Menopause, HRT & Cancer: Separating Fear From Science - with Dr. Shauna Watts

Menopause can flip your life upside down without a single hot flash, and the most dangerous part is how often nobody connects the dots. We sit down with Dr. Shauna Watts, a physician, mother of four, and BRCA1 carrier who went from caring for patients to becoming one overnight, facing risk-reducing surgery and a sudden surgical menopause that reshaped her body, brain, relationships, and identity. Her story is raw, practical, and packed with the kind of details women usually whisper about, if they talk at all. 

We dig into the real symptom map of perimenopause and menopause: brain fog, anxiety, sleep that breaks at 3 a.m., joint pain, skin and hair changes, weight redistribution, libido shifts, and the genitourinary symptoms that can make sex painful and trigger recurrent UTIs. Dr. Watts explains why these changes happen, why younger women get dismissed, and why “normal hormone labs” can still miss a textbook clinical picture. 

Then we go straight at the fear that still blocks care: hormone replacement therapy. We revisit the Women’s Health Initiative (WHI) fallout, what later analysis clarified, and how to discuss HRT using individualized risk, modern formulations, and real-world tradeoffs like bone health, cardiovascular risk, mental health, and quality of life. We also talk lifestyle medicine, including alcohol, sleep, resistance training, and nutrition, plus why every clinician should be menopause-trained. 

If this helped you, subscribe, share it with a partner or friend, and leave a review so more people can find evidence-based menopause care. What belief about HRT or menopause do you want us to unpack next?

Dr. Shauna Watts: 

Website: https://youbydrshaunawatts.com.au/

IG: @dr.shaunawatts

      @youbydrshaunawatts

Podcast: All About You Podcast

Tweet me @realdrhamrah
IG @drhamrah

Transcript

Why This Conversation Lingers

SPEAKER_00 0:02

Every once in a while, I have a conversation on this podcast that stays with me long after we stopped recording. This was one of them. My guest today is Dr. Shauna Watts, a physician, a mother of four, and someone whose understanding of women's health became deeply personal when she suddenly found herself on the other side of medicine. As a patient. What begins as a conversation about menopause quickly becomes something much bigger. We talk about fear, cancer, motherhood, identity, relationships. The enormous changes that can happen to a woman physically and emotionally. And why so many women still suffer without understanding what is happening to them. There are moments in this conversation that become very emotional. And there are other moments that genuinely made me angry. Because some of what women have been told for decades simply does not reflect what we know today. Whether you're a woman, a partner, or a physician who takes care of women, this is a conversation I really don't want you to miss. So without further ado, this is Dr. Shauna Watts. So Shauna, thank you so much for coming on to the show and sharing your personal experience as well as your professional experience and professional mission, which is very inspiring, not just to your patient and colleagues, but personally to me, as I'm sharing a very similar viewpoint, albeit as a male, which I'm not gonna pretend I can feel how you must have gone through or feel, or a lot of my female patients feel going through menopause. But that is the very reason why I like to speak to someone like yourself. So not only can I understand better what is going on during menopause and women's health in particular, but also share that with my audience, whether it is patients or colleagues of ours that perhaps don't have as much experience as yourself and carry the responsibility in educating their patients without fears from the past and with more knowledge so that they can empower their patients to make the best decision for themselves. So you've been very open about your own experience with BRACA. That's why honestly I brained up. Some of the audience might think, oh wow, he's getting into very personal issues, but you've been open about it. And going through early menopause as well. So can you take us through that journey and what is it like experiencing it as a doctor? Not just as a woman, but also as a doctor. So you turned from doctor into a patient overnight. So can you kind of walk us through it?

BRCA1 Shock And Cancer Fear

SPEAKER_03 3:28

Well, thank you for having me. So, yes, when I was um in my early 30s, I walked a journey with my auntie who I was very close to, and she passed away with breast and ovarian cancer, and I walked that journey with her. And within our family, I had two quite young cousins who also were diagnosed with breast cancer. And at this stage, this was on my dad's side of the family, and my dad had unfortunately already passed away, and so genetic testing came to myself and my sister. And I don't know why, but I was just absolutely convinced that I wouldn't have this gene, and I was not worried at all. I now know stupidly that I, to be honest, kind of went into it quite naively, and it came as a really massive shock to me when I was given the diagnosis that I was a carrier of the BRACO 1 gene.

SPEAKER_01 4:26

How old were you?

SPEAKER_03 4:27

I was 31 when I found out, and I have to say, the day I found out I drove home from work and I don't remember the journey home. It was about a 45-minute drive, and I don't remember even driving. I was just so shocked. And please remember that I had literally been at a hospice with my auntie months before, and I'd really been there every step of the way of her death. And at this stage, I was pregnant with my third child and had two young children who were already with me. And so it was I was very distressed because I'd watched her die quite a difficult death, and it was really terrifying. And I obviously was pregnant at that point as well. So I was had all of these emotions of what am I going to do? And you know, the other thing about me is that I actually started my journey as a doctor, training to be a surgeon, and I'd worked really closely with the breast team on a number of my rotations, and so again, I was very um much comfortable and confident around this sort of part of medicine as the doctor, albeit the junior doctor. And suddenly I was like, oh my goodness, I'm I'm gonna be having these surgeries potentially that I watch people having. And to be honest, I was actually very, very scared that I was going to die. And I'm gonna be really honest with you about that. And I did cry a lot, and it was very upsetting. After a while, I made the decision once my third child was born that I was gonna have uh risk reducing surgery.

Risk-Reducing Surgery Explained

SPEAKER_00 6:16

Can you explain what that is for for the audience? What is risk-reducing surgery?

SPEAKER_03 6:20

Just so maybe if I take a step back and what I explain is so that what BRCA1 or BRCA2 are is that they are DNA repair genes. And whenever someone says that they are a BRCA 1 carrier or a BRCA2 carrier, it means they carry a faulty gene. And therefore, basically, we're not as good at mopping up our DNA mistakes. And so in tissue, you and I always are having little DNA errors and mutations all the time, but we've basically got this really cool system in our body that checks on these and gets rid of them most of the time. But people with BRCA1 and BRCA2 have sort of a faulty gene, and therefore a lot of these errors go undetected. So you start accumulating more and more errors, and it would seem that people with these genes have a very significantly increased risk of things like breast cancer, ovarian cancer, and some other cancers. So bear in mind this is now nearly 20 years ago. You know, at that point, there was definitely a real push to have risk-reducing surgery, and that sort of has come and gone and come and gone a little bit over the years. But ultimately, having watched my auntie pass away, I decided that once my baby was born, I was gonna breastfeed for a short period of time because I really wanted to do that, and then I was gonna have this risk-reducing surgery. Well, of course, the best paid laid plans don't work out, and unfortunately, my third child was born and was extremely ill. And we were traveling from our home in Belfast to London and to Great Ormond Street Hospital, and my surgery just kept being pushed back and pushed back because I had this really sick baby and she was my priority, and I also wanted to continue to feed her. And so, in the meantime, I'm having all these scans in the background, and then I get a phone call to say, actually, we're really not that happy with your breast scan, and we just want you to have this surgery. So I went into hospital, had a double mastectomy or a bilateral mastectomy. I didn't have a lot of time to think about it because it all happened very quickly.

SPEAKER_00 8:35

And the good news is this is this is while you this is while you were in training as a surgical resident, or at this point, I I had at this point I had decided to swap from doing surgical training to be a family physician.

SPEAKER_03 8:51

Um I knew I loved it.

SPEAKER_00 8:53

Had you graduated at that time or were you still in training?

SPEAKER_03 8:57

Um I had graduated as a doctor. I was a fully qualified doctor, but I wasn't a specialist. And so I decided to change my specialty. Um so I had my bilateral mastectomy because my daughter was ill, I had to just do a very quick implant reconstruction because I didn't want to stay in hospital for a long time. I wanted to be able to go home to my sick baby. And um, I recovered well. Look, it's confronting to have a bilateral mastectomy. You know, I a lot of people will say, I'm sure you're really glad that you knew that you had BRACA-1 and you can have this risk-reducing surgery. And yes, I am glad that I know it, but please don't underestimate how upsetting it can be, you know, as a woman to have to do this surgery. You know, you have a very different appearance in your body, your sensation is gone. And it's, you know, I also knew that, for example, if I had any more children, I could never breastfeed. So it definitely wasn't an easy decision. But I did it, I had to do it quickly, and that was good. And when in fact, when we got the pathology back, um, everything looked good. Actually, everything was fine, and I didn't need to do anything more. And what I will say, what was going on in my family was at that point my 27-year-old cousin had also just gone to have what was supposed to be prof prophylactic or preventative surgery. And when they did her pathology, she actually already had breast cancer. So bear in mind she lives like five miles from me. So this is all very scary. I then do make the decision. I know I love children, to have another baby. I want to have another baby, and I have another baby. Then during that pregnancy, we make the decision that we're going to be looking at potentially removing my ovaries quite quickly, and then I have my cesarean and the decisions made during the cesarean with my fourth child. No, actually, we're doing this during the C-section, and I won't get into all the details of that, but the decision was made quickly.

Overnight Menopause After C-Section

SPEAKER_03 11:13

And so I went from the high heights of pregnancy hormones to um obviously being literally menopausal within 45 minutes. And so I didn't get to have perimenopause, and I'm not saying that perimenopause is fun, it definitely isn't, but it it it it does give you that kind of gradual reduction with spikes, but there is a gradual runway into menopause. Whereas women who have a surgical menopause, we literally are one day having probably reasonably normal hormones, depending on our age, of course, and then suddenly we're menopausal.

SPEAKER_00 11:51

Not what does that mean? What does that mean as far as how you feel because you went from a peak hormone state being pregnant, obviously, to zero? How does one feel during that drop or right after? Physically, mentally, like what changes were you surprised by, or even though you knew it academically because you're a physician, it they still surprised you or were tough to deal with?

SPEAKER_03 12:22

Well, I'm gonna be really honest with you. Even though I was a family physician who really focused on women's health, I'll be really honest that I still, and I'm I'm happy to admit this, I did not know a lot about menopause or perimenopause or surgical menopause, and I'm embarrassed to say that, but I know lots of my colleagues feel the same way. We really just weren't taught a lot. And remember, this is now the era when no one's prescribing hormones, so we're just all pretending that it nothing happens. But what was, I suppose, it was complicated, and like all women, I started blaming everything else. I've got four children, I've just had a fourth caesarean section, I had a double mastectomy a year ago. So everything I was putting down to, oh, it must be just having four kids. I always had this really, really sharp brain. Like I never wrote anything down. I could remember everything, I could remember appointments, I never had a diary, and suddenly I couldn't remember anything. I remember this one time that I missed a physical therapy appointment two weeks in a row, and and the physio phoned me both times, and I was so embarrassed. And then I literally did it the exact same time the next week. He was like, Like, what are you doing? Like, we're waiting for you. And I just felt like my brain had turned to mush. I'd always had, for example, a really low cholesterol, and suddenly I had this high cholesterol, and yet I didn't look any different. And then it went on from there. I started getting these um pains in my hands and my thumbs and my wrists. But again, I blamed it. I thought, oh, I must use my mobile phone too much. That's what it is. I'd also had very mild rosacea and suddenly had these really red cheeks. I'd always been slim and suddenly, and I'd always managed to lose weight after all my pregnancies. Suddenly I was gaining all this weight and I had belly fat. So, but you know what? I genuinely and very stupidly did not put any of it down. Oh, this is menopause. And on the rare occasion that I tried to maybe join in a conversation with some older women who were talking about menopause or hot flushes or something like that, they would kind of dismiss me and say, Oh, for goodness sake, you're you're too young for that. And I would get really embarrassed and and think, oh, well, I'm not gonna get into a whole story. So I kind of felt like there was this club of women, but I wasn't in it. And all my friends are in their early 30s, they're maybe just starting to have children or get married, lots of them are doctors, and no one is really understanding what I'm going through. And so, to be honest, I really didn't say anything for a very, very long time.

Symptoms, Shame, And Feeling Alone

SPEAKER_03 15:24

I did also, and I am open enough to talk about it because I think it's unspoken about, I did develop really very significant genital urinary symptoms, and again, that was extraordinarily challenging. I was really embarrassed by it. I was embarrassed with my husband. It was, it made sex almost impossible. But again, it was such a taboo thing. I just felt really embarrassed to go and talk to anyone about it. I didn't really know what else to do. So I think that, you know, young women who go through surgical menopause are often a group who perhaps are kind of left in a bit of a limb by themselves. And I also think there are a lot of young women who have cancer, and everyone with them, it's kind of like, oh, well, they should be so grateful that they survived their cancer. Like, why are they complaining about some hot flushes or vaginal dryness? But but people don't understand that the actual impact that this can have on your on your life is massive. And so I suppose what was really challenging is that I just didn't recognize who I was anymore. I didn't recognize what I looked like physically. I felt uncomfortable, I had started putting on weight. I think I then suddenly had abnormal liver enzymes and I had looked like I was developing a fatty liver. And I was like, I just don't even understand. Like, I don't, I'm not a drinker, I don't really drink alcohol. So why have I got these weirdly abnormal liver enzymes? Now please bear in mind, I've got four children, one who's really very unwell still. So this is all like I'm thinking about it, but I'm kind of not really thinking about it. Because you know, as a mother, you're always putting everyone else first. And of course, I'm I'm trying to make sure that I can still work a little bit as a doctor and I'm still trying to be someone's wife, and I'm still having these kids to look after. So I want to say that it wasn't that this was like front and center, and I was thinking about it all the time. I kind of was just putting up with it a lot of the time because I was just like, oh well, this is what my life's like now, and that's how it is. And I do look back now and think, wow, like I'm so upset for myself that I didn't ask for help or I didn't ask for different help sooner than I did. I I let a lot of stuff accumulate for a long time. And I think that's why I'm so passionate about being open about my story, but also wanting to work in this pace, because I think sometimes when people say things like, you know, vaginal dryness, it just sounds like a really like, oh, you know, you put a bit of vasoline on your lips, your lips are a bit dry, but it's really very significant. Or if you're somebody who's having constant UTIs all the time, like it's really impacting your life. And so for some women, I feel like these symptoms can be utterly life-changing in a really negative way. Uh, and I just wanted to ultimately work in this space because I felt like actually, you know what, I really get what's gone on here.

SPEAKER_00 18:36

I want to thank you for sharing. This is gosh, I I I just I I don't I mean, I don't understand how or I I want people to wrap their head around what you went through. You are arguably the most time-consuming, challenging profession, which is going through medical training and then working as a physician, then having four children, one newborn, one sick, going yourself through risk reducing reduction surgery, going through menopause. How did you keep it together?

SPEAKER_03 19:20

I'm really gonna cry. I think that I have got a beautiful family and really lovely friends who've been very supportive to me. But look, it's been really difficult, and at times it's felt very overwhelming. And but you know what, life's busy, and I I think I am really quite a positive person. So I've probably thrown myself into helping other people, focusing on my children, and um, you know, just trying to keep putting a foot in front of the other all the time. But look, it's it's not been easy, and at times I've lost myself and too busy sort of looking after everyone else. But um, I I turned 50 in May, and I kind of decided when I was coming to 50 that it was going to be time and this is gonna be my time to maybe start putting some boundaries in my life and to put my health and my wellness as a real priority and maybe not worry so much about everyone else for a little while. But look, I appreciate that, but I also think there are so many other people out there who've been through even worse than me. So I would I was definitely blessed.

SPEAKER_00 20:42

Yeah, I understand, and and you're you're being way too humble. Of course, there's always someone that has it worse. I mean, absolutely there's no discussion, but usually when we go through hardships, usually we compare ourselves with people that are better off, not worse off. I mean, that requires a lot of perspective for you to say that. My question is you know, during that vulnerable stage where you basically as a human being, I don't care how strong you are, it's easier to give up than to fight. Well was there a single thing that gave you the strength and motivation to overcome this? I mean, you you mentioned you have supportive friends, family, but there's always this one thing, and I've been through this situation, not as bad as yours, but there's always this one thing. For me, it was my kids, my children. That just the thought of it one second gives you these superpowers and you overcome probably the biggest hurdle against all odds. And what was that for you?

SPEAKER_03 22:02

I it was my children. They are absolutely everything to me. And I think, to be honest, I watched my daughter, who's now 17 and amazing, but I watched her be extraordinarily ill as a baby and toddler. She had like 26 surgeries. She was, we literally flew around the world trying to work out what was wrong with this girl. And she's amazing. She's training to be a professional ballerina right now. So she is incredible. And I think that her and my other kids kept me going. But you know, don't get me wrong. I whenever you've got a genetic abnormality like Bracna Braccawan, I carry a lot of guilt. I'm worried. I'm worried about my daughters. I'm worried I've got two daughters and two sons. I'm worried about everyone. I feel guilty. I feel like, oh my goodness, I could have given this to them. Are they going to have to walk the same journey as me? Sorry, I'm getting emotional, but it's it's really hard. It's a like it's a burden. You think, oh my goodness, I have given these kids something awful that they will have to go through. My 22-year-old daughter at the minute is beginning to, you know, look at a journey for genetic testing and to decide what she's going to do. And it's you you feel really bad. Like as a parent, you never want to give your children an extra burden. So I think that's challenging. But my children definitely were my main motivation. I had watched my auntie, um, the one who I walked every step with her right to the end. And she actually had seven children, and she died at 50, and it was absolutely heartbreaking. She did everything, she put herself through every treatment to try and stay for as long as she could. And so I kind of just have always had my kids as my North Star that I'm I want to be here, and I want to be here as long as possible. So yeah, they're the people who keep me going.

SPEAKER_00 24:10

Well, thank you so much for sharing. I think imagine your parents would have carried the same guilt, and I don't know if they did. I mean, it's it's human to carry guilt, but do you think if they let's assume they carried guilt just like you and now looking at you, how you are empowering a whole generation of women, how you're helping, now how you have the ability to help, not just professionally as a physician, but also as a patient or a former patient with a perspective of a patient gone through everything you've gone through, having this ability to help thousands, if not millions, of people who are going through the same health scare or health problem as you. And what if your purpose was to bear give birth to four children who then can themselves be champions because of the adversity they go through that they've seen their mother gone through, be able to help millions of people? Well, do you still would you would do you still carry guilt knowing that?

SPEAKER_03 26:00

I I think I do. I think I'll always carry some guilt. And you know, my my dad unfortunately had died before we knew anything about Braca One being in his family. Um, and I always took comfort in knowing that he didn't know because I know he would have felt terrible about it, and I would never have blamed him. So I do know that my children also don't blame me. And I I do although it took me a long time to share my story, I didn't share it straight away, but I definitely want to share it, and I know that I see a lot of women who have the BRCA 1 or BRCA2, or women who've had breast cancer, and I know they feel that kind of affinity with me because they know that I have walked sort of a similar pathway to them and that I do understand. So, yes, you're absolutely right. And it it is a while, I I wish I could change it, and I'm not gonna stand here and say, Oh, I'm so glad that I've got this gene. I'm I'm definitely not. If I could get rid of it tomorrow, I would. I wish I didn't have to have this surgery, but I also am really glad that I have a platform and that I'm, you know, well enough to be able to share what happened

Hormones And Cancer Get Entangled

SPEAKER_03 27:17

to me. And I think the other thing I want to say is that I do also want people to understand more about, you know, the interaction between breast cancer and hormones and and how those rules have become very, very confused. And, you know, even write down to women like me. So all those years ago when I um had my surgery, unfortunately, even though I was very young, there was very mixed messages, but even between my treating team. So some of my team wanted me to have HRT, but a lot of them didn't. They were really scared for me to have hormones, and it was very much that phrase of as low a dose for as short a time as you can possibly manage. And I'll be honest, I spent a lot of time not on HRT, which probably has had health consequences for me. And I now understand that was not the right thinking, or it's certainly not the thinking now. And I don't blame anyone, everyone was doing their best for me with the knowledge we had nearly 20 years ago. But the thing is for BRCA1, BRCA1 doesn't make oestrogen dangerous, it makes DNA repair unreliable. And I think those two things got very mixed up. And, you know, whenever people were having risk-reducing surgery of having their ovaries removed, then people got a bit confused and thought, oh, well, that must mean that this group of women can't have hormones. But actually, you were removing ovaries and fallopian tubes to remove tissue that was at risk. And you're also, um, and we now understand that it's absolutely fine for those people. So if you're a BRCA1 carrier or BRCA2 carrier and you have risk-reducing surgery now, you should be put onto hormones and in fact should be put onto a really good dose of hormones because you're only in your 30s or 40s. And I think that's one of the messages that I'm keen to get out there is that the thinking has changed a lot, and we need to really start to separate hormones and cancer because they've somehow got all mixed up together, including in doctors' minds as well. And there's all this fear, and I think people suffer, people like me suffer the consequences.

SPEAKER_00 29:37

Yeah, I think you went through all of this during a very tricky time. I assume it was about what 15 years ago you went through this, which would make it around 2010, right?

WHI Headlines And A Generation’s Fear

SPEAKER_00 29:51

Yes. And although, you know, basically the whole scare just for the audience, just to so they have a little history and understand where this fear actually came from and how it all started and why we think differently. Because in I believe it was 2002, right? The W H I T study came out, which by the way was, I think, to at that time the most expensive study to ever be conducted. I think it cost about two billion dollars, and many renowned investigators were on in included in that study. And it basically the study itself was very valuable. The data of the study was very valuable, but it was how the data was interpreted at that at that time that brought this association between hormone replacement therapy, which by the way, in that study they used synthetic hormones and cancer. And the reason why uh there was an association because they didn't stratify really by timing, by age. So I think the average age of the study was like uh early 60s, so they there weren't any people included or women included, uh younger women included in their hormone replacement therapy. And also the the timing, uh the the study wasn't stratified by time and by even route, what what what how the hormone therapy was administered. And so the data was be the data, even though it was good, the interpretation was very misleading. And can you talk about the journey of how we were able, after we stratified the data, be able to draw a better conclusion, come to better understanding, which first is that in fact it's it's more nuanced than the study initially said, and then later on in the studies, I think the first the first follow-up on that study, they used the same data was I think before 2010, around 2007, and then again 2013-14, and then 2020. So we're talking about 26 years, 24 years after the original study, and over 10 years after they took another look at the data after stratifying it and looking at the nuances, only to realize that in fact, not only it doesn't cause breast cancer, but it also is doesn't cause cardiovascular risk. As a matter of fact, it reduces cardiovascular risk. So during your journey, can you relate the timeline of those events to your personal journey and what what what happened, what decisions you made about your own treatment together with your physicians, and how much of it did you take in your own hands versus just rely on other specialists?

SPEAKER_03 33:02

Yeah, so I think what I would say is I remember I was a very young doctor when the WHI study came out. I worked in Belfast at that point in the UK, and um, I just remember the screaming headlines. I remember it was on the evening news, you know, HRT causes breast cancer. As very young doctors, at that point, the UK is a public health system, and we were basically told that you had to stop everyone's HRT. So bear in mind that, you know, I've had this message very much reinforces a very young doctor, you know, stop all the patients at the gynee clinic, and they all had no one's allowed to have a prescription anymore. It was really very dramatic, and lots of women had their hormones ripped off them as a junior doctor. I watched that unfold, and and you know, look, I was quite young and impressionable. There were lots of much cleverer and more senior and experienced doctors than me who were all telling me, you know, go into clinic, you have to stop all the hormones, etc. etc. So, look, whenever you're a young doctor, sometimes you just kind of do what you're told. Um, and I did that, and I obviously have regrets about that. And I look back and think, gosh, did I even read the study at the time? I I have to admit I can't remember whether I even did. Um, and I think lots of doctors will say the same. We kind of all went with these headlines. So I do think that everyone was very influenced by that. And I think one thing I want to say as well about in medicine or Western medicine that I think that we're quite bad at is I think that whenever we don't have a solution to something as doctors, if we don't have a prescription we can write or a procedure that we can send you off to have, we probably don't really like talking about that topic that much. Because, you know, and I think if you look back over the last 20 years, you know, how many women went to the doctor and probably tried to have a conversation about their symptoms? And the doctor in front of them, you know, probably steered the conversation in a different direction. You know, there's no coincidence that when hormone prescribing went like this, and sleeping tablets went the up the other way, and um antidepressants went the other way. So, you know, we we just changed the trajectory and suddenly everyone was being diagnosed as being depressed and anxious. And that's not to say they weren't. But what we, of course, have come full circle to understand is that anxiety and depression are often very hormonally related. So I think, you know, I was definitely very influenced as a very young doctor, but also please remember that no one was also really talking to me about it. No one was proactively asking me any of this stuff. And I also will put my hand up and say, as a doctor, I'm a really bad patient. I don't, I'm not really good at going to the doctor. You know, we just tend to, you know, pitter along ourselves and think, oh, you know, it'll be okay. I think there's lots of statistics that say that doctors are terrible patients, and I'm definitely not a great patient. And I was also very much given the message that only take hormones if I really needed them, if the symptoms were really bad, and even if I did take them, take them for the lowest dose for the shortest possible time. Like that was just the phrase repeated over and over again. So again, as I said, I really didn't take hormones for for big sections of time over the following decade. And I I would, and then I eventually at one point was on some HRT that I did really like, and then COVID hit and I couldn't get it anymore. So I think there's been lots of things that have impacted my hormonal journey, not only professionally, um, but also, you know, my silly decisions as well. Um, and I think just that general consensus within the medical community that when we don't know about something, we're not that great at talking to our patients about it, or if we don't have a solution, we don't want to talk about it. Um, so I think that really impacted my decision. And look, I'll be honest, I was still scared. I I I'd watched my auntie. I literally sat with her when she died in the hospice. I I didn't want that to happen to me. I didn't want to leave my children. I was terrified that I might die. So I'd done all these surgeries. So I thought, well, I'm not going to do anything to put myself at increased risk. So I definitely had lots of mixed stories in my head. And I'm so frustrated at that because, of course, when you look at the data, you know, remember the newspaper screamed, HRT doubles your risk of having breast cancer. It sounded absolutely terrifying. But in fact, when you actually looked at the data, the group who were on estrogen only actually had less breast cancer than the group who were on nothing.

SPEAKER_00 38:06

And in fact, and less cardiovascular risk too.

SPEAKER_03 38:08

Yeah, absolutely. And you know, I think what we also have to remember is we can't just reduce women to a set of breasts and breast cancer, because what about all the other things that women die from? You know? And so I think that you know my Yeah, go ahead. No, no, sorry. You're you're fine.

SPEAKER_00 38:26

So so I mean, and because I I don't want this to get lost, you said something very important, and and I and this is very important for the audience because there's still, I would say, seven out of ten women that I see in my clinic, when I bring up hormone replacement therapy, they still look scared and they say their physician does not recommend hormone replacement therapy for them because of risk of cancer today seven out of ten.

SPEAKER_03 39:00

So I I agree.

SPEAKER_00 39:03

So why is it that still with the internet, social media, podcasts, why is it, how is it even possible that there's still a single physician out there denying hormone replacement therapy or at least not omitting the opportunity for the dis even to have the conversation with the patient. How is that even possible? And that that's something that I don't understand because I'm not in a primary healthcare field, I'm not in the women's health field, and honestly, it baffles baffles me.

SPEAKER_03 39:40

Oh, look, I find it so frustrating. Every day I'm seeing women in clinic and I'm being told the same thing. I literally had a woman yesterday morning who told me that her dentist had told her that I was a very dangerous person, that I had put her on hormones, and did she not know that hormones caused breast cancer? Like, it's so frustrating. It is like, how are we ever going to untangle this thing? And the thing I find so frustrating is that nowadays we use hormones that are absolutely identical chemically, molecularly, to human hormones, and yet so many doctors remain terrified to give someone a hormone, but yet, you know, they're not scared to give the newest drug that the you know comes out on the market, which is some other compound. And it doesn't actually make any sense to me. And I I say to myself every single day, there's all these women suffering, but also not only are they suffering from symptoms, but they're having people make them feel bad, question their decision, make them doubt themselves, and also quite frankly, make them doubt those of us who are trying to help them, you know, suggesting that we're somehow leading them down a dangerous pathway when in fact we know that the data does not say that at all. And, you know, I I, like you, feel very frustrated. I've run another a number of educational events, not only for women, but for professionals. And what's really interesting is that, you know, you get this natural selection. The people who come to the education events are actually already quite educated. And the people who you really need to get to those educational events, yeah. They're not coming. They don't want to know. And they've just got this really fixed mindset. And I just don't know how we separate this hormones and cancer thing. I've never seen a marriage that you can't break out like this.

SPEAKER_00 41:47

I think it's very hard because it's basic human behavior and it's called, it's a phenomenon called cognitive dissonance. And it affects physicians, it affects all humans, regardless of their experience, regardless of their profession. You know, one assumes physicians are scientists and they should only judge and think with a scientist mind, but unfortunately, cognitive dissonance is so powerful that despite providing all evidence, one's beliefs are much stronger than any evidence presented to them, and they still believe their old beliefs because it's so ingrained in them, and and that is the problem. It's basic human behavior.

What The Evidence Actually Shows

SPEAKER_00 42:35

Now, let's for the audience now, so we can give them something productive and maybe help with the fear, let's let's separate the evidence from fear. Now, we have an entire generation of women, as we talked about, who obviously have become frightened of hormone replacement therapy, not just women, actual physicians too, like we said, after the women's health initiative. What did we actually learn from that study today? You know, because a lot of what we learn today is from the data that was provided during that from that study. And how is our understanding now changed over the past 10 years? So that for example, if a patient comes to you and says, Hey, my doctor said, or my sister said, or my dentist said hormones cause breast cancer, how do you explain the actual evidence to her so that she kind of at least gives you a chance to treat her?

SPEAKER_03 43:36

So what I say to every individual woman is I said the person in front of me, you have your own individual risk. And what we also have to remember is that we don't know why people get breast cancer a lot of the time, but we know it's associated with various things. So for example, if you drink alcohol, if you drink alcohol every day, then you are Increased risk of having breast cancer. If you're overweight or obese, you are significantly at increased risk of having breast cancer. And we don't entirely understand all the mechanisms of this. Again, I have women who come in and they'll say, Well, my dad's sister's cousin had breast cancer, so I've got a family history. But listen, breast cancer is very, very common in the population. Very common. And so it's highly likely if you know more than 20 people or you've got 20 people in your extended family, that someone will have had breast cancer. But that doesn't necessarily mean that you've got a genetic predisposition to having breast cancer. And so what I think we need to really separate out is that this study showed, even though we we don't like this study, but the reality is it actually showed that women who've had hysterectomies or who don't need to have progesterone and took estrogen only, they had less breast cancer. So in fact, that kind of debunks part of the myth that estrogen seemed to be causing breast cancer. And then even when you look at the group within the study who were taking estrogen and a synthetic progesterogen, the increased risk was still very small. And we, I mean, nowadays I don't even prescribe that type of progesterone anymore. But you know, even if we did, I think we need to also be thinking about okay, well, what about the reality for you? So if I have a woman in front of me who can't sleep, is about to quit her job, her marriage is on the on the rocks, she's you know fighting with everyone, she's having complaints at work because she's grumpy and irritable, she's forgetting everything. And let's not forget, you know, we have women who actually become suicidal over this, who are going to lose their life. Are we actually gonna just say then? But hey, listen, because you know, when we look at a thousand women, there might be, you know, one additional case per thousand if you take HRT, like, is that really gonna make us not let that woman have hormones? And so what I say to every woman in front of me is like, let's have a look at your own personal risks, let's have a look and see how we can make you as healthy and safe as possible on this journey. For me, the menopause and perimenopause journey is absolutely not just about hormones. And I'm certainly not here to tell everyone they should take hormones. I'm here to take you on a journey where you make your own decision. But what I wanted you to do is make it based on facts rather than fear or something that your mum told you or your next door neighbor said, or your dentist said, and sorry, my best friend's a dentist, so I'm not meaning to bad wife dentists. But um I think I um I just think that we have to start looking at people very individually. And I also want people to understand that you know your individual risk is your individual risk, and we have to think about all the things that you can do in your life to minimize your risk and stay as healthy as possible. But if in that moment you can't sleep, you know, you've you know that you've got a strong family history of osteoporosis, um, or you know, you've already had a DEXA scan and it's already telling you you've got osteopenia, or you've got severe anxiety and you're about to quit your job. Well, I have to say, I would say that really, why are we worrying about something that's completely theoretical and incredibly low risk and not dealing with the person in front of us who's actually living a life that is way less inoptable right now. So that's kind of what I say. I think we everyone has to be comfortable with their decision. And another thing I do say to all of my patients is that some women that I give hormone replacement therapy to will end up with breast cancer. That's just the statistics. If I see 20 women in a day, over the next 30 years, some of them will get breast cancer. But both they and I have to feel comfortable that me giving them hormone replacement therapy has not given them breast cancer. And I've reached the point in the in my understanding of the liter literature is that that is absolutely the case. And is that what you think?

SPEAKER_00 48:19

Yes, I mean a hundred percent, because regardless of hormone replacement therapy, and the proof is the past generation, the past 20 years, women that didn't get HRT and still got breast cancer. It's not like suddenly the breast cancer cases dipped. As a matter of fact, they haven't gone right, they've gone up and they've gone up despite us omitting them from HRT, and for reasons that you already stated, which is alcohol consumption, increased body fat, a poor lifestyle in general, which is uh one of the root causes for all kinds of cancers, not just breast cancer. In in women, obviously, breast cancer because women have breasts, and of course, uh the if all cancers in general increase, for example, I think with men, but also in women, colon cancer, the the cases have gone up. And it's not surprising that these rates of cancers go up in more of the Western world, and which is more associated with high stress, high alcohol consumption, high processed uh food consumption, basically poor lifestyle, as opposed to parts of the world where people live into their 90s or have a higher number of centenarians because they have a totally different lifestyle, and which, you know, for obvious reasons, the reasons of cancer are much decreased in those populations.

Lifestyle Risks We Ignore

SPEAKER_00 49:50

But I want to talk about what you already mentioned, which is something that most people don't talk about, or if they talk about it, they don't take it too seriously, perhaps because it's not very sexy, which is lifestyle improvements. The effects of lifestyle improvements not just on your general health, but also on cancer risk reduction. And there's multiple studies out there that show the relationship between your lifestyle and cancer, as well as cardiovascular disease, neurodegenerative disease, metabolic disorders. I mean, all of the symptoms or diseases of aging are related to lifestyle. And there is a lot of studies from the UK Biobank that have shown us how that's related to your to all-cause mortality and your lifespan. And I think the latest one was actually published this year that showed up to 64% reduction in all-cause mortality simply by sleeping extra 90 minutes per day, exercising 15 minutes, moderate to vigorous exercise per day, uh, 15 minutes, and adding one fruit and one uh cup of vegetables, and getting rid of ultra-processed junk food. That alone reduces your all-cause mortality by 64%, as well as cancer, because part of the reason people die is because of cancer, it's the number one reason of death, unless you get in a car accident. So people don't talk enough about that, but when it comes to HRT, now it's this cancer machine that is, by the way, not true. So, how do you or why are we having such a hard time shifting the narrative? And why do people not hold themselves more responsible when it comes to a prescription that says, hey, you can't drink alcohol, you have to exercise, you have to sleep better, and you have to eat better?

SPEAKER_03 52:07

Yeah, look, I think all of us we want an easy um we we want an easy fix, don't we? We all would love someone to give us a tablet that gave us more energy, more motivation, made us have a six-pack, had muscles, you know, well they are doing that.

SPEAKER_00 52:26

With there are people are selling these tablets and injections on social media. They call them peptides. Um but the question is, do they work?

SPEAKER_03 52:38

Yeah, I know. Well, but apparently they work on a on a slug and a and a and a rat. So um I um so what I will say is that the alcohol, I live in Australia, the weather is often very, very good. Even in winter, even though we're complaining, you know, it's probably still 15 degrees C, so uh, and we're all we're all really cold. Um, but you know, there's definitely a real culture here of women um sort of in their 50s to 70s, where it's wine o'clock, wine is opened early in the evening, Australia makes a lot of good wine, there's a lot of wineries, it's pretty cheap. Um, and there's very much this culture around drinking, drinking while you're cooking, drinking with friends, drinking at your book club. Um, you know, this is just very, very much the culture. And uh what I also find is that a lot of my midlife women are also drinking because they're anxious, they're drinking because their relationship is in trouble, they're drinking because they're really worried that they're not doing well at work anymore, and they're also drinking because they can't get to sleep, and so they somehow think that maybe drinking alcohol will help that. I will tell you, it tends to make things much worse. Alcohol will keep waking you up, so please don't use that as a remedy. But we know that women really are using alcohol a lot, and again, big study out of the UK just showed how much women are medicating. And so, one of the challenges I would say to my colleagues who are so scared of hormones is like, do we really, are we really so scared of giving women HRT, which we know to be extremely safe for the vast majority of women, for the benefits to outweigh the risks in the vast majority of women? Are we really so scared of that that we would prefer women are drinking a bottle of wine every night to get past their anxiety, their social anxiety, all the things that I've just mentioned? Because I think that we really need to have a bit of a look at ourselves as a profession. And it's one of the reasons that my husband and I, who he's also a doctor, we decided to really jump into lifestyle medicine. Because I think it's something that Western medicine we lost our way a long, way, way uh a long while ago. Like our grandparents and great-grandparents, they kind of knew this stuff, you know. They they cooked from scratch, they were physically active all the time. That's what their life was like. And somehow it's like, you know, we we think, you know, how do they how do they not know that washing your hands was important before surgery? Um, but you know, somewhere along the lines, we keep forgetting stuff that we know and we've forgotten all this stuff. And then everyone's frantically trying to research, you know, why is bowel cancer rates going through the roof in young people? Well, I would hazard a guess that it's very strongly related to all the ultra-processed foods that that generation have been fed. Um, and you know, I'm not saying I eat perfectly in any sense, but I think that we have to face the reality of the world that we live in. I mean, I know I've been to the US many, many times, and you know, the portion size um in the US always blows my mind and the availability of snacks. And I always remember my kids used to be excited every time we went to Florida because we'd go to the cereal aisle and they'd never seen as many cereals and as much sugar in their whole life. And so I think, you know, we do have to take some personal responsibility. And as I have that woman sitting in the room with me, and I will tell you that my consultations for perimenopause and menopause are a 60-minute consultation, and I struggle to get through everything in that time. But you know, what I'm exploring with these women is I think you're scared of the wrong thing. I think you're scared of this theoretical cancer and when actually maybe we should be more concerned about the bottle of wine that you're drinking every evening. And I think that's a good thing. Yeah, they don't want to give that up. No, and I think you know, the other thing is that we're, you know, actually heart disease in Australia is the number one killer of women. And yet again, if you ask a room of a hundred women, put your hand up if you're more scared of breast cancer or heart disease, they'll all put their hand up and say they're more scared of breast cancer. And I understand that breasts are a very uh female, they're all about identity and all the things, but you know, maybe we're really scared of the wrong things. And I think absolutely. But you know, that's the reality, is that more women are dying of heart disease than are dying of breast cancer in Australia. So I think you know, we need to really change the narrative. And of course, I know it's hard. Like who wants to get up early and go to the gym? It it's it's hard. You have to motivate yourself, yeah. You know, you have to find it within yourself to change it. But we also have to face the reality that it is our lifestyle that's creating the the monster that we've got.

SPEAKER_00 57:38

Yes, I think you touched on this, which are the not just the symptoms of menopause, it's it goes beyond hot flashes because one can have menopause but not have hot flashes.

Menopause Symptoms From Head To Toe

SPEAKER_00 57:50

That doesn't mean you're not going through menopause. Can you help the audience understand the difference? Why some people get hot flashes, some don't, uh, despite both of them going through menopause? And what are some of the unsung symptoms that we don't often talk about that are symptoms of menopause? You briefly mentioned that. But it's very important for people to know that some of the changes that they see or feel in themselves is actually menopause, despite them not having hot flashes.

SPEAKER_03 58:25

Yeah, absolutely. So if we talk about hot flashes, or as we call them in Australia, hot flashes, and so they are related to you've got a thermostat in your brain. So just like you might have a thermostat in your house to regulate the temperature of the room, you've got one of those in the hypothalamus of the brain, and it is very estrogen sensitive. During perimenopause, the general trend for estrogen is to be going down. Now it does have a spiky journey along the way, but the general trend is that you're losing estrogen and you've got less and less estrogen. And that thermoregulatory center is really impacted in some women. Now, what we do know is that even women who don't complain of actually overt hot flashes or night sweats, actually, if they monitor them in studies, they definitely don't have the same temperature regulation. And if you look even at them when they're sleeping, often their temper temperature regulation isn't as good as it was. So I think that sometimes women think that if they don't have that one set of symptoms, then this must not be menopause. But what we know is that this is a whole systems issue. And for a long time, and probably when I was at medical school, and I think, and probably when you were at medical school, we did learn about menopause as like this sort of end of reproduction, end of periods, and hot flushes, and that was kind of all we were taught.

SPEAKER_00 59:49

That was pretty much it.

SPEAKER_03 59:51

Absolutely all I was taught. But I want to take you from the top of the head to the tips of the toes, and I want to tell you what the symptoms are. And this is not an exhaustive list, but let's start with people's hair. So women will often say, My hair is falling out in clumps in the shower, or my hairdresser is saying, My hair's getting really thin, or my hair's really dry. And then, of course, the opposite complaint is I'm getting chin hair, I'm getting hair on my lip, I'm getting hair on my nipples and my neck, and I hate it. Why can't I have this hair on my head where I want it and not where I don't want it? They'll be complaining of that their skin is dry and more sensitive. And you and I will see this all the time. I see all these barrier impaired skins and almost say, oh, you're completely, I can tell that you're in perimetopause because I can just see you've got like no skin barrier anymore. Um and people will tell you that their skin feels dry, they're putting all this moisturizer on it, and also the products that they used to use that was no problem. They could walk through the department store and take a little sample of something and put it on their face. Now everything is stinging, and their face just feels like they just want to put more and more moisturizer on it. And if they're like me, if they've got rosacea or acne or psoriasis or eczema, suddenly that is completely flaring up and they maybe haven't had a flare-up for years. And then, of course, you've got the people who've got the dry eyes, and they might wear contacts or they might not wear contacts, but they know their eyes feel burny and sore, or in fact, their eyes are just watering all the time. And that's because you actually need hormones to give you a really good quality tear. They're complaining of a dry mouth and a burning tongue, itchy ears. The number of women who come in and they've made their ears bleed because they've been sticking things in their ears to try and stop the itching, and then they're also complaining of dizziness and tinnitus and vertigo, and just can't explain why they've had these awful attacks of vertigo. And as we just keep moving down the body, they've got frozen shoulders, sore elbows, sore hands. They're blaming themselves, thinking, Oh, I must be on my mobile phone too much, and my joints are really hurting. They're complaining of palpitations. They often will tell you, my heart feels jittery, my heart's beating really quickly, I'm feeling anxious all the time. And they'll complain of that suddenly, you know, they're doing all the things. They're going to the gym six days a week. They haven't changed what they're eating, but the weight is just creeping up and creeping up. They used to be a pear-shape, they used to have all their weight on their hips, all their fat was under their skin, and now they're getting this belly fat. Their trousers won't close anymore. They're having to have find a different size of clothing, and they feel really self-conscious about this tummy that they go to the gym and work on and work on, but it's not changing. They've got hip pain that means that they can't lie on their side. Or they've got plantar fasciitis, which means that they're limping when they're walking because the soles of their feet are so uncomfortable. They are also complaining of getting up during the night to go to the toilet. Their vagina might feel dry and sore and burning, and it can be uncomfortable to have sex. They're having recurrent UTIs and they're just feeling that they're not strong anymore. They feel weak. They feel like their muscles don't feel like they've got any energy, and recovering after the gym feels really hard. And then if we jump inside the brain, they're telling me that they're feeling anxious. They're worrying about things that they didn't worry before about. Lots of women suddenly become scared to drive their car. They're scared to drive on the freeway, they're worried they're going to have an accident, or they're in a presentation at work and their brain just goes completely blank. They're standing there, they've probably given the same monthly meeting year on year, and suddenly they can't remember a word and they are literally feeling like they are an idiot. They're doubting themselves, they're questioning their ability to do their job. And then they're also describing that very phrase that I'm sure you hear all the time. I just don't feel like me anymore. And it's so hard for people to articulate. What do you mean by like that? And they just keep saying, I don't know, I just don't feel like me. And then they'll tell you 10 things like I used to get up at five in the morning to go to the gym, or I used to be the friend who organized all the girls' nights out, but now I just can't be bothered. Or I used to like love doing stuff with my family, but now I feel like I'm just watching everyone else. Um, I do I used to love life, but now I'm just like, meh, is this it? And that is the type of story that I'm hearing over and over again. And so this is a literally top of head to tip of toe set of symptoms. And of course, the other one is energy, fatigue. No energy for life, no libido for life, no libido for sex. If they ever had to have sex again or never had sex again, they wouldn't really care. They're often having um, you know, what I call duty sex because they're really worried that their husband or partner is gonna leave or that that's what the expectation is. But quite frankly, they'd rather read their book or watch Netflix and they are so tired. They're so tired they fall asleep, okay. But 218, 3.14, 410, every morning they are chinged, wide awake, and they cannot get back to sleep, even though they they know they're tired, but their brain is wired. And that is why we have to think about this as a whole body phenomenon and stop telling women it's about hot flushes and it's about not having a period. Oh, and aren't you lucky you don't have to worry about getting pregnant anymore because it's so much more.

SPEAKER_00 1:05:42

Isn't it isn't it crazy? Like I'm listening to you. Of course, I know all of these things, right? But sitting here listening to you summing up all these symptoms of what happens during menopause. And the reason is because all our tissues, our brain, Our skin, our blood vessels, our GI tract, our GU tract, everything has estrogen receptors that has a specific function to keep those tissues vital and functioning. And when you deplete the body of estrogen, the whole system falls apart. And it is crazy. It is crazy. I just even though I know this, just listening to you blows my mind because pretty much everything we do in medicine with women that present with all these symptoms is just disease management. If someone has is moody or has sleeping disorders, we gave them antidepressants or sleeping pills. If someone has hair loss, we try injecting PRP or doing hair transplants. When someone has marital problems because of the, for example, moodiness or lack of or lack of interest in sex, which has a lot to do with bonding between couples. They go through couples' therapy. Look how many different medical specialties feed off of this one thing that declines in women. And I feel listening to you, it is a crime for the medical community not to get their act together and act swiftly and as quickly as possible in educating themselves and making it mandatory so that women's and husbands' lives can be saved. And I think if anything, we owe it to our own profession from an ethical standpoint, not to mention to the patients we treat. I mean, this is crazy.

SPEAKER_03 1:08:09

I I agree, and I I've racked my brains trying to think of which specialty in medicine would not need to know about every specialty needs to know.

SPEAKER_00 1:08:19

Every specialty.

SPEAKER_03 1:08:20

I was like thinking, like if you even think of like ENT, okay? So what do women start doing in parimenicals and menacles? They start snoring. They start having more sinus issues. We know that is related. So, you know, even the ENT surgeon. I literally thought to myself, is there any specialty that might not need to know? It's like, oh, would a psychiatrist who only specializes in men, would they need to know? Yeah, they do, because they they're probably the men who are attending them need to understand about their female partner. So there is no specialty in medicine. And that's why it's so disappointing when we do have educational events. As I say, the people that you want to have there just don't come because they don't think it's relative, uh relevant to them. But whether you're an orthopedic surgeon, a physiotherapist, an occupational therapist, any specialty needs to be here and talking about this issue. If you're an obesity doctor, if you're a gastroenterologist, if you're an allergy doctor, if you're a rheumatologist, like how many women, this is what I want to know, is how many women get diagnosed as having seronegative orthopathy are actually just not just, but women who have perimenopausal joint issues. And I was thinking, how many men have I seen with frozen shoulder in 27 years? And I can remember one. Um and yeah, wow, all these women, and yet I but why did I never put that together? Why did I not think, why is it only ever middle-aged women who kept frozen shoulder? Like, why did we not put it together? And so it's so frustrating. And I think we have to stop thinking about this as just about the end of periods and stop telling women, well, look, just do your best. And if you can't manage the symptoms, then come and talk to us because it's absolutely crazy.

SPEAKER_00 1:10:23

It is criminal. I'm I'm sorry to say that. I know it might come across harsh, but it is criminal. And if you're a physician listening to this and right now thinking, How dare you? I I really mean it. Because I mean, at this point, if you don't see the force for the trees, I'm sorry. You have to I mean, I don't want to say it, but it's it's malpractice. I mean, because the science is out, I mean this is not anything different than malpractice if you don't address it. Right? Or am I being too harsh? Am I being too harsh? Because the science is there. I don't think you are, and I think I would be so I'm a I'm I'm a man, right? And I'm pissed right now. And and I and I uh for a second I'm thinking if I was a woman, I wouldn't be pissed, I would be something else. I would probably go crazy because it is just simply not fair. And for me now, it's I can't unknow or unsee something that I've seen personally, and I don't want to take much of it away. I know we're gonna discuss my perspective on your podcast. So for the audience, if you want to know my perspective on it, make sure I think we're doing it next month. Uh I'll come onto your podcast and share how it changed my practice because I can't unsee it anymore. I mean, the cat's out of the back, so I can't, I wouldn't be able to deal with my own conscience offering my patients services or procedures or treatments that I know treating the root cause is more effective, which is hormone replacement therapy. And that's why I work with a lot of physicians.

SPEAKER_03 1:12:16

Can I can I tell you one thing is that when women come to see me, they are often frustrated, disappointed, and to be honest, they're nearly I know they're waiting to be disappointed again. They're almost holding their breath when they come into the appointment thinking, is this gonna be another doctor who is gonna dismiss me, minimize my symptoms, you know, tell me that it's not that bad or that it's probably not perimenopause. Like the number of women that I have who come in and they literally are textbook, but again, one of our colleagues has done a blood test and got a normal hormone panel and said, Oh, well, your hormones look normal, so it can't be perimenopause. And I'm like the silence screaming in my head is so frustrating. But for these women, it's so annoying for them. Like, you know, I think it should be an expectation. Like, you know, if you look after human beings, you need to know about this. It's like saying you don't know. Like as a doctor, even if you're not anything to do with antenatal care or pregnancy, you of course know about that because you know you can't do a lot of treatments or you have to be careful or whatever. Why do we say that certain specialties don't need to know anything about this? And even think down to things like, as I mentioned, dentists, and I have some great friends who are dentists, like the change in the mouth, the change in the pH of the saliva, the increase in gum disease, the change in the palate and the snoring and the teeth grinding and the clenching, that all change. So every single specialty needs to know this. And I just feel like all of us would have a much more enjoyable day-to-day career. Is life's so much more interesting as a doctor when you know more and you can really get what your patients are going through than whenever they're talking about stuff and it's just going over your head. There's nothing worse than your patients. You know, I love being educated by patients, but I it makes me feel then interested to go and do my own research. And I just feel like as a doctor, we want to be more curious. And as you said at the beginning, we should all be scientists. And any good scientist has to be able to change their mind. When the evidence changes, you need to know that the evidence has changed and change your practice respectively. You can't just say, Oh, well, that's the way I've always done it. So I'm gonna just dig my heels in and refuse to change because that's so unfair to our patients.

SPEAKER_00 1:14:47

Yeah, I mean, we all swore the oath of Hippocrates. So what what happened now? How come we don't hold ourselves to the same to the same standards we think we're treating other things?

Stigma, Misdiagnosis, And Medical Duty

SPEAKER_00 1:15:01

And I think if I was the health secretary today, I would make it mandatory for every medical profession, for every health profession, includes dentists, chiropractors, physical therapists, I mean you name it. Anyone that takes care of human beings, uh, psych psychologists, psychiatrists, all of them, they should get a mandatory training in many menopause. I would make it mandatory because it affects every specialty, because it affects every organ in the body, including the brain. And unless you educate all specialties, all healthcare professionals, there will be millions of women that will slip through the cracks, that will get symptomatic treatment for a symptom of menopause, of lack of estrogen, where the treatment would simply be you know, give them estrogen. I would make it mandatory, and I hope that happens. And I you know, f when I said it at first it sounded crazy, but now thinking of it as not crazy at all. You know, there are here in the US, we have a lot of primary care physicians, family physicians, and OBGYNs, they can go get menopause certified. There's a certification for menopause here in the US that you can go is continuing education and you get menopause certified. And I would recommend every physician listening to this podcast, and it doesn't take much, do that because you could help your patients at a complete different level. You could save lives. You know, I don't wanna you could save marriages. You could, I mean, if you're interested in health, health span, or if you're, you know, it's funny, there's so many colleagues of mine that are obsessed with getting NAD infusions. I wish they carried half that obsession with thinking about okay, what is causing my lack of energy? And instead of treating the symptom, which by the way, NAD infusions don't even work, but they think it works, and that's why they make that decision. So instead of uh treating the symptoms of getting an NAD infusion, uh think about maybe my hormones are not properly regulated. Maybe I should go to a specialist and get that looked at. And that that is even for physicians who are patients themselves, too. You know, if you're an orthopedic surgeon and you're going through menopause, you know, how are you gonna treat your frozen shoulder? I literally had a friend of mine during uh it was two years ago, we're at a scientific meeting, very well-renowned dermatologist, and we're just chatting, kind of small talk, how are you, blah, blah, blah. And she's like, Yeah, you know, my shoulder has been bothering me. I can barely lift it up. I think I have a frozen shoulder. And my doctor sent me to physical therapy, but it's getting worse actually. And I'm thinking, What? Did she not connect the dots? And we're literally there at a gala drinking a glass of wine, chatting about life and catching up, and she's telling me these things, and I'm like, should I tell her? I mean, is it am I out of place? And I said, Look, sorry, I I I I don't mean to intrude, but is it perhaps that you're going through menopause? And she goes and she goes silent, she's like, actually, yeah, I am. And I felt she was kind of embarrassed a little bit, but then she opened up, she says, Yeah, I know I have this you know brain fuck and I'm tired, and now my shoulder, now I can't go to the gym anymore. I don't know what to do. And I said, You should see someone that specializes in hormone replacement therapy and menopause. This is not an orthopedic problem you have. Sure enough, she calls me four months later. We actually talk about, we're supposed to be on a panel together and we're discussing our talks and everything. She's like, by the way, I started hormone replacement therapy and my frozen shoulder went away. Thank you so much.

SPEAKER_02 1:19:31

So amazing.

SPEAKER_00 1:19:32

And I was like, wow. And this is just one, this is a microcosm of what's going on.

SPEAKER_03 1:19:39

Absolutely. And I want to pick up on one other point that you made there about her embarrassment. Um, and I wanna to address something which I think is still very much pervasive, is that a lot of women are embarrassed to be menopausal. At the minute, being parry is definitely seems like it's maybe a little bit more acceptable. Um, so it's being chatted about and somehow, but there's still this underlying cultural societal thing that when a woman is through the menopause, um, that it's somehow that they're over the hill, they're washed up, they're no good or whatever. And and women they almost cringe when they tell you um that's exactly what happens. Menopausal. They it's like they feel that they need to shrink away, that it's admitting something that's I don't know, kind of embarrassing. And I just wonder how we've got to this point where, you know, I I love whenever you look at different cultures. Yeah, it absolutely is. But you look at some cultures in the world, and older women are really revered as being the grandmother who who knows everything, who's got the wisdom that people go and talk to them. But I think US and and Australian society are quite similar in that older people are kind of ignored, and women definitely become more and more invisible, both on screen and in real life. And I think, you know, it's just perpetuating this. I mean, the flip side of it is there are definitely lots of female physicians, many way, way more well known than me, who are really changing, hopefully, that narrative. And even the fact that like Forbes have now got a 50 over 50 list shows that, you know, you know, this phase of life does not have to be about deterioration and things getting worse. I think it's actually an episode of your life when actually it can be really thriving and probably really focusing on your own goals and your own health. And you've probably done your child rearing. Um, and it is probably a real opportunity to put all the years of knowledge into good practice. But I think, you know, what you said is so interesting that even this dermatologist felt a little embarrassed to admit, but she probably wouldn't have felt so embarrassed to say that I don't know, she had high blood pressure or whatever. And yet we just have this stigma around admitting as a female that you don't have hormones anymore, is somehow makes you less than. And I just wonder how we're gonna change that.

SPEAKER_00 1:22:22

Yes. Very well said, and I think if anything came out of this conversation, is for the physicians in the audience or healthcare providers, educate yourself. Please, please educate yourself. And for the patients in the audience, if you feel you're not heard, if you feel your doctor is not able to help you, there is more doctors out there. There is something called the internet. You can now search. I mean, the menopause train has already left the station, and you know, you choose if you want to be on that train ultimately or not. And for the people that are still in fear, is the answer to fear is education. Just educate yourself. You know, don't cave in, don't hide, don't run away. You know, educate yourself. You don't just owe it to yourself, you owe it to the people around you, your family, your children, your spouses, your parents, and your neighbors, and and so I've become now so passionate about this topic as a male that because 80% of my patients are suffering, and I again I can't unsee that anymore. And for us in the aesthetic industry, and I know our we intersect there too because you also provide aesthetic services, and you but you're doing it the right way, you're addressing the root cause first, and then helping them, empowering themselves through aesthetic treatments. And for me, it's the opposite. I usually refer them out first, make sure they get their health in check before I initiate any type of aesthetic treatment, because I would be basically only treating the smoke instead of the fire.

SPEAKER_03 1:24:19

So and I love I love that you do that because I I will say that one of the reasons why I end up very much completely merging my women's health and and menopause and aesthetics together was because I felt they were just inextricably linked. Yeah. And I think that, you know, a beautiful uh, you know, facelift surgery is a beautiful surgery, but um if it's not built on a foundation where that tissue is um healthy and optimized, you know, to me the result is only ever going to be um not as good as it could have been if we have really healthy tissue that we're working at because your foundation isn't there. And again, as I said, it's not to say that everyone has to take hormone replacement therapy. That's not what I'm here to say. But I want it to be an option, I want it to be a conversation and I want it to go alongside. And it's also not that HRT will do it all. You have to do the other things as well. So, for example, like lots of women seem to think that by just taking HRT and that they're gonna just completely maintain their bone mass. We know that is actually not true. Whenever you look at some of the most recent studies, they actually looked at groups who they got to do resistance exercise, who did also very, very light exercise on hormones, and they looked at their bone mass. And yes, the group who did resistance exercise with HRT really did maintain their bone mass really well, and they they had really good bone scores. The group who did gentle exercise on HRT actually did continue in certain parts of their body to have ongoing bone loss or bone degradation. So you can't just take hormones and go, oh, well, that's great. I'm gonna have fantastic bones now. It doesn't actually work like that. And the lifestyle stuff that you've talked about before, the resistance training, the good diet, they have to go hand in hand. And so what I don't want is for people to think that the hormones, you give someone hormones and that's it, they can just do whatever they want and everything else will come good. It's not just quite as simple as that. But I just want people to know that it should be an option. And the other thing I want people to know is that you know what? You can try hormones and you can try them for a couple of months. And if they're not for you, you don't have to stay on it.

SPEAKER_02 1:26:36

Yeah.

SPEAKER_03 1:26:37

Like people get really worried that they have to make the decision, and if that's the decision, then they're stuck with their decision. You can change your mind. You know, you're not stuck with any kind of decision. You can try hormones and you can take them for three months, three years, ten years, whatever you want to do, whatever you feel comfortable with, that's okay. But um, never feel that you're stuck if you made one decision or the other that you're stuck.

SPEAKER_00 1:27:01

Good point. Good point. And I I I see that with my patients that come for Botox. You know, for the first time they they're not sure. I said, because they feel like if they start doing Botox, they have to continue forever, otherwise their face will fall apart. I'm like, no, not at all.

SPEAKER_03 1:27:17

Yeah, exactly. I I hear the same all the time. And I'm like, you can do this as a one-off, and if you love it, you can still do it as a one-off, or you can keep doing it. It's totally up to you. Nothing bad will happen by giving it a go.

Building A Whole-Person Midlife Clinic

SPEAKER_00 1:27:30

Now, I want to talk about your your clinic. We talk, we talked off the record, but uh now on the record here, you you have a very unique clinic. It's something I actually admire, something I've been contemplating to set up, and then you're actually the first physician that I've ever met, virtually or in person, that has such a unique clinic set up. Can you talk to the audience about how your clinic is set up and why you even could? Constructed it that way.

SPEAKER_03 1:28:01

Yeah. So I'm always really open about this. I set up my clinic. It's so my clinic is called U, Y-O-U, U by Dr. Sean Oaks. And I love it by the way. I love my clinic. Yeah. So it was like I want my patients to walk through them the door as themselves and they walk out as themselves. I'm not trying to change anybody, make them look different. I'm here to make you the best, most confident version of yourself, whatever that might be. And what I very quickly realized in my journey was that midlife women would often ask my advice, like, what do you think about hormones? Or what do you think about this or what do you think about that? Or what do you think about weight loss medication? And I was kind of running these two separate entities. And I was like, why am I doing this separately? Because I was kind of saying to this group, okay, you need to book in to see me in my family physician practice. And then these people are going, okay, you need to come and book in and see me in my skin in a static clinic. And I was like, why am I doing this? And so I was like, right, that's it. I'm going to have one space where I do everything. And but what I realized very quickly in my career is that the most enjoyable part of medicine for me is collaborating. I always think two brains are better than one, three brains are better than two. And so what I knew is that I couldn't know everything about everything. And I also wanted to create a space where, to be honest, we don't have sick people there. So it's not like a doctor surgery where there's coughs and colds. People are well. Um, but they are coming and we're looking after everything from their midlife health. So we're looking after their skin, their weight management, their nutrition. So within the practice, we have exercise physiology. So if you've got like osteoporosis or a weight issue, or um I'm concerned about some factor, I'm sending you to my exercise physiologist who is trying to create an exercise program to deal with whatever our concern is. I've got a pelvic floor physiotherapist who's going to help you. So let's say sex is very uncomfortable for you. I want to see what your pelvic tone is. Do you have vaginal atrophy? Or let's say you've got a lot of urinary symptoms or stress competence, she's going to help you with that. We actually have a sex therapist and relationship counselor because we know this is a time. There's a real peak of divorce. Um, at this time, relationships are breaking down and women are navigating their way. And sometimes those relationships need to break down. Sometimes they're not healthy, and women have had enough, and that's good. Um, and then sometimes these are relationships that are just really struggling with the fallout of perimenopause and menopause. So we have her in the clinic. We also have um we have a psychologist who specializes in the psychology of weight and eating and the people's relationships with food. So she helps us with our patients all related to that. We have a dietitian and she helps us navigate all the issues that you and I have already talked about, things like uh high cholesterol, weight gain, helping our patients eat more protein, helping our patients eat more fiber, which is the soapbox I'm gonna die on, I think. That's my new obsession with fiber. Um so, and then I have a team of other female doctors who work with me. I have nurses, so I've got a menopause nurse coach, so she helps coach my patients, her on my programs with me, so she checks in all the time. So the thing that kills me in medicine is that people see something like perimenopause or menopause or peptides or whatever it happens to be, and they see an opportunity. But what actually frustrates me is that they're not prepared to actually put the work in. So, for example, if my patients are on a weight loss journey, I'm seeing them every month, and my nurse is talking to them every single week. We're checking in all the time, they're going off to have dexabody composition scans because I don't want them to lose excessive muscle. They're seeing my dietitian. So I think that, you know, if you're um a physician listening and you think that having a clinic like this is a really good idea, first of all, it's a lot of work and it's trying to keep a lot of people happy, which could be challenging in itself. But also, I think it is the best way to practice medicine because we cannot know all the things. Like, I don't know about your education on nutrition, but mine in medical school was quite frankly appalling. And so I love that I've got a dietitian who knows way more than I do, or I love that I've got a pelvic floor physiotherapy who's a bit of an expert in that, or the psychologist. So we've definitely got this whole multidisciplinary team approach to our patients. We've also, we've even got in our clinic, we've got pathology, so they can literally come and have their bloods drawn in the clinic so they don't have to go anywhere else to do that. And then I've got a full complement of abdermal therapists, nurses, nurses who specialize in aesthetics, and doctors who are um specializing in aesthetics as well. But the nice thing is that we actually all try and do have an overview of everything. And of course, you can't be an expert at everything, but we are very holistic in our approach. So everyone is kind of lifestyle medicine trained, um, everyone has got a real interest in women's health, and then a few of the doctors do aesthetics as well, but they do it as part of their day. So I think that that works really, really well for us. And I also knew right at the beginning, I know that there are a lot of clinics that really focus on very young patients, and maybe perhaps, you know, that very dramatic aesthetic look, which is definitely not my style. Um, and so I knew that from the outset, I wanted my clinic to be about an ignored group of women. And of course it's become very trendy now, but like eight, nine years ago when I was starting out my clinics, um it wasn't really a thing. No one was talking about menopause that much, but that's kind of how we try and approach it. And look, are we doing it perfectly? No. Is there things that we could improve? 100%. But I think that we're we're moving more and more towards having this really holistic approach and because I think that's when women do best. Um and sorry, we also have a physiotherapist who um looks after our frozen shoulders and our brusitises and all those sorts of things as well. So I think we're trying to be as you know all-encompassing as we can possibly be.

SPEAKER_00 1:34:41

That's

How To Find Dr. Watts

SPEAKER_00 1:34:42

amazing. It's it's everything you said is music to my ears, is something that I've been dreaming about and contemplating for the past couple of years, and here you are. And how do how can people find you if they want to seek your services? And obviously, I know you're you you you're you're Irish, but you you live and practice in Australia. So just for the audience, in case you picked up on our on Shauna's accent, how can people find you?

SPEAKER_03 1:35:12

Yeah, so I um my website is UYO by drshaunawatts.com. They can find my podcast um on all the usual outlets and YouTube. It's called All About You with Dr. Shauna Watts, and we do offer um some telehealth and video calls as well. Um obviously I'm not a registered doctor in any other country than Australia, so I can't be a doctor and prescribe for people outside of Australia, but I can absolutely um coach and recommend and support people and you know wherever they are. And I think you know, my podcast is a really, really great source. I have incredible people on there, some extremely well-known names in this space, and some lesser well-known, but no less helpful. They bring so much wisdom to the table, and I'm I'm really excited to be having you on next month because I want to be picking your brain about a whole lot of things.

SPEAKER_00 1:36:16

I can't wait, and I'm really excited that we're gonna meet soon again. I regarded you very h very highly and just following your content and learning about what you're about and what you're passionate about, but now having talked to you for over hundred minutes now, you're your true champion. And um you're a hero, you're a survivor, you are you're an inspiration to me now, and I'm sure to many people whose lives you touched. And I really uh commend you for everything that you're doing, and I'm also sorry for everything that you've gone through. But I don't think you would have become the person you are today if it wasn't for all the adversity you went through. And I think for if I look at people that really change other people's lives, what they all have in common is that they've gone through tough times through a lot of adversity, and that's why they are who they are. And for those of you who feel you pulled the short straw and you have it worse than everyone else, I could tell you also from personal experience, there is a reason for that, and you might not not understand it today, but if you are patient and if you hang in there and let the chips fall, it was meant for you to go through that so that you can do greater things, things that you never thought you will be able to. And with that, uh I want to thank you, Shauna, for coming on to my show. And uh so uh honored and so uh proud to uh have met you and really excited to uh talking to you again.

SPEAKER_03 1:38:21

It's been such a pleasure.

SPEAKER_01 1:38:23

Thank you, Shauna.

Final Message And Listener Prompt

SPEAKER_01 1:38:25

Alright, everyone episode so far. I hope this will be emotional. Please don't forget to leave your video or leave your comments in the question. Thank you, and we're gonna do it.