:59]:
I like analogies for things, and I think that’s quite a good one. But you’re right, it is. It is sometimes really hard to notice the symptoms of perimenopause, because perimenopause hits women at a stage in life when there’s lots going on. You know, we might have. You know, some of us have got children, and some of us have still got young children. Some of us got children who’ve just left home. And that’s a new life transition phase. We might be dealing with elderly relatives who are aging, you know, who are perhaps sick, and you need to be there for them and caring for them.

Dr. Charlotte Gooding [00:09:35]:
Work situations, often. Actually, women are sort of at quite a pinnacle phase of their career. They’ve had some time off, perhaps for maternity. They’ve returned to work, and they’re really getting stuck back in. Work is busy. It’s stressful. It’s that mental load that we’re all carrying as women, you know, holding up the sky. And so those tiny little symptoms often sometimes get confused with other things that are going on in life.

Dr. Charlotte Gooding [00:09:58]:
Like, am I not Sleeping, because I’m really stressed at work. Is this just stress? Am I just feeling completely overwhelmed and burnt out? And it’s sometimes really hard to kind of tweak out all the individual symptoms and say, well, this is life, this is perimenopause, this is your hormones. It’s difficult to do that because lives are complex and everything affects everything else. And so it’s not always about that, it’s about looking at the whole picture.

Nicky Lowe [00:10:26]:
Yeah. And I think that’s what you do so brilliantly. And so many women that I’ve heard of in my kind of network have gone to their GP with symptoms that do feel psychological or emotional. And the first port of call is, let’s put you on antidepressants. I feel like antidepressants will help here and they’re anecdotally, I’m hearing, but it’s not helping. So what might be. If you were to kind of paint the picture of potential range and I know it’s so individual, what could somebody be coming to you with and you go, this could be perimenopause or. Or part of the perimenopause picture.

Dr. Charlotte Gooding [00:11:04]:
Yes, it is hard because there was probably like 35 plus symptoms of the perimenopause. And counting, I would say, because I see things all the time. So they, you know, you have estrogen receptors from the top of your head to the tips of your toes, so every part of your body can be affected. So you’ve got like the mood type symptoms, you’ve got fatigue. Sleep patterns can be disrupted because they’re quite hormonally controlled. You’ve got things like vaginal vulval symptoms, urinary symptoms. They’re the ones that probably women don’t pick up on as much. And I know you’ve spoken before about how you didn’t really piece those together for yourself, but, you know, low libido.

Dr. Charlotte Gooding [00:11:45]:
But then again, libido can be really affected by everything else that’s going on in your lives. Dry eyes, dry mouth, dry skin, hair drying, hair falling out. I could go on. Even things like tinnitus, that’s a really common symptom. Restless legs. The problem is that sometimes you’ve got to be careful because sometimes these symptoms are also symptoms of other things. So quite often when women first come and there’s this kind of picture of these evolving symptoms, it is sometimes a really good idea just to make sure that nothing else is going on as well. What we don’t want to do is we don’t want to be caught between the two extremes where we’re saying nothing is perimenopause and then we’re saying everything is perimenopause, menopause and so we miss stuff.

Dr. Charlotte Gooding [00:12:32]:
So actually sort of looking at the bigger picture and, and of course that is quite tricky because it, you know, it is hard to do in a 10 minute GP consult. My background is in general practice, I’ve worked in general practice for years and, and it’s sometimes hard to do that and I think that. But if you ask women and you really listen to them, they will tell you I’m not depressed. And I think women do know their own minds and they know their own bodies and it isn’t the same as like a true depression. And often what I’m looking for is those kind of fluctuations in symptoms, are they at all related to the cycle? Have there been some cyclical changes as well? So are periods changing and just trying to kind of piece those symptoms together with what’s happening for that person now? That’s not to say that other things might be influencing them. Of course, if you’re already stressed out, your, your stress load is going to be higher and so you are going to feel some of these symptoms more. But in a way that’s the kind of beauty of what we do. You know, nothing exists in isolation, so it’s about picking out those symptoms, working out how they’re impacting on that person and what we can do to support them.

Nicky Lowe [00:13:40]:
Yeah, and I. And what I loved when I first came to see you. So for context, I’d probably been struggling with perimenopausal symptoms, some that I was aware of, some that I wasn’t aware of for quite a few years. But as we’ll get into, I’ve got a very strong family history of breast cancer. Both my mum and my grandmother died of breast cancer and my mum and dad both were one of six children and every single one of my mum’s siblings has had cancer in some way, shape or form. And on my dad’s side there is kind of four and grandparents. So I’d got kind of both a strong maternal and paternal history of cancer in my family. So I think I was very scared of looking at potential HRT options and I know we’re going to get onto that.

Nicky Lowe [00:14:31]:
So I tried to do everything as naturally as possible. So I’d looked at my diet, I’d looked at my exercise, I’d looked at supplements and I for years had been kind of layering on, going kind of let me try and do this as, I suppose naturally as possible. But I noticed that I became quite anxious and I’d never been an anxious person before and I hear that a lot. So my resilience, I just didn’t feel resilient to everyday life. And I’m like, I’ve always prided myself on my resilience. I was like, that’s interesting. I became incredibly irritable and I’ve. That’s just not part of my personality.

Nicky Lowe [00:15:10]:
So I lost, I’d got no patience and I could go to rage quite quickly and I’m like, who is this person? And again, I’m sure you hear it a lot. I hear that a lot from my friends. And my cycle had changed so I was having a longer cycle. I was bleeding more and getting more and more heavy. And just like you said, that was something that I was like, oh, that’s just perimenopause. And I remember saying to people, oh God, this is the gift that keeps giving. Because I thought menopause, your period slowed down and got, got less. And I was like, oh no, mine are just getting more.

Nicky Lowe [00:15:43]:
And I’d got to the point where I had lost my connection to Joy. And I remember somebody saying to me, I’ve just become a shell of my former self. And I was like, that is it. So I decided to reach out and have that conversation with you.

Dr. Charlotte Gooding [00:16:00]:
And that is a familiar story that I will hear all the time in clinic or just amongst women that I’m talking to. You know, that real lack of self, that kind of not recognizing this person, who they are. And I think the anxiety can be quite frightening if you’re not someone who is being an anxious person and all of a sudden you’re getting quite a lot of anxious feelings and, and quite often sort of quite overwhelmed by those feelings and not really able to kind of justify them and sort of say, well yeah, that was a really anti provoking situation, just overthinking over worrying and that. That can be really scary if that happens to you out of the blue all of a sudden and it’s sort of taking over your life, you know, it’s affecting your sleep because you’re kind of waking up in the night going, oh my goodness, what if this happens? What if that happens? What if I can’t get back to sleep and it just becomes all consuming? So yeah, anxiety can be a really big one. And like you said, that irritability and that rage and I think just that threshold, you know, we all have this window of tolerance to be able to cope with things. And I think that window of tolerance really narrows when you’ve got all this other stuff going on. And that is something that I hear women say a lot. And it’s hard because it’s, it’s often embarrassing if you’ve suddenly flown off the handle or, you know, you’ve gone in, flown into this rage and you know, you spend a lot of time trying to make up for that and saying, oh, I’m really sorry, I completely overreacted.

Dr. Charlotte Gooding [00:17:38]:
No, I don’t really know why that happened. I can’t even explain it. It just comes over me like, like that red mist. And it is very true. And I hear, hear that a lot from patients and I think that can then make things like relationships work really quite difficult.

Nicky Lowe [00:17:54]:
Yeah. And the other thing that I, I started to experience and not so much as some of my friends, was that brain function fog. Like literally I would kind of feel like I was wading through mud. Like I’m normally quite switched on, productive person. I’m like, I just feel like I’m wading through mud. And there would be times there were particular words that disappeared from my memory. One of them was skirting board. And I would be talking to people go, you know that bit that sits at the bottom of a wall and it’s that bit of wood.

Nicky Lowe [00:18:21]:
And literally skirting board disappeared from my memory. It was like it just got erased. And I was like, oh, isn’t that weird?

Dr. Charlotte Gooding [00:18:28]:
I mean, and women can often say, you know, I think I’m getting dementia here. I feel like, oh my goodness, I’ve seen this happen to my grandma or my mom and I feel like I’m getting dementia. And that is frightening. Especially, you know, it can really impact on things like your confidence to do your job. You know, if you’re getting up, doing presentation or you’re just having, trying to have these high level conversations with people and you’ve just forgotten the word that you’ve used every day for God knows how long. It can really affect your confidence in your ability to do your job. And I think that’s really important. Important.

Dr. Charlotte Gooding [00:18:56]:
And unfortunately, you know, I have seen a huge number of women exit the workplace or, you know, not take a promotion or step down a level because they’ve been so affected by those things and it’s really rattled their confidence. And often they haven’t had much support in the workplace either. So I think those things are really significant and really important.

Nicky Lowe [00:19:17]:
And I think that’s really powerful that you’ve said that because I used to go to A yoga class where the women were predominantly in their 50s, 60s and perhaps 70s. And I remember them having a conversation about the menopause and perimenopause. And three of them had said to me in different guises, oh, I left my job because I could no longer do it, or I left my marriage or I. And then they were like. And then I went on HRT and went, oh, I didn’t need to leave my job or I to leave my marriage or. And I was like, okay. And I remember clocking that. But again, because of my family history of cancer, I was like, oh, I don’t know if HRT is an option for me.

Nicky Lowe [00:19:57]:
And so just to layer in, I ended up reaching out to you probably about a year ago, and I specifically was looking for somebody that was a menopause expert with a kind of specific knowledge of breast cancer. And I was so glad I found you. And I think you did this brilliant intake session with me where you looked systemically at everything from my family history to my symptoms to my lifestyle. And one of the things that you’ve already mentioned about kind of vulva health, I’d about. It’s about 18 months ago now. I ended up having this sensation that I was like, what the hell is that? Never had anything like it before. And I was just this burning sensation and it was so horrific, like I’d never experienced anything like it. I ended up having to go to my GP to get a swab and I was like, what have I got? Have I got some kind of std? How the hell have I got something like that? And it turned out to be thrush.

Nicky Lowe [00:21:01]:
And again, in conversation with you, you were like, oh, UTIs thrush, they’re a really kind of common side effect that you don’t hear anybody talk about. Like, I’d never even made that connection.

Dr. Charlotte Gooding [00:21:13]:
No. And there’s probably hundreds of women, I would predict, that are entering into various pharmacies all over the country right now, getting another thrush treatment and just sort of self treating for these things or, you know, when I was in general practice, I always used to be really sort of switched on to the women who were repeatedly asking for the thrush treatments and then kind of looking at their age group and thinking, should I have a chat with them about perimenopause and what this might actually be? Is this actually thrush? And I think, you know, women still find it incredibly embarrassing and stigmatizing to talk to health professionals about, you know, genital symptoms, whether it be itching, burning, whether it be Painful sex, whether it be urinary incontinence type symptoms, they find it really hard. So they do look for things that they can just kind of get hold of themselves and sort of self treat, which I just think is incredibly sad because, you know, I think, I think as well, we’re probably not that good as health professionals sometimes about opening up those conversations and that needs to get

Nicky Lowe [00:22:11]:
better as well because I love the actress. Halle Berry talks about this a lot. So she talks about, talks about how she discovered that she was perimenopausal. She had what the doctors told her was an std. And she went and ended up, I think falling out with her boyfriend at the time going, you know, have you given this to me? And it wasn’t actually. But again, there’s not that many people talking about it. So what came out of our discussion was that the heavy bleeding and I remember you saying to me I’d had a fibroid when I was pregnant with my, my second child that had led to a planned C section. And you’d said, can you go and get that check for me? Because actually we need to look at that first.

Nicky Lowe [00:22:53]:
Can you give a little bit more context around that?

Dr. Charlotte Gooding [00:22:55]:
Yeah, I’m always, I guess it’s, it’s very easy to kind of just go, oh, perimenopause, you know, changes in bleeding. But I’m always suspicious, like I think probably bordering on nosy. Most people would say it’s like, I love a little nose into my people’s histories. And I really like when I’m speaking to patients, I really want to know all about them. Professional curiosity, probably why general practice I find so hard because I’m like 10 minutes, how can I possibly hear everything about this patient? I really need to know the nitty gritty. And so as we’ve been talking, I was thinking about that and then you’d said that your periods were getting heavier. And I just thought I need to know a bit more about that. And that’s when we kind of said, look, I think we should just check that this fibroid, you know, hasn’t under the influence of more hormones in your life, hasn’t grown back.

Dr. Charlotte Gooding [00:23:48]:
Because what I was thinking was if we’re potentially going to think about something like hrt, I’m going to give you some estrogen and estrogen grows fibroids. So you won’t thank me very much if I then cause your bleeding to get heavier. So there’s often little cues in patients histories that will make me curious and there are Sometimes things that we would just like to check out before we get started. And a good job we did, really. Yeah.

Nicky Lowe [00:24:16]:
So for people listening, when I went and had a scan, it turned out I’d got a 9×8 centimeter, quite large fibroid that ultimately led to me having a hysterectomy about eight weeks ago. So I am now classed as a kind of medical menopause. And thanks to your support, it has been such a positive journey for me. So in that you’ve already talked about estrogen, can you talk a little bit about the hormones that we might be connected to perimenopause and menopause? Because, again, I think there’s a lot of confusion around.

Dr. Charlotte Gooding [00:24:55]:
I think there is. I think, you know, you essentially, your ovaries make estrogen progesterone and they also make some testosterone as well, I think sometimes shocks women because we think of testosterone as this male hormone. Although there is a lot of chat, I think, about testosterone in women now. So, you know, they’re the three main hormones that we’re looking at. And obviously when someone goes into menopause, if they’ve had their ovaries removed because, you know, surgery or whatever, then we need to replace those things for them too, in order for their symptoms not to suddenly get very severe. In perimenopause, we’re kind of just holding up the system. I call it a bit like a flight deck. So in perimenopause, your hormones are going up and down and all over the place and at times you’ll get very big dips in estrogen and that can make you feel quite symptomatic.

Dr. Charlotte Gooding [00:25:43]:
But actually, at times during perimenopause, you can have quite a lot of estrogen circulating, probably perhaps more so than other times, apart from obviously, when people are pregnant. So the way I describe it in perimenopause is almost like you’re building in a flight deck, so you’re trying to stop the lows, but you equally don’t want to give so much that if their own estrogen goes a bit high, it’s too much and their body just feels a bit overwhelmed. So it’s quite tricky actually, sometimes getting that balance right. But obviously when someone is put into menopause or goes into natural menopause, then we’re replacing the hormones. That’s not to say that there’s no hormones left at all in your body. When your ovaries go goodbye or get removed, it’s you will still produce some weak forms of estrogen in fat cells. That’s why we get that lovely tummy. During perimenopause menopause, the body is trying hard to lay down some fat cells to get some kind of estrogen going around the system.

Nicky Lowe [00:26:38]:
I never knew that was why.

Dr. Charlotte Gooding [00:26:39]:
Yeah. And then your adrenal glands, which are by your kidneys, will produce a little bit of testosterone as well. So we’re not devoid of hormones postmenopause, but just not at any level that is the same as when. When we’re premenopausal.

Nicky Lowe [00:26:56]:
So if somebody was to come to you as a menopause specialist, you’d be looking at actually what are the signs and symptoms that might tell you what is going on between those hormones in the mix of it.

Dr. Charlotte Gooding [00:27:08]:
Yeah, absolutely. And obviously progesterone also starts to decline and that is sometimes the reason why we can see this heavier bleeding and irregular bleeding as well. So it’s about those. They’re the three main characters that we’re kind of looking at. But you’ve also got to remember that things like your hormone, those hormones are also really connected to other hormones in your body. So things like thyroid. So if you’ve got a thyroid issue, you can often see that that might change, or your requirements for your thyroxine medication might change as you go through perimenopause. Body parts of the body don’t exist in isolation.

Dr. Charlotte Gooding [00:27:44]:
In medicine, we love to put things in boxes. We like to say, right, we’re dealing with that, we’re dealing with that and we’re dealing with that. That’s just not how these. These systems work, really. It happens like a harmony. Everything has to go on together. Yeah.

Nicky Lowe [00:27:58]:
And so you’ve picked an area of kind of medicine. I suppose you are a general practitioner, but looking at kind of the menopause specialist, it is so tricky, isn’t it? Like, I know I came to you going, well, I know that I’ve got an estrogen dominant. And I suppose one of the reasons I probably had a fibroid was I’d got kind of estrogen that was feeding it. But I’d also got polycystic ovaries, which can have. You’ve got increased androgen, so the male hormones, so potentially higher testosterone. So I remember we had a conversation about that and me going, my. My assumption would be I wouldn’t necessarily benefit from a testosterone. But you actually said that hasn’t been anecdotally what you’ve experienced.

Dr. Charlotte Gooding [00:28:38]:
Yeah, I think it’s really. I think. And I think every woman is different and I think, particularly when it comes to testosterone, I really think that everybody’s different, but I also think that we all have different sensitivities to the hormones that are in our body. Our bodies react differently to them, and particularly in the brain, I think our receptors are very different depending on different people. And you certainly see that across the board when you’re working with different women. So, you know, polycystic ovarian syndrome, you know, that we typically think about that as being, you know, people worry about it when it comes to fertility. So everyone’s like, oh, you know, it might be cause a problem with having children. It doesn’t always, but really we need.

Dr. Charlotte Gooding [00:29:18]:
And so then they have babies if they want to, and we sort out their period so that they’re having more regular periods. Because obviously one of the hallmarks is that you don’t have regular bleeds, and that can be dangerous for the womb lining. So we need to make sure you do have regular bleeds. So we source all that out in sort of early life, you know, like in our early reproductive years, and then we kind of forget about it. But actually, and I’m sure we’ve talked about this, is that PCOS is a lifelong metabolic condition. And if you have pcos, then you are at higher risk of metabolic disease throughout life. You know, you’re higher risk of cardiovascular disease, high risk of type 2 diabetes, high risk of things like endometrial cancer as well. So we need to be thinking about women’s, not just their lifespans, but their health spans and looking at how these conditions are going to affect them going through the rest of their lives.

Dr. Charlotte Gooding [00:30:11]:
Because you’ve got like three decades left and you want to live them well and healthy, and we want to try and reduce the risk of disease. So for certain women, their hormones play a much more sort of main role in their life and in disease processes. And we have to be able to identify those women and be able to kind of look after them, I suppose, as time goes on. And you’re right, you know, raised testosterone is a hallmark of pcos. But it’s quite interesting in that women with tendency is that women with PCOS tend to come in, in perimenopause with more regular periods. So all of a sudden they’ll be like, I just never really got periods. You know, I might have been put on something that made me have a regular bleed. But now in perimenopause, the first time in my life, I’m having a monthly bleed.

Dr. Charlotte Gooding [00:30:59]:
And so you see that quite frequently. But the testosterone thing, I think, is Interesting and complicated. And I don’t. It’s really hard to identify women who will need testosterone or who will respond well to it. And so it’s about kind of looking at what their levels are. I don’t think, and I haven’t seen in clinical practice that really levels correlate to the way patients feel or their symptoms. And one of the problems is, is that regarding testosterone is that we have very little data, apart from things like libido. And so whilst anecdotally we will see that some women really benefit from testosterone in terms of mood, sometimes cognition, that kind of joy feeling, which is really hard to pin down in a research study, we don’t have evidence to support its use for that.

Dr. Charlotte Gooding [00:32:01]:
So we have to. So it makes it a little bit more nuanced. And that’s why we have to kind of take each person as an individual when we’re looking at those things. So some women, yes, we will really benefit from testosterone. Some women, it won’t be appropriate for. Their levels might be sitting a bit higher anyway. And if you give it to them, you’ll probably load them with a load of side effects that they won’t thank you for. And some women, you give it to them and just.

Dr. Charlotte Gooding [00:32:25]:
They don’t feel any different. So I suspect, and this isn’t scientific and I don’t have a study to back this up, I suspect that everyone just has a very different response to testosterone. So I think some women perhaps are quite driven by it and perhaps, you know, that point in their cycle, usually where the testosterone is higher, that’s their time, you know, just for ovulation, they’re driven. That’s when they’re the most productive. Other women, it just doesn’t really factor in their cycle. It’s not something that they’re driven by, but that is just by looking like there’s no evidence behind that. That is just my observation of women over time, treating hundreds of women.

Nicky Lowe [00:33:04]:
And that would make sense because I also hear friends anecdotally talk about their experience of progesterone. But before we move on to that, something that you educated me on, which again, people may not know, because some women are like, just give me the testosterone, it’ll give me the boost and the give me my umph back. And you made it very clear, actually, if we don’t get your estrogen levels right, is it right that testosterone just converts to estrogen?

Dr. Charlotte Gooding [00:33:28]:
So. So the testosterone will convert to estrogen and in the body. So if you haven’t got enough estrogen, then testosterone is probably not going to work that well for you anyway, and I think so. So I tend to do things step wise and I always think as well, it is always better where you can. And I’m sure we’ve had this conversation about just doing one thing at a time, whether it’s hormones, whether it’s other medication. You know, years of clinical practice have taught me when you try to do too much all at once, it’s generally a disaster. So I try to just introduce, as much as possible, one hormonal change at a time, because that allows the body to adjust to one thing and it allows us to see what’s benefiting, but also what might be causing some side effects as well.

Nicky Lowe [00:34:19]:
You’ve only got like one variable to

Dr. Charlotte Gooding [00:34:21]:
kind of keep things simple.

Nicky Lowe [00:34:26]:
Obviously, I’m slightly different because I have had a total hysterectomy, but for the typical woman who still has her reproductive kind of organs, when it comes to hrt, can you just take estrogen or is it right in saying you would need to take a combination?

Dr. Charlotte Gooding [00:34:44]:
Yeah. So essentially, if you’ve still got your womb, you need to take progesterone alongside oestrogen. And the reason for that is because oestrogen makes womb linings grow. So if we just gave estrogen to women who had a womb, their womb lining would grow and grow and grow. And if we don’t stop uncontrolled growth, that’s when little mistakes can happen in cells and that’s when we might get the risks of endometrial cancer or womb cancer. So it’s really important that if women have got a womb and they’re taking estrogen, they have some kind of progesterone alongside it. Now, if you’re still having periods, even if they’re not particularly regular, and say you haven’t been 12 months without a period, so you might have had six months of no bleed. We would generally put you in a cyclical regime with the progesterone.

Dr. Charlotte Gooding [00:35:31]:
So tend to do two weeks on, two weeks off, or 14 days, 12 is the minimum. It varies a little bit, so you probably hear differences amongst women. But generally two weeks on, two weeks off of the progesterone. And when we take the progesterone away, you get a period like withdrawal bleed, so you get a regular bleed as part of that. If you are 12 months post your last period, then you go on continuous progesterone. So you take your progesterone every single day. And there are different ways of doing that. There are different types of progesterone and progestogens, which are more synthetic.

Dr. Charlotte Gooding [00:36:07]:
And some women might have something like a Mirena coil which can do the job of protecting the womb lining. It just sits, it’s progesterone in the coil, it sits inside the womb and does that job. It’s like a little lawnmower, keeps the, keeps the womb lining nice and short so we don’t have to worry about it. But if you’ve not got your womb, generally you can have estrogen only hrt. However, there is a caveat to that in that if you are someone who has had endometriosis diagnosed, particularly if it’s just mild endometriosis, we sometimes don’t add progesterone. But generally if you’ve had endometriosis, quite extensive disease, then you would put some progesterone back because the hallmark of endometriosis is that you’ve got endometrial. So womb lining type cells that are outside of the womb. So even if we remove your womb, you’re still going to have those little cells usually in the pelvic and abdominal cavity, but they can be in other places as well.

Dr. Charlotte Gooding [00:37:09]:
So we have to make sure that they’re not reacting to the estrogen.

Nicky Lowe [00:37:13]:
Yeah. So one of the conversations we had as part of my plan, wasn’t it that I was having my cervix removed as well and you were like, actually, if your cervix is removed, I know that I can actually just get that.

Dr. Charlotte Gooding [00:37:25]:
And that’s the other time. So sometimes people have what is called a subtotal hysterectomy, which means that the cervix remains. It’s quite rare now. It used to be done more in the past, I very rarely see that now, but we always check with women because some endometrium. So some womb lining cells can be in the stump of the cervix, so you just need to make sure. So what we would tend to do with those is that if we, if we’re not sure or if we think they still have their cervix is do a bit of a test and see if they bleed. And if they do, then we’ll have to keep them on some kind of progesterone. But if they don’t, then they can have estrogen only hrt.

Dr. Charlotte Gooding [00:38:05]:
So it’s individual and it gets quite complex when you really get down to the nitty gritty.

Nicky Lowe [00:38:10]:
And also because you might, people might hear about from an estrogen perspective, some people are on patches, some people are on gel and can you tell us a little bit? I mean, again, I know it’s so nuanced, but just at a high level what the differences are and how you would kind of.

Dr. Charlotte Gooding [00:38:25]:
Yeah. So, I mean, we’ve, we’ve got very fortunate over time and that we’ve got better ways of doing things. So previously we were mainly using oral hrt. So whether that be or released and alone or combined oral and progesterone product. So that was kind of the way that HRT was done. And it was, it was using kind of conjugated equine urine, horses urine, and it was not a great form of estrogen. Quite high risk for blood clots. And so we don’t tend to use that anymore.

Dr. Charlotte Gooding [00:38:55]:
We now have more body identical types of estrogen. So estradiol body identical means that when you look down the microscope, it looks the same, it isn’t the same. We haven’t extracted it out someone else and we’re putting it in you, but it looks the same in chemical structure as your own body’s natural hormones. And so the body tends to work a bit better with those. And we can get body identical forms of progesterone as well, but we can use synthetic progestogens. And the type of HRT really matters because oral HRT gets metabolized in the liver. So that means that there is, it can affect clotting. So there is a risk of blood clots, so in the legs or the lungs, so DVTs, pulmonary embolisms, there’s a risk of those when you take oral estrogen, whether that be alone or whether it be with progesterone as well.

Dr. Charlotte Gooding [00:39:52]:
So now we’ve got transdermal products, they’re products that go through the skin for estrogen, which is great because that means that people who perhaps would have been told, you can’t have HRT because you’ve got a high risk of blood clot, you know, you’re a smoker or you’re overweight, or you perhaps have got some genetic issue that predisposes you to blood clot. Now those people can have HRT because they can have estrogen through the skin in form of patches, gels or sprays that. And the other thing to say is that quite often what would happen is that people would start an hrt, but then as we age, so you’d start an oral hrt, but as we age, our risk of blood clot goes up. So then people would be told we can’t use that anymore because it’s too risky in terms of blood clots, they would have to come off it. But now, because people tend to be using the. Through the skin products of the patches, gels or sprays, they tend to be able to stay on HRT a little bit longer. And people that perhaps couldn’t have HRT in the past can now take hrt. So there’s been some sort of big changes over time, and sometimes we’re not always caught up with these changes in the medical field.

Dr. Charlotte Gooding [00:40:59]:
I think it’s a lot. It is a lot and it’s a lot to get your head around. And I think that. And that’s why everyone has to have these individual discussions, because there isn’t this sort of one size fits all and what your friend might be doing might not be suitable for you. And I guess sometimes that does worry me a bit because I do see, you know, a lot of forums and a lot of chat on the Internet and women sort of saying, oh, well, you could try my HRT or whatever. And I’m thinking, oh, God. So, you know, I think it’s really important that the type of HRT that you’re taking is individualized. For example, you know that in terms of progesterones and progestogens.

Dr. Charlotte Gooding [00:41:40]:
So the progesterone is the body identical, what the body naturally produces, and the progestogens are the synthetic forms. There’s even a difference between those. And I might pick different ones depending on what’s going on. So if I’ve got someone who’s a bit of a bleeder, has always had heavy bleeds, I might choose a synthetic progestogen. But generally progesterones are better tolerated. So you’ve probably heard of like the Eutrogestan and things, they’re better tolerated. So if someone’s a bit sensitive to synthetic progestogen, I might choose that. So it’s all about choice.

Dr. Charlotte Gooding [00:42:14]:
And the more options we have, the more choice women can have and make and the more widely available then HRT becomes to different groups of women, which is brilliant.

Nicky Lowe [00:42:24]:
And I love the nuance that you bring to this. So what I’d love to move us on to now is the specifics around HRT and breast cancer, specifically, because I think there has been a lot over the years of concerns then people kind of bringing out new research. And I know you’re at the forefront of kind of the latest on this. Would you mind just sharing what some of those previous considerations were and what we now know in what we. March 2026?

Dr. Charlotte Gooding [00:42:59]:
Yeah, so I think the. The whole World of dominant of HRT was pretty dominated by the Women’s Health Initiative study which came out 2002 and was very vilifying of HRT and particularly in terms of cardiovascular risk and in terms of breast cancer risk. Looking back now at that, it should never really have been reported in the way that it was. And a lot of the data was not reported in a very responsible way, shall we say. And so it over, well, it sort of over egged, I would say, is the risk of breast cancer. And so immediately overnight women were, were taken off it. And that was when I was sort of in training. So I’m interested in HRT probably because my mum had a very early menopause and she had surgical menopause when she was in her late 30s or might be mid-30s actually.

Dr. Charlotte Gooding [00:44:02]:
So she was really young. So obviously had been on HRT her entire life. And I just thought it was really normal. And then I’m getting onto the hospital wards and I’m, you know, I’m thinking, oh, why doesn’t this woman have hrt? She’s having a hysterectomy and the gyne doctors are looking at me like, are you mad? You would kill this woman if you gave her hrt? That’s how, that’s how serious people were. Just no one talked about it. And I feel quite sad for those women really because they really were just, it was taken away from them overnight. It just wasn’t talked about. People thought it was too dangerous to be using.

Dr. Charlotte Gooding [00:44:37]:
But over time people have combed through that data, they’ve really gone back and over it and actually now we kind of recognize that it just never would be presented in that way again, that there is a risk of breast cancer when it comes to combined forms of hrt. So estrogen and progesterone forms of hrt. So the ones you have to have if you have a womb or endometriosis. And there certainly is a risk and that’s fine, there are risks with lots of medicines and drugs that we give out. But what we need to do is we need to find frame that risk in the context of the patient that sat in front of us. So we need to look at it in comparison to other things that are risky for breast cancer. So your biggest risk for breast cancer is age. The risk of breast cancer increases with increasing age and particularly when we get above 50.

Dr. Charlotte Gooding [00:45:33]:
So when I’m using combined HRT in women who are perimenopause, their baseline risk of breast cancer is really low and they would have a risk of breast cancer if I was prescribing the combined pill or the progesterone only pill for contraception. But we don’t hammer that home to them when we’re having those discussions. And so it’s all about looking at risk in the context of the patient. So it’s about things like looking at family histories and actually examining whether that family history does mean that they’ve got an increased risk. Because some, although patients might think that they’ve got this massive risk of breast cancer because there’s someone in their family breast cancer, it doesn’t often constitute a risk to them. We need to look at their lifestyle. So things like smoking increases your risk of breast cancer by more than HRT. Drinking 2 units of alcohol a night will increase your risk of breast cancer more than HRT will.

Dr. Charlotte Gooding [00:46:25]:
And being obese BMI over 30 hugely increases your risk of breast cancer. And even things like not doing active regular exercise increases your risk of breast cancer. So I guess when I’m talking about it with women, you know, I’m not saying that there isn’t a risk when we’re using combined hrt, but what I’m saying is let’s put that risk in context for you and see how you then feel about that risk. Don’t let it be a barrier for even having the conversation. And I think that’s really, really important because you could look at it. If you’re going to look at risk, you’ve also got to look at benefit. And for many of these women, you know, there are significant benefits to their lifestyle of going on hrt. So they might not have those two units of alcohol night because, oh, they can sleep better.

Dr. Charlotte Gooding [00:47:12]:
So they don’t need to have a glass of wine to get them off to sleep. Or they’re not sort of drowning their feelings by having an extra glass of wine. They might have less joint pain and less hot sweats and they might just feel mentally better. So actually they can go out and do some exercise. Exercise. Oh, lo and behold, if they’re exercising better, they might make healthier choices with diet and they might lose a bit of weight. So it’s all about context and it’s all about personally, for me, I think that we downplay the role of lifestyle factors in the risk of breast cancer. But we’re very, very happy to plaster headlines across newspapers that say, HRT will give you breast cancer cancer.

Dr. Charlotte Gooding [00:47:54]:
But what we don’t have is a big bus going around the country saying drinking two units of alcohol will increase your risk of breast cancer by more than hrt, because that doesn’t suit the agenda.

Nicky Lowe [00:48:05]:
And I love how you frame that because it is so complex, isn’t it? And I think that’s what I really appreciated when I came to see you, because I was balancing my sanity and my safety. So I was like, I’d got to the point where actually this was impacting my quality of life, not having any hrt, even if there was a risk. I was like, how do I navigate this? And you kind of. Kind of held me beautifully through that process. I have many people in my network that have had breast cancer. So if you have had somebody that has had breast cancer, what are their options? And again, I know this is very nuanced because there’s different types of breast cancers, but where would you be pointing people to if they’ve actually had a breast cancer?

Dr. Charlotte Gooding [00:48:52]:
And it is complicated, it is nuanced, but I think it’s really important that just because something is complicated and nuanced, we don’t shy away from talking about it. And so, you know, Nikki, I have a particular passion about talking about breast cancer patients because I think they get a really bummed deal because, you know, there’s all this conversation going on about, you know, HRT and how wonderful it is and, you know, everyone’s taking it. And these are a group of patients that just don’t feel heard, that don’t feel that they’ve got a space at this table to have these conversations. So actually, I run a menopause and breast cancer service within the nhs, which I set up, and it’s probably one of my, like, proudest achievements. I just. I just love doing that clinic and spend a lot of time, you know, trying to advocate for women with breast cancer, because when a lot of the treatments that we use in breast cancer, they. They affect menopausal type symptoms, so they don’t always put you into menopause, because don’t forget, the majority of women with diagnosed breast cancer are postmenopausal, but they can make those menopausal symptoms worse. And of course, there’s lots of people who get diagnosed with breast cancer who are on HRT and then they have to stop their hrt.

Dr. Charlotte Gooding [00:50:06]:
So all of a sudden their symptoms come back and then we give them a drug which makes them feel worse. There’s younger women who might be perimenopausal or premenopausal. We might switch off their ovaries as part of treatment. And there are also some who obviously then go into this sudden chemical menopause. And there is a huge difference between a perimenopause menopause journey and a sudden menopause. The symptoms are. Are very severe. And so I think we really need to look at how we can support these women.

Dr. Charlotte Gooding [00:50:40]:
And the problem is that I think lots of breast cancer surgeons, oncologists, don’t know how to navigate that space. And I think it’s a lot to ask of a GP as well. So what happens is these patients just get lost in the system and they don’t really know who to ask for help. But there’s loads of things. And I think that what worries me is that with the conversations that you hear at the moment, you know, the big fancy headlines of if you take hrt, you won’t get dementia, you know, like, that’s the most common one at the moment, I think. And, you know, if you don’t take hrt, you’re going to die of a heart attack and you’re. You’re going to get osteoporosis and that’s it. Doomed forever.

Dr. Charlotte Gooding [00:51:19]:
And, you know, if you’re sitting there and you’ve had a breast cancer diagnosis and you’re trying to deal with that and you’re just reading these headlines, it’s devastating. And women actually come to my clinic crying, not because they’ve got breast cancer, but because. Because they’re thinking, oh, my God, I can’t take hrt. I’m basically doomed, doomed to this life of osteoporosis and heart disease. And that’s where I think we need to be quite careful about how we’re having these conversations about HRT and that it isn’t this golden elixir, it isn’t for everybody. And there are certain groups of people that might not want to take hrt, don’t need to take hrt, or who can’t take hrt. And it’s really important that they are able to explore the options that are available to them. And that’s when, hands down to you, Nikki, we’ve always said, and I’ve always said to you, is that lifestyle is key.

Dr. Charlotte Gooding [00:52:13]:
And when I saw you, you know, you had this really good lifestyle, you’d done all that stuff first. But often when I’m seeing people, they haven’t done all that stuff. So often that’s a good place to start. You know, heart disease and things depend on lifestyle more than anything else. So, you know, bone building, exercise is important for preventing osteoporosis, so we need to try and get those things going. But sometimes it can be hard to do those things when your symptoms are bad. So we have to look at what other options do we have for treating things like hot flashes and night sweats. There are drugs such as some of the antidepressants which, no, we’re not fobbing you off with an antidepressant, but we’re using the way that they work.

Dr. Charlotte Gooding [00:52:51]:
The chemical ways in which they work can switch off hot flushes and night sweats. We’ve got things like bladder drugs as a bladder drug called oxybuty which we found out is quite good at treating hot flushes. So that’s a useful one I’ll sometimes use. We’ve got new drug vioza which has just been approved by nice, brilliant option, non hormonal treatment for hot flashes and night sweats and can help sleep as well. So I think there are lots of medical options. There’s also lots of other options. So there’s the lifestyle stuff. You know, if we can help women to support them to lose weight, they will have a reduction in their night sweats, they will have reduction in their cardiovascular risk.

Dr. Charlotte Gooding [00:53:30]:
Things like acupuncture can really be helpful. Some women things find things like hypnosis really helpful or cognitive behavioral therapy. So there’s like a whole toolbox that women can explore, but they’re only going to know about this if someone can sit down and have a conversation with them about it.

Nicky Lowe [00:53:47]:
Brilliant. And would somebody that can’t, that has had breast cancer, can they have, you know, we’ve talked the difference between topical oestrogen versus vaginal estrogen. Could they have vaginal estrogen?

Dr. Charlotte Gooding [00:53:59]:
Yeah, so vaginal estrogen is different and I think it’s really good to clarify that. So when I generally talk about hrt, I’m talking, talking about systemic forms of hrt. So you have, you know, your estrogen and your progesterone and then there’s the localized treatments. So your vaginal pessaries, your creams, and there’s even a vaginal estrogen ring that you can use and they are very different. So they are absorbed locally into the local bloodstream. They just go into the tissues where they are used and can be really, really helpful at supporting, you know, vulval dryness, vaginal dryness, painful sex, urinary tract infections, bladder issues. So increased frequency. They can support women who have got prolapses.

Dr. Charlotte Gooding [00:54:42]:
Really, really helpful. And we do use them in our breast cancer patients. So anyone who’s had previous breast cancer or patients who are on tamoxifen, they can use and it is in the guidelines that they can use vaginal estrogen. Anyone who is on there’s another type of drug called aromatase inhibitor, which is aiming to react really flatline levels of estrogen. It’s a little bit more complex, but still, it, you know, we can have discussions with breast teams, we can have discussions with oncologists, and there are patients that I do use it in who are on those treatments and there are other treatments as well that can be explored for those symptoms. So there’s. There are so many options for those type of treatments and. Absolutely, they’re the type of treatments that actually may be available to people, people who cannot take the systemic HRT and definitely worth exploring.

Nicky Lowe [00:55:34]:
That’s really useful to know. And. And the reason I keep bringing up about the vaginal issue, it just was not something that came across my awareness at all. And I was listening to a podcast, actually, that Davina McCall did with a sex therapist expert, and I can’t remember her name. She’s an Australian woman who, back in like the 90s, was always on, like, Cosmopolitan, writing kind of the sex columns. And she. She shared that she’d had. And I don’t know if I’m going to get the term right.

Nicky Lowe [00:56:02]:
Is it vaginal

Dr. Charlotte Gooding [00:56:05]:
atrophy?

Nicky Lowe [00:56:05]:
Atrophy, yes. When she said, even as a sex therapist, she said, I know as much as there is to know. She said, I’d never heard of this before, so can you explain what that is? Because that’s what put it on my agenda.

Dr. Charlotte Gooding [00:56:17]:
And I was like, wow. So vaginal atrophy is basically. So, basically what happens is, as you lose estrogen, the tissues that are so reliant on estrogen in the vagina, the vulva, the bladder, the pelvic floor, they can become weaker, they can become drier, they can become thinner, they can become more fragile. Often women postmenopausally will notice that they get. Now, I need to be clear here, not a disappearing labia, because this is another thing that’s going around. TikTok and the Internet is like disappearing labia, but the labia do become more. Less plump. And so vulvas do look very different in the pre and post menopausal stage.

Dr. Charlotte Gooding [00:56:56]:
I think some women can be quite shocked by that. You get less collagen in those tissues. Like you get less collagen everywhere as we age. And so, you know, we need to look after those tissues. So it’s. It’s kind of. The old name used to be vaginal atrophy. I don’t love that term because I Think, you know, when you say it just feels horrible, it feels like God is there not enough to be contending with.

Dr. Charlotte Gooding [00:57:20]:
But now my vagina is withering away as well. Like it doesn’t feel good. And so now we would tend to use gsm, or genitourinary syndrome of the menopause, because that is a really good term to use because it’s about the genitourinary symptoms. So it’s not just vulvas and vaginas, it’s the bladder and the urethra as well. But also it relates it to menopause. So it’s about the loss of estrogen, so it’s telling us why this is happening. And I quite like the idea that it’s got the word syndrome in it as well, because it is a lifelong thing. So you can have women in their, you know, 60s, 70s, 80s, 90s, care home residents, you know, who would really benefit from some vaginal estrogen still.

Dr. Charlotte Gooding [00:58:05]:
And it’s not too late because that might prevent them from getting how many, you know, I’m a gp, so I have spent my life going in and out of care homes and so many of those women in and out, in and out, UTIs, back in hospital. Urosepsis, you know, really high mortality rate for women from something like urosepsis, which can come from a uti. So. And then they get delirious with their urinary tract infection, then they fall over, then they break their hip because their bones are fragile, because no one ever told them about the menopause and how important it was to do bone building, exercise and all of that. So we’ve got this real problem. But we can use vaginal estrogen and it’s safe and it’s easy and we need to be using more of it, essentially, because you need to be using it long term. So when you’re using your vaginal estrogens, which can come in the form of creams, pessaries, like I said, a ring. If you stop them, your symptoms will probably come back.

Dr. Charlotte Gooding [00:59:04]:
And most women will experience some symptoms of, you know, vaginal, bladder, vulval sexual issues around menopause. But a minority of those women will come forward and talk to us about those. So we need to be proactive in talking to our friends about them and, like, breaking down the shame and stigma and, you know, you have to name it to unshame it. Someone once said to me, and I thought, that’s brilliant. Yeah, the more we shout about this, more we talk about it, the more I wang on about vaginas. And things like that, people might start to kind of switch on and listen and notice the bigger picture.

Nicky Lowe [00:59:38]:
So, yeah, and I would really encourage people listening to, as you say, have these conversations, because it was only in a conversation with actually an old school friend. And I was saying, oh, I was listening to this podcast and was having a conversation about it. And she’d gone into early menopause, actually, she was in her 30s. And she shared that she had had this experience and was in, you know, horrific pain, and it was, you know, really impacting her life quality. And I was like, oh, my God, there’s somebody that I didn’t know in my network that was actually experiencing it. And that’s when I was. I’d said to you when we were in consultation, I was like, right, talk me through this. What do I need?

Dr. Charlotte Gooding [01:00:20]:
Yeah, yeah. Then I think in touch, really impact on people’s lives and the impact on their sex lives. And that’s really important to women. And like you said, you know, particularly that, you know, to go into your menopause in your 30s, it’s really young, and that does have significant health consequences. So we really need to look after that woman for the rest of her life. And we need to be thinking about all the things that might be depleted of oestrogen, and that includes those tissues as well.

Nicky Lowe [01:00:49]:
Yeah. And it made me think. You mentioned earlier about eyes. I had this situation, oh, about six months ago where I was. I woke up and I thought that I’d got a eyelash in my eye. And by about an hour later, I was like, this is. This is really distressing. And I ended up having to book an emergency appointment at the opticians.

Nicky Lowe [01:01:09]:
And I was like, oh, I’m so embarrassed. It’s just an eyelash. And when she looked, I’d got a severe abrasion across my eye. And I was like, what would have caused that? And she was like, well, can be perimenopause.

Dr. Charlotte Gooding [01:01:20]:
I was like, oh, the gift that keeps on giving.

Nicky Lowe [01:01:25]:
And I’d got this severe abrasion because, again, I hadn’t realized that the estrogen affects the kind of lubrication around your eyes.

Dr. Charlotte Gooding [01:01:31]:
So so many women have dry eyes and really easy to treat as well, you know, with lubricating eye drops. But also maybe if it’s suitable for you, some general estrogen being back in your system can be really helpful for those symptoms as well. You know, I’ve seen people with. My husband’s a dentist, and he sees lots of people with, like, dry mouth or burning mouth syndrome as well. Is very, very common during the perimenopause. Menopause. Yeah. And I’ve seen some cases of like burning mouth have been so severe.

Dr. Charlotte Gooding [01:02:05]:
Had one patient, this woman, she. She could only drink like liquid things and she lost so much weight and actually for her, just replacing some estrogen, just a teeny tiny smidge, really. It didn’t solve her symptoms, but it made them much better. And she was able to eat again and put on some weight because she’d become quite severely malnourished. So it’s things sometimes that you don’t even think of that are worth mentioning because they may be, they may be to do that. There’s lots of other reasons why you can get these things as well. So that’s what I was saying before about how important it is to make sure that if things aren’t getting better, let’s switch our head back on and think again. Or do we need to rule out other things like fibroids or whatever, thyroid issues or things like that before we go down this route?

Nicky Lowe [01:02:51]:
I just feel very grateful to have had your support on my journey and the fact that you proactively got me onto HRT just before my operation a couple of weeks before to get it in my system. And it has genuinely been life changing for me. So thank you. If there was just one thing that you would want somebody who’s listened to this conversation to take away, what would you want that to be?

Dr. Charlotte Gooding [01:03:14]:
I think it would be, don’t be frightened about perimenopause and menopause. I think sometimes we see it as a very negative stage. Whereas I think it’s a great time to kind of, I always say to women, put your ducks in a row for health. Because I think it’s a really pivotal point in, well, women’s general lives, but it’s a really pivotal point in your health as well. And we want to be living in a body for the next few decades of our lives that is healthy and as disease free as possible. So it’s a really good moment in time just to. To kind of gather your thoughts about the way you’re living your life and any changes that you can make, but also your overall health. And don’t think that it’s all doom and gloom.

Dr. Charlotte Gooding [01:03:59]:
You know, plenty of women in perimenopause. The Japanese call it second spring. And it can be quite an empowering time. But sometimes that gets missed a bit in the kind of being bogged down by all the symptoms. So if you’re struggling, then speak to someone, have the Conversation, conversation. You know, open your mind a little bit to what’s out there and, and, and try and look for information in sort of evidence based sources. There’s an awful lot of myths and misconceptions flying around the Internet at this particular time, which worries me every night when I go to bed. But you know, I think don’t let that put you off things that you’ve heard.

Dr. Charlotte Gooding [01:04:40]:
Go and check it out with a reliable source and actually just sit down with someone and have the conversation and just be honest about how you’re feeling and how these symptoms are making you feel. Because it might be hrt, but there are lots of other things that we can do to try and support you with these symptoms and you don’t have to kind of go and suffer it alone.

Nicky Lowe [01:05:01]:
Well, thank you for being the reliable source in my life and I’m sure people are going to want to find out more about you and some of the kind of information, information you share. So where would you point them to?

Dr. Charlotte Gooding [01:05:12]:
So I work at Menopause Care Ltd. So people can get in touch with me there. There’s quite a lot of information on our website and I am on Instagram. I’m very, very bad at keeping up with Instagram. It’s Dr. Charlotte Gooding. But I tend to not share too much medical information because I would probably never go to sleep with that. And three children and a small football team to manage a girl’s football team.

Dr. Charlotte Gooding [01:05:39]:
I just don’t think I’d have any time to do Instagram content. But yeah, you can find me there if you need me.

Nicky Lowe [01:05:45]:
But I love following you on Instagram because you show the realities of you navigating your life as a perimenopausal woman. Three kids, you know, you’re a busy gp, you’ve got a dog as well as the football team, like and I just love because you keep it real and it’s like, well, this is my moment of self care and how I, I’m finding it in.

Dr. Charlotte Gooding [01:06:02]:
I just think there’s too much. There’s so many smoke screens, isn’t there? I think it’s really, you know, I am a health professional but it’s very easy for me to get sucked down a rabbit hole. Like, you know, midnight when I’m scrolling on my phone and all of a sudden I’m like, oh my God, I should take that supplement. I, my life isn’t as good as this. You know, I’m not as good a doctor as them and you know, I’m not helping as many people and it’s really easy for us all to do that. So I just think, you know, there is a little bit of something nice about sharing the reality of situations. You know, when you forget to put the rice in the rice pudding because your perimenopause brain fogs stopped you from reading a recipe properly. You know, that is the reality of life and sometimes it’s nice to share those things as well as the glossy.

Nicky Lowe [01:06:44]:
And finally, you mentioned earlier that you do the NHS breast clinic. Where would you point people to if they wanted to find out more about.

Dr. Charlotte Gooding [01:06:53]:
Yeah, so that’s in Newcastle. So I’m only allowed to see patients in Newcastle, but if you happen to be a patient in the surrounding area, then do you know, oncologists will often get in touch with me and ask for advice if you’re lucky. You know, there are a few other areas, you know, Glasgow, Cambridge, where we do have menopause specialists within breast teams. And I would like to see a day where every single breast team has a menopause specialist sitting alongside them. And I hope that day will come. But, you know, there are a few of us floating about, so it’s. And I think education is improving within breast care. You know, I talk at breast conferences, so do some of my colleagues that do this type of work.

Dr. Charlotte Gooding [01:07:37]:
So we are trying to get the information out there and I think it is getting better. But one really, really great source of information for breast cancer patients is the menopause and cancer website. And Danny Bennington has done an incredible job there and she also has a really good podcast which I would really encourage any cancer patients who are struggling with menopause to go through. And that’s where I would usually signpost patients to, for evidence based, accurate information, you know, and just a shared understanding, which I think is completely invaluable in these circumstances.

Nicky Lowe [01:08:13]:
Brilliant. Thank you, Charlotte, for joining me today, but also for the work that you’re putting out into the world, because I know I, I’ve benefited greatly from it and I hope people listening will do too. Thank you, Nicky. If you’ve enjoyed this episode of Wisdom for Working Mums, I’d love for you to share it on social media or with the amazing women in your life. I’d also love to connect with you. So head over to luminate co.uk where you’ll find ways to stay in touch. And if this episode resonated with you, one of the, the best ways to support the show is by subscribing and leaving a review on itunes. Your review helps other women discover this resource.

Nicky Lowe [01:08:53]:
So together we can lift each other up as we rise. So thanks for listening. Until next time, take care.