Ep241: 'Menopause Transition: Soft Tissue Implications’ - Reflection with Hannah Tabram

Music. How are you doing? Welcome to episode 241 of the Sports Therapy Association podcast.

My name is Matt Phillips, creator of runchecklive.com. And as always, this episode is being recorded live 8pm Tuesday on the Sports Therapy Association YouTube channel.

In this seventh episode of our reflection series, I will very shortly be chatting with sports massage therapist Hannah Tabram, who will be reflecting on episode 87, Menopause Transition Soft Tissue Implications, that was recorded as part two of a Women's Health special we did back in February 2022 with special guest Jenny Barrel of Barrel Education.

Before that, my thanks as always to last week's reflector, Sharia Keousawang, also known as Louis Physio, who reflected on episode 73, Evidence-Based Pilates, which was recorded back in October 2021 with special guest Raphael Bender of Breathe Education and the Pilates Elephants podcast. I'm in a great episode as well. Really nice to hear Sharia commenting on how a lot of the concepts that she'd learned in Pilates also were taught on her physiotherapy course.

And Raphael really woke some stuff up and made her realize that she didn't have to throw it all away, but just tweak it a little bit. So it was a really healthy listen.

For anybody who's feeling a little bit threatened by some of this evidence-informed stuff that tends to get shouted out on social media, but not here on this podcast we break into you gently and help you realize that it's just a little tweak but with amazing results for your clients so um people who joined us live this evening thank you very much cecily's always first through the door i'd love to see cecily kind of one of those big sales things at harry's

i can imagine it's just arms sprayed wide just bursting through the door to get all the deals that's the image i have of you cecily tell me if i'm wrong uh nikki mansford is here as well saying evenings as nikki just finishing up watching my plans be within two ticks. Thank you for sharing, Nikki. That's good. We were concerned about that. Great. I think we've got some good case histories tonight, tonight's episode. It's going to be very interesting. So if you are affected by any of the.

Conversations tonight, whether personally or with clients, then do share. It'd be really cool to have your input. That's why we do it live. And Sir Glenn Murphy's in here as well saying, good evening all. Good evening, Sir Glenn. Sarah Jones is in as well saying, this should be a good one. Okay, no pressure there, Hannah. So great. Love it. Love seeing people come in. Thank you very much.

Let's clear those messages. If you are listening to the podcast and want to join us live, then what happens is if you leave a message or comment, I can bring it up on the screen. And obviously you can ask our guests questions direct and share your own experiences and have just a great networking opportunity. So there we go.

On the subject of networking and opportunities, that was a great segue, Matt. I liked that. I mentioned it last week, but the details and tickets for the STA Southwest Conference, a collaboration with the ST School's Hands on Hub, are actually going on live tomorrow evening. Fingers crossed, he said, clenching his teeth. But yeah, they should be going live on the ST School website tomorrow evening, May the 14th.

And this collaboration is is yeah it's going to be great i mean i'm personally involved in it i will be emcee across the two days of education and it's kind of advertised as be part of the future of healthcare education which i had to twist and murray has kind of risked a little bit to put that in there but it really is it really is a twist on probably everything you've been used to in a conference with the idea of taking it back to.

Boot education, the learning cycle. There'll be lots of reflection, self-analysis, assimilation of information, practicals and stuff. So it's going to be great. It's happening in Exmouth, as it is the STA Southwest Conference as well, on the 20th and the 21st, which is a Saturday and a Sunday. It's a good start, isn't it? Yes, for some of you. It's badly people who prefer it midweek, but we decided to do it on a weekend.

It's a full day Saturday and then half day Sunday, which means you can still get back to wherever you've got to do in the second half of Sunday. So we've really thought about this together and tried to deliver something which is putting you in the centre of it. You put your patients in the centre, we put the therapists in the centre for the conference. So yeah, really excited. Details will be there on the ST School tomorrow evening.

If you're not in the south-west of the UK, then don't worry because another thing we're doing to try and help with this future of healthcare education is we are planning on moving around the country so that you haven't got to travel miles to get to this amazing conference. So it'd be lovely to see you. And if you can travel, then do come along. But there are plans for it to move around and to come to somewhere near you.

A bit like Noel Edmonds and the Swap Shop, but different in lots of ways as well. So right, if you're interested in following, revealing of speakers, I'm so excited. Actually, I'm going to reveal a speaker tonight at the end. So there's the hook. There's a wonderful segue into one of the speakers that I'm so excited to reveal. And we'll do that at the end. But yeah, make sure you do follow at UK underscore STA and at the ST School on social media and go to thestschool.co.uk.

And as of tomorrow evening, there'll be a page up there showing not everything, but enough to make you have a little think about whether this truly will be the conference to go to in September. Right. I've left her down there for long enough. So let's get rid of that beautiful artwork.

And let's bring up Hannah Tabram, who will be reflecting tonight in episode 241 of the Sports Daily Podcast on menopause transition, soft tissue implications. Music. You're listening to the Sports Therapy Association podcast, putting evidence back into soft tissue therapy. Hey Anna, how are you doing? Hello, I'm good thank you, how are you? Very well. I've just heard some lovely tweeting in the background, you are outside aren't you? I am in my lovely treatment room, yeah.

It's good to see the treatment room because you were actually on the show back in March, last year, February and March. Was it that long ago? It was. Yeah, it's just over a year. What have you done in that year? Oh, I don't know. Oh, it's not even going to. Yeah, you gave us, you and other clinicians gave us a really well-received episode about how to set up a sports massage therapy business. It really was really popular.

The first one was how to set up a sports massage therapy business at your home. You introduced us to the conversions and what was involved and you gave loads of really helpful tips. And I know people were taking notes.

I know around the country now there's people, there are sheds everywhere little doppelgangers of your friends, not parallel to the universe they really do exist probably around the corner for you and then you came back for the part three which is mobile event work when you share the experience as well so in other words you're a pro and you're just ready to rant at length about the menopause.

For people who don't know you and didn't watch these episodes yeah could you give us a little intro into yeah who you are what you do what you what involves yeah of course so yeah I'm Hannah I'm a sports massage therapist or soft tissue therapist I'm never entirely sure which one I want to use I am down here in Norfolk in kind of the middle of nowhere normally working from a shed in my garden and I have been doing this since late 2021 is when I qualified

with my level three and then I got my level four just over a year after that. So I still feel quite new to it, but not brand spanking new anymore. Because of where I live, the population density is quite low. So I wouldn't say I specialize really strongly in any particular kind of client. I get a bit of everything, but I do have certain issues, client groups, I suppose, that really interest me.

And one of those is women, and especially women going through perimenopause who are, you know, menopausal, postmenopausal. I see quite a few of those women as well. So yeah, it's something that really interests me.

Fantastic thank you very much i just have to say for the podcast because people can't see where you're sitting when you say shed i know it's a sudden thing but shed for me is like a very small place which looks a bit like a big kennel and there's no way there's no way what you're sitting in could be compared to kennels beautiful and that episode kind of you have to describe us and there's i think it's photos and images as well before and after yeah if i

remember your hubby or something in wellies oh i don't think i posted the picture of him using the concrete breaker in his crocs it's fine we won't bring it up again brilliant so um so i guess that's i mean my next question is going to be why out of all the episodes we've got did you choose jenny bowles one but i guess that's it were you at that time do you know what i so i didn't listen to this one when it was first recorded i listened to this one it would have been in kind of late summer early

autumn of that same year so I had been going for a few months and because I initially when I started my training I joined the FHT and then that membership had lapsed I decided to join the Sports Therapy Association instead and I was kind of at that point of like okay it's going okay I'm getting clients through the door you know things are building up nicely but what do I actually want this business to be? Where do I want it to go?

I think also, and I know this has been talked about on other podcasts and it's discussions that, you know, people in the industry have, I think you sort of qualify and you're like, I'm going to go and I'm going to massage people and I'm going to save them and I'm going to make their muscles longer and I'm going to change their joints and I'm going to release all the toxins because that's what very often,

that's what I was told when I did my training course. And of course you believe what people tell you.

And then you learn a bit more you're like actually I'm not going to lengthen muscles and I'm not going to release toxins I'm going to do something but what's it going to be and actually am I doing any good am I making a difference am I just giving people a nice back rub and making them feel better so then I listened to this podcast and I found it really validating and really inspiring, and in some ways a bit frustrating not because of the information or the podcast or Jenny but because.

I'll talk about why in a minute, but really inspiration. It's like, yes, this is something that's worth doing. This is something I'm going to carry on and this is what I now want my business to be. That's great. I mean, I'm sure I'm going to edit that and send it to Jenny because I'm sure that's everything she wants to do.

Great. That's amazing. So, yeah, I mean, that's such nice to hear that for listeners, I think that, yeah, you went through the same kind of process where you did have to tweak and change some of the things you've been taught.

You do go through some emotions don't you where some people get angry straight away some people get sad some people just chuck it in and think i can't do this anymore which is tragic it's a waste of a wonderful human being who wants to help others so that's a great reason okay i'm really glad to hear that episode helped with that so maybe for listeners who aren't aware i mean straight away in the episode jenny and you've mentioned a couple as well jenny introduced to terminology

like perimenopause of menopause menotransition of postmenopause yeah maybe for the listeners could you give a little breakdown of of how they are different and and the timeline yeah sure so perimenopause is when all this starts is when your hormone levels start to fluctuate.

One of the things i think that i thought because a lot of this was new information to me when i heard on the podcast which is what made me so cross because it's like i am a woman heading for 40 and no one has told me any of this stuff and this is going to happen to me why did no one think did no one think this would be happy, this would be good to mention. So it's not a smooth kind of downward slope. Your hormones kind of go, they go up, they go down, they go crazy.

Your estrogen levels will fluctuate. It's one of the reasons that, for example, if you go to talk about your hormone levels and someone says, we'll do a blood test, there's not much point because tomorrow, your hormone levels could be totally different. That's only a snapshot in time. You go through all that for a period of time that can be years. And then menopause is the one day when it has been one year since your last period. And that's the day you hit menopause.

And then every day after that, you're postmenopausal. That's kind of it. That's really interesting. And it reminds me, yeah, the points made in there. So when we think perimenopause, and I'm speaking out for listeners, I know not thanks to people like Jenny, but I think people believe that that's kind of like the months leading up to menopause or something. But you said yourself it could have been happening. Yeah, yeah. And it has, there are so many different things that perimenopause affects.

Again, people, you know, my impression was like, you might get some hot flushes and you might not sleep very well. There you go. That's perimenopause. It can affect lots of things. It can affect, you know, I've got really dry eyes. I have contact lenses in and I have to put eye drops in all the time now. That can be a perimenopause thing. It does affect your sleep. Yes, you will get hot flushes, your temperature regulation. You can end up feeling cold.

You can end up having all sorts of weird and wonderful symptoms.

I did a really interesting evening in the local village hall, the perimenopause specialist nurse, the menopause specialist nurse in the area did an evening and we went along. And the list of symptoms we all came up with was extensive and alarming. And it was also great for me because virtually everyone in there was either a client or someone that I knew in the villages. I know all of you, half of you have been semi-dressed in my treatment room. Nice to see you all.

But yes, this is definitely one of my main client groups. Here they all are.

But yeah and i do and i did and yeah that is what i found so frustrating this lack of information, that women have this idea that we all or at least in my case nobody ever thought it was worth mentioning this nobody ever thought it was worth explaining this and you can end up feeling like you're going bonkers i'm interested i'm interested in this like i i don't want to pry too much into personal life but sisters mum was there opportunities for people

to say it to you I'll watch out for this or so I my sister's younger than me so she's got all this to come. My mum I knew a bit about what my mum went through but it wasn't a big conversation we'd had, I've talked more about it now actually with women in my family quite often anxiety is a big thing that happens. I know that my grandma ended up on Valium during her sort of perimenopause transition and then had to go cold turkey.

And that's one of the things that my mum remembered. But I think that, again, one of the things that I think Jenny talked about was making this a normal conversation for people to have. And I think our generation of women, because we have the internet, it is a much more normal conversation to have. You can go online and you can talk. You can find women all over the world and you can talk to them about this and you can do so if you want to.

You can do so anonymously so you don't have to feel embarrassed.

Actually people in the past did not have this and i don't know if there was a stigma but i think there was a bit of a taboo and so yeah it wasn't discussed hugely openly let's say, very interesting so for listeners listening now one if you suspect that you are having symptoms that could be connected this and you're in your mid to late 30s one is put it's potentially possible you're not going crazy and two is normal that you haven't found out about it or no one's told you about it.

There's not to be embarrassed because you'll probably find that a lot of your friends as well don't know about it. I think Jenny says something, which I remember now, she says something along the lines of you find out, oh no, you know about menopause when it happens or something. You know, you know about menopause when it's there. In the lead up to, you've got no idea and then boy, do you know about it when it happens.

Absolutely. You're just bimbling along, quite happy. You've spent the last 30 years getting the hang of periods and all of that stuff and then suddenly your body goes, hey, no, no, no, no, we're not doing it this way anymore. Like, oh my God, I wasn't ready for this. So yeah, and I think that often we can have those conversations as therapists because we have the chance to build relationships with our clients and to build that therapeutic alliance.

And so I feel quite strongly that it's important that we have at least a basic understanding of this, even if we're not title experts, I think that's fair enough, but that we recognize it or recognize it on some level.

I think it's really important that we try and find out what's around in your local area. Who's there? Where can we send people to? Where can we send women to if they find they're struggling? Because we might be the first point of contact someone has. Someone comes to you with something like a frozen shoulder. Or I think Jenny was talking about gluteal tendinopathy that just won't go away. All that kind of thing. Perhaps they'll come to us first. And I think that's, it feels like quite a

responsibility in some ways, but it does feel important to know about this stuff. Thank you. It's interesting. So because it's one of those things, isn't it, which feels weird to add to your subjective and your initial consultation and stuff. But we ask about pregnancy, that's going to be on the list. I think most people now will ask about potential saddle soreness and things like that or pain when you go to the toilet and stuff like that.

But it's just another thing which might feel a bit weird to start off. But at what stage do you remember when you did start asking people about if they knew about symptoms of menopause or maybe history of pregnancies and things? Sure. It was right after I listened to this podcast, I went out and rejigged my consultation forms. So before every first appointment, I send an online form out, which is like, you know, have you had cancer?

Have you done this? And now there's a section that I ask, do you have a regular menstrual cycle? For my female clients, obviously. Are you pregnant? Are you in perimenopause? Are you taking hormonal contraceptives? Are you taking HRT? Are you postmenopause? And then explain what that is. And so it opens that conversation up, I think. And I also think putting that in writing and then sending that over to someone gives them time to think about it, as opposed to just confronting someone when

you've only just met them. So how are your hormones? Very good. You know, that can be a bit of an intimidating question. And some people, I mean, I would be delighted if someone asked me that. I would probably spew out all the information immediately. Let me tell you about what's happening to me right now. I'm furious about it. But some people will feel more reticent, and that's fair enough. It gets people to think about it. And you might not mention it.

In the end, it might not be relevant, but it might be. And it just gives you an idea of what's about to come through the door as well.

That's such a good bit of advice. That really is. In terms of communication, I'm sure a lot of what we talk about in the next 20 minutes will be about communication and that. But yeah, sending that pre-questionnaire, which you've got the open-ended questions of just yes and really cool to get them out of the way. Because otherwise, if you do it when they come in, it just turns into a Q&A session of closed questions, isn't it?

Where they just go, yes, no, yes, no. And you're not going to get your client to talk or really unpeel layers sort of stuff. So get them out of the way and then give them the open-ended questions when they come in. Yeah. Very cool. And it can be, it might be several appointments down the line that this becomes relevant. So I had a lady who came to see me quite a few times. Basically, she had fallen over playing a racket sport and she had,

I say she fractured her clavicle. I saw the x-ray. She did a proper job on it. It was surgically pinned. She was having physiotherapy and she came to massage to help. And as we went through our chatting, I was like, you know, after a few appointments, I was like, you know, you really did do a number of, did anyone sort of talk to you about bone density and that kind of thing? So, well, they said it definitely wasn't osteoporosis. Okay.

You know, you said you're postmenopausal. When did you hit menopause? Well, I was 42. That's quite young. And I was like, okay. And then later on, we were talking about her mum having experienced osteoporosis and having suffered with that. And because I had all those bits of information, it's like, I'd probably go back and have another chat with your GP about that and see if they'll refer you for a DEXA scan. You know, I would probably go back and have that chat, I think.

And she went back and she had the scan and we're waiting for the results. But because you've got all that information, it gives you what you need to talk to that client and help them come to the decision. And empower them to go back and say, well, actually, just you saying, oh, no, it's definitely not that and not explaining why. I'm not very happy with that. Actually, I'd really like you to explain your reasoning if that's okay.

Because we don't screen for osteoporosis. I think we should personally. But I'm only a massage therapist, so what do I know? But, you know, we don't. And really, waiting until someone's broken something is a bit late. So, yeah. It's lovely hearing you because, and we say this so much, as a massage therapist who is straight away getting that therapeutic alliance, you're about to put your hands on them, they're taking their clothes off. There's a trust there and a confidence.

So when you do, if you give them open-ended questions, they're more likely to come out of these things and adopt a state of mind where they're actually going to go to the GP instead of just going, yeah, yeah, I'll do it.

I'm not going to do it at all. so we do have a wonderful opportunity to play such an important part in the diagnosis and earlier diagnosis and prevention of misdiagnosis in this so it's great it's really nice hearing you do it does it empower you does it make you feel good as a therapist when you know that she's been to see a lot of allied health professionals and that and it wasn't really, signposted whereas you just a massage therapist you must feel quite good about

it without blowing out chumpy but it's course fulfilling i mean yeah it is i think i think there's something.

I don't want to generalize too much and say all women experience this, but i've certainly experienced having sort of women's problems fobbed off and dismissed and not really taken very seriously and i think that is a wider problem than you know just the medical profession i think that speaks to our whole society women's pain is undervalued it's not always taken seriously so actually being the person who gives someone hopefully the impetus to say no it is okay for you

to go and argue about this feels really good and it's like I really wish someone had said to me you know what you can go and argue about this you don't have to wait 20 years you can go and you know complain about it and say no this is not good enough it's really nice to be the person that I kind of wish had spoken to me if that makes any sense brilliant that's amazing so it's so nice to know that listeners are going to hear this from you amazing

and thank you so much for sharing with this it's so so very much what.

I think these reflection series can help therapists with you know hearing it from other clinicians it's so cool i just wanted to say nikki that was nice as well nikki mansfield said gives the client permission to talk about it too and might spark their own curiosity about how linked all these things might be sparking curiosity in their own health is just how to get behavior changes you You know, we tell people all the time, listen to your body, listen to your body, listen to your body.

Sometimes maybe what we need to be saying, these are the questions you should be asking your body. Here are some things to listen out for. Otherwise, it's a bit amorphous and a bit like, well, what does that actually, what does that mean kind of thing? Listen to your body. You can sort of, You can sort of help people to draw their own conclusions, I think. And I mean, also, we are in a strong position, I think, as therapists, as you said, to link things together.

So one of the questions that we might ask, for example, is, you know, how are you sleeping? Which is something that we would probably ask every time when we're doing our subjective.

If someone is perimenopausal or postmenopausal and they say to you well do you know I'm not sleeping very oh why is that I have to get up and wee three or four times a night that again that can be a menopause thing that can be a sign of vulval atrophy or vaginal atrophy that is incredibly common and eminently treatable and it can really really affect people's eyes very badly it can cause things like recurrent UTIs which when you're a younger woman is okay But when you're getting to, you know,

20, 30 years down the line after your menopause, it can make people really ill. It can finish them off. So, again, if you can be the first person, say, well, actually, you don't have to put up with that. You can go and see your GP. Maybe go and have a word with them. You could really be helping someone, not just today, but sort of 20, 30 years onwards. So that is one of the things that I feel quite firmly about.

Yeah, but it's great. It's just a lovely process of just questions and many questions and they start answering and reflecting and the aspirant can lead to, yeah, like you say, in some cases, yeah, very much life-changing situations. You mentioned a couple of times. Oh, sorry. There you go. Sorry. I just can say we have the luxury of time. We don't have to fit it all into 10 minutes. That is true. And like you say, it might not be straight in that first initial consultation.

It might be after you've given them some fantastic relaxation and kind of desensitization that they're going to open up.

So that's the power of them the human touch i wanted to make sure we fit it in you mentioned a few times like gluteal tendinopathy and shoulder issues can you explain to our listeners what the connection is with regards to menopause and a higher prevalence of tendon issue so when you your estrogen levels drop during menopause that sends your body into kind of an inflammatory state essentially so when you then tweak something you're

already in a state of inflammation and then you're getting more inflammation on top and so you know we the link between frozen shoulder and menopause is not one that I'm fully clear on I have to be honest but I'm not sure how well studied that's been but there does seem to be a link there although as I understand it we don't know fully what it is but yeah tendon issues because everything's already a bit inflamed and then you go and poke it and it gets even more so.

And that's one of the things that Jenny talked about as well. And that's one of the things I talk to clients about, because one of the things that means is that things might take longer to clear up than you might hope. And, you know, if you have tweaked your knee before. And it cleared up in this many weeks, maybe now it's going to take a bit longer.

If you can introduce that and explain that and say, look, it doesn't mean it's going to be like this forever, but it might take a bit longer to get better. We might need to progress your exercises more slowly. You know, you might need to look at, Jenny talks a lot about anti-inflammatory diet, you know, making sure you're doing what you can to get your systemic levels of inflammation down, which will then help with that kind of topical localized inflammation as well.

And i think again just having that information just knowing that it's okay it's going to get better it might take longer but it is going to get better and i'm not going to be cropped forever is really powerful and will really affect someone's mental state and of course that affects then how they feel in their body without a doubt and of course the whole ecosystem as well because we're not just seeing that patient we're seeing also their relatives

the people that live with the children the husband the partner whether it is the pet it's all you're changing very much that whole ecosystem which is so it's lovely i like to think of it as a really nice responsibility it's something we can help with hugely especially and i think even if someone comes to see you and they haven't got you know tendinopathy or frozen shoulder or something one of the things that tends to happen that age of menopause transition

of perimenopause is often an age where women are getting pulled in 14 different directions already. And then your hormones go crazy. And I think one of the things I'm probably paraphrasing a bit here, but one of the things that was said in the podcast is actually just having a massage and some time to be looked after is very powerful and very worthwhile. And I think that's what I found really validating about this.

It was like, actually, even if all I'm doing is having someone lie on my table for an hour and be looked after rather than the person doing the looking after that is still valid and valuable and worthwhile.

And so I can keep doing that and know that I am making a difference even if I'm not I don't know, lengthening their quads or whatever that's fine and yeah I think sometimes the best thing that we can do is just look after someone for an hour so they don't have to look after anyone else.

Wise words hannah very wise words i was gonna rant you have to try and get along to the fta conference because it's just i mean this is something which we're trying to help people with because massage therapists do believe they're at the bottom of the food chain that they're just giving someone a massage to feel better but what you've just said encapsulates the whole thing about that down regulation of the nervous system is something which will help people either talk about

something if they want to maybe not with you maybe when they get home it gives them time to think get clarity relief from pain even if it's only temporary it allows those better decisions to be made and it's yeah it's massively huge it's why the other guests we've had on the show say even whether it's surgeons or it could be female health physiotherapists it could be male pelvic health physiotherapists they all have massage therapists involved in that circle of care because they recognize that

this down regulation this yeah this touch is can plays such an important part not always but a lot of the time because humans basically like a bit of, primal grooming they like that contact it's in our nature most of the time yeah absolutely.

Very cool stuff i'm going to address jackie's comment here thanks for sharing jackie i'll read it out loud for people listening to the podcast jackie barker says i had a surgical menopause age 28 this year now 28 years post-menopause i was told i had to acquire a dexascan every five years i had one 23 years ago i had a few msk issues and have been asking for a dexter scan on and off for the past five years eventually i spoke with a different gp who asked when did you have a last dexter scan yeah

i don't know and it is ridiculous because you know obviously if, jackie's having there's going to be a massive cost to jackie you know in terms of vulnerability to fractures and the pain that causes, there's also a huge cost generally to us as a society. If we've got women falling over and fracturing their hips left, right and center, this is not good for anyone. And, you know, from, I've never had a DEXA scan, but from speaking to my client who went and had one, it was not an involved process.

You know, it didn't take a long time. I think she went, it was set up in a supermarket car park somewhere in one of the local towns.

So it's like, why this is this is something that we could be doing why are we not doing this why are we not doing this why are we waiting for problems to develop and then go oh dear we're going to have to do a hip replacement or oh dear you're going to be in hospital for ages or oh you're going to be in rehab or you know or maybe you'll never go home again because once you get to you know talking about much older people you might not be able to live independently anymore,

if you break a hip that could be it, So why on earth are we not addressing this? Although this is going away from massage therapy and back into the world of campaigning. And I don't do that anymore. She said. She said. No, it's great. Thank you, Jackie, for sharing that. But I think what's interesting for me is when you went to a different GP, and that kind of reminds me of what you said, Hannah.

If women are empowered to actually speak up and go and see someone else, if they're not happy with the way they've been treated or something. And this reminds me of Alistair Beverley, the learning disability physio. He was talking about diagnostic overshadowed, which I'm sure you saw that episode. And he was talking about it initially with how people with learning disabilities can come with an issue and symptoms, which if they didn't have that learning disability, they would be investigated.

But because they've got Down syndrome or something, then it's kind of, they thought, oh, it's just part of that, isn't it? That's why you're acting like that. But he was very quick to say this can happen with women. In fact, it happens a lot with women.

They say that he seems just because oh you're going through the you know it's a menstruation issue or it's because you hit the menopause and it's it is sadly diagnostico-shadowing yeah, and i mean it's something the someone in my own family was suffering from certain issues, and went to the gp and was told well that's normal it's not normal what she was suffering from it's common but that's not the same as normal and she had to go and see someone else to get treatment And you just think,

how many women are being sent away going, well, that's fine. Somebody else, I'm really going to start ranting that. It makes me really close. It was anyway since 90. I know. That's true. You'd be like, cut her off. A friend of a friend went to see her GP who was trying to persuade her to stop HRT. And he said, well, we used to go through menopause without any of this HRT stuff. Did we? We? Who's this we?

We? Okay. As my friend said, we used to do amputations without anaesthetic, but we have moved on from that point. That's a good point. But yeah, it's... But it's interesting. I mean, yeah, even with GPs, people think all GPs are going to be trained the same amount and they've got the same way of dealing with patients.

But there's going to be good and bad in every profession. But I think, Leah, the important thing is have the power, in this case, if you're a woman with symptoms like this and not quite sure that what you've been told is you've been treated fairly or listened to. If you've ever been listened to, then yeah, go and see someone else. Yeah. You know, don't let them say you're just nagging and complaining about something you should put up with it because it's, no.

And don't wait till it gets bad. You don't have to wait until it gets really bad. You are allowed to go when it's just irritating. Oh, yes. Leslie has been triggered and we haven't released the rant. What a lovely iteration, Leslie. Thank you very much. One of my clients called me a terrier the other day because I was ranting about this very issue. Yeah. It's funny, isn't it? Because the patriarchy who told women, oh, stop ranting, stop going off.

The patriarchy who used the word hysterical, taking it from Latin for the woo, they're the same people who are probably saying, oh, just go away. There's nothing wrong with you. It's ironic. I'm sure we used to manage without this kind of thing, did we?

Very interesting that is so interesting yeah amazing amazing yeah reflection thank you and i think i liked how jenny because we've talked already how yeah the depletion estrogen and that and more susceptible to this and this and this blah blah blah and even towards the episode back two or three years ago with jenny i was like inside i was thinking oh wow women listening to this are just thinking this is the end of the road i might as well just give up now turn the

light off because it's all downhill from here my body's just giving up but I liked the way well first of all you know in your experience is that a common feeling amongst women is there a danger for them to think I think there's definitely a danger of that I think especially when you're in the thick of it and I'm not fully in the thick of it yet I am on the nursery slopes and there are still days when I think could we just stop this is not fun I remember saying to my mum I feel like all the

things that give me joy in my life are going to be gradually stripped away. I'm not going to be able to run anymore. I'm not going to be able to do this. I'm not going to do that. And I know that's not true. In my head, I know that's not true, but that is how I felt. But I know, I remember you asking Jenny that question. Is everyone going to be massively, massively depressed? Is it actually all terrible? And my observation is no, there is, the other side is there.

I think I've just signed up for Jenny's Third Age Woman course. I haven't managed to watch any of the videos apart from the introductory ones yet. But she describes it as a rite of passage, and I think it is. And no one ever said rites of passage were easy. But you do go through it, and there is another side. And I think there is power in getting through the side and still being there and still being willing to use your voice.

And especially now, when we do talk to each other more, when it is so much more of the conversation now, people like Davina McCall and other sort of celebrities talking really openly about their experiences and really removing some of that taboo, I think the only way is up.

The other thing that jenny said that i really liked in the introductory thing was when you're talking about the statistics so things like stats for osteoporosis and all that kind of really scary but they are historic they are reflecting the situation you know these.

Ladies they were going through their menopause transition maybe 30 years ago without any of the information or treatment options or knowledge that we have available to us now so in 30 years time how different will those statistics look we have the opportunity to make to make that change no one was talking about lifting weights 30 odd years ago not for women anyway because you didn't want to get bulky it was all about i was having this conversation with a client she's like yes you did aerobics in

your green leotard with the green goddess, and it's all about cardio and i find that very reassuring as well that we do have the opportunity.

You know to a certain extent aging is going to happen but we can use the information we have now to do it as well as possible that's very cool yeah yeah that's it's great and yeah i mean it's easy to say isn't it but i think with people like yourself helping patients and other listeners if you can do that then you can help the person find if you might not be straight after you say this wonderful thing they might just go yeah right thanks bye but you can sow the seed and it is like jenny says it

is kind of the beginning of a new chapter it's not the end it's the beginning of a chapter i think she describes it she says lovely she says women over 50 are both powerful powerful terrifying and dangerous that was the one yes i agree liberation you know that's the way to kind of look at it but yeah society needs to change everything around you needs to change to understand that as well to make it you know I think my observation is you appear to run

out of flips to give it's a family show yeah I was like do you know what yeah that's fine and I think yeah there is power in that. Very cool. Okay. Well, that's been a wonderful reflection. Thank you so much, Hannah, for your time. Excellent. I can't wait for people to listen to this. If you have been listening and you have been affected by it, then do please let us know. You can go to YouTube and leave some comments in the YouTube section that they get a life forever.

They've got a wonderful shelf life and they're appearing in Google as well. So use YouTube if you can. If people want to get in contact with Jenny, then bowleducation.com.

Still there very much so. A lot of it's online now. i've had some wonderful courses including i saw recently the brand new 200 hour therapeutic coaching for women diploma the one you mentioned hannah was i think it's third age woman so it's all the way through the whole menopause extravaganza yeah there's an awful one there and it's worth just checking out to stimulate thought and and get the same kind of empowerment which hannah had from listening to

the episode i hope you've got from listening to hannah tonight so do check that out viraleducation.com link will be in the show notes and then if people well when people have enjoyed what you've been saying and if they want to follow you and get in contact with you we've got hannah tabham.co.uk website and then social media where do you mainly hang out these days at the moment mostly on facebook although i have to admit most of my updates at the moment are making sure people don't

go to the wrong place because i've had to move out of my treatment room temporarily i love i was just looking i love the comment that um nikki just made about not waiting for the other side and finding good things in perimenopause, which I think is awesome. And yeah, talking to your friends and finding that kind of community, I think is awesome. And it's kind of a shared experience in a way. So yeah, I love that. Nice one, Nikki. We like it. Sisterhood has been a massive one.

I'm talking more deeply with my girlfriends than ever before as we share it nice very cool so yeah hannatapham.co.uk Facebook just look up Hannah Tappham Sports Massage Therapy there is an Instagram page as well just got some stuff on there Hannah Tappham Sports Massage yeah I remember to post on there.

Now we've announced this to the world and you're going to have to put something on there okay that's fantastic, next tuesday continuing this reflection series i'm going to be talking to it's the same ballpark it's brilliant i'm so glad that these two i mean you just chosen one that interested you next week physiotherapist emily sweet has also been on the show before she's going to be reflecting on one that was actually early

on this year in february which was pregnancy related back and pelvic pain so you kind of we're in the same kind of ballpark here which would be nice, excuse me which would be nice to continue the conversation i'm sure there'll be lots of parallels. That episode 229 was recorded, like I say, in February with a special guest, Michelle Lyons.

And yeah, Michelle Lyons, spoiler alert now in case you wanted to wait until tomorrow evening, but Michelle Lyons is signed up already to be speaking at the Hands On Hub and STA conference in September. I'm so excited. I couldn't keep it any longer.

So yeah, if you're interested in seeing Michelle Lyons once again, oh man, last time I saw her at conference, it was just in the aisles it's amazing so yeah exmouth september look out for the release of details and tickets tomorrow but yeah michelle lions is one of our keynote speakers who will be talking in exmouth in september at the hands on hub and sda conference so that's great glad i got that off my chest now it's like i feel cleansed so so wonderful thank you hannah

it's been really really great listening to you really really nice really enjoyed it and thank you everyone who us live thank you for everyone who shared your own personal experiences i really appreciate that so jackie barker thanks for sharing and nikki and everyone else who is with us in the live lounge i really do appreciate it if you have listened to the podcast and you want to join us live then like i say eight o'clock

on a tuesday on the sports therapy association youtube channel if you're happier listening to the podcast then that's fine but do please just leave a rating, and a review because that's how we get this kind of word good word out to more people The more you leave a rating and a review, then the more it goes up the Google rankings. And that's what we're trying to do, put out quality information.

So do please take time to do that if you'd be so kind. Right then. Thank you, everyone. Hope to see some of you on Tuesday. Thank you, Hannah Tabra. I really enjoyed it. I'm even looking forward to listening back to it. It was wonderful. Thank you so much. Love the chance for a rant. Music.