UCL Health of the Public


Transcript for 'The change-up, demystifying the menopause'

Join hosts Doctor Xand van Tulleken and Dr Rochelle Burgess for Season 3, Episode 4 of Public Health Disrupted with Prof Joyce Harper and Rachel Lankester.

Xand Van Tulleken: Hello and welcome to season three of Public Health Disrupted with me, Xand Van Tulleken

Rochelle Burgess: and me, Rochelle Burgess. Xand is a doctor, writer, and TV presenter, and I'm a community health psychologist and Associate Professor at the UCL Institute for Global Health.

Xand Van Tulleken: This podcast is about public health, but more importantly, it's about the systems that need disrupting to make public health better.

So, join us each month as we challenge the status quo of the public health field, asking what needs to change, why and how we get there.

Rochelle Burgess: In today's episode, we are talking menopause, particularly demystifying The Menopause, which I always put in a capital for The Menopause. I feel like that's how it's supposed to be. Because the lack of public awareness around this natural phase of a woman's life has resulted in Menopause being associated with a lot of shame and a whole bunch of negative misconceptions. So, we'll be talking about the ways in which menopause affects women's health and the knock-on impact on day-to-day life. We'll hear about the different social and cultural factors that affect how a woman might experience the menopause, focusing particularly on the negative narratives and misconceptions around menopause in the UK.

Xand Van Tulleken: Joining us for this process of the Menopause demystification are an award-winning academic from our very own UCL and an author who founded an online community offering support for women in midlife. So, let's introduce you to our first guest. Professor of reproductive science at the UCL Institute for Women's Health, Professor Joyce Harper.

Now, when Joyce isn't open water swimming or day raving, she can be found or indeed sleeping in her car. As we discovered before the podcast, she can be found debunking myths around women's reproductive health on her own, I have to say, brilliant podcast, Why Didn't Anyone Tell Me This, or in any number of her other roles, which include Head of the Reproductive Science and Society Group, founder of Reproductive Health at Work and International Reproductive Health Education, collaboration, and co-founder of the Fertility Education Initiative.

Joyce has worked in the fields of fertility, genetics, reproductive health, and women's health for over 30 years. She's committed to shining the spotlight on three key stages of women's health, the menstrual cycle, the fertile years, and, The Menopause. Her latest book, Your Fertile Years was published in 2021.

Rochelle Burgess: Our second guest today is Rachel Lankaster. Rachel is an author, podcaster and editor of Online Magazine, the Mutton Club for Women over 40, which I'm now able to proudly join. I must say like when I saw that, I was like, yeah. I always love that phrase, mutton dressed as lamb, which is where that comes from, right?

And I just feel like I've been waiting for that part of my life to begin. So I'm very happy. Happy to join this club. Following her own experience of the menopause. Rachel founded Magnificent Midlife, a hub of community and support for women over 40. Rachel's midlife reinvention came after a long and varied career in finance, journalism, and pr, which took her all over the world, and she now works to help support women navigating the often messy middle of life.

Rachel's written a book called Magnificent Midlife, transform Your Middle Years Menopause and Beyond, and also The Magnificent Midlife Podcast, inspiring Women not just to survive but thrive.

Xand Van Tulleken: So both of you, thank you so much for coming on. Joyce, can we start with an overview from you of the menopause and its impact on women's health?

What's going on in the body and what does that look like in the context of a woman's day-to-day life?

Joyce Harper:  So it's great to be here. Thanks very much for the invite. So the menopause well, Women's fertile years are governed really by our hormones, and our sex hormones are very, very powerful. They have profound effects on us from puberty to the menopause.

So for our whole fertile years, women have a cycle of hormones, a a number of hormones. But the two that we'll talk about today are oestrogen and progesterone. And these hormones go up and down through our whole menstrual cycle. So they caused some problems. In a normal woman's life because they are the hormones that are responsible for the feelings of pre-menstrual syndrome just before our period comes and they start giving us problems actually at puberty.

So at puberty, our hormones are oscillating up, so they're all over the place and young girls going through puberty will experience a whole range of physical and psychological issues because of these hormones having their effect. And obviously then they will start their periods. So when we get to the menopause, I always refer to it as the reverse of puberty.

This time our hormones are all over the place. They're roller coastering again, but they're now going down. So any one moment in a woman's life when we, what we call the perimenopause, so. Before our periods actually stop. So menopause is, the definition is that a woman has been for one year without having a period.

Now, obviously you won't know that until you realize one morning, oh, it's been a year since I've had a period. And the day you realize it's been at least a year since you had had a period, you actually become postmenopausal. So, so

Xand Van Tulleken: Wait is the definition of a menopause, just that one year?

Joyce Harper: Yeah. So one day after the last day of your last period, after one year is the menopause.

Xand Van Tulleken: How do I not know that? Like no one ever told me. That’s why we're here we're, we've learned something already. Does everyone know that other than me on this podcast?

Rochelle Burgess: I did not know that. I, okay, good. Thank you. I tried to tell my doctor I was perimenopausal, and she's like, no, you're not. And I was like, I think I am.

So I'm already in this space of trying to fight about what's going on in my body. Which probably sounds about right to our guests today, I imagine.

Xand Van Tulleken: Anyway. But by the time you define your menopause, it's over, like the day you go that you're like, what was that? That was your menopause. Now you're postmenopausal.

Joyce Harper: Yeah, and, and not the thing is we use, we use the word menopause very widely. So, um, we, we talk about, Actually what, what we're experiencing in perimenopause and menopause and post menopause. And we often just say menopause. It's not grammatically correct, but it do you know what? It's just easier. So, so today we are, we are demystified.

We've demystified a little bit already, so the perimenopause. Is the most tricky time because that's when the hormones are rollercoastering and you are quite right. It can, it can start in your early forties. It can start at any time. It can start in your thirties, any, any time at all. For most women, the day they realize they've had their last period will be somewhere between age 45 and 55.

So that's the day they actually now become post menopause. But the average age is 51. But it, it, yeah, it could be anything around that. As I said, it can be earlier, but the perimenopause symptoms, they can start up to 10 years before that. So you can see if you have your last period at 45. You can start your perimenopause symptoms at 35.

And one of the biggest myths around this is that women keep saying, we keep being told by their GPS or their friends, oh, you are too young to be pre menopausal. You are only 41 or 43, or even fifty, you know, 50, uh, people think, oh, at this magical age of 51, everything will happen then. So that's what's really important to know.

The perimenopause can start at any age, and the these effects, the symptoms that I'm sure we're gonna talk about now can start affecting women at any age. And what's really important is that women do not understand about the symptoms because they've never been told about them. And what we're seeing is that women take a long time often to realize, oh, this is perimenopause.

I'm not going crazy, or I'm not falling apart, or aging. All of a sudden, these symptoms. I'm experiencing are due to the perimenopause. And then if we know that they're often going to be transient and you should come out the other end feeling wonderful as Rachel and I do, um, then you know, it can be a very tricky time.

Rochelle Burgess: So education is absolutely key. Could we talk about the symptoms? When you said that phrase, you feel like your body's falling apart? That is literally what I said to my husband yesterday. I woke up and like, why is my leg feeling weird? I feel like my body is falling apart all of a sudden.

Joyce Harper: The most talked about one is the hot flushes or hot flashes. Yeah, so that's something that people know about, but lots of women don't get them. Really important part is that. Every woman is individual. Some women won't really get any symptoms that I'm gonna talk about. Some women will get all of them and it will really devastate their life.

And this is due to their genetics, their lifestyle, their bodies, so many different factors. So remember, we are all different and we'll all go through this differently. So hot flushes are the, the most common. Then we have issues around, um, Um, our genital area so we can have an increasing incontinence. The, the skin around the vagina and the vulva can become quite thin and sensitive.

So lots of women have issues with, uh, physical sexual function, but also lots of women have a loss of libido so they can have a psychological. Uh, reduction in their sexual urge as well. Uh, then we've got things that affect our joints and our body. So you can get achy joints, achy muscles, that, that whole thing that your body's feeling like it's, it's falling apart.

And then there are really important. And in the work that I've been doing, the top one women tell me that it's affecting them is a psychological issue. So we've got brain fog, we've got loss of memory. Confusion, depression, anxiety, all of those things that are really affecting a woman's daily life. A woman at work, a woman in her, in her private life, and.

So it's really important, and the list can go on and on. There's a, there's a very controversial topic of what is a menopause symptom and what's not. You can see some lists, lists of like 50 symptoms, but I've just sort of very briefly covered the main ones. But it's, it's really important for women to know this and then join the dots about, okay, I've actually got this, this, and this.

Oh, they're all perimenopause symptoms. Maybe that's what's going on.

Xand Van Tulleken: Can I, get a sense of, does anyone kind of get away scot-free? Does anyone just go, oh, the menopause, that just wasn't really a thing for me. Um, or is it something that's sort of, is it like a train coming down the track and it is gonna hit everyone? In some way at some point.

Joyce Harper: So 80% of women have symptoms, so 20% say that they're either don't have them or very mild. I meet someone every now and then who said, I think something's wrong. I've been through, you know, my periods have stopped. I post menopause. I didn't have any symptoms. But one of the symptoms is that your menstrual cycle will change.

Because your periods are going to stop. So if you count that as a symptom, every woman is gonna going to have that because their periods are going to change. They'll become longer, shorter, heavier, lighter, and eventually just stop. We are doing, um, focus groups at the moment with perimenopausal women to ask them about their periods and how they're affecting their wellbeing.

And for sure, women are telling me they're having really. Heavy long periods that they've never had before in their life. It's like sort of one last, um, sort of, you know, kick up the backside, you know, okay, this terrible period you've had all your life, we're gonna go out with a bang and really, you know, you'll have one almost the whole time and then they stop.

Um, so I tell the women on the, on the focus groups we're doing, the good news is they will definitely stop, but they can be a bit difficult getting there. So yeah, they, they will stop. So that's something that every woman is definitely going to experience. But yes, 20% of women say that they get through the perimenopause really almost scot-free.

Rachel Lankester: But can I add that, um, what we are talking about is the UK experience of menopause, because what happens is that, your experience of menopause depends on your culture, depends on your race, depends on your mindset about aging and menopause. So let me tell you a little example. So they did a research survey in Mexico with a group of Mayan women, and the woman who was running the survey came from Ethiopia.

So she personally didn't come from a culture where menopause was a big deal, so she did not prime her. Audience. She asked her audience if they had noticed anything other than a cessation of periods when their period stopped and they thought about it and they said, well, I stopped getting pregnant. There was nothing else.

And this I find absolutely fascinating because we have this concept of menopause being this big thing and that all of these symptoms come and you know, as Joyce has said, you can have a 34 list or a 60 list, or I'm sure the kitchen sink is on there as well. But if we look at other cultures and we look at the way other people, you know, for example, there's a correlation between.

The status that a woman gets as she ages and her experience of menopause. You know, correlation doesn't equal causation, but there is a correlation there, which I find absolutely fascinating. Um, and so I think there is a real cost to modern life. I think the fact that we have all of these symptoms is because we live our lives in a certain way, particularly in the UK and America.

We have a great deal of stress, and a lot of us are not very good with dealing with stress. Two of the earliest symptoms that women do complain about, particularly in the workplace are anxiety and brain fog and anxiety then feeds into anxiety because as joy said, if you don't recognize the symptom as being part of perimenopause, you're gonna get more anxious about being anxious, and then it just gets worse, and then you get the brain fog and you don't know that that is.

Potentially an issue and you think you've got early onset Alzheimer's. So this is why Joyce and I are just really, we're trying to lower the temperature and really just add some perspective to what is currently being discussed about menopause. Because, you know, look at the Mayan women, they didn't, they didn't notice anything other than their period stopped.

Joyce Harper: There's, there's quite a few cultures that don't have a word for menopause in their language. Really interesting.

Rachel Lankester: And the Chinese describe it as second spring, um, which, which I love, you know, and, uh, that's amazing. And also have to tell you whales, the whales go through menopause as well. Did you know about the whales?

So there are two creatures on this planet, human females, and whales who go through menopause. And when whales go through menopause, they become the leaders of their pods. Right. The younger male whales, sorry, Z, they die off cuz they're not needed. But it's a matriarchal society and the female whales, they go on and they lead their pods and often for up to 50 years.

Because there's a role for them as the grandma matriarch within their pod. So I believe that postmenopausal women, we as value valuable as our communities. Well, we're more valuable to our communities post menopause as leaders than as breeders.

Xand Van Tulleken: But it's interesting that these questions have taken so long to pose.

I mean, which I suppose emerges from the number of botanists and the, the do the male dominated science. Even if it's, if it's, um, zoology, you know, the, the, the male zoologists are not going, oh, I wonder if that elephant's menopausal.

Joyce Harper: Yes, you're right.

Xand Van Tulleken: We haven't done the study. I will confess. It's not a question I've ever asked.

Um, looking at an elephant, it reminds me of, I was talking to a, a friend of mine who's a female business leader. She's called Alison Cork. She kind of mentors women starting businesses, and she said The fastest group of entrepreneurs in the UK is women over 50. And she said they're unbelievable, but they are part of the reason for the dynamic, um, quality of this group.

Is that they're escaping male dominated environments, where the easiest way of doing it is to become an entrepreneur and set yourself up for yourself. So it just kind of, you know that the elephantine or the, no, the whale, what's the word anyway, the whale kind of method of doing things we could learn something from I guess.

Rochelle Burgess: One of the things that that made me think about was how little women are valued in our mainstream Western societies, isn't it? The value of women is so, Structured around reproduction. Rachel, if you could talk a little bit more about this, this idea and your experience that led you to this sort of thing around the Magnificent Midlife because that's it, isn't it? It's, you're nodding very deeply at me, so,  

Rachel Lankester: well, I do believe that, you know, well, obviously there are three stages to a woman's life. There's, you know, pre puberty, there's our reproductive years and there's our post reproductive life. But what has happened in today's narrative is that we have taken the default stage of womanhood as a reproductive woman.

So the patriarchy, I'm sorry, sound again. But it doesn't make room for a postme nopausal woman because what is the role of a woman if she's not there to reproduce? And, and if you look at the way our society is structured, if you look at. You know, the, the budget's out there for anti-aging products. If you look at the way a man is allowed to age and a woman is not allowed to age, and all of this, I think, contributes to the way women experience menopause because they're fighting to hold onto what they were, because society doesn't give them a value for where they're going.

Rochelle Burgess: Ugh. Sorry, I should be on mute, but, but that is, totally the phrase, isn't it? Where we're going.

Rachel Lankester: This is the next iteration of a woman and a postmenopausal woman is as valuable as any other stage. And when we talk about menopause as a deficiency, which is the narrative, now we are again talking about this default stage of womanhood i e with your full compliment of.

Reproductive hormones and that your post reproductive life is invalid unless you got the full compliment of your premenopausal sex hormones, which is rubbish in my view. It's complete and utter rubbish. Our bodies don't malfunction in midlife. We are designed to go through menopause like the whales. You know, Susan P.

Madden has written a brilliant book, the Slow Moon Rises, um, about the history of menopause and how menopause is good for the evolution of our species over millennia. There's a postmenopausal zest as well that's been talked about. You know, there's an energy that comes. Um, our most creative times are supposed to be in our mid twenties and our mid fifties, and I think that that really corresponds with, with menopause, you know, because, When we don't have as much oestrogen in our system and it doesn't go away completely.

That's another myth that it goes away completely. It doesn't. Our body still produces it. The body has a plan, but we mess it up by not looking after our bodies and by, you know, not dealing with our stress very well, but when we have less oestrogen. So what's oestrogen designed to do? I get really, this is me getting a bit radical here.

It's designed to make us nurture. It's designed to make us re help us reproduce and nurture whatever we produce, right? And when we have less of it. We can get a bit feisty, we can get a bit, okay, we're gonna think about me now. I'm gonna put me and my needs first. And isn't that exciting? I just think that is just so exciting and, and that's what drives me because, you know, I'm completely different now than I was.

Pre menopause. I'm a different person. I'm a different woman, and society tells us that that is something wrong, whereas me and Joyce are out there going, Uhuh. No, it's not there.

Joyce Harper: There's a whole, there's a whole group of us who feel exactly as Rachel's just, uh, explained. I, I keep telling everyone, I feel better now than I did when I was 18.

I think this is the best time of my life. I. Don't have anything on my to-do list. I've done education, job, kids, partner, blah, blah, blah, house, all of that, and it is me. It's me time, and I feel at work the most productive I have ever felt. I'm getting the best ideas, I'm doing the best work I think I've ever done, and it is a second spring.

I feel so alive, so. We just need to make sure that everyone knows that. So in the, in the corporate world, we worry that people are going to think because of this negative narrative, oh, don't employ a woman in her forties. She's going to go through this crazy menopause time, and then she'll be a disaster.

I would say hold onto her tightly, because when she's post menopause, she will give you the best work ever. Her mind is, It's, it is like being a different person because as Rachel said, those hormones have gone. They're very powerful and they do give us a totally different outlook. I, I felt like a fog had lifted from my brain when I was postmenopausal, and it's a wonderful, enlightening time of women's lives, but no one talks about it.

Rachel and I and our little group are talking about it to let them know there's massive light at the end of this tunnel.

Xand Van Tulleken: I've gotta say you are really, it's so interesting having had very little sort of training or, or teaching about the menopause and just absorbing what is out there in the culture about it.

It has always struck me as something to dread that is part of a, sort of the physical decline of aging. And you are, it's not just that you are, you are resetting my, my sort of prejudices or assumptions. But you are, you are literally making me. Female colleagues, um, senior female colleagues in terms in terms of, uh, older female colleagues where I kind of go, wait a minute.

What you're saying is actually what I observed. Like, yes, there are loads of incredibly dynamic people who are having this phenomenal kind of second stage of their career where it's going gangbusters for them, but. Somehow that has not informed my views on the menopause, but, but your kinda biological basis for that.

Its so interesting. Joyce, can you give us a bit of a, a discussion that I often think as a clinician that's, that's my background, although public health is as well. And metabolics is quite medicalized. And I remember my mother agonizing as we started at medical school, she'd say, what H R T should I be doing this?

These hot flashes are horrible. I'm worried about my risk of cancer. I don't really know. What role should clinicians the public health community be playing in how medicalized it is helping women through a difficult perimenopause stage? How should that all be navigated?

Joyce Harper: Yes, it's a situation in the UK that's become really polarized.

H R T is definitely the answer. For some women, it's going to be their lifesaver. Um, and, and, and other countries. About five to 15% of women are taking h r t, but we've got this narrative in the UK that H R t is the elixir of life that it's going to. Stop you getting Alzheimer's, stop you getting dementia, heart disease, diabetes, osteoporosis, um, keep you looking young.

Stop you putting on weight, uh, revive your sex life. Basically do all these crazy things that I, I said to someone on a podcast yesterday, I said, even if you take it, it's, it's only giving you your hormones back. It's not gonna make you a better version than you were before you took it. You know, it's not gonna give you loads of energy.

Um, so, and I'm one of the most energetic people I know that everyone keeps telling me. Um, and I'm, I've never taken h r t, so it's a woman's individual choice. There is no evidence. I've looked at all of it. There's no evidence it's going to prevent heart disease, prevent dementia, et cetera. But it's being sold like that because if you are a big farmer and you've got a drug that half of your population are going to take for a third of their life, Wow, that's, that's big business.

So it, I can see why people are promoting it, but some women don't want to take it. Someone want a, a more holistic approach and that, that was me. I. I think when I took the pill, I went a bit crazy and I know the hormone makeup's a bit different, but I, I personally didn't like estro and progesterone in my body and being post menopause, I, I'm liberated, so I, I never wanted to take it.

Um, and there's many women that don't want to take it. There's women that can't take it. They may have breast cancer that's sensitive to estrogen, so it's dangerous for them to take it. But people are telling them, oh, it's fine. Don't worry. You might get recurrence of breast cancer, but just take it, you'll get rid of your hot flushes. So I think that's it, and you won't die. There's no mortality. You'll get the breast cancer, but you won't die.

Joyce Harper: Okay. That's really dangerous. So, so yes, for some women, but because there's been this big propaganda that H R T is the elixir of life. This is one of the reasons we've got shortages in the UK because all these women who don't need it, there were women who have no menopausal perimenopausal symptoms who are now thinking, oh, who are definitely taking H R T.

H r t is a drug to overcome some symptoms, some quite specific symptoms. If you don't have them, why would you take it? Why would you take any drug that you don't need that's not going to prevent something? So we've got this misinformation that's really propagated in the UK and uh, Rachel set up this group, uh, me, clarity that I'm part of.

And it's unfortunate that we have to spend our time and energy debunking myths. But there are many myths around, and H r T is one of them. Absolutely. The lifesaver for a certain number of women. If some try it and they just don't get on with it, uh, it, it's not the answer for everybody. We're individual, we should be treated as such, but we get told we are medically gaslighting If we.

You know, say, say that you haven't got this disease and you need this treatment, you know, but in honestly, we've got to get this in perspective.

Xand Van Tulleken: The, the gaslighting people are usually the people making money in my experience.

Rochelle Burgess: Um, Rachel, I, I'd just love to hear your thoughts on that as, as well, because for me, I'm coming into this from a particular position as somebody who was feeling the fear of that next phase in my life. So I must say that you two have been like a breath of fresh air. I feel like I have hope where I was looking at it and I was like, oh, just like really terrifying. And so I, I, I wonder if, like, if you could say, To all the women like me, what should be our first port of call to get a more realistic view of what is to come.

Rachel Lankester: This is gonna sound awful, but, but just read my book because it's all in there. Because I was so fed up of the narratives, I was so fed up of the scaremongering and the fear. You know, fear does not feed into health. There's you fearful of a natural transition in your life, and that's terrible. I think that's awful that you are fearful.

What about women younger than you who are being fed? Yeah. This narrative, it's, it's the same, you know? And. We know fear doesn't feed into health. We know that it can be a vicious circle. We know that if we expect something to be bad, it can become a self-fulfilling prophecy and it can be bad. Whereas if we feel empowered that this is another stage in my life, this is an evolution, this is, I'm is taking me somewhere good.

As Joy said, it's a tunnel. It is not a cave. It is not the end of meaningful life. You know, you are not irrelevant. Um, just my personal story. So I was given an early menopause diagnosis at 41, and I think on balance, looking back that diagnosis was wrong. Um, and I was tested because I was trying for another child and.

I went on a new regimen. I changed my diet. I changed the way I lived and having had the definitive diagnosis after five weeks I had a bleed and I had another test and I was told I was back to being premenopausal. So it was all very confusing. I think what was happening was I was in perimenopause, I was not through menopause and such was the, the lack of knowledge then.

But my first. Response to that diagnosis was that I was a dried up old prune. And nobody had actually told me that, but when I say those words, lights go off in women's eyes because that is their perception of menopause. That is their perception of aging as a woman, and that is what we have to change. We really have to change that, and we have to do it internally as well as externally because we get ageism outside, but we have internal ageism as well.

You know, I did that to myself, you know, that was my perception of me. So I think, you know, we have to find, you know, good role models. We have to, you know, listen to podcasts like this, you know, and, and just stay curious. I think for all women, if you hear anything about menopause, be curious. Where's it coming from?

Who's saying it? Why are they saying it? Does it benefit you? Does it empower you in any shape or form, or does it actually contribute to diminishing you as you age? And is there any money involved? Z I think you are absolutely right. I think a lot of this is driven by money. So who's benefiting? You know, if I fear menopause and I want to fix it because I've been taught it's a deficiency and it's something that needs to be fixed and my body is malfunctioning, then I'm going to invest in things to fix that.And that's gonna make somebody a lot of money.

Xand Van Tulleken: I've gotta say this in terms of disrupting my thinking about something that I would not have said I even had a strong view on. Uh, you have both. I literally want to go and grab my female friends Pre,, Peri and post menopause and be like, no, no, you gotta, I want to tell them about the whales. Like, it's so good.

Rochelle Burgess: So my final question is, You know, what is it that employers and the NHS could be doing to support women going through this transition?

Joyce Harper: So I've gone into a lot of companies and given talks on the menopause and how the companies can support women going through the menopause. I, I think it's a problem if we're creating a very negative narrative because we.

Are stigmatizing those women within those companies, and we don't want to do that, but we need to give them support. So heavy periods, hot flushes, things like this can affect their days at work. So they do need support. In my experience, the men do not engage in this. Unfortunately, EV, every time I've given a corporate talk, we've got a couple of men on, on, on the meeting and not enough, and the women are telling us they want the men to engage.

But I think if we try to train every male line manager about the menopause, I think it's, it's going to be problematic and I think the women will still feel uncomfortable going to get support of the male line manager. So my suggestion to companies are that they need someone within each company. Because I work in reproductive health, I would label them the reproductive health.

Ambassador. So they would also talk to men about like maybe they're going through fertility treatment or you know, if their partner may have had a miscarriage that would support men and women going through any reproductive health issue. Because I. The menopause is related to the whole of a woman's fertile year, so we don't, we shouldn't isolate it.

So, you know, the woman may have had problems with her periods before. She may be having perimenopausal problems, she may have endometriosis, whatever. So we, I, I don't like looking at menopause as an isolation. But if we have this reproductive health ambassador who is there within each company to support women and who would then learn and, and see many different scenarios, and they e everyone needs to really understand that every woman is different.

So, One issue is that they, they might, or a line manager might see a woman who is okay and has gone through it and she's not got a problem, but then the next woman's really suffering and they might, if they're not educated, they might think, oh, the other woman was fine. This woman's just making a big fuss.

So the last thing is I think, um, we need to let women have flexible working. So the, these periods that I mentioned, you know, can really be heavy and really disruptive to a woman's life. Let the woman work at home when she's going through these days where she's literally at high risk of flooding. She's worried about changing her, um, period product every hour.

You know, those sorts of situations. They don't last forever. They are transient. Those last few periods are problematic. We need flexible working. We need support within the workplace. We need someone who we know that the women can go to to get that support.

Rachel Lankester: And, um, I've actually been working on a new standard, which has just been published. It's from the British Standards Institute and it's on menstruation and menopause in the workplace. And you can actually, currently, you can download that for free from the BSI. Um, website and that gives companies and organizations a framework that they can, you know, it's easy to say, just do this, but companies often, they're not quite sure how to do it.

But, um, that actually gives organizations a framework for action. So I think that's a very powerful tool that's available now. Um, and I think, yeah, the key thing is I. I love Joyce's idea that actually menopause isn't stripped out because then it just gets so linked into ageism and you know what's ageism and what's menopause and, and then you've got gendered ageism and it's all too easy to tick the menopause box and not actually look at the other issues of gendered ageism and women in the workplace and making work work better for women in general.Also, ask women what they want.

Xand Van Tulleken: Have a meaningful relationship with your female employees like doesn't seem too difficult, it's like amazing. You have to say it. Those are, those are both incredibly sort of practical and and useful suggestions.

Rochelle Burgess: Thank you so, so much. One of the things that we do on this podcast, which is just I think really special is that we, we ask every guest about what has disrupted their thinking. So not disrupting our thinking beyond public health, but you know, in every space in our lives. And so we ask our guests about a piece of art or music or poetry or piece of the world that has disrupted, um, their perspectives.

And I'd love to hear from each of you what that has been for you. Rachel, let, can you go first?

Rachel Lankester: Okay. So, um, I was a bit worried about this question cuz like music, poetry, or art. I couldn't think of anything. And then I thought of actually a piece of music that was quite influential when I started out on this midlife journey and when I had started my Mutton Club magazine, which I'm glad you like Rochelle because there's an awful lot of women who hate it because the, the idea of mutton dressed as lamb just strikes fear into the hearts of women, whereas, You got it immediately.

I was trying to make it a club. I was trying to make it cool. So the very first podcast that I was a guest on, they chose some theme music for me, and I didn't hear this until I heard the podcast back and it was, Queen of Clubs from Casey and the Sunshine Band. And when I heard that, I thought, oh, I am doing something quite important and quite radical.

Whereas before I kind of thought, oh, it's just me doing a little bit of dabbling. You know? So that was, it was really nice. It was very affirming of, yes, I could be the queen of clubs. I like that.

Rochelle Burgess: I don't think I know that song, so I'm gonna have to go.

Rachel Lankester: It's on Spotify, listen to it. I play it whenever I need a little boost.

Rochelle Burgess: Joyce,

Joyce Harper: This is a great question. So for me, post menopause, I've always been a bit wild, but I think I've become wilder. So it's not a particular piece of music. But if you listen to my podcast, I say at the end, I always ask people where they're happy places and what makes them happy. And for me, it's dancing and ideally dancing in a field.

And I'm going to six festivals this year, and I did seven last year, so I'm about to do three weekends. Almost in a row of dancing in fields. And my favorite music to dance to that really gets into my body is techno and trance music. So I, I keep seeing these little memes of these older women dancing to some banging techno, and I keep saying, that's me.

So, yeah, for me it's. Reminding people that you can dance. You can always dance, and it's so great. So if you used to do it and you loved it, do it again. Go and go to those clubs. And the great thing about music now, the age range in clubs and festivals now is from every age. So I'm normally one of the oldest, but.

We can love all types of music, dance in our kitchen, dance in a field, and let's do it. Don't worry about your age

Rochelle Burgess: On that amazing note I hope everybody who's listening today is gonna go dance immediately after I'm gonna go dance.

Xand Van Tulleken: Thank you so much. You've both done the perfect thing. You have both been amazingly disruptive and even though we want to be disrupted, it still shakes you when it happens.

So, Thank you so much. It's totally brilliant talking to you.

Rochelle Burgess: You've been listening to Public Health Disrupted. This episode was presented by me, Rochelle Burgess and Xand Van Tulleken, produced by UCL Health, the Public, and edited by Annabelle Buckland at Decibelle Creative. Our thanks again to today's amazing guests, professor Joyce Harper and Rachel Lancaster.

Xand Van Tulleken: And in case you're wondering, Rachel Lancaster's book is Magnificent Midlife. If you'd like to hear more of these fascinating discussions from UCL Health of the Public, make sure you are subscribed to this podcast so you don't miss future episodes. Come and discover more online and keep up with the school's latest news events and research.

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