Ep.228: ‘Menopause: Bone Health & Muscle Mass' with special guests Christine Bird & Jo McEwan

You're listening to the Sports Therapy Association podcast, putting evidence back into soft tissue therapy. Music.

And we're live. Hey people, welcome to episode 228 of the Sports Therapy Association podcast. My name is Matt Phillips, creator of RUNCHECKLive.com. And as always, this episode is being recorded live at eight o'clock on a Tuesday evening on the Sports Therapy Association YouTube channel and Facebook page.

In this part two of our focused on women's health month entitled Menopause, Bone Health and Muscle Mass, I will very shortly be joined by special guests Christine Bird and Joe McEwan, co-founders of Menopause Movement. But first of all, a big thank you to my guest in part one last week, who is Siobhan Donovan, aka the booby physio, who gave us a fantastically informative hour on avoiding the booby traps of breast weight management. And we've had some amazing feedback for that. And it's lovely.

There was a definite peak, a perk, you may say, in feedback for that. It was a topic which touched a lot of people, both male and female, and something which is, yeah, I think the nicest thing I received was it was exactly what we need in this current age, enough taboos about things like this. Half of our patients are female or something like that, which is exactly why we're doing it and exactly why we're talking about it. So thank you, everybody who did send us feedback.

If you do want to listen to that, you can find it on obviously all popular podcast apps. If you want to watch it, you can find it on YouTube. But yeah, it was a fantastic hour with Siobhan discussing how the impact that breast weight management can have on the physical, psychological and social health of women and girls, and how we, most importantly, as soft tissue therapists can play a valuable part in helping reduce the myths and misconceptions out there.

For more info on that topic and for much more, then check out posturefittingphysio.com, including details on the Gals Against Gravity community and the Posture Fitting course. Right then, back to tonight in part two. If you have joined us live, let's just say hello to people who have joined us live. Gary Benson is in here. If you do join live, then what I can do is I can bring your comments and questions back up onto the screen.

And it's a great way to let people know where you are in the world and network a little bit so i encourage you to leave questions and comments if you want to i'm going to say hello to cecily who is in the room as well hey cecily how are you doing mike kathory nick sorry about the pronunciation on that how you're doing thanks for i'll settle for a second there we go uh tracy marsh thanks for joining us nikki mansfield is in here becky carroll is in here

says good evening folks it's been a while since i've been able to make the live session and it looks like a smasher excellent good you've come to a Perfect time, Nicky. Perfect time. But do make sure, sorry, Becky, do make sure that you catch up with the others, okay, because you're a little bit behind. Good to see you. Louise Asher, that's what I'm going to settle with tonight. It says, good evening, all.

Really looking forward to this episode. Great to meet Christine and Joe at the Expo last year. Yes, definitely. A lot of you did meet the wonderful Christine and Joe at the Expo. And this is where we had a chat and said we need to do a whole month on women's health. And this is the fruit of our chat and discussion. So here we y'all.

Right then so feel free to ask questions if you had joined us live if you listen to the podcast and thank you very much you can ask questions as well obviously not live but just put them in the youtube's the best place go to youtube and put them in the comment section in youtube and we will get back to you i do monitor it and if there's questions we can't answer then we will contact our guests and they may even jump on an answer or we will get an answer for you so sit

back relax and enjoy part two of women's focus on women's health which is called menopause bone health and muscle Bass with special guest Christine Bird and Joe McEwen, co-founders of Menopause Movement. Joe and Christian, how are you? Hi there. Hello, how are you? Very well. Thank you much for joining us. Good to see you again. I was just saying, it feels much longer than two months since we stood in the NEC and chatted. It feels like half a year. I don't know why that is.

Yeah, it does feel like a long time ago. Nice to see Louise again who we met I remember meeting you it's true yeah I know a lot of our people who give up their evenings to join us live they're the people who just come every Tuesday and don't miss a thing so fantastic um so thanks very much for joining us um for part two of our focus on women's health some as somebody's always mentioned you were at therapy expo last year was it the first time you've been to therapy expo can't be cool,

I really enjoyed it. And I think it was a great audience. Fantastic questions. So we'll be back next year. This year, Christine. This year. It's November. It is, isn't it? Yeah, yeah. And in fact, it was so, we loved it so much that we've kind of booked a stand and we've got Christine on the agenda. So it was just a great experience for us. Oh, wonderful. That's great to hear that. That'd be really nice. I'm sure the people of TherapyX will be very happy to hear that.

Sir Glenn, I've got to just bring this up. I love having a sir in the house. So Glenn Murphy, MBE, has joined us this evening. Thank you, sir, Glenn. Thank you very much. Thank you for joining us. The calibre we have here on the show. Right. So there we go. So for people who don't know you, I'm hoping out of the 2,000 or so downloads, there are some people who don't know anything about you. So I always say, otherwise, this is a waste of time.

So for people who aren't aware of the great work you do, could you give us a little discussion between you two about how you came to be and how menopause movement and why menopause movement came to be? Christine, how did we meet? You and your rubber chicken. Oh. I suppose it was. Yes, I was talking at a public event. I suppose I'm a pelvic health physio, women's health physio, and years ago, no one was talking about the menopause.

It wasn't popularized yet like it is now. Not for everyone, but there's luckily enough a lot more talk about it. So when the menopause took me by surprise, I thought I'd better do some research.

And when I started doing that, I started talking about a few people and started speaking at public events with gynecologists and nutritionists and one day joe and ann were the audience and they ran positive pause which is a public resource for women into the menopause and yeah i talked about pelvic floors about how to have a perfect poo to leak or not to leak when you exercise and sort of all the things about vulvas and vaginas and joe and

ann seemed to be fascinated by it and they organized their own events invited me and the kind of rest is history and joe you might want to fill in a bit what happened through lockdown and yeah well I'm not one to be silenced but when I first met Christine and heard her talk I was literally blown away and silenced and I'm not meant to give away what happens with the rubber chicken but she demonstrates kind of what happens to the pelvic floor and it was just

like and the data and everything behind it and so she presented it really nicely and a really friendly sort of like this is going to happen to one into the population And at that point, I'm going one in two of the population. But never fear. There's so much that 85% of this can be improved, reversed. And I just went, hang on. This is going to happen to one in two of the population. Population. I wanted women, sorry, in menopause. And a lot of them won't talk about it because it's too personal,

too embarrassing. And she's going, in 85% of cases, it can be reversed, improved.

And I thought that was shocking. We used to organize training days, very, very long story short, which involved, we used to make a really nice day for women who were going through menopause or perimenopause of women.

And we'd have nutritionists, psychologists, gynecologists. we could not give the tickets so christine was one of our speakers we couldn't give the tickets away we used to give them a really nice day no cold village halls nice venues great food comedians and christine said you know what you're putting on something that is like cpd level so we then christine was on the education committee and still is of her professional body the pogp so she took

us she put the proposal together we got commissioned for that we were going to do an academic study day based on because our course is essentially all of our collaborators kind of who would have done this day with us christine we got commissioned we went to this big in-person event march 2020 something came along if any of us can remember what that was so after pottering in the garden cancelling it looking at our sourdough look going what we were going to do now we realised that we actually had.

We've got the day ready we're very lucky because our third partner's family are in tv production so we were able to put our course take it completely online but it was only for pelvic health professionals wasn't it christine physios and we had to say no to so many other people who were contacting us contract it ran out we went we've got this course and christine is our bloke christine's trumpet because she won't do it for you she's not only

a sort of a health professional so she's got that um pelvic physio background but she is also she's like a phenomenal one woman. Exercising mad woman olympic what are you christine age age group some age group out an age group triathlete triathlete so she does and she's sort of done training for an iron man this year. So Christine is like, she walks the walk and talks the talk.

And from that, we developed this course to bridge the gap between health and fitness, because Christine's always said, you're going to see so many people in the treatment room. It's everybody else who is working out there with these women who are going through men, of course. And now more than ever, women are kind of going, right, I need to be doing X, Y, and Z. They know it. They've been told, but they don't know how to do it.

So we've developed this online course for health and fitness pros we thought it would be 50 50 but it has turned out this it's consistently 85 sports and fitness pros who are taking our course and we've developed an advanced course and it's 100 percent of our participants in the advanced course or you have to do the core course do the advanced course so there is there's a hunger out there there's a desire to be really well informed because you You know, you want a great client base.

You want to know about the changing body. And that's where I'm non-clinical. So I'm going to, you know, oopsie-daisy. I flew in excitement. My headphone fell out. So, Christina, is there anything I've missed out there? I mean. No, and I think, you know, obviously we sell business to business. But then if you think of all the women out there, and it's a big, and a really important factor is that 75% of women in menopause will experience symptoms and 25% of them will be extreme.

And there are about 30 million, about one third of women that are either experiencing or approaching the menopause. So also for all of us.

Health and fitness professionals there's so many people women to treat and train out there, and i always think it doesn't really matter if you're a partner a male trainer or a therapist or a female or a house rabbit at some points you will either go through the menopause or you will stand beside someone or a loved one that's going through it and maybe in the thick of it as as well and that's why we need decent support to reduce the struggle that some women experience because

it's not all bad you know it's definitely light at the end of the tunnel i think it's interesting how you pointed out that like once upon a time and i don't i think this is part of the problem it was considered as something you'd only talk to a gp about or maybe a physio and there's women in so many different contexts of life where maybe they've got a better relationship and i think soft tissue therapy is a great

example of this if you're already taking your clothes in front of someone and you're lying face down allowing them to get that body contact and there's that trust and you're filling out having this longer subjective and you're an hour with them and that's kind of this is why i love having people like you on the show it's the perfect place where these conversations can unravel be unpeeled and and talk about ways which could change someone's life absolutely

and for that reason apart from the core and advanced course for therapists like that we're also now developing a menopause mot which will have come with the tracker and a. The therapist, then to send to people. So we don't all have to keep reinventing the wheel. Although it's not a protocol, because it's actually not one size fits all.

Every woman experienced menopause very differently, but it's still guidance to make it easier for the therapist to ask all the right questions and also to be able to audit the difference. So this is hopefully something we're launching in the summer.

And I think for sports therapists, a sort of a set MOC model, I'm hoping, and we're obviously really looking forward to hearing the feedback it's just a guidance really to start this work because really we'd like all women to have a menopause moot excellent i'm just going to bring this up for people who aren't looking at the screen or listening to the podcast and you can't see the shots but i've got a shot here i'll put on full screen for those of you who have joined us live so we're talking

about the website menopausemovements.co and that's got so much information on there it's got access to loads of free information which is lovely the blog there is wonderfully laid out so much information you can read and swat up on, give yourself more confidence. I think that's one of the problems, isn't it? If you're not confident, then you're less likely to ask the questions. You're thinking, oh, they're going to share something, trying to know the answers

to. So there's a great free blog there. And then you've got details of courses as well and e-learning courses and all sorts of stuff, which is accessible to you all. Given that our listeners are non-allied health professionals, we've got sports therapists, sports massage therapists, sports rehab specialists.

Just to check, is the courses and the things and the content you offer, is it more physiocentric or is it kind of available and for everybody it's absolutely available and if anything we produced it to not just be physiocentric because that already existed in our professional body and we had so many requests of non-physios and also very much to bridge the gap between the fitness exercise and sports world and the therapy world

because i think i've been in clinical practice for so long if we keep all our information between the treatment and walls is just not good enough. And we got to work with some people there. And that's also the idea of providing the training as evidence-based, quite practical and no nonsense. Because especially now, I think that all the influencers out there.

Women are often made to believe that if they don't follow the advice of the influencers and they lose a bit of lean muscle mass, they might suddenly turn into a Teletubby. And that's also not the case. It's just practical, no-nonsense advice that doesn't send women into a rabbit hole of panic.

Excellent. Really healthy to hear. And obviously, we're not saying that in some cases, people that you see will need to be referred to physios or pelvic health specialists or maybe GPs or whatever, or consultants. But for the patient, and this is how it's always supposed to be, patient-centered care is about providing that circle of all different types of healthcare professionals, isn't it? Absolutely. For the need of the patient, not just because you've got the certificate on the wall.

Brilliant. Okay, thank you for that. Amazing. People are already commenting on here. Cecily Hislop says, I've already had a gawp at the website. Of course you have, Cecily. And Louise Asher says, yes, please, menopause MOT. I've got a lot of people joining us tonight. I'm in this topic, obviously, interests an awful lot of people. And tonight in particular, we're talking about menopause, bone health and muscle mass. So let's start off, let's get knee deep in that.

So is it a topic which you find women or patients as well as therapists are not that aware of? Well, I think I'm sure you're a sports therapist, probably more so than a lot of physios, because sometimes I think physios miss out on some of the rehab, more holistic rehab concepts.

But muscle mass definitely does become more important into the menopause because estrogen so our main female reproductive hormone declines into the menopause it fluctuates like crazy to start with and then we we continue at a very low level and basically estrogen is an anabolic steroid so it helps our rebuilding our restoring so without that we do really need to bring in new stimulus to to maintain that lean muscle mass which can be strength training interval training bits of nutrition, sleep.

But again, it's also not that women don't lift very, very heavy. Shit, it doesn't mean they are going to turn into a Teletubby. I kind of always want to go back to that again. There's lots of different ways of doing this. And some women start at a very different place than other women as well. And the way the women that really start to exercise will probably have initially more benefit than the women that are already performance-minded and exercise a lot.

But there's one small study that I absolutely love. And some of you might have seen the MRIs going past on Instagram as well. But basically the authors of that study claim that muscle mass will save your life. And I don't know if you've seen, but I can put a link in the show notes after the show. And so basically for a muscle fiber, when you're sedentary, without sufficient stress, muscle fibers die, leading to loss of muscle mass.

It's as simple as that. So what this study did, they looked at fitter older athletes and half them are women and they were all in the menopause who exercise hard four to five times a week. And on the whole, we often associate aging with the loss of lean muscle mass and strength. But most of those studies actually look at relatively sedentary adults. So that always leaves the question whether these changes are really associated with menopause, with aging, or is it kind of disused atrophy?

Is it sedentary behavior? And when they compared the intermuscular fat, subcutane fat of middle-aged athletes, elderly athletes, and the elderly sedentary person, the difference was absolutely staggering so the 40 year old triathlete compared with 70 year old triathlete in terms of intermuscular fat and subcutane fat were very similar and still had a lot of lean muscle mass as the relatively sedentary person had so much intermuscular fat and this was the same for the women as well and if

you then consider that women already have accelerated lean muscle mass decline and being sedentary that's the bit that we want to change really and what really makes me sad at times is it is still a societal acceptance that women are fragile like a little fragile old lady behind a simmer frame with no bum in her trousers is still accepted and we really want to change that so it's sarcopenia it's atrophy real atrophy of the glutes and aging is inevitable,

but fragility absolutely is defensible and I suppose menopause movement vision is very much on having lots of 80, 90 year olds walking around with bumps in their trousers upright and not behind a cinema frame. That's what makes us very happy.

Fantastic. Now, I love that. Aging is inevitable, but fragility is defensible. That's a great message. Especially in women. There is still societal acceptance that's okay. And it's not okay, because we want women to feel powerful into the menopause and beyond, of course.

Excellent. So sticking on the subject of muscle for the moment, then, let's imagine that somebody has come to clinic yeah what should because it's not necessarily an age thing is it i think this is one of the mistakes therapists make as well but what are some of the red flags or and questions that therapists should be asking to see whether the symptoms that are being presented to them could be connected with perimenopause or menopause

what should you be looking out for in terms of muscle mass in terms of muscle mass i think one of the early symptoms on the menopause are musculoskeletal, especially multiple joint problems. And I think women often confuse that. And of course, that often goes together with fear of exercising and fear of exercise and often leads to reduced exercising and not necessarily to modifying exercise, what we would like women to do. So I think that's probably one of the first points to look out for.

If women get multiple joint problems, it's probably an early sign to perimenopause and then do less exercise because of fear of injury. And that fear of injury is real because estrogen is a natural anti-inflammatory. So they are more likely to have more joint problems. There's often sleep disruption as well. And of course, if you've got less estrogen, if you've got less anabolic steroids, you need a little bit more sleep for that extra recovery.

But that's often disrupted into the menopause. So it is quite a balancing act in that perimenopausal period when everything goes up and down. And I think that's when women really benefit from some guidance to have the confidence to keep that lean muscle mass going. And, of course, then when big muscles pull on bones, bones are reactive. That's what keeps our bone health. But in terms of questions to look out for in terms of bone health, it's very much going back to women's history as well.

Because basically we peak in our bone health when we're about 30. So any of us over 30 here, we're slowly listening to this. We're slowly losing bone mass while we're listening to this. And that's actually something we want to reverse as much as possible.

With some impact with some strength sort of enough to keep that bone structure going and, we've got blogs on this on our website as well that are worth checking out what sort of questions to ask what women need screening we feel very strongly that a lot of women probably all women over 65 need bone unless they're on hrt if they're not probably need bone mass screening we would like it to become like a you know mammogram you have your breast checked but you also have your

bone health checked because osteoporosis is for a lot of women's life the most devastating condition they can have in terms of independent living in terms of mobility. Etc so it can really have such an impact in terms of the level of disability and that starts really in your 20s that's when you want to put your money in the bank in your bone bank really and then so it's not something okay it's the first three years of the perimenopause you get an accelerated a decline.

But the more you got in the bank beforehand, we always look at it as an overdraft. You really want to kind of not be in the red at the start of the menopause. There's so much to it, isn't there? And it differs so much on the population of the people you're seeing, because I guess from what you've said with an athlete coming in.

Symptoms could be disguised considerably because they think that the tendinopathies they're getting, for example, could be related to the fact that they're training really hard. So as a therapist, you've got to spot and see whether, hold on, is this all down to load or could this be something else going on there? So yeah, you've got to ask the other questions that could be kind of red flags.

I think Matt, that's a really good example as well, because like a couple of months ago, I treated a lady that is a really good runner. She's still racing age group 5Ks pretty fast. And she had a DEXA scan and she was absolutely devastated. She's always been fit. She's always done impact and she had very low bone density.

But then if you sort of ask her she had all the risks she had an eating disorder when she was younger she always had low was relatively low weights and all the movements she did was very linear so although the impact was great it was always in one direction so she really needs to kind of diversify what she does do more plyometric jump up and down forward backwards add some strength training it's taken her quite a long time to kind of really change her routine of just wanting to put her

trainers on and going running out the door and that she can't get away with anymore. But actually, I met her running in a park the other day, and she said she's still not doing her plyometrics. She just wants to go out for a linear run, and that's it. But she's absolutely fallen in love with strength training, and that's kind of good enough. You know, no one kind of ticks all the boxes.

Brilliant. Okay, so it's almost, I'm just trying to think, for our listeners, there's so much information there, depending on, there's so many things I want to make sure that we cover.

So, okay, so for example, repeat injuries and injuries not getting better, you've really got to pause and think, right what have i missed here because you might have had a quick intro and not done the subjective as much as you could so the basic questions you've got to ask to see whether there are symptoms or signs of it let's let's concentrate on the early menopause because you might have missed it because they're younger you automatically think that

oh they're not 50 or 45 50 yet it's not going to be that what are some things which if you delve deep enough or just ask a few basic questions could.

Uncover the fact that this 30 if yeah 30 year old 35 year old female running in front of you is actually got early symptoms of menopause yeah and 10 of women have an early menopause so before the age of 45 luckily enough before the age of 40 becomes a bit more rare but always something look out for of course facial motor symptoms like the ones that we probably all think about like hot flushes and night sweats but then a lot of women we treat will say i've always

had night sweats so it's not always so clear either and also when if you've gone through pregnancy and you've been breastfeeding breastfeeding is very similar to menopause as well and what we also see more and more that women have babies later at age they almost go from breastfeeding into very smoothly into the perimenopause and it's actually not dissimilar because eastern and after your pregnancy when eastern is very high it drops off the cliff and until you get your cycles back when you

stop breastfeeding you know effectively your body is quite similar to a post-menopausal women and if you're already leading all of that yeah so if you go into your 40s you know you kind of could smoothly go from one into into another and that often gets missed as well and very confusing for women if that was if that was put to to a woman like. Are you having symptoms now the same as when you were breastfeeding or stopped

breastfeeding early on? Would that be enough of a trigger to go, yes, it's actually like that? Is that a question which is worth asking? It could be in terms of low mood and anxiety. Okay. And it often breaks my heart that we're still not looking at that. Women that really suffer from low mood and anxiety postnatally are much more likely to have similar symptoms than menopause.

And because we can treat it in the menopause, women often suffer for months and months and years and years well actually we could already have picked up that they may struggle and may need support that's why we want to end up with our training as well that we're all more aware and start sign a lot of it's about signposting too and then the women obviously you signpost to different people different options some women might take up certain things now people

patients often ask me are you for against hrt and always say yes yes right we'll get on the subject of hrt in a second i just wanted to check joe's been sitting there nodding away no more so at times and so yeah joe what have you been nodding there with and what would you like to kind of talk about as well i think one of the things that christine just touched upon was the impact of mental health and i think.

That that women having children later in life and that that combination that perfect storm almost you know they've just had the baby they've stopped breastfeeding enter perimenopause knocking at the door and they can't not let it in because it is going to come but they're not you know women are not prepared and too often the professionals.

That they consult are not prepared so it is all about raising the awareness knowing what those flags are knowing what questions to ask knowing how to how to get people you know like i think you said earlier matt that you know they're in that they're in that therapeutic space they are it is an opportunity for them to with the right questioning with that right awareness from that professional who is.

Treating them to to be able to coax that information out of them and to know is there's no there are no medals for this there are no like you just have to power through it you really don't have to power through it and there are so many options um you'll hear we say it's so much so often it's individual it's unique to everyone we will no woman will have the same you look for a combination that can be the same but the impact isn't going to be the same on your body on your

relationships on your working life i mean it just is it's multifactorial and it impacts on on so many areas of your life but there's so much that can be done and that's what we're all about going look you know we're not like throwing everything out with babies out with bath waters mixing my metaphors there we're going right what could be done here you know if it is bone mass do you get your dexascan do you what do you know do if you've got your pelvic floor christine's very very

favorite topic if you've got a week you know issues with your pelvic floor what are you going to do about it you don't have to have a prolapse you can or if you are going to have a product it's manageable and i think it's remove it's empowering women to be able to speak up for themselves and to know that the person that they're going to talk to has some awareness of it. And you guys, I think, are very, very, very well-placed to have those conversations.

I'm glad you mentioned relationships. There's a question here that Becky's asked. She says, are there any resources you could recommend for specifically men to read? There are them. I think I've been nodding my head at that one. Because this is the other thing, isn't it? Because the men might need some support with it as well, which I'm sure most men will be going, yes, we need some support because it is a tricky time for

partners, especially if you don't understand it. The women often don't know what they're going through at the moment. That is changing. I think there's much more awareness. Like when Christine and I would have been going through with this, you know, I remember the doctor saying perimenopause and I went, what do you know what perimenopause mean?

I've never even heard the word that long ago, I shan't go into detail but it does impact on relationships because you know, if you're anxious and you know, these sort of insomnia view this, it creeps in the night terrors between one and three prime times perimenopausal women in the morning, not one, three in the afternoon, that's just terror of trying to get through your working day, I'm talking it you've been woken up, you had a you've you're you're just in a state of of absolute

anxiety and you're probably not joining the dots that you're thinking well it's you know work my relationship the kids my parents etc because you know something you're here it's the sandwich generation but potentially on the other side of that bed there's a partner who's thinking oh my god the duvet is off the duvet is on and I'm not clichéing on that because hot as someone who has night sweats they're deeply unpleasant and you're boiling hot.

Duvet is off, wakes your partner up, your partner's got to go to work, your partner's thinking, this woman, she's just like, she's changed. You know, it's like we all have to kind of find a new normal. So for partners, I don't think there's anything specific. We have another website called Positive Paws. Very good. Yeah, and I was going to mention that, Jo. I think your Positive Paws website, which is for the general public, is such a good resource. Which was that, sorry? Positivepaws.org.

Oh, no, positiveforce.co.uk. Sorry. But we started off, thank you for that, Christy, because we started, we were going to have a men's room on there and then we went, do you know what?

You know, let's just find out the symptoms. There's everybody, you know, if you see your partner's, you know, increasingly anxious or this is just a change in mood, a change in attitude, you know, there's so many things that you just think something's not quite right and knowing that and having that awareness and knowing average age is 51 but it isn't that sort of menopause and actually just to clarify for anyone who doesn't know this menopause is

just one day in a woman's life it is the 12 months to the date of a woman's last period so the terminology we don't even use the right terminology hairy menopause is the critical one the critical stages and that's when women and the professionals aren't always joining the dots because i'm really glad that you raised early menopause and younger women. Because we all get, oh, it happens to sort of grey-haired women sitting in fans.

That's another media like misrepresentation. You know, lots of, I'm really in favour of celebrities bringing their fans.

Situations to the fore because we live in a celebrity-obsessed society and if people can go oh Damina McCall, Zoe Ball, they're sort of women that they can relate to and there are younger women whose names I can't think who are talking about their early or their surgical menopause and that's something that women won't want to share that they you know for many reasons it's incredibly personal it's private it's often linked with the loss of fertility fertility is linked with aging it's it's it's a

pretty complex subject however there's lots that we can do to not to sort of normalize.

It really and to bring it into a phase of women's reproductive lives so in terms of specific guidance I think somebody did mention menopausing you know yes most resources are relevant to men if they think my partner is of a certain age and I think I would like to know more and we do workplace training actually and it's the men who ask most of the questions it's interesting though isn't it because i would have been seen dead with a book with davina

mccall's picture on the cover because i'm a man and i'm hetero and i've just got that much testosterone in me but i'm being a little bit sarcastic but it's if we want men to know about it then it kind of it needs to be packaged rightly or wrongfully in a way which men are going to sit and read about it as opposed to sitting there with a picture davina on the front so i don't know I appreciate what Nikki says it's a great book and if if guy it's a bit like I don't know reading cosmopolitan

as a young child I got a lot to learn about women quite well looking through but no one would ever see me with my cosmopolitan it would be no one's asking you to read it publicly go on your phone you know you can read these things you know it's true actually and as Christine said positive porn you know we got we cover every symptom we cover treatment we talk about supporting and actually it is important to have because you know there's

relationships where it can break down um there's a high rate of suicide in menopause all. All these things can be mitigated, reduced, or they can be improved. Because, you know, I think if, you know, I think the mental health is a massive issue for women. And I think the more partners know about that, you know, I think often people can, you know, you come out of this post-menopause and suddenly women may have changed jobs, left their jobs. And it's not all bad.

Giving their partner the heave-ho and gone, oh, that was good. It was all right.

All kind of afterwards gone that didn't need to happen so there's such a misunderstanding for for um for men and our partners in general great question nikki yeah and and communication isn't it it's about men talking to men as well that's one of the big problems if you're suffering with problems with your wife because she's going through this and yet you meet your friend male friend just go everything right yeah fine mate yeah watch football and don't talk about it that's part of the problem

if you actually said i'm going through this with my wife and i really feel really vulnerable and i and how to help and I feel like I'm not really serving as a husband anymore bam conversation other guy goes oh me as well what do we do about it have you read Davina McCall something like that.

Or talking to other men like I think you're saying what you're saying is really because that's what you know we say we know there's so much about community and that's one of our menopause movement mantras that you know we're working with and sports and fitness professionals who work with women one-to-one and in groups and there's all that data about saying you come together you know you walk together you go to the pub together you do this you know you just the more you talk the.

More you normalize it oh cecily's got a husband she's doing very well my husband's coping quite well with inane repetitive questions and brain fog and that was before the menopause wasn't it cecily or oh no i was going to suggest that's because he was used to it but yes my really nice statistics about brain fog that when they test women into the menopause they definitely have reduced a word recall and memory right but then if they compare it to men of

the same age even when we drop significantly it's still better than the average of men oh really that's really quite interesting i think but of course in the workplace we perceive it as oh my god i can't remember there's a recall well well men possibly this is probably stereotyping i've got quite used to just talking around it and not beating themselves up about it so again i think the brain fog is real and our brains go through a brain change because menopause happens in the brain too

and at the same time if they test it our work recall and memory is still so pretty good the brain basically rewires and there's some really interesting research that's been going on and it's about you know then everything sort of just reconnects and post you know that nurturing element and we're kind of going off track here but you know women biologically those hormones are there to keep us fertile, to keep us caring, nurturing, well, those reproductive hormones have gone.

So actually, that need when someone says, where's my shirt? Be blinded. There's the iron, you know, there's the fridge, there's the, there's the microwave, you know, people go, this isn't the person I marry or this isn't my mother. They've really changed. And it's like, this is kind of like, you know, women actually come out of it so much stronger. And that is something, you know, that doesn't, it's about, I think it goes with the weak bottoms that, you know, Christine's talking about.

We're supposed to lose our bottoms and lose our sorts of, I don't know, our capabilities and just be, you know, and we're just not. We didn't need to do that. There are some benefits in losing some of our oxytocin, oxypocin as well, our love hormone, because we just don't give a shit anymore. Yes. So I'm waiting for the benefit. Oh, you mean for women? Okay. Because that can be not much of a benefit for men. You're not going to help the relationship, is it? We just don't give a shit anymore.

You can have sex with their partners and then they're not going to get pregnant.

There you go. There's a benefit. it there we go i'm looking for the silver lining actually that was going to be my question next because we're talking about how there is a loss of lots of things and bone and muscle mass and and forgetting things in brain fog are you forgetting if it's a serious comment i am oh i've been i'll take off my mom i blame her but how do you how do you no that's fine how do you put a positive spin on it for clients?

Because soft tissue therapists in particular, if they open up these conversations, then often it can end in tears. And many, many soft tissue therapists have had to learn, what do I do? Do I lead them by themselves? How do you put a positive spin on menopause? Because it does seem at the moment we're saying it's deal with it. Everything starts breaking down and generating.

What are some of the, how do you champion it a little bit and turn into more of a power rather than just something we've got to deal with and it's just going to get worse from now on yeah i think there's some lovely theories about that as well and a lot of it is with sort of loss of some those hormones we we get a brain change so that reset of the brain is a little bit complex we have that in pregnancy in pregnancy happens as well that

really we go into a little bit of a mama bear brain when we're pregnant and that's why we have brain fog as well because you know our caring part of the brain grows and we have an almost opposite reset of our brain into the menopause there's some lovely like one of them is the grandmother hypothesis and that's not so much about biological grandparents but in a way because we don't care so much anymore what people think of us oxytocin

goes down anyway with aging that's not just a menopausal thing that we are actually much more in a place of empathy and not worrying about ourselves but worrying about you know kind of being more of a mentor looking after our grandchildren while, All the younger ones can still produce beautiful children or whatever, you know, who genetically probably in a better place to be than we are on through in our 50s, 60s, 70s, but we play on another role for that next generation.

So that's what they call the grandmother hypothesis. Very much in, you know, it takes a village to bring up a child. Very good. As a community, there is a real role for women to play that, you know, when they're less worried about themselves and building their nests, that they play much more of a mentoring. And a lot of women we talk to, it can be such a time of reinventing themselves and having a reset. It doesn't mean it's an easy time.

No. I think it struggles. Christine if I can come in on the struggles because I think sometimes too often we all focus on the struggles and we know that there's for every four women one in four women will have absolutely no obvious symptoms at all but that doesn't mean and this is really important for you guys to remember that it isn't having an impact on their hearts on their brains and on and women who are breathing through it and women can be

very unsupported of themselves and each other because like oh i'm not going through menopause they are whether they but they may not be having we all focus too much on the hot flushes and the grumpiness and this and that so that's really important to know one in four will have no obvious symptoms but their their body is going through it so they that needs to be accepted 250 i'm going to go and change my figures here we've got

two out of the three out of the four no 50 there we go it's like a it's like a continuum will have symptoms.

That get you know some of them will be it starts to build up and then by the time you get to that last 25 or one in four they have the debilitating symptoms and they're the stories that kind of get the focus and get everybody you know it's all over the sort of daily mail or what tiktok or whatever women go to go oh you know having this break not to denigrate any of their experience but too often we focus on that far end and we we you need to remember what is going on for because as christian's

talked about those hormones that have kept the bones strong healthy and the brain healthy and protected as estrogen gives us.

That protective factor it's waning so you there are then things that you do to build it so that's why we're talking about building strength building help it helps build your bones build your muscles it helps with your mental health and it helps with how you feel so yes it's a it all can be a bit of a churn but there are so many things that women can do and it will benefit um their their life outcomes full stop if they sort of start

to get i mean i'm a great example aren't i christie christians are triathlete i am the reluctant kind of oh my do I have to exercise but I know I do cardio and I really enjoy it now I do strength I've always been really good about my diet but if you know if you're sitting there kind of having a you know drinking too much eating processed food you need there are so many fairly low-hanging fruit changes that you can make in terms of being informed about you know we

all read oh you need to eat more legumes, nuts, berries, but you need to sort of explain to them why this will help. If you're going to eat a lot of fried food, yeah, it's going to give you your heart issues, blah, blah, blah, energy, possibly make your hot sweats,

eat your heart flushes worse. So. It's it's about education who was it one of the politicians said oh tony blair i think education education education everybody needs to be educated the women themselves professionals who work with them and their partners so but it is very much as christine said it can be the start of something and it's almost that if not now when are people going to make those changes menopause is a little bit of a it's a little bit of an opportunity

to reset and I think we we should frame it as that and go yep you've got there now what are you going to do to be in the best health post-menopause especially in in the world that we're living in and in the you know your GP you get 10 minutes with them it's I think somebody's just asked a question about the GPs why is it so difficult to get htf's of the nhsdp's contraception pills i think that would very much becky depend on who your gp is most gp practices

now should have a menopause trained gp if you're not happy with them ask to see another one because get familiarize yourself with the nice guidelines which will tell there's a patient version of the nice guidelines which again we'll send you a link to read it And also my stagons have just been updated. Oh, Christine, I thought it passed. I'm sorry, because I forgot. Yeah, I know, but I think it's so important.

And I was so helpful also, because I've got to bring up one point before we run out of time, bring in filth of vaginal and bladder health as well. And especially in terms of topical local vaginal estrogen.

Because what is a really big mouthful, but genital unary syndrome of the menopause, gsm is so miserable you know sex can be painful can be dry but also sitting might be painful you can't sit on your bike seat anymore it can be itchy it can be painful and it's so treatable with pelvic floor muscle training and local topical vaginal estrogen and even if women are reluctant to take systemic hrt so for your whole system which has some very small side effects,

local topical issue in hasn't and what joe i was really helpful that joe was talking about even if you don't have symptoms menopause still impacts your body and often by the time the symptoms come out like osteoporosis the boat sailed many years ago and the same with vulva and vaginal atrophy as well it might start when you're 41 but you might not get symptoms until you're about 50 60 and you get urinary tract infections and all those things that women.

Suffer with and don't always get prescribed hormone replacement, which is so effective and so safe as well in terms of the topical local one.

And I like to think that GPs are getting much better at prescribing HRT, but bringing in the guidelines and showing the guidelines, I think it's a really good step forward because that's their guidelines. That's telling them what they are able to prescribe. So, you know, the patient brings it in. I mean, I know they all hate Dr.

Google, but this is the nice guidelines. And there is a patient's version, very readable, and it sort of recommends that you, and this is something you could share with your clients or patients, that you basically bring a checklist in and say, this is what I'm experiencing, this is the impact. Because you're going in, they've got a 10, 20-minute appointment. You need to have some sort of resolution.

And I think Louise said there's a three-month waiting list. I think that's down to the restrictions on the service It's an aging population. People like Davina bringing this out. And so people are now looking for help where previously they possibly didn't. I think it's a bit of a, I don't know, when something's a victim of its own success, maybe. Some of this publicity. You have to keep knocking on doors. Yeah, yeah. Essentially, if you all keep knocking on doors and putting pressure

on, hopefully it will change. But it is frustrating that exodus is so poor. The question, can I just ask about the topical oestrogen? That's now available. You don't need to wait for your GPD. They can talk, people can talk. You can buy it off the counter, over the counter as well. You're over 50. Yeah. I wanted to, I wonder, it doesn't do it justice, but I wanted to spend five minutes just to talk about HRT, which we touched on earlier on.

It's not for everybody, but it can be a saviour for some people. Again, how are women supposed to decide whether it is going to be something suitable for them or not? I think the hardest thing about this is there's no black and white answer to this. And it's often for women more a philosophical decision as well. Of course, the medical world sometimes looks more at pure symptoms. And of course, what we look at more is really optimising women's health,

as in thriving rather than surviving. I know that's becoming a bit of a cliche, but it still really matters.

And the benefits of HRT outweighs the risk for most women, but not for all women. So I think it's a really important discussion to have with your GP. The British Menopause Society has got a directory of people that registered with them. And if there's someone in your local area, and also if people can afford it, But it's often very helpful to have one consultation with a private practitioner. And after that, they can put a prescription.

Now there is a pathway back into the NHS as well. And if you can afford that one prescription, I think it's so worth your while. You take your car for an MOT. I think this is. And then they can look at all the benefits and explain it for you. And most certainly in terms of bone health, HRT, if you've got any risk factors, is the most effective prevention for osteoporosis plus the other benefits you get from it.

Well, I'm liking Becky's actually said that, you know, people are talking, their clients are coming to them with patients and saying they're so disheartened with the support they're getting. So Becky's actually said she's going to have the nice guidelines in her toolbox.

And that's it. We need to be just saying, here is the information and this is the information that your GP, it's a non-negotiable with them because this is what has been agreed and this is their prescribing tools and it's not all about HRT. They will talk about diet and lifestyle and exercise. It is the first port of call. They don't just say you need to take HRT. It should be an informed discussion, shouldn't it, Christine?

And those factors should be considered, And people will be going in with completely different backgrounds as to their lifestyle. Yeah, because I really don't want women to think either. They really miss out. I work with women who have such a good outcome in their menopause journey that mainly do it with sleep, exercise, and reasonable food.

So HRT is not the only outcome either, but is beneficial for most and effective for most women.

So there's just lots of different ways to to make this journey i like the i like what you said about keep knocking at the door because i mean i don't know if the nhs is getting better sarah suggests that she says so glad i went private my gp was useless back to the nhs now and they have improved i think it might depend on where you are and your local the actual practitioners and how many staff they've gone and stuff but i think knocking

on the door is important and what you mentioned yeah having those nice guidelines and giving confidence to your clients to go to the doctor and knock another couple of times because some.

People just these days it's always the nice people they don't want to bother you know so it's a shame where you can guarantee the people who like think that life deserves them everything they'll be knocking and knocking and knocking you know just to get something so it is i think again we've got a wonderful honor as as as kind of healthcare practitioners and and complimentary or whatever you want to call yourself to give confidence to your

clients and say you know take this bit of paper have a little read keep knocking you know just big up the gp say they do want to help you they're busy but they really can help you with this and it's going to give them a lot of gratitude so and also to say to your clients to be prepared for those you know just don't go in going i feel a bit this go this isn't what's happening and then that's going to be a really productive meeting so whatever they've talked to about

on when they're with you guys go right capture that take it to your gp you know. It's great that you're in here with me and you're sort of you're empowering them and sort of giving them the confidence.

And and that reassurance that they will be listened to and of course not all gps are great but they've been we're not in the we're not in the business of gp knocking and if you're not happy with what you got you get then you do need to ask for a second opinion and i know that can be easier said than done but you know very cool this hour is just shot by we're gonna have to have a part two somewhere it's ridiculous i can't believe it's already 8 55 there's

so much more we could talk about i do like and i think again it's a bit of a cliche but i think it's really applicable in this case it's just starting the next chapter of life i think that's always a really healthy kind of way of looking at it isn't it life's full of chapters some are sad some are happy some are full of romance some are full of death it's just a chapter you know and it's just what makes up life so i think that's quite useful right,

Amazing questions, people. Thank you so much for people who joined us live. So if people have, obviously, they'd love to listen to you and they want some guidance from you, the website, which you mentioned before, menopausemovement.co has got loads of information on there. Tell us a little bit about the courses and things that people can do with you as clinicians. What have you got out there?

Christine? Yeah, okay. Yeah, so we've got the core course, which has a combination, Again, it's all multidisciplinary. So we've got a gynecologist, a nutritionist, a dietician, a psychologist. Myself talking about pelvic floors, bladder, prolapse, et cetera, and also a strength and conditioning part. And that's the core, really. Then we really felt the need to develop the advanced. And I just chip in.

Currently, you get four SIMS for CPD points, which we're hoping is going to go to eight, but it is four currently.

And the advanced course we just got our sim spa accreditation as well which is which is great four and a half yeah and that one goes much deeper in terms of rehab and strength conditioning so i think so for your membership that's a really relevant course because we didn't dive in deep enough in terms of the evidence base around it and what makes it different in the menopause to your your other your other clients and then like the really exciting development at the moment is the mot which

comes with the tracker with all the right questions the screening which hopefully all make the process much easier for therapists to put into place and and opens doors for for women as well so that's being developed or something yeah so it will definitely come out this year so the next couple of months we're quite a long way down but we haven't put a date on it yet but anyone who subscribes if you go to our website and subscribe to

our newsletter So then you will get all the information when that comes out, and I hope within the next couple of months. But I'm always a bit optimistic, and Joe will tell me too. That's a wonderful partnership. I'm actually called the negative Nelly, and I'll go, maybe there'll be a bit of a reality check here. I know it's not fun, but it's not cool.

But we'll get there. But I think we're really excited about how this is going to develop, and it's sort of the missing piece of the jigsaw, really, especially when in that sort of setting that you guys are in, where you will be able to, you know, with these resources, these screening tools, get a bit further into what's going on and come up with a plan with your client.

I'm coming to see what Gary is just saying, that he'd be happy to assist with accrediting CPD, because obviously for the fitness professionals, we've got the SimSpa.

For all the hbc people like the physios it is sort of quite sort of set but we'd be really interested to talking to gary about very much so i realized as i said cpd i thought oh that's simple that's fitness it's not my world i'm i'm but thanks gary thank you yes and what about following you obviously the website we said menopause movement.co facebook active on there instagram We're menopausemovement.co. We've got Anne as our creative partner. Anne runs that.

And, yeah, we've got Facebook as well. So hello at menopausemovement.co is a really good way to get hold of us. And it is .co. It is .co. It's interesting, isn't it? Instagram is probably our best social media platform, and that's Menopause Movement. And we'd love to see you all there and comment, because really it's all about feedback and developing. Brilliant. What everyone needs out there. And we do do webinars and we've got

one coming up with elite athletes, but we haven't got a date on that yet. So watch this space. It's hopefully going to be an Olympian menopausal experience. But that's all we can say because we've not actually tied it down. Because, you know, elite athletes go through menopause. It's not just all about, you know, as you will know. And that's, I think, will be really interesting for us.

For your followers. So we'll send that on to you. Fantastic. Yeah. We'll keep everyone up to date with that. If you listen to the podcast and you want to be part of this conversation, then like I said before, do use YouTube. I mean, go to these places and follow our guests on social media. But if it's specific to this, then go to YouTube and put something in the comments there.

I'd love that to get used a little bit more as well. Because the great thing about YouTube is it just stays alive forever as opposed to Facebook, which disappears.

It'll be there or come up in Google results. Every question you put there and every answer will help and fuel information to other people so do use youtube if you want to right there we go thank you so much there's i've got people in the live lounges demanding a part two now so we'll have to have a chat about that and and but it's been a wonderful yeah and captured so many different topics and to do with menopause so thank you so much for that thank you and thanks for the

good questions and comments as well thank you to everyone for yeah for your comment for sharing what you've been through you know it's going to continue it's going to continue fortunately not with your two lovely sales but we're going to continue the whole focus on women's health next week we get to this can be episode 229 we are going to spend an hour with michelle lyons which a lot of our listeners will be aware of and

know michelle is going to be focusing on pregnancy related back and pelvic pain which is going to be exceptional i know you two know michelle very well It's going to be a lovely hour as well. So I encourage you, listeners of the podcast, I'd really encourage you if you can. I know some people work, but if you are free on a Tuesday at 8 o'clock, then come along like our listeners here and share your experiences, particularly with topics like this, because it's so...

All my guests say it's so nice to see people enthused and asking great questions. So if you're one of those people who's got questions and it affects you, then come along and join us for that. And then the week after, which is going to be February the 25th, and that will be episode 230, we have special guest Dr. Gemma Parry. Some of you will know from Therapy Expo again last year, who's a performance specialist and research associate at the University of Bath.

I said Bath there, my wife would be so proud of me. University of Bath. And she's been talking about developing female athletes, women and not small men. So really focusing there on helping young women, girls, older women who are athletes and looking at the research and how far we have come from the days when all research was done by men and therefore talked about men.

It's getting better, but maybe not good enough, but we are getting better. But you definitely got to consider the athletes in front of you and realize a whole different set of circumstances when it comes to diagnosing and looking what could be potential reasons for the symptoms being presented. So do join us for one of those if you fancy. If you can't join us, then I'm not having a go at you, but I will have a go at you if you don't leave us a review and a rating.

And I have got all your IPAs addresses and all that, so I can find you, and I will. So we have about 2,000 downloads a month. We've got about 50 reviews. What's that about? 1,500 people a month are just not listening to me. So if you're listening to the podcast, please leave a review. Thank you.

There we go. Right. On that note, thanks everyone who joined just live yeah nicky matt it's such a lovely community it's so i love these so much nicky manswell says brilliant chat room activity this evening loving you ladies too and you fellas too of course thanks for being there and thank you for your lovely comments we haven't been able to respond to them but please do follow us and we will be in touch and yeah thank you so much and we'll be back matt we'll be back

we'll be back somebody else wants that fantastic yeah now we'll look forward to that right we will be back next tuesday if you can join us as always eight o'clock on either youtube sports therapy association youtube channel or if not on facebook just once again thank you to joe mcguyen and christian bird of menopause movement.co and yeah thanks everyone take care and hope you see brilliant thank you. Music.