Menopause is big news right now and rightfully so. But with all the noise, how do you know what’s right for you? On this week’s episode of Period Story, I’m joined by Dr Claire Phipps, the Menopause GP, who talks me through common perimenopause and menopause myths and misconceptions.
In this episode, Dr Claire shares:
- Why she’s only just understanding her menstrual cycle at 48
- Why empathy is vital as a doctor
- Why moving away from a paternalist model towards patient empowerment is an important part of her work as a GP and menopause trainer
- Why the 10 minutes you have with an NHS GP should be the start of the conversation
- The difference between perimenopause, menopause and post-menopause
- How a holistic approach to menopause may or may not include HRT
- Why it’s important to meet patients where they’re at
- Why perimenopause can be a time of unmasking for neurodivergent women and the rise of AuADHD diagnoses
- And of course, the story of her first period
Dr Claire says the we should try not to be fearful of menopause or pathologise it, but instead, embrace it and move towards a positive natural transition.
Thank you, Dr Claire!
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SHOW TRANSCRIPT
Le’Nise Brothers: Hi Claire. Thank you so much for coming onto the show today. I’m really excited to speak to you, to delve into your knowledge of perimenopause menopause. But first, let’s take it all the way back and can you tell us the story of your first period?
Dr Claire Phipps: Yeah. Hi. Thank you for having me. So my first period was when I was 12 and I was thinking about this a lot when you had emailed me and given me the heads up that this might be what we were talking about.
Because I was like, when was my first period? How old was I? And I didn’t really remember my age, and I don’t know if other guests have said this, but I vividly remember where I was, the sort of time of day, the things that are really imprinted in my memory. And thinking back, I remember being at home, it was something we talked about quite a lot.
And I remember going to the toilet and going, oh, this has happened. I’m feeling slightly overwhelmed, slightly confused, slightly sad actually, that I’d sort of transitioned into a another phase. And it took me a few days to really sort of get to grips with the fact that this had happened. Even though we talk about it a lot, and it’s sort of maybe a bit more commonly talked about today than it was 25 years ago, 30 years ago, but even still even happened, it still took me by surprise.
And it wasn’t like, you know, this floodgates have opened and all these nasty things I was expecting to happen. But it was, it was a landmark, it was part of progression from childhood to womanhood. And it still still took me by surprise, and it still made me slightly sad, I think, actually in retrospect.
Le’Nise Brothers: And when you had those feelings of sadness and surprise, did you talk to anyone about what you were experiencing?
Dr Claire Phipps: No.
Le’Nise Brothers: Why not?
Dr Claire Phipps: No, because I think at the time. It was still very much sort of hidden. You know, the fact that you had started your periods wasn’t something you really wad about or shouted about.
You know, I might have talked about it with my friends. I probably did, but it wasn’t something that I felt that I could really divulge in an emotion, just sort of got on with it. Maybe we’re a bit better about kind of encouraging those emotions today, but I didn’t feel at the time, maybe I didn’t even realise at the time that that was an emotion I could discuss.
But it’s certainly something I just sort of suppressed and got on with.
Le’Nise Brothers: And what was your experience of your period like?
Dr Claire Phipps: So I think I was pretty, you know, I think my mom had pretty well prepared me for what would happen. I think the first experience was, you know, it was painful for me. I, it felt sore.
It felt uncomfortable. Not in a way that wasn’t manageable, but I wasn’t used to having that pain. You know, I wasn’t used to experiencing that sort of sensation. So that was a little bit surprising for me. I think it’s all so individual, isn’t it? You know, how we might experience that, that sensation. So I think that’s very difficult to prepare for.
But it was, it wasn’t a terrible period. It was, you know, a bit of cramps. I remember it really vividly. And it was some light bleeding. It wasn’t long, it wasn’t heavy. It lasted for three or four days and then it was done. It’s a lot different now.
Le’Nise Brothers: Okay. So can you say more about that?
Dr Claire Phipps: Yeah. So I’m perimenopausal.
So, as I often say to anyone that sees me, anything goes when it comes to your period, you know, they could be shorter, longer, heavier, lighter. Mine are heavy. They’re not particularly painful, but they’re just like, oh it’s my period. It’s heavy. It’s, you know, having to plan around it. Having to think where am I going to be?
Am I going to be on a tube? Am I going to be on a bus? What, you know, when have I last changed sanitary protection? I know I’m on a hormone replacement therapy. Full disclaimer. Have I taken everything correctly? You know? And so it’s, it’s more of a mission, I think, for my period now. And I know that there’s a lot of grief and sense of loss over moving through the menopause and losing your period.
But for me, I can’t wait to lose my period.
Le’Nise Brothers: Wow. Okay. That’s so interesting because I’ve heard so many different things. Mm-hmm. Um, you know, we have the one end of the spectrum where when you get a period, and some people, they’ve had a party, their parents have thrown them a party. Mm-hmm. Other people, it’s this like very secretive and shameful.
And then again, when you go down to other end, it’s that same like mixed bag where some people just want it over, and some women are just like, okay, I wish I knew when my last period was, so I would celebrate that. So it’s so interesting that this event, this monthly event, that 50% of the population experience, we have such a spectrum of emotions attached to it.
So we’ve gone from your first period all the way to talking about how you’re ready to be done, done with your periods. What about in between. You had your period, it sounds like it was slightly painful, but it was manageable. How about as you went through your twenties and your thirties?
Dr Claire Phipps: Yeah, so I think what I did, um, what many people probably did was you know, I was very active. I was very sporty. I swam a lot. I ran a lot as a, as a teenager. And my period just felt like it was getting in the way. So I think I did a, and it was also uncomfortable for me. And again, there’s a spectrum, isn’t there, of pain.
Some people can manage it a bit better, but I’m trying to move away from that, that thought process and if it’s impacting you, how do we manage it? And so it was painful. So I did what a lot of people did and I went on the combination pill and I think I was probably 17 or 18, and it was purely to control my cycles.
It was purely so I could go, I don’t want to bleed this month. Not because they were particularly heavy, but business, I just felt they got in the way. And I did that for a few years until I probably had finished my, A Levels, taken some time out, gone back to medical school. And it was in my early medical school career.
I was like, I’m getting migraines, I’m getting migraines with auras. I probably ought not to be on this pill. Probably ought to stop. But I didn’t because I loved the fact that I had control.
Le’Nise Brothers: Wow. So you’d rather have experienced the migraines than
Dr Claire Phipps: Yeah.
Le’Nise Brothers: Period.
Dr Claire Phipps: Wow. I, not for very long because I realised that it, it was dangerous.
And so I did stop it and I didn’t go back on it actually at that point. And my periods were manageable. And they were quite irregular after that. So they were quite irregular for a long time. And it didn’t really bother me because they weren’t particularly heavy, so weren’t, you know, if, if they weren’t predictable and I got a period when I wasn’t expecting it. It was manageable, you know, it wasn’t this flooding or anything like that. And it wasn’t until I sort of started to think about conception that I started to take more notice of what my cycles were doing and going, actually they’re every 40, 42 days, every 45, sometimes a bit longer, sometimes a bit less.
And that’s when I was diagnosed with PCO, so polycystic ovary and not the syndrome, but sort of that irregularity of cycles. So it, that took me up to sort of wanting to have my first child, which was a little bit harder. It wasn’t impossible, but it took us a while to conceive. Had my first child, breastfed for my first child for a bit until he decided he didn’t want that anymore.
And my periods came back and they came back regular as clockwork.
Le’Nise Brothers: Wow.
Dr Claire Phipps: So something had kicked in and I had a period every 28 days, so I could, I was looking at my period tracker before I came on today, and I was looking back all this time going, wow, they’ve just been regular as clockwork ever since.
So conceiving my second child was actually, thankfully for me, relatively easy, um, because I could time it really well and again, had my second child and they came back regular as clockwork and they’re regular as clockwork now.
Le’Nise Brothers: Wow. So interesting.
Dr Claire Phipps: Yeah, it’s really interesting what the body does, you know, kind of, you have, it’s always a, a moving goalpost.
It’s always a transition and, and I often say to people, I see, your periods will change, your cycles will change, and it might not necessarily be anything you are doing. It’s just those hormonal fluctuations that your body is managing and navigating. And I also think, I’m 48 now and I look back and I go, God, I’m only now just understanding my cycle.
I’m only now just understanding those slight changes of physical wellbeing, mental wellbeing. I’m only just getting it. I’m only just realising now, oh, it’s because I’m mid cycle or I’m towards the end of my luteal phase, or I’m eating that because what my hormones, you know, that that sort of adjustment and that that understanding of what your hormones do to your body and to your cycle and to your health has taken me a, taken me a long time to figure out.
And again, now I figured it out. It’s changing again, isn’t it? Of course.
Le’Nise Brothers: I wonder, what you’ve been saying about now understanding your cycle and everything that you’ve experienced with your period, how does that translate to your work as a doctor? So you’re working with patients, how does your experience affect how you work with patients who have had similar experiences?
Dr Claire Phipps: I think, being able to identify with somebody, whether that’s a patient or whether that’s a friend or a family member, and have that empathy and that insight gives you an understanding of what someone might be going through. And I think that’s, that’s gold dust really, because we would all have a different feeling, a different sensation, a different experience of our periods and our bleeds and whatever that entails in terms of that change that we feel.
So I think putting yourself in the, in that position, putting yourself in someone’s shoes is really important. I think the ability to, I don’t think that necessarily makes me any different from you or anyone else. Just being able to put yourself in someone else’s shoes is really important for me. Having heavier bleeds now being perimenopausal, I think I can understand how impactful that can be or someone who’s having that all the time.
And how much of an impact that has on someone’s life. People take time out of work, don’t they, to plan around their periods. People lose two weeks of their life if they’ve had severe PMDD, for example. And so I’m very mindful of how our cycles can impact not just that 3, 5, 7 day, 10 day bleed, but just how it can affect, affect every day of our lives, because we’re not just having a period, we’re cycling all the time.
Le’Nise Brothers: Yeah.
Dr Claire Phipps: So having that mindfulness, I think is really important as a women’s health GP, vital in fact.
Le’Nise Brothers: Yeah. It’s so helpful to hear you saying this because I’ve had so many experiences, not only myself, but my clients have had so many experiences and people I’ve spoken to have had so many experiences where they have worked with doctors who have said, it’s all in your head.
Periods are supposed to be painful. A heavy period is supposed to be, that’s normal. And we’re skipping ahead a little bit, but I think this is really relevant to what we’re talking about. You’re a trainer member of the British Menopause Society, a medical advisory council.
How do you work with other doctors who you see don’t have the same empathy that, you know, you’ve shared, that you share with your patients?
Dr Claire Phipps: Hmm. So I think it’s really important that we train our healthcare professionals and move away from this, whether it’s paternalistic medicine. So I’m telling you what to do.
I’m telling you what I think to you are the expert in your body. I have the medical knowledge, but you are living the experience. And so I think it’s really important that for me as a GP trainer and a menopause trainer, I’m training our healthcare professionals to move away from this. It’s normal, because what is normal?
What is the kind of, you know, that bell shaped curve that we’re all sh shown, everyone falls into these normal parameters. But what about, what’s outside of that? And what about if we’re in that parameter and we don’t feel it’s normal? So I think it’s important that we train our healthcare professionals.
It’s important we empower ourselves and we know that if, and I always say this, let’s move away from that word normal, if it’s impacting the quality of your life, and that’s going to be different from you to the next person. But if it’s impacting the quality of your life to a degree where you are having to take time out, to a degree where you are planning things around your period to the degree where you are flooding, you are using sanitary protection, that’s, that’s, you know, lasting an hour, 30 minutes, two hours, whatever it is for you, then that’s significant.
And the degree of significance in terms of what we do medically will obviously differ. But that’s what I want to be having a conversation with you about how it’s affecting you and what we can do about maybe easing that a little bit. And there may not be a huge amount we can do, but having the conversation is so important because again, we’re breaking down taboos of it’s okay to be in excruciating pain, it’s okay to experience discomfort during sex.
It’s okay to have flooding or, you know, a period every two weeks. It’s not okay in my opinion. I think just moving away from that and I think, I think we’re getting better, but as always, there’s, there’s lots more work to be done to empower, empower us as patients ourselves, but also to make sure our medical professionals ask about this and don’t normalise anything.
Le’Nise Brothers: Mm-hmm. You talked about moving away from this paternalistic model and that’s so interesting. This very, what I say goes just do everything I say to this idea of you’re the expert in your own body. When you use this kind of language, have you had any challenges from doctors who’ve said, that’s nonsense or, you know, that’s mollycoddling patients, or, you know, that sort of thing.
Dr Claire Phipps: So little bit of pushback and it’s across the spectrum. It’s not one sort of group of people that I get the pushback from more often than not, though, if you, I think language is really important, and I think having a kindness and empathy is really important.
Whether that’s to a medical professional or to anybody, to, you’ve heard perfectly honest, but I think the language you use around this and the impact that it can have is vital. So more often than not, I don’t have the pushback. I, I find that people are actually more eager to learn and say, actually that’s, that’s got me thinking.
Bearing in mind, GPs in the UK obviously have limited amount of time with each, each patient. So there is a little bit of, I can’t do this in 10 minutes, but I would say to that, well, you don’t have to, no one’s asking you to do anything in 10 minutes. But start the conversation. Have that conversation where you are encouraging somebody to speak up, particularly with ethnic diverse populations where there’s a language barrier, perhaps, starting that conversation, building rapport, building trust, allowing someone to regain trust in perhaps what’s a bit of a broken system.
And the same with healthcare professionals. I think we’re, what we’re moving away from is you’ve got to do everything in short space of time. No. Start the conversation, have the conversation, and then encourage the conversation to continue. So I don’t really feel like I get a lot of pushback. There is a little bit in that what I say goes, and I’m like, really?
Do we really still think like that? Or, you know, would I encourage you to think a bit more, a bit more holistically and encourage the conversations?
Le’Nise Brothers: Honestly, you’re blowing my mind with these things because that you’re saying, because again, we’ve had so many experiences with doctors where it’s, you just feel like you have to do this big preparation to go in.
How are you going to use that 10 minutes wisely? How are you going to maximise your opportunity to have face time with a doctor? What are you going to get out? And I’ve had so many conversations with women who we talk about, okay, what is your strategy when you go to the doctor? How are you going to use this time?
And so for you to say it’s the start of a conversation, that’s, for me, that’s mind blowing. Wow. Honestly, I just like kudos, chapeau, like a round of applause for that. I’m really excited, you know, for the work that you continue to do in helping other doctors have this mindset because especially when you’re going through this, these big transitions in life, so perimenopause, menopause, and post menopause, you need to know that you’re working with a medical professional that has your best interest at heart and that it is an ongoing conversation.
On those transitions that I’ve just mentioned, something that I find really interesting is this transition that we’ve gone through kind of culturally in the UK from, I remember speaking to a woman about 10 years ago, she said, my doctor told me that perimenopause is not a real thing to, now we have conversations about those three phases, but what I’m also seeing is that there’s kind of this blending that’s happening.
Can we just talk about the difference between the three: perimenopause, menopause and post menopause for those who are listening to kind of do a level set there?
Dr Claire Phipps: Yeah, absolutely. And I think we’re, even I’m guilty of saying menopause is, or when we talk about menopause, it’s this. And I think we use those terms for ease, because perimenopause, post menopause, postmenopausally is just, it’s a mouthful, isn’t it?
Le’Nise Brothers: Yeah.
Dr Claire Phipps: And again, does it really matter in terms of when we’re talking about it as healthcare professionals? It does, but as as patients, I mean it does too, but I wouldn’t, I would worry about it less so when, when we think about perimenopause, we’re thinking about this transition time to when we might experience our last period.
And you might question, well, how do I know when I’m going to experience a la my last period? We don’t, it’s retrospective, but perimenopause really is this transition. And it can happen and it happens at different ages for every one of us, but it can happen as young as 40. It can happen a lot younger than that.
And that transition in the UK can be anywhere from about four to eight years. So that’s four to eight years where we may experience a change in our cycles and a change in physical, mental, genital symptoms. Menopause really is just that one day in time when we can look back and say, I’ve not had a period for 12 consecutive months and that’s normally one day, I’ve gone, you know, and I’m crossing my fingers for that.
I’ve not had a period for 12 months. Obviously that brings other symptoms too. I’m mindful of that. And then post menopause is the time after your 12 months without a period. So we’re postmenopausal for the rest of our lives so we don’t get through menopause. We may transition through that cycle of change where we’ve not had a period, but we’re postmenopausal for the rest of our lives.
And why that’s important is because we want to be thinking about this transition as holistically as possible, embracing this transition, making it a joyful process rather than this dreaded process. I speak to a lot of young school children actually about menopause now, in the way that we spoke about periods, contraception, pregnancy, I’m talking much more about menopause.
And everyone’s like, oh my God, it sounds like this awful, awful. And I’m dreading it. I’m like, we don’t need to dread it. We just need to be aware, empower ourselves with knowledge and make it a good positive transition. Because I think, for years it’s been, oh, it’s going to be an absolute nightmare.
I’m not going to be able to manage, and don’t get me wrong, it can be really tricky if you’re not getting the right support and the, the right holistic support. But actually I don’t think it has to be. I think it can be a really positive experience too. But there’s a process, there’s a grieving process for some people, and there’s a grieving process, um, in terms of loss of reproductive health for some, perhaps if you’ve not achieved fertility and you’ve wanted to, but for some it’s, it’s a joy. So I think there’s phases, and I’m digressing massively. You’ll have to keep me on track. There’s phases that, that help us as, as healthcare professionals think about where you are and therefore plan treatment appropriately.
Le’Nise Brothers: I think personally for me, so I’m 46, I’m turning 47 in a few months, and there’s this mental barrier that I’m trying to get over where I know I’m perimenopausal, but I don’t want to identify myself as menopausal, because when I think of that, I think of like, it’s the Golden Girls, those kind of old stereotypes of older women.
Although what I realised is that the Golden Girls, they were only in their fifties.
Dr Claire Phipps: It’s crazy, isn’t it?
Le’Nise Brothers: Yeah.
Dr Claire Phipps: Yeah. And I grew up watching the Golden Girls and I, and I think of them and I think, oh, they’re like, are they my granny? You know? No, they’re just,
Le’Nise Brothers: yeah, they’re us. It, all of these things where you realise how old people actually are, and like, you compare yourselves, yourself to them.
And then, so for me, it’s that mental thing of I don’t, okay, I’m perimenopausal fine, you know, cool, but I’m not menopausal.
Dr Claire Phipps: Yeah.
Le’Nise Brothers: What we, so we’ve talked about the three different phases and you’ve identified, what we need to be thinking about as patients. But what about any myths?
Myths that you see, you know, what are you seeing in, in clinic when women come to you and they talk about what they’re experiencing and what are some of the misconceptions that you have to break down?
Dr Claire Phipps: I think by the time many people get to see a menopause specialist, they’ve, like you said at at the start, they’ve had to have formed a strategy to try and get what they need.
And I often say that there’s no agenda here. Just tell me what’s going on. And some of the commonest myths I see is that people have been to their doctor many, many times and they’ve been told that they can’t be perimenopausal because they might still be having a regular cycle. And on the whole, that can be true.
But if again, this is where you are the expert in your body, if you sense some changes happening, and that might be physical, that might be psychological, that might be genital. And that is, that is a change for you. And that change needs to be discussed. And I think as doctors we were very closed-minded and going, you have to be around the age of 45 to start having perimenopause when we know ethnicity, environment, lifestyle all affect when we might start to experience this and it might be a lot younger.
So I think a lot of people find that, the myth is I still have a regular cycle, therefore I can’t be perimenopausal. And that’s not the case. The other big one is the HRT is dangerous, hormone replacement therapy is dangerous or it’s going to give you breast cancer. The other, and, and we know that for the vast majority of people, the benefits do outweigh the risks.
That’s not to say I didn’t want to have a holistic discussion with you. Hormones aren’t the be all and end all, but they can be helpful. A really big one is that if I’m approaching menopause, I can’t, I can’t get pregnant. And there are people I do see who have conceived at the age of 51, 52, and most people don’t want to do that.
There’s some that clearly do, but most don’t. So contraception’s really important in the perimenopause ’cause you’re still fertile. And that once you get through menopause, so once you’ve passed this stage of not having a period for 12 consecutive months, your symptoms will go away and you’ll start to feel better.
That’s our hope, that’s our blue sky because as our hormone levels stabilise, postmenopausally, some of us do feel better, but not everyone. And so there’s this myth that you’re just going to get through it, it’s all going to be fine. Off you go, fine and dandy. That’s not always the case. So there’s, there’s a few things I think I see commonly.
And those are, those would be my top three.
Le’Nise Brothers: Mm-hmm. What’s really interesting is this word transition and you know, we have this expectation that when we’re on the other side, we’re going to go back. But if you think about, you often hear this comparison to of perimenopause, to puberty and calling it the second puberty.
We don’t expect teenagers to be the same when they’re on the other side of puberty. And so it’s interesting that we don’t think about it for ourselves and you know, how these hormonal changes affect us and how they affect our brain and our cognitive function. We talk about the negatives and the symptoms, but there’s a lot of positives as well.
So that’s kind of what I’m, I’m thinking about when, you know, I’m managing my own experience of perimenopause, but I want to ask you about HRT. So you’ve talked briefly about it and there is, especially in ethnic minority communities, there are a lot who have reservations about HRT due to, you, you mentioned that myth about breast cancer.
We have all of these kind of whispers about HRT and also this kind of fear of, of going on long-term medication. What do you say when you work with a patient who has reservations about HRT?
Dr Claire Phipps: So I think part of the way I approach any, and I use their umbrella term here, menopause consultation, is that what I want someone to leave with is feeling like they’ve, they’ve left with more knowledge and they’ve left with evidence-based knowledge.
So what we’ll always talk about is a very, very holistic approach to menopause, which may or may not include HRT, but HRT is one tool in our box of many tools, which can help to support somebody’s menopause. It may be that someone can’t take it or chooses not to take it. Fine, as long as their understanding is correct in why they’re choosing not to take it.
Perfect. That’s all I want for you. I want you to be empowered and knowledged. When we think about hormone replacement therapy, what we commonly think of is body identical preparations, which essentially mean preparations that are licenced and regulated. So they’ve gone through robust clinical trials and we know that they’re very, very safe for the vast majority of individuals.
So the benefits outweigh the risks. There is this misconception that HRT causes or increases hugely our risk of breast cancer. And that stemmed from a study done by the WHI, the Women’s Health Initiative many years ago. We know that that study was incorrectly published in terms of its statistics.
So its statistical analysis said that it was an increased risk of breast cancer. That wasn’t the case. And the subsequent studies have shown that that’s not the case. That’s not to say there’s no risk. In medicine we can never say zero risk, but actually we know with the body identical hormone replacement therapy preparations, the risk is still going to be very, very low.
And the risk is going to be dependent not only on how long you take it for, but also your other medical history, your personal history, your family history, and importantly your lifestyle history. So smoking, alcohol, movement, self-care, all of that plays apart. So HRT is a really, really good, what we call gold standard treatment of menopause symptoms that are impactful and affecting the quality of your life.
And that will be different for every person, but there are lots of other tools in our box as well than a non-hormonal that are supportive than are non, non prescribable as well, that we would want you to be aware of so you can make a really informed decision about which way to go down.
Le’Nise Brothers: Mm. You’ve mentioned holistic, you’ve mentioned non-hormonal.
Obviously that’s piquing my interest as a nutritionist. When you have a patient who comes to you and you look at what their lifestyle factors and you see their diet and you see, okay, that’s not optimum. You see they’re not getting enough sleep. You know, we know sleep problems are an issue in perimenopause and beyond.
Do you gently nudge them towards, maybe, making some dietary changes, maybe considering some supplements alongside having this HRT conversation?
Dr Claire Phipps: Yeah, absolutely. So I, I would always say that the foundation pillar of treatment of menopause is thinking about our lifestyle and our nutrition and our self-care is fundamental.
I think if we get that right, we know that it can help so many people without any medication whatsoever. And I’m very much or less as more doctor, but I don’t need to give you something I don’t want to necessarily, because it’s a medication. It is something that we have to remember to do. And in menopause that can be difficult enough as it is.
But I think the foundation pillar is, is helping people to understand the huge impact that may be hacking our lifestyle a little bit can do to our, to our bodies and to how we feel. So when I first see somebody, I think it’s really important to kind of meet them at where they’re at at that point, because we don’t want to be having to change too much too quickly.
It can be difficult to do that, particularly if you’re struggling with symptoms, but is where are you at this point in time and what can we, what small changes can we make? What life hacks can we make to improve how you might feel? And that might be one change that might be doing a few squats while you are boiling the kettle.
That might be, try not to have that packet of biscuits on that day, but not completely excluding that from your diet. If you’re someone that enjoys that, maybe just reducing it. It’s small hacks, not doing everything altogether. But I think the fundamentals, and, you know, this is a nutritionist, is I think they can be game changing in terms of how we feel.
But it’s important that we meet people at where they’re at now because making those suggestions or not, what I would say is I always, I’d always want to be invited to make those suggestions and ask if it’s okay to make those suggestions. Because for some people it’s too much, it’s too overwhelming and it can feel intrusive.
So actually, am I okay to discuss this with you? Would you like to hear some of these recommendations that I have? Would you be interested in knowing about what supplements might or might not help you? And then meeting that person somewhere in the middle of that? Some people are obviously going to say, absolutely bring it on, whereas other people aren’t ready to hear that.
And there’s an element there of meeting somebody where they’re at and then working from there, step by step.
Le’Nise Brothers: That’s really interesting. You mentioned that it can feel intrusive and that surprises me because the expectation is that someone goes to the doctor and they’re there for advice. But can you say a little bit more about what you mean by it can feel intrusive?
Dr Claire Phipps: Yeah. So when someone, certainly as a GP when someone comes to you, they often, they want advice, they want resolution, and they want fixes.
Le’Nise Brothers: Mm-hmm.
Dr Claire Phipps: Um, some of those resolutions and fixes need to come from us as patients. Mm. And if you are not ready to make those changes and you hear that those changes are what you need to do, it can feel intrusive.
Le’Nise Brothers: Okay. Okay.
Dr Claire Phipps: But also I don’t want to be that paternalistic doctor that says, you know, I’ve got a million things going on in my brain when I hear someone’s story and I don’t want to suggest everything and I want to give them a list and lists of things to do, and I know that these will help. But I have to hold back and go, where are you at this point in time?
And meet you at where you are at and meet you at where I think you can make some small changes because if we can make some small changes that don’t feel too intrusive for you, then we’re much more likely to build on that rather than rushing in and trying to make 50 different changes when actually mentally you could only manage to do one.
You know, that overwhelm, that mental overwhelm at menopause is huge sometimes. And so adding to someone’s plate is probably not going to be helpful. So it’s inviting change, you know, what can I do? What small things can you do or what can I suggest that you think is is manageable for you without feeling overwhelmed?
Le’Nise Brothers: This is fascinating and it reminds me a bit of this time I was working with a woman who, she was perimenopausal and you, she clearly had a dependency on alcohol. I wouldn’t have called her an alcoholic. That’s obviously not my place to give her that label, but you could see every night it was come home, two or three glasses of, of wine.
And she had a list of issues that I would say that if she had reduced her alcohol intake, she would’ve felt ease from some of her symptoms. But I could also see that she wasn’t ready to not drink. And so it was like, whatever the, as you say, those little steps, those nudges were, you know, you could see that that would make a difference.
Dr Claire Phipps: Mm-hmm.
Le’Nise Brothers: It’s, can you drink a little bit more water when you are out? Maybe could you switch to a small glass?
Dr Claire Phipps: Mm.
Le’Nise Brothers: ’cause she was just not ready, you know, she loved drinking and that social aspect.
Dr Claire Phipps: Mm.
Le’Nise Brothers: And you know, we could have a whole conversation about alcohol and perimenopause and cultural attachment to alcohol in the UK, but I actually want to ask you about your work in cognitive behavioural therapy, because I find that fascinating in that you are giving people tools, again, with the principles that you’ve just described, you know, meeting people where they’re at and seeing what they’re actually ready to do.
But can you talk a little bit about the mental side of perimenopause and menopause and how this marries well with CBT?
Dr Claire Phipps: And again, this is one tool in, in the toolbox, isn’t it? It’s one way that we can help help you to start feeling better. So when we think about hormones in perimenopause, certainly in the early stages of perimenopause, we know that how oestrogen levels, which is the driver of many of our symptoms actually go up, and they can go up really, really high.
And sometimes oestrogen levels being really high can be the first triggers of menopause symptoms, perimenopause symptoms, and that tends to be psychological in, in, in nature. And oestrogen is a bit like our fight or flight hormones. So it’s our party hormone, our get up and go hormone. So when levels go super high, we can start to feel a little bit more anxious, maybe have some palpitations, maybe feel a bit more on edge or unable to cope, or I need to juggle everything.
And again, completely separate topic is the unmasking of AuADHD, so all the neurodivergence at this point as well and how oestrogen acts as a buffer. And when that buffer is no longer working well, how that can also feed into our symptoms as well. But actually when oestrogen levels go really high, those psychological symptoms are some of the first to present.
What we want to do in an ideal blue sky world is recognise those symptoms certainly as your healthcare professional and not put those down to depression, anxiety on its own. Are they hormonal driven? If they are, and perhaps you’re having some physical symptoms such as hot flashes or night sweats or insomnia.
CBT, cognitive behavioural therapy can be really helpful as a tool to help reframe how we’re thinking about things. It clearly isn’t going to rationalise what’s going on physiologically, but sometimes if we are anticipating a hot flush or night sweats and we’re going into a meeting or we’re having to present something in front of a group of people, the anticipation of what could happen when a hot flush comes, can often be worse than the hot flush itself.
So can we anticipate how we might feel and change the way our brain thinks about that in a bit more detail? So it’s about, cognitive behavioural therapy is about changing the way our brain deals with a, with a potential situation or a situation when it happens. And by helping us reframe that, rethink about those things, we can often make those symptoms better.
We can’t always change them a hundred percent. And again, cognitive behavioural therapy is a skill. We’ve got to learn how to do it. And it sometimes is difficult, sometimes it works, sometimes it doesn’t. But it’s a very non-intrusive way to try and make some changes. And so those little hacks, thinking about how we can re train our brain about sleep.
So for many of us, we begin to dread going to bed because we think, oh, I’m just going to take the ages to get to sleep, or I’ve got this massive to-do list tomorrow. Or I know that I’m going to wake up at three or four o’clock in the morning and then I’m not going to to get to sleep and I’m going to start catastrophising.
But can we change the way we think about sleep or can we change the way we’re thinking about a bedtime routine? And again, cognitive behavioural therapy can give us some tools to do that and to work on. And so I think it’s a really useful way to and again, it can be used for many aspects of our lives, not just for menopause symptoms, but to sort of anxiety, low mood.
It can be really helpful to, to think about things on a slightly different perspective. So can we shift the perspective essentially?
Le’Nise Brothers: Hmm. That’s fascinating. And for someone who wants to find out more about how C-B-D-C-B-T cogniti, not CBD, CCB
Dr Claire Phipps: D probably we should talk about that too.
Le’Nise Brothers: How that can help them, what are some resources that you might point them to?
Dr Claire Phipps: So in the UK, if you are thinking about having cognitive behavioural therapy, your GP could refer you for this. And you can ask for that referral to happen. And some of it can happen online. Some of it can happen face-to-face, depending on, depending on your need. There are lots of good resources on the Women’s Health Concern website and also the British Menopause Society website that can signpost you to, to CBT as well.
They can’t actually refer you, but there’s some resources on there. And the British Association of Psychotherapists and Psychologists, it’s a bit of a mouthful also has some good resources about where to go if you’re looking for a therapist itself.
Le’Nise Brothers: Okay. I’ll have all of those links in the show notes.
I want to just go back, we have time for one more question, and I want to go back to what you said about unmasking. And what I am also seeing is this increase in diagnoses around autism ADHD in perimenopausal woman. Can you say a little bit more for someone who is intrigued by this and thinks that might be what’s going on for me here?
Dr Claire Phipps: Yeah. Um, I think we have seen a huge increase in the diagnosis of AuADHD, so the spectrum of neurodivergence, I guess we’ve seen an increase in assigned female at birth, individuals being diagnosed. And there is this sort of rhetoric I guess, is that, oh, it’s just a, it’s a trendy diagnosis.
That’s why there’s, there’s been an increase in, in its incidents. And I don’t think that’s the case. I think it’s always been there. I think women and girls inherently are very good at masking ADHD. So we’re very good with oestrogen as a buffer. And again, it’s not just oestrogen, obviously, I know, but with oestrogen as a buffer, we’re very good at, and you’ll see this in schools, you know the difference between girls and boys with ADHD or autism or spectrum disorder.
Girls are very good at getting on with things and just focusing a bit better and masking a bit better. So this ability to complete a task, maybe they might go sort of tangentially around completing that task, but they’ll complete the task. When we get to perimenopause, we sort of lose the natural cycling of oestrogen as a buffer.
So what we see in many individuals is that their ability to multitask or their ability to get a task done or their ability to focus or have attention goes out the window. And not all of this is going to be because, you know, they’ve unmasked a spectrum disorder. Some of it is, and we do see it really, really commonly because oestrogen tends to be the thing that lubricates ourselves, our neurons, our joints, our vaginas.
It just makes clarity of thought a little bit more easy. So when we, when we lose that buffer, I think what we’ve got to be very mindful of as GPs, as psychologists, as healthcare professionals in general, is, is there an underlying neurodivergence here that we’re, we’re missing? Because that also can complicate how you manage as a patient, your perimenopause. HRT might help, alternatives might help, but we really do need to think about you very, very holistically, massively thinking about your nutrition.
We know how much, and I don’t need to speak to the expert on this, but we know how much hacking your diet can help with your nervous system. And so even simple changes can be really effective, but it needs to be not just hormones, not just nutrition, it’s combination effect. But unmasking at perimenopause is common.
Le’Nise Brothers: And, f or someone who’s listening to this and is thinking, this is what I think is going on for me, are there any kind of key words when they speak to, or phrases that they should use when they go to their GP that will help them push them down the pathway to perhaps if they were seeking a diagnosis, to getting that diagnosis?
Dr Claire Phipps: Yeah, I think track your symptoms, track your psychological symptoms and think about how they’re affecting you. If you are considering this as a possibility, make yourself some notes about how it’s affecting you and the aspects of your life that it’s affecting you in.
That’s really important. That’s a key part of diagnosis. Send that to your GP before you go to see your GP so that they can just have a little kind of I’ve had a thought process about this because when we do a referral, what we need to do is, it’s a really long-winded referral. We need to know every aspect of how it’s impacting you.
Work, family, life ,home life, you know, your ability to function, just driving a car. It has an impact in every aspect of your life. And that’s part of how a referral, certainly within the NHS works. So if we can kind of think about that before you even get to us, that’s brilliant. And write that down and send that to us.
So that’s a really good strategy to have, but also just have an honest conversation if you can, conversation with your doctor or healthcare professional about it. Because I think there’s a myth that we’re gate keeping referrals, and that’s not the case. It’s just that because there are so many more referrals to do, the referral process takes longer and the waiting times are longer.
That’s not to say that you won’t be seen, but, but I would start the process if you’re considering it, and get that into your GP so your GP can start thinking about it from the get go.
Le’Nise Brothers: Great. We’ve explored a lot today. We’ve talked about AuADHD, we’ve talked about perimenopause, menopause, and post menopause.
We’ve talked about HRT, we’ve talked about strategies for working with doctors. What’s the one thought that you’d like to leave listeners with today?
Dr Claire Phipps: So I think from a menopause perspective, I would really love people not to be fearful of it and to embrace it. That may well take some time because there may be things that you have to work through as a result of that.
But I think let’s move away from this disease process, and let’s move towards a natural transition that could be positive if we allow it to be. And if we work with our healthcare professionals who also need more training to understand it. But also let’s break down some taboos. Let’s talk about this more openly with our family, our children, our partners, so that we can get the support that we need.
Let’s get more workplaces involved so that we have a more understanding work environment. But talk about it. The more we talk about it, you know, the more taboos we break down. And we’ve seen that, you know, certainly in the last five or six years that I’ve been, I’ve been working in the medical space for a lot longer, but certainly in the last five or six years, the taboos have really begun to break down.
Not enough. There’s still work to be done, of course, but it’s getting better. And I would say from a gender affirming menopause perspective, let’s start to make this space more inclusive. More work to be done there. But let’s, let’s really focus on that so that we can, we can help.
Le’Nise Brothers: Thank you so much for your time today and for sharing your wisdom. Where can people find you?
Dr Claire Phipps: So I’m an NHS and a private GP. I work out of London Gynaecology in Central London. But I’m also @themenopausegp on Instagram and my aim is to try and post as much information there so you don’t need to go to seek private support.
And lots of that will be evidence based, so just take a look there.
Le’Nise Brothers: Fantastic. Thank you so much.
Dr Claire Phipps: Thank you for having me.