[00:00:00] Dr Renee White: Knowledge is power and we are all about empowering the mamas of the world. In each episode we will unravel and interpret the latest research and evidence based practices for pregnancy, postpartum and motherhood. As mums and researchers ourselves we have experienced firsthand the overwhelming complexity of information, myths and those classic old wives tales.

[00:00:27] I'm Dr Renee White and this is The Science of Motherhood. Hello and welcome to episode 164 of the Science of Motherhood I am your host, Dr. Renee White. Hello everyone. This is a, this is a cool episode. Um, this is if you haven't already worked out from our social media and lots of other things, I'm very keen to learn more and more and more about perimenopause and menopause, because I think these are discussions that we need to start having in our thirties and forties.

[00:01:00] So we know what's up before we kind of get. To that pivotal mument and go, what the heck? So this is going to be our second kind of episode in our little mini series. If you haven't heard episode 154 yet, ah with my discussion with Jay Webb, who is a nutritionist. We talk about perimenopause and how your diet can play a major role in that.

[00:01:29] I would jump back into that episode. Today's episode, we're going to be talking with a fertility specialist about, you know, what you need to know. But before we dive into that particular episode, I just wanted to remind everyone about Fill Your Cup, which is an amazing doula village that I run here out of Hobart, but we have doulas all across the east coast of Australia.

[00:01:57] We are in Brisbane and Melbourne, Newcastle, Sydney, Geelong, and as I said, Hobart as well. And so if you are one of these people who is pregnant and you are thinking, I've never done this before, I would really love to have a support person by my side who knows hospital policies, who understands about birth, who can literally be my birth BFF and cheerleader, then you might be wanting a birth doula.

[00:02:38] And we have those lovely people in our doula village. Um, we also have wonderful postpartum doulas as well. So if you're one of those people who maybe you've got a toddler, maybe you're thinking, Oh my goodness, it was hard enough with one. How are we going to juggle multiple kids, you might be feeling a little bit guilty about not, you know, giving older kids enough attention.

[00:03:11] Maybe your first postpartum was not what you desired and you are looking for something a bit smoother and you want real confidence in balancing, you know, work life balance and, you know, getting back on your feet and really investing in your health and well being with nutritious meals and you're not eating toast and Tim Tams like I did.

[00:03:39] There may be a postpartum dollars for you and as I said, we have lots of those people who can help you with in-home care. We come in, pop into your house for three hours a week. Generally it can be more, can be less, but generally it's weekly. You get to pick, um, some beautiful meals and snacks from our menu.

[00:04:01] Each week we get to hold your baby while you go have a nap. Can you imagine that? Imagine waking up from a two hour nap and you've got a hot lunch and you've got snacks, uh, ready to go for your feeding station. So when you are up at 3 AM that night, and you're feeding your bubby, you're not thinking, OMG I'm starving what am I going to eat? It's all there. It's all done for you. If that sounds like the dream to you, I can assure you it's not a dream. It can be your reality. Pop over to our website, ifillyourcup. com, or if you have a look at the link in the episode show notes. You can have a look at all of those offerings and we can treat you like the queen that you deserve to be.

[00:04:53] All right, let's jump into today's episode. As I said, it is the second episode in our little mini series on perimenopause and menopause. And we have got the wonderful Dr. Cheryl Phua with us today, and she is the a distinguished fertility specialist at IVF Australia. Um, if you haven't caught her on our previous episodes, she holds a master's of reproductive medicine from the University of New South Wales.

[00:05:25] And she also has, um, a BSE and Masters in Biotechnology from the University of Pennsylvania. She is extremely passionate about everything from pre pregnancy to menopause and beyond. I love talking to Cheryl, she's got such a beautiful energy. And in today's episode, we are going to break it down for you people.

[00:05:49] We're going to talk about real definitions of perimenopause, menopause. We're going to be talking about treatments. We're going to be talking about, you know, with perimenopause and fertility, is it all doom and gloom? And we're going to debunk some myths along the way, because there is a lot of misinformation in this area for many, many reasons.

[00:06:12] You know, women's health is not exactly the top of, uh, research priorities, particularly here in Australia and so there's a little bit of stuff that we just don't know about yet. And that's okay. We're working through it. So without further ado, he is Dr. Cheryl Phua. Hello and welcome to the podcast or should I say welcome back, Cheryl, you are on a roll here with us.

[00:06:39] Um, yeah,

[00:06:44] We have previously spoken about egg freezing, we've spoken about fertility treatments, IVF, all of that. Today we're kind of shifting gears a little bit, um, because of my own self indulgent, this is what I do with this podcast, I have questions and I find experts and I'm like, please tell me all the things.

[00:07:02] We're talking about perimenopause and menopause today. I am on a little bit of a rant about all of this because I'm about to turn 40 and my friends, most of them are older than me, so they're kind of well into the perimenopausal kind of sphere um, and so I want to get a leg up on all the information in this area.

[00:07:26] So we're going to talk about that today, we're going to touch on a few. What is it? What's the difference between perimenopause and menopause? We're going to debunk some myths. And also you attended the, was it the World Congress on menopause in Melbourne?

[00:07:42] Dr Cheryl Phua: Yeah, in Melbourne just recently.

[00:07:43] Dr Renee White: So we're going to talk a little bit about that as well, but for all those playing at home who might not have listened to your previous episodes, First of all, please go back and listen.

[00:07:53] They're fabulous. Cheryl, do you want to talk to the listeners and let them know who you are and what you do on the daily?

[00:07:59] Dr Cheryl Phua: Hi Renee, thanks again for having me back and I hope your listeners aren't bored about listening to me speak about passionate topics.

[00:08:05] Dr Renee White: No, I love your energy. I keep telling the team, I'm just like, oh my god, this woman is amazing.

[00:08:10] Dr Cheryl Phua: I just can't believe it. It's annoying because I'm passionate about all these things that aren't very always sexy in terms of general health and GP stuff. So I'm Dr. Cheryl Phua I'm a subspecialist ONG doctor specialising in reproductive endocrinology and infertility. So that encompasses everything from problems with your periods when you're going through puberty, all the way up to fertility preservation, egg freezing, sperm or embryo freezing.

[00:08:33] And let's not forget our women who've contributed so much to society, menopause, because that area is even more taboo sometimes I think than infertility because lots of women get to late 40s or mid 40s, some even earlier that see me for period troubles and then we find out they've gone through early or premature ovarian insufficiency.

[00:08:52] But when you're 50, you've had your children, you might have some grandchildren, you're at the second stage in life, usually you're sort of relaxing out, the kids have sometimes left home, sometimes they come back is what I hear from my parents, the parent bank, and then from that, they've sort of been forgotten because they've given all of their work, mothering, society has sort of forgotten them in their 50s. It's like, Oh no, you'll be right. You know, your appearance will stop. These hot flushes will go away. All of your symptoms are just normal. What women should feel like, and there's nothing we can give you to help them. And that's not really the case in 2024 or going into 2025 soon.

[00:09:30] Dr Renee White: Absolutely. And I think this is, I, I'm, I'm assuming it's probably because I'm in this, you know, sphere of women's health and things like that. But, um, and I don't think she's going to get cross at me for saying this, but my mum, my mum is the one who's also kind of spurred me on in this area, being the scientist in the family.

[00:09:52] She is in her early sixties. And so, she has been experiencing menopause for quite some time, and she keeps coming to me going, Oh my God, I've got these symptoms. What the heck? What do I do? Blah, blah, blah. And she has had this rhetoric for so long with her own circle of friends, which is exactly what you said.

[00:10:16] You're at that stage of your life. You just suck eggs. That's where you're at. And you just like, that is, this is it. Like you can't change it. And my mum is just like. Nah, I'm not doing that.

[00:10:29] Dr Cheryl Phua: It's not good enough.

[00:10:30] Dr Renee White: It doesn't sound right to me. Is there anything we can do?

[00:10:33] Dr Cheryl Phua: Yeah, exactly. In sort of developed countries, so say Australia, for example, the average age of menopause is about 51 for most women.

[00:10:42] Symptoms can start in perimenopause. Peri just means around the time of menopause because, annoyingly, And I always think that the reason why definitions are so weird is because it's probably made by a bunch of male doctors back in the day. Then.

[00:10:56] Dr Renee White: It's always like they've got their eyes closed and they're just, you know, pointing their finger to a map and they're like, yep, that's the, that's what we're going to do.

[00:11:04] Dr Cheryl Phua: It's basically retrospective. So we look backwards. So when you haven't had your period for 12 months. Say you're 52 now, you haven't had a bleed for 12 months, we can throw the pads or tampons or menstrual cups and the period undies out, then that's the definition of menopause 12 months after your last period.

[00:11:21] However, studies have shown that people start to sort of be in the menopause transition or start to get irregular periods, funny changes in their bleeding patterns, start to get things like bothersome flushes, difficulties concentrating, maybe just hot flushes at night time, maybe in the daytime, maybe just in response to trigger factors like spicy food, alcohol. exercise for example is slightly different for everybody and also they might also start to get changes in the vaginal flora or the bugs that live in our vagina normally, leading to things like dryness, UTIs, irritation and other sort of skin issue changes within the vaginal area as well and all of these people Most older women might just grin and bear it, like your mum, like a lot of her friends say, Oh, don't worry.

[00:12:13] It'll stop eventually. Just leave it. Nothing's going to happen. And I think that this is because back in the day, in the 90s, there was this big study that came out that got a lot of media attention then that said, Oh, you can't go on hormones for menopause because any hormone therapy, HRT at the time was what it was.

[00:12:31] Now, um, termed, it's bad for you. It's going to give you a stroke. It's going to give you heart disease. It's going to cause you to die. So don't go on it. Just suffer through it. Who cares? It's a couple of hot flushes.

[00:12:42] Dr Renee White: God,

[00:12:43] Dr Cheryl Phua: you know, and your mum knows it is not just a few hot flushes. I've had people that see me that gone through debilitating symptoms of menopause and nobody can help them, their GP says there's nothing they can give.

[00:12:54] A lot of people aren't comfortable with prescribing it because they haven't caught up with the latest evidence and the latest. forms of treatment that's available. And so these poor women come and see me sort of three or four years later, having been suffering through things. And then when we talk about what's available for treatment, they're like, Oh my gosh, that's, you know, so good.

[00:13:13] Um, from that perspective, you know, and then we feel like a normal person again, and, you know, we can go back and enjoy life because now is when they're at the stage in life where they've got different responsibilities and aims and, you know, and things that they want to do. Achieve in life. And so it gives them that freedom to go and explore other aspects of life that gives them pleasure.

[00:13:32] Dr Renee White: Absolutely. And I think, you know, on top of that, the complexity of the mental health status of those women through that three, four, five years time of just grinning and bearing it, it's just deplorable, like, We have a, you know, I, I, we spoke offline about this, um, the fact that there was a, a menopause kind of webinar, um, workshop thing here in Hobart and one of the GPs was kind of mapped on a timeline in terms of the rate of suicide in specific age groups.

[00:14:11] And it was no coincidence that the peak was kind of around that perimenopause menopausal kind of age bracket because so many women are suffering in silence and they just kind of think to themselves, I can't do this anymore. Like, I just can't. This is, this is what my life is going to look like for the next 20, 30 years.

[00:14:32] I'm out.

[00:14:34] Dr Cheryl Phua: And also like that sometimes also that timing of your late 40s, early 50s, sometimes 60s might be when your family dynamics might start to change as well. So life's stressors are different and it can be quite a stressful time for women transitioning to menopause. Children might have left, there might be relationship breakdowns, there might be differences sort of in terms of family movements, and all of that can be quite a load on mental health in general.

[00:14:57] Dr Renee White: Mm hmm. Absolutely okay, so we've kind of defined, you know, what perimenopause is in comparison to menopause. Let's talk about the treatments. Let's talk about the positive sides of what women can actually do. What are some of the options available?

[00:15:17] Dr Cheryl Phua: So generally speaking, menopause treatment we treat the symptoms. So we don't just give hormones just to prevent menopause from happening and we don't give hormone treatment or any other treatments if someone is not having bothersome symptoms. Most of the time, people see me, patients come to me with hot flushes, night sweats, difficulty sleeping, loss of libido, for example, weight gain when everything else is exactly the same that they've kept on in their life.

[00:15:44] Some people experience brain fog, irritability and more and more anxiety going back to what you said about mental health. A lot of people say, look, I'm just feeling really anxious. I get these palpitations out of nowhere. All of these is due to sort of the menopause changes in our brain hormones and the lack of estrogen primarily being released by our ovaries because they've now gone to the stage where they've got not enough capacity to release any more hormones, leading to these symptoms.

[00:16:10] In the past, the reason why hormone therapy had a bad rep was because of that study I alluded to, there were two big ones in the 90s, but women were started on hormones for no symptoms, Renee, this is the problem. So that group of patients were in the 60s, they finished the hot flushes 10 years ago, and they were started on hormones to try and see if there was any benefit for women who are completely well, starting on hormones and clearly there was harm because there was not the right reason to start treatment. Nowadays, we normally sort of start saying, look, let's optimise your general health, make sure your BMI is in a healthy range, cut down your things that may be flaring up your symptoms, like reducing alcohol, stop smoking.

[00:16:50] If certain foods and things trigger flushes, we try to avoid them and sort of eating healthy things with a lot of high antioxidants or phytoestrogens may be helpful in someone with mild symptoms. If that doesn't sort of quite improve things, then there's hormone therapy, which is the first line for troublesome symptoms.

[00:17:10] When someone sees me with troublesome hot flushes, when I always say, look, your hot flushes, might be at an eight or a ten severity right now. The aim is to get it to a manageable level because unfortunately a lot of the times we are not always able to completely eradicate the flushes. Knowing women and how much they put up with throughout their lives.

[00:17:31] Even people who see me with like an eight or nine hot flush severity, if it gets down to a four, they're very, very happy because that means that instead of having a hot flush every hour, if they just have one once or twice a day, they can go about doing the other stuff that they need to do and be able to sort of, you know, enjoy other aspects of their life.

[00:17:51] With the hormone treatment, there's a couple of types, and it sort of depends on patients, their preference and their age group. Most of the time, the safest form of hormone replacement therapy would be the form of what we call transdermal or absorption through the skin. Ways of getting it, one is a little patch sticker form that you change every couple of days.

[00:18:11] Another one is, oh, let me show you. Another one is in a pump gel form. Oh, yeah. Yeah. And that's just like a facial cleanser type thing. And it pumps out from the pump and people just rub it on their skin till it dissolves and wash your hands afterwards. So the estrogen is what's important to relieve the symptoms, but having estrogen only, Renee, it's not very good in women who still have a womb.

[00:18:39] Dr Renee White: Okay.

[00:18:39] Dr Cheryl Phua: Because having unopposed estrogen by itself can lead to overgrowth of the cells in the lining of the womb. And it's some women that might lead to things like pre cancer changes. So in the little patch sticker patch, we've got both estrogen and progesterone, which is the molecule that helps shed the lining or keep the lining thin to prevent the overgrowth from the estrogen, which helps women's symptoms.

[00:19:05] Dr Renee White: Okay.

[00:19:06] Dr Cheryl Phua: If people are on the gel form, they just take a tablet. So there's two medic, two bits of medication and the gel is slightly more expensive versus a patch, which is a lot more affordable. Because again, women who are needing treatment for their hot flashes and things might find it hard to be paying lots of tens of dollars every month. until they need to stop the treatment. So that's the other consideration that's really important to discuss with my patients.

[00:19:32] Dr Renee White: I've heard, and again this is from my mother, I've heard that there's a shortage of these patches.

[00:19:38] Dr Cheryl Phua: Always, always. Menopause treatment is not sexy, it's not like, you know,

[00:19:43] Dr Renee White: What the heck is going on?

[00:19:45] Dr Cheryl Phua: Again, it's my conspiracy. I love it. It's not sexy. They know that people will always buy it. Yeah. Men are not needing it.

[00:19:54] Dr Renee White: No, it's not viagra so we don't have on tap.

[00:19:58] Dr Cheryl Phua: There's how is that? How do we, we every year, there is always a time where they run out of the patches, which is why things like more expensive options come on the market because they know that people are that desperate for treatment that sometimes when the patches run out, that they've got no choice.

[00:20:15] We've got to change to something else while waiting for the patches to come back into stock.

[00:20:19] Dr Renee White: And from a, okay, so let's just say someone has to do that. Is that okay to switch between the two?

[00:20:29] Dr Cheryl Phua: Totally okay to switch between the two. They're usually sort of the same underlying molecule or hormone that we need for the hot flushes. Most of the time, majority of patients switch between the two with no problem apart from a bit of annoyance in having to take two things versus just one patch.

[00:20:45] Dr Renee White: Yeah. Okay.

[00:20:47] Dr Cheryl Phua: It's so annoying, the production, Renee, for the patch that I've had patients that go on like their camper van trips or whatever through rural Australia and then buy up all the stock from the pharmacies because they know say,

[00:20:58] Dr Renee White: That's what I told my mum to do.

[00:21:01] Dr Cheryl Phua: Because they know I was like, just keep searching. It's, it's not, you would never, you know, that would never happen if it was like a blood pressure.

[00:21:08] Dr Renee White: Oh yeah, 100%.

[00:21:11] Dr Cheryl Phua: Or like a cholesterol tablet.

[00:21:13] Dr Renee White: The other underground thing that I've heard is that, say, say the, the patch that they require is 50 milligrams or whatever it is, is that if they can't get the 50, just get a 100 and cut it in half. Is that okay to do or are you compromising the patch?

[00:21:31] Dr Cheryl Phua: Totally okay to do, yes. that sometimes instead of that it's not as sticky because they're sticky that sort of sticky bits on the edges but people do that all the time.

[00:21:40] Dr Renee White: Wow because my mum suggests she said oh you know so and so said so and so said I should do this and I panicked and I said don't do that mum because I don't know because like being the scientist I'm like you could compromise the integrity of the patch something could come out of it I was like don't do it so she was like okay not gonna do it um so yeah okay okay all right Okay, so we can cut the patch. I think I need to text her now and tell her to cut the patch, mum. Just cut the patch.

[00:22:11] Dr Cheryl Phua: Going back, people worry because, you know, it's very hard to shrug off all of that bad press that came with treatment therapy back in the day.

[00:22:19] Dr Renee White: Yes. And she went through that as well. She was like, I can't do it. I'll die.

[00:22:24] Dr Cheryl Phua: People still worry. So we know that if you start hormones when you're going through troublesome menopause symptoms, so usually 50 to 60 years old, that's relatively safe because it doesn't appear to increase risks, of blood clots, heart disease, stroke, or breast cancer over and above the population risks. And when we looked at women starting it, There's no increased incidence per 10, 000 women of things like breast cancer or heart disease.

[00:22:54] The later you start it though, so in older women, so in their 60s or 70s, if you are starting hormones, then that's when it's risky, because that's when people have had more time to develop that's in their like heart vessels, more disease in their arteries of the heart and the brain leading to those complications of stroke and heart attacks.

[00:23:15] Dr Renee White: Yes.

[00:23:16] Dr Cheryl Phua: Whereas if you have it early, it actually protects you from heart disease, colorectal cancer. It protects people's bone strength. So it reduces the chance of osteoporosis. and also treats people's hot flushes. Back to what you were saying about the International Menopause Conference. Interesting, endocrinologists or hormone doctors are now using hormone replacement as one of the therapies to help women who are at risk of developing osteoporosis.

[00:23:43] Dr Renee White: Wow.

[00:23:43] Dr Cheryl Phua: I know, I was like, oh, that's interesting. So that was a really sort of good takeaway and that that's actually an add on treatment for women who say have a head of fracture or something to try and help maintain their bone strength because as we get older, the bones start to get more brittle. And it's not like there are injections that people can use, but from what I was listening to them speak, there seemed to be some side effects.

[00:24:06] And some of these drugs for bone health can't be continued past a certain time.

[00:24:11] Dr Renee White: Yeah. And so estrogen plays into that loop.

[00:24:15] Dr Cheryl Phua: Yeah. Of preventing the bone cells from like for degenerating themselves.

[00:24:20] Dr Renee White: Wow. Okay. That's fascinating. Um, I'm curious to know, apart from like that crazy study in the 90s, are there any other kind of big myths or misconceptions that you would love to debunk like right here and right now? Like, what are the things that you hear from people?

[00:24:41] Dr Cheryl Phua: The thing we hear is that, oh no, it's normal to get UTIs and you know, I've got so much vaginal dryness. I've got these like, incontinence and stuff. That's just because, you know, I had three babies. They were 10 pound each and that's just what I have to live with. I'll just get my depends and it'd be fine.

[00:24:55] Dr Renee White: Oh my goodness.

[00:24:56] Dr Cheryl Phua: When we go through menopause, Renee, everything in our body lacks estrogen because the ovaries have shut down. That's just what biology dictates and that's what happens. Having the menopause hormone therapy through the skin through patches, for example, will give you some relief from your hot flushes and sweats, but we might also have to add on.

[00:25:14] So some people are like, oh, you know, but like, you know, I'm still having these problems with my, what we call genital urinary or down the bottom bits. All of those things can still be quite severe and people are like, Oh, I just keep giving, just give me antibiotics for my UTI, not realising that it's a lack of estrogen around the vaginal tissues that makes everything dry, painful, more susceptible to UTIs and incontinence sometimes.

[00:25:39] So again, creams, vaginal creams that have estrogen in them, prescribed by a doctor can be helpful for that. And that's actually even safe in women. Some women see me and they've had a history of breast cancer. Following on from that treatment, and if they are now in their fifties, they can have really, really severe menopause symptoms.

[00:26:00] In some of these women, after close discussion with their treating team or their oncologist, we can give some form of vaginal creams of estrogen that's relatively safe because it doesn't get converted back in the body. Whereas a lot of these women, even the skin preparations of hormones is not quite safe because of the theoretical risk of bringing back the breast cancer.

[00:26:20] But vaginal creams. can be safe in a select population of women, for example, who had breast cancer before. I think too, I know, so breast cancers and all these things, really, I don't know about you, but we're seeing it so much more these days. Younger women, more women are coming to see me even before they've started their family.

[00:26:38] The knowledges and the, we can keep a close eye on these women, but there are options for treatment for these women even after, and if they're suffering from menopausal symptoms.

[00:26:48] Dr Renee White: Mm. Yeah, absolutely. Um, and I think that's like on the whole UTI thing, it again is this whole like, oh, yeah, it's just part and parcel. But I also heard, um, a statistic where it was like, um, the majority of women end up in nursing homes and, you know, aged care facilities because of incontinence issues, which, you know, if we kind of cycle back, it's that consistent UTI thing, it's the lack of estrogen, it's the, you know, things that we could have taken care of in our 50s, 60s are then just snowballing into our 70s, 80s, 90s.

[00:27:34] Dr Cheryl Phua: And also really don't forget, women live longer than men. That's been proven. Australian statistics and worldwide, we know that we live longer. One of the reasons is because of our periods and our estrogen levels staying high to usually about 50 ish on average. That's what protects us.

[00:27:50] But by the time we live to about 70, then we actually overtake men, in terms of cardiovascular risk. And that's the other sort of take home from that conference, which is quite scary.

[00:27:59] So we always thought that as women, we've got estrogen to about 50 something. We'll kind of protect it from heart disease.

[00:28:04] So don't worry about it. But the grass starts to intersect from about 70 or late sixties, because by then quite a few men have died from other causes. But then women's health starts to deteriorate at that stage because there's no more protection from estrogen by then. And if you haven't had it and you had menopause even earlier, say in your 40s or younger, then you've been lacking that protective estrogen for more than that 20 years from 50 to 70.

[00:28:33] So that was quite an eye opener.

[00:28:36] Dr Renee White: Just from like the science nerd in me. What is it about estrogen that protects us from cardiovascular disease?

[00:28:43] Dr Cheryl Phua: They think that it's got action on the lining cells within the vessel walls of the blood vessels and that's why they're protective until we stop having them. That's one of the theories and it's sort of oxidation and stuff within the blood vessels seems to be better in younger women.

[00:28:57] Dr Renee White: Okay.

[00:28:58] Dr Cheryl Phua: That's it though, Renee. Sadly, last take from the international conference, women who present with chest pain to emergency are less likely to be adequately diagnosed with a heart attack because that's not what they think women get.

[00:29:14] Dr Renee White: Oh, what?

[00:29:16] Dr Cheryl Phua: I know it's quite interesting. So this cardiologist gave a talk, she was really good. She actually set up this research foundation with a patient of hers that had a heart attack in her 30s, which is unheard of. But because in emergency, when you come into emergency, you get triaged based on your symptoms, how severe they think it is.

[00:29:34] Women, generally speaking, don't get worked up as well. If they've got chest pain, they don't get diagnosed with heart attacks and also the aftercare, the preventative stuff to take after someone's been diagnosed, for example, say with a mild heart attack. Women don't seem to be getting as close monitoring or treatment as men do, which is quite interesting take home from that really good talk by the cardiologist from Melbourne.

[00:29:59] Dr Renee White: Wow, I feel like I need to dive into that, because isn't, like, have you said this already, but maybe it's just been in my head, but like cardiac disease and cardiac arrest is the leading cause of death for women, is it not?

[00:30:14] Dr Cheryl Phua: It's leading cause of death in general, but depending on the age group it's slightly different.

[00:30:19] Dr Renee White: Okay, all right.

[00:30:21] Dr Cheryl Phua: Yeah.

[00:30:23] Dr Renee White: Oh my goodness. I know. So we don't have, we don't have our patches and then when we turn up to emergency, we're not being taken seriously.

[00:30:30] Dr Cheryl Phua: If you have the same symptom as another person and in that man, like 45 year old guy, he'll be like, Oh my God, make sure he doesn't have a heart attack.

[00:30:37] But because you're 45 year old female, they might say, Oh, did you hit your chest? Was it like, you know, which was quite interesting to me from that perspective that even when they looked at the long term health after someone presented with an incident event. Yeah.

[00:30:49] Yeah. that they also tended to fare poorer because of that whole lack of the long term follow up for women.

[00:30:58] Dr Renee White: Okay, that's fascinating.

[00:31:00] Dr Cheryl Phua: I know, it is quite interesting to me.

[00:31:02] Dr Renee White: Yeah.

[00:31:02] Dr Cheryl Phua: And all the more, we have to be proactive and look after ourselves. And also, Renee, I think it's important for younger listeners out there that if you have irregular periods or anything funny, you Sometimes people brush it off to say, Hey, ladies, don't worry.

[00:31:16] That's all normal. Oh, it's PCOS or your polycystic ovary is causing those things. There's been quite a significant number of women that seen me with irregular periods. They might not have been bothered by hot flushes quite yet, but it's actually not their polycystic ovarian syndrome, but they've actually gone to, so I would always say if your periods have become funny after you've stopped your pill, or if, you know, things have just changed in terms of periods and how they are, how often they come, don't worry at all, just see your GP because sometimes it's as easy as doing a blood test for the diagnosis.

[00:31:55] And if we do it early enough, we can sometimes still offer fertility preservation strategies, but more importantly, we need to look after you as a patient till you go into menopause naturally, which is 51.

[00:32:06] So I've got patients who see me at 29, having gone through premature ovarian insufficiency, which is the new term now. And they're looking down the barrel of at least another 20 years of having, bugger all estrogen if no one were to treat them.

[00:32:20] Dr Renee White: Wow. So, okay. So in that, in that age bracket, say they came to you, is it still possible to have a family? Like how do you, yeah, how does that work?

[00:32:33] Dr Cheryl Phua: Yeah, it depends on certain what their numbers are and how high their hormone levels are.

[00:32:38] Sometimes there's still a 5 percent chance in the early menopause, group of women that they might release an egg and get pregnant naturally. Otherwise a lot of women see me and then they move on to the donor egg option because their womb is still healthy. Right. We always prepare the lining of the womb in the setting of say preparation for IVF treatment, but we'll need an egg.

[00:33:02] So if my patient can't produce an egg anymore because she's run out of her own, then she, you're looking down maybe potentially using an egg donor, either someone you know, a family member, for example, or egg banks that all IVF clinics will work with. We can implant the egg with partner sperm, donor sperm, and then help my patient carry the pregnancy. So they're still the mother.

[00:33:28] Dr Renee White: Okay. That's fascinating.

[00:33:29] Dr Cheryl Phua: And they're still falling pregnant. They still carry it to nine months and then everything else just happens.

[00:33:34] Dr Renee White: And is that an expensive exercise? Is that covered by like Medicare or anything like that?

[00:33:40] Dr Cheryl Phua: Not all aspects of it, so it can be quite costly depending on where the eggs come from.

[00:33:46] Dr Renee White: Okay, um, any other highlights from the conference?

[00:33:52] Dr Cheryl Phua: I think those were my main ones and it was just interesting to see all these experts speak about these things and also lots of women, back to the early menopause population, lots of women come and ask me, hey, can we find out why? I said, yep, we've got these little basic tests we can do to check if there's a genetic reason for why you've got the menopause early, if there's any autoimmune condition that's associated with it.

[00:34:15] But a lot, a lot of the times we don't actually find anything. Okay. What they're trying to do now is they're trying to have these genome wide or checking all of the genes involved in somebody that might then give us a better insight as to why someone's gone through menopause. You can't treat it and these gene panels aren't quite widely available just yet, but hopefully in time to come, a bit like carrier or genetic screening for couples wanting to fall pregnant, hopefully it'll come soon once it gets a bit easier to check things and run these little gene panels.

[00:34:48] Dr Renee White: Mm. I think that would be really useful because my understanding is also that if you're in that kind of perimenopausal, uh, zone, there's not a clear definitive blood test because your hormones could be all over the shop and like, it's a single time point. So.

[00:35:03] Dr Cheryl Phua: Exactly. And that's why they want to get one blood test. And then sometimes it involves getting another one, but close monitoring is really, really important versus, you know, someone's coming to me saying, you know, for the last five years, I just had weird periods, you know, we may or may not, but we may have been able to sort of do something when you first present it with those funny symptoms versus the longer we leave it, the harder it is sometimes to offer certain options or certain treatment options.

[00:35:29] Dr Renee White: Okay, that makes sense. That is all the questions I have before we jump into our rapid fire. Was there anything else you wanted to add before we did that?

[00:35:39] Dr Cheryl Phua: No, I think it's just for your listeners, Renee like you said, it's really important just to chat to your GP about it or in Hobart that um, GP who's running a menopause clinic.

[00:35:47] Dr Renee White: Yes, Dr. Hannah Chapman.

[00:35:49] Dr Cheryl Phua: There's a lack of that so much so that the, in New South Wales. The government's given some public hospitals funding to set up more menopause public clinics, because they know how hard it is to access and how expensive it can be for pensioners to go privately, to see someone for treatment.

[00:36:05] It's important to reach out, look online for people who are, who have a special interest in menopause and currently now, like I said, we're expanding our public clinics, so hopefully people will be able to get in. The problem is like, you know, in the public sector, sometimes wait time is an issue.

[00:36:21] Dr Renee White: Oh, 100% and I think that's, and I don't know how many people do this, but given the fact that we're from Melbourne, originally my family, and now we're here in Tassie, I have really been leaning on like the whole telehealth thing, um, because my husband sees a specialist in Melbourne still. And so we just continue to do that. I don't know how, I don't know how regular it is.

[00:36:47] Dr Cheryl Phua: And that's a, that's a, that was one of the positives that COVID, the pandemic came out. Is that we now can do telehealth for most things, unless there's something we need to examine or you're worried about a lump or bump. Yeah. Telehealth is quite good most of the time for most of these management issues.

[00:37:03] Dr Renee White: Absolutely. Okay, let's dive into our rapid fire. Um, first question, and I'm gonna like context these. What's your top tip for women who maybe think they're going through perimenopause or menopause?

[00:37:21] Dr Cheryl Phua: Reach out to your friends, reach out to your family as well as your GP. Have a chat to them. There's a lot of good online resources.

[00:37:29] The Australian Menopause Society's got a really good website. You can look at the symptoms, see if it applies to you. If you're feeling uncertain about whether or not you want to see somebody and then have a chat to your GP about it and they might be able to talk you through simple management strategies first before even starting your medications, unless you really want to. So don't worry that we're going to say, Hey, start on these hormones. Not at all. There might be other simpler, simpler things, or might be other hormone imbalances, for example, thyroid imbalance, that we can treat easily that might be improving your symptoms.

[00:38:00] Dr Renee White: Um, do you have a go to resource? You've just mentioned that website. Um, was there anything else that would be available for people who are wanting to know more information?

[00:38:10] Dr Cheryl Phua: There's some good apps as well for menopause, but I find the Australian menopause that has breaks it down really easily. They've got little charts to tell you the absolute risk of developing say breast cancer if higher hormones.

[00:38:22] It breaks it down into extra five women in 10, 000 will have breast cancer if you're on hormones from 60 to 69. So you can see how sort of that number is actually not quite as bad as what the other studies suggested that to be.

[00:38:36] Dr Renee White: Okay, fantastic. And I don't know if this has changed since we've previously spoken to you, but we um, always ask, what do you keep on your bedside table?

[00:38:45] Dr Cheryl Phua: Already now, eye drops. New thing that's happened on my bedside table.

[00:38:49] Dr Renee White: Hay fever related?

[00:38:50] Dr Cheryl Phua: Hay fever related. I think it's just springtime in Sydney, so I should have eye drops at night time. I might have to start on my own hormone soon, Renee.

[00:39:00] Dr Renee White: I visited Melbourne, um, a few weeks back and I had really bad hay fever when I lived in Melbourne. And here in Tassie, we clearly just don't have the same pollen. Yes. And I was in Melbourne and both my daughter and I, we were walking along the street and I just kind of started coughing and then my eyes started watering and I looked at her, she started coughing and I went. Oh, that's it. We're going to get out of here.

[00:39:24] And we were, we were doing our last kind of quick shop before we headed to the airport. We ended up going to the airport four hours early. Cause I was like, I can't, I was like, I don't have any Zyrtec. What am I, what am I doing? I was like, that's it. We're out of here. Goodbye.

[00:39:40] Dr Cheryl Phua: Renee, what's on your bedside table? I've meant to be asked.

[00:39:43] Dr Renee White: That's a good question. I have a lamp, I have my Kindle always. I've got this beautiful flag. It's like, um, it's the shape of a kind of a long flag, but I got it in Japan. Last year or the year before, and I still haven't framed it. It's still in its packet. And I've got, um, There's always one of my daughter's books. You'll just always have like a book there that she'll come in. If I'm sitting on the bed, she'll read. And I don't know why I always have this, but I have the book, The Alchemist. Um, yeah, I just, it's one of those books that is. I just always have it. I just like to pick it up and read it. It's so short and like, I don't know. I absolutely love it. And always my, um, my Frank Green water bottle. So, yeah, that's what I have on my bedside table for all those playing at home. I've never actually told anyone that thank you Cheryl.

[00:40:50] Dr Cheryl Phua: Thanks for having me again, Renee. I think so hopefully it's helpful for your listeners. Oh, absolutely. Even if it's not for them, it might be for their mums, their sisters, their cousins, aunts. It's really important to look after ourselves because really nobody else will look after you but you.

[00:41:03] Dr Renee White: Exactly. Exactly. So everyone, please feel free to share this episode and get talking about it because this is the only way that we're going to start squashing this suffering in silence because Totally done with it. Not interested.

[00:41:17] Dr Cheryl Phua: It's like period pains, Renee. It's exactly the same thing. People just, I was just talking to a patient this morning that I sort of collected eggs from her yesterday and I said, you've just got a really high pain threshold because most people will be in bed.

[00:41:27] Yeah. And that's just the thing. People just normalise it so much that people don't go finding reasons for why they have debilitating period pain.

[00:41:34] Dr Renee White: Absolutely. Absolutely. Well, I'm sure this is not going to be the last time that we chat to you, but thank you so much for your time.

[00:41:40] Dr Cheryl Phua: Thanks so much Renee, have a good holiday season.

[00:41:43] Dr Renee White: Yes, you too. And, um, we will chat soon. Okay, everyone.

[00:41:48] Dr Cheryl Phua: See you soon, bye

[00:41:50] Dr Renee White: Bye!

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