Simply Hormones Podcast

#18: Bio-identical hormones from your GP?

SH interviews Prof John Studd who continues to care about improving hormonal health in women. SimplyHormones Presents: Professor Studd on Bio-identical Hormones KC:      I'd like to talk if I may about bio identical hormones. A lot of women are very interested in this because they are told it's a more natural way to go because the hormones are absorbed in a more natural way than the equine oestrogen that's mostly prescribed. Do you have an opinion on that? Bio-identical hormones have been available in the UK for 20/30 years! PS:      Sure, I mean I've used nothing else but bio identical hormones for the last 20, 30 years. It's been very common in Europe and what's happened now is the Americans, now that they've overcome their love affair of horse urine and horse oestrones, they've just discovered it, they've just discovered the importance of using oestradiol, oestrone, testosterone and they've labelled this bio identical hormones and gullible people all around the world are thinking of this new American discovery which is a re-awakening on their part, a discovery of what we've been doing for 20 or 30 years and it's quite true. If I hadn't used Premerin for 20 years I think there's no place for it whatsoever. We're not horses, we're not plants either, we should use natural human hormones, and that is oestradiol, oestrone and testosterone EHEA, which is the precursor to testerone perhaps, and natural progesterone if you can, and that's all possible except the progesterone; we by and large use progestogen because it works. Progesterone cream doesn't work, it's not even absorbed, we've just spent, or I've just spent £100, studying this preparation and it's not even absorbed, it has no effect with the bones, the mood, the flushes, the sweats. KC:      It's not metabolised. Want effective Progesterone cream? Ask your GP for Utrogestan PS:      It's still a racket that you go on the internet for £35 a pot per month and it's a waste of your money. I wish it did work, it would be very, very useful and convincing logically and so we really, although we use the bio-identical oestrogen and testosterone we are by and large stuck with sythentic norethisterone or Provera, although there is a more natural progresterone called Utrogestan, which is effective, and so the compromise is that I use this almost natural progesterone Utrogestan. KC:      So are the bio-identical hormones that you ‘re identifying with, where are they derived from, are they? Hormones naturally sourced from Vegetables PS:      They all come from a laboratory. They don't dig them out of the ground or dig them from trees, they are all made in a laboratory, by vegetable precursors and they're pure and they are the same as the natural hormones in your body and my body. KC:      So it's just a case if women really want to go down the road of  bio-identical hormones it's really only available from a private practice isn't it? Get your bio-identical hormones from your GP! PS:      No that's not true. There's no reason why a general practitioner should not give you oestradiol either by tablets or preferably transdermally, that's by patch or by gel, that would be my ideal way of giving hormones, through the skin, just rubbing the oestrogen gel or testosterone gel, or a patch, but the patch caused rings, black rings where they use it very much or with an implant of course, which is very effective, a very convenient way of giving natural oestradiol and natural testosterone. KC:      That's very interesting that you've explained that more fully, women can now go to their GP and say that I heard that you can prescribe me XYZ and they are then getting a la carte prescription aren't they? PS:      They may choose not to, and this happens more and more these days, and so many GPs have just shut up shop for HRT and the menopause and there's no justification for it and it's wrong. GP's could offer effective, cheap treatment KC:      ‘Cos there are about 7/10 women that experience debilitating symptoms, so it's not good on their part that they are not getting the advice they need. PS:      They are not getting very simple, very safe, very beneficial treatment. It's also very cheap treatment. KC:      Yes, OK, we'll have to stir up the GPs then to get their act together. I know the British menopause society is trying to push for GPs to be more informed. PS:      We've been trying that for now for 20 or 30 years! KC:      Yes, trying to get everybody singing from the same songsheet it's a difficult one to achieve isn't it? Thank you very much for that. Interview ends. If you’d like to know more about Professor John Studd: www.studd.co.uk Professor John Studd DSc, MD, FRCOGwas consultant gynaecologist at the Chelsea & Westminster Hospital, London and also professor of gynaecology at Imperial College. He is now in fulltime private practice and runs theLondon PMS & Menopause Clinic at 46 Wimpole Street London W1G8SD. At the same address he hasThe Osteoporosis Screening Centrefor the assessment and treatment of osteoporosis. He is Vice-President of the National Osteoporosis Society and Chairman of the British Menopause Society. In 2008 he was awarded the Blair Bell Gold Medal of the Royal Society of Medicine which is given every five years for the obstetrician/gynaecologist who has made the greatest lifetime contribution to the specialty. www.studd.co.uk [http://www.studd.co.uk/] For information on Menopause in a non-medical setting, there are over 200 pages waiting for you  at www.simplyhormones.com Average Rating: 4.4 out of 5 based on 233 user reviews.

#17: Osteoporosis - the brittle bone disease you can prevent

SimplyHormones presents: An Interview with Prof John Studd, Vice President National Osteoporosis Society and Chairman of the British Menopause Society.  Osteoporosis is a natural disease of aging but one we can ALL do something about – this brittle bone disease most often eats away at bones  after degeneration of hormones at menopause. SimplyHormones Presents: An Interview with Prof Studd on Osteoporosis [http://simplyhormonespodcast.com/wp-content/uploads/john_studd.jpg] [http://simplyhormonespodcast.com/wp-content/uploads/john_studd.jpg]Prof. John Studd KC:      I'd like if I may now to talk about osteoporosis, the silent disease as it's often described. It's something I very much don't want to happen to me, I just can't visualise myself walking down the road with a zimmer frame. The press and magazines, womens' magazines are full of information telling us that we are supposed to be doing lots of exercise, weight bearing exercise, having better nutrition, in order to stay fit and healthy and stop the degeneration of our bones. What would you say, is that the right answer? Overweight? You won't get osteoporosis! PS:      Well there is some truth in that, but it's more complicated. Having a good lifestyle, good diet and exercise is very good for you and what about exercise, it's very good for the brain, it's very good for the heart, it's very good for the mood, depression etc and in large amounts it's not bad for the bones, but I think it's somewhat of a deception to think that if you just keep a good diet and you're exercised by walking the dog for an hour a day, then that's going to prevent osteoporosis, and I see it very often, you have these healthy 60 year old women, slim, healthy, who walk for 2 hours a day, with a dog, without the dog and they've got rotten bones. And they mustn't think that because they are dog walkers and they exercise, that they are free from the risk of osteoporosis. Particularly, as I say, the thin women, the healthy thin women. By and large fat women don't get osteoporosis, and the reason for that is because with this excess fat they make oestrogens in their body fat, and that protects the bones. Thin women and anorexics at risk of osteoporosis The thin women don't make the same amount of oestrogens, so they are at higher risk, although they don't know it, if they have a healthy lifestyle with lots of exercise. So it's these women, they may have the menopause, they may have had anorexia when they were young, and they were very thin and healthy, and have lost their periods for 2 or 3 years when they were teenagers, they're the ones that are at risk, whether they exercise or not. KC:      I suppose that's why women have a natural propensity to gain weight as they go through menopause, because their cells are changing into fat cells instead of energy cells and in our day and age that's something we don't really want to see, women don't enjoy putting on weight, but actually it's good for us. Weight gain in men and women is complex PS:      Well, weight gain in men and women is a complex thing, I don't think it's that simple. As you get older you do less exercise, you probably eat more, you might even drink more. KC:      Metabolism is slower. Fact: HRT does NOT cause weight gain PS:      Metabolism is probably slower with age, so you tend to put on weight and I don't think it's a great deal to do with hormones, it's to do with age and exercise. And the same thing applies to giving HRT, because HRT causes weight gain when it doesn't .  All the studies looking at thousands of patients over the years, what we call a longitudinal study does not show any increase in weight with HRT. There is an increase in weight, a small increase in weight with age and the menopause, but not HRT. Now that's quite clear, but of course there is the occasional woman who has an idiosyncratic effect of oestrogens who does put on weight.  You stop the hormones and they loose weight so you have to accept that. But if you are looking at a big population apart from these odd cases you don't really put on weight with hormones. I used HRT and did not put on weight – that came later! KC:      No, I found that myself actually.  Thank you very much. Here is a brief bio of Professor Studd together with his contact details: www.studd.co.uk Professor John Studd DSc, MD, FRCOGwas consultant gynaecologist at the Chelsea & Westminster Hospital, London and also professor of gynaecology at Imperial College. He is now in full time private practice and runs theLondon PMS & Menopause Clinic at 46 Wimpole Street London W1G8SD. At the same address he hasThe Osteoporosis Screening Centrefor the assessment and treatment of osteoporosis. He is Vice-President of the National Osteoporosis Society and Chairman of the British Menopause Society. In 2008 he was awarded the Blair Bell Gold Medal of the Royal Society of Medicine which is given every five years for the obstetrician/gynaecologist who has made the greatest lifetime contribution to the specialty. www.studd.co.uk [http://www.studd.co.uk/] You will find a huge variety of information on menopause at www.simplyhormones.com. Over 200 pages of qualified information. See you again soon. Kathryn Colas signing off… Average Rating: 4.5 out of 5 based on 292 user reviews.

#16: Testosterone puts your lights back on!

Testosterone for libido, oestrogen for depression – when the imbalance of hormones with monthly PMT and later on menopause are the cause depression, why are women referred to psychiatrists and prescribed mind-numbing anti-psychotic drugs? You may well ask! Prof. John Studd, specialist  obstetrician and gynaecologist tells us here, in the first of three interviews, about his quest to break down barriers in the medical profession to correctly treat women when hormone imbalance is not obvious. SimplyHormones Presents: An Interview with Prof John Studd on Testosterone, oestrogen and depression [http://simplyhormonespodcast.com/wp-content/uploads/john_studd.jpg] [http://simplyhormonespodcast.com/wp-content/uploads/john_studd.jpg]Prof. John Studd KC:      I wonder if we can start in this interview by talking about low levels of Testosterone. Headlines that are attracting a lot of media interest, especially in space are talking about this, how men can improve their sex life just by having more testosterone. What's your view  from a woman's perspective and the menopause? JS:      It's certainly true, there's a relationship between Testosterone and libido and levels of Testosterone and ease of orgasms and so on, and we've literally known for a long time, and certainly in this country we've been using Testosterone for many many years. So it is not an American discover, it really is not.  They are becoming aware about Testosterone about 20 years after we have in Europe, mind you the Americans are rather keen on treating men with Testosterone and they are just getting round to treating women with Testosterone. We forget that Testosterone is a normal female hormone. Women have 10 times Testosterone in their system, it's just that we men happen to have more than women, thank the Lord, so it is not a male hormone, it's not a foreign hormone and I would think that of all my patients that have HRT in various forms, probably about 80% have Testosterone as well as Oestrogen, and the reason for that is that it is good for their energy, good for mood, depression and of course for libido. They generally feel better if their Testosterone levels are at the correct level. KC:      And I've read and even attended your lecture, when you've spoken in depth about this, but what do you think about the placebo effect? Do you think that plays a part as well? JS:      There's a placebo effect with any drug that you want to give, this is why it's a very important that the study that we do have a placebo belonging to it. And I think I wrote the first paper on ‘Testerone and Placebo' about 30 years ago and that was an uncontrolled study, and it is the one paper in my career that I regret writing up inadequately, because I did not, then, 35 years ago have a placebo belonging to it, so you are absolutely right, the results could all have been worthless, in fact they are not, they've been repeated many times and it's quite clear that apart from a placebo effect there is an extra effect of Testosterone. KC:      Yes, so it's beneficial. JS:      There is no doubt it's beneficial to women. KC:      And I've also read that you feel it's beneficial, especially for depression as well. JS:      Yes, absolutely. Depression in women is a complex thing. Much of it is hormonal, and improved with Oestrogen, transdermal Oestrogen; that's Oestrogen put through the skin by gels, patches or implants. And also the addition of Testosterone does improve mood as well. And it's very important because depression is more common in women than men and it occurs at times of hormonal fluctuation, like pre-menstrual depression, post natal depression, depression around the time of the menopause, depression after removing ovaries at hysterectomy. All of these types of depression in women should be treated as first option by Oestrogens and perhaps also Testosterone. KC:      So there are a lot of benefits there and thank you for making women more aware of what it can do for our health. JS:      What I would like to do is make psychiatrists more aware of this, because psychiatrists are very unwilling to treat this sort of depression with Oestrogens and it's obvious to any woman if they have depression that's cyclical, every month, for 10 days every month, it's related to their periods. Psychiatrists don't see that. There is a severe depression, which is pre-menstrual or post natal, it's an endocrine problem, it's not a mental, psychiatric problem and the first option of treatment should be oestrogens. In the case of pre-menstrual depression, to suppress ovulation; if you suppress ovulation you suppress the cyclical hormonal changes whatever they are, which reduce the cyclical symptoms of PMS. It's very obvious and it is very effective treatment. KC:      And so many women are experiencing PMS. JS:      Well they're given anti-depressants, worse still. I certainly have patients who have spent a month in a private psychiatric hospital for their PMS or for misdiagnosis of bipolar disorder and they are given heavy duty anti-depressants, mood stabilisers like lithium, or worse, when they have an endocrine problem that is so easily treated with Oestrogens. KC:      Yes, I must admit when I was going through menopause I self-diagnosed myself as being leaning towards bipolar because there moments, days when I was on a complete high and other days when I was in the depths of despair and that can be quite frightening, to be referred to a psychiatrist as I was, was quite frightening as well, but I declined the heavy drugs and went for the talking therapy, which did get me through it, but it was emotionally quite painful. Thank you for that information. See below for a short biography of Professor John Studd together with information on http://www.simplyhormones.com [data:image/png;base64, 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

#10: Cervical Cancer is a known STI

My interview with Gill Burgess tells you everything you ever wanted to know about this silent killer; cervical smears – why they’re important and much much more.  Gill Burgess is the Cancer Screening Co-ordinator for Croydon PCT, specialising in Breast, Bowel and Cervical Cancers. Gill is innovative and forward thinking – just listen to what she has to say and the full transcript appears below. Interview with Gill Burgess on Cervical Cancer KC:  Hello everyone, it's Kathryn Colas here from SimplyHormones.com and I'm here today talking to Gill Burgess, who's a Cancer Screening Co-ordinator for Croydon PCT (NHS Primary Care Trust) and her speciality is breast, bowel and cervical cancer, and we're going to be talking to Gill this morning on cervical cancer to see if we can find out some more about it. So good morning to you Gill. GB:   Good morning. KC: We're going to be talking about cervical cancer, and I think the first thing our listeners would like to know is what is it exactly? GB:  Well, it's the most common cancer affecting women in developing countries Kathryn, and it's caused by Human Papilloma Virus, which is an infection of the cervix. It's associated with cellular changes which can be detected early on under microscopic examination; for example the smear test. HPV infection usually clears within a few months, I think it's about 90% within 2 years. The problem is it's persistent infection beyond 12 months which is associated with the high risk of cervical cancer. KC: And who is most at risk? GB: It's transmissible mainly in the younger age group.  You find most of it in women under the age of 30, but it's younger people that will pick up this virus. It's a very transient virus and it just goes from one to the other very very quickly, but like all viruses they move on as well, it's those, that as I said earlier, that persist that create the problem of cervical cancer. And only a very small proportion will go on to develop the cancer as well. Diagrams detailing the uterus and cervix (161.gif) [http://www.patient.co.uk/pilsinl/161.gif] KC:  So it's still quite rare in a sense? GB:  Yes the risk infection is soon after sexual activity begins. In some populations               there is another peak among women actually at the menopause in older women, and although HPV is sexually transmitted, penetrative sex is not required for transmission. Skin to skin genital connections, penile to vulva for example, contact is a well recognised mode of transmission. KC: That throws a different light on it, doesn't it? GB:  Yes, I think some data was brought up a while back on age specific prevalency of HPV, suggesting that there's a pattern of infection between regions and socio- economic groups. Also HIV infected individuals are at a higher risk of HPV infection. And they can be infected by a broader range of HPV types. So if you've got HIV you've got a low immune system and you're very sexually active with different partners, then you are at a much greater risk. KC: I've also, continuing on risk, I've read some research that says the pill could increase the risk. Do you have a view on this? GB:  Yes, there are risks to the pill. It is actually one of the contributing factors alongside having a lot of children, at the early age of the first sexual activity. Cigarette smoking is another huge factor. And long term use of the pill, you're absolutely right, it is another risk along with co-infections like Chlamydia, because persistent infection, again, this is the risk factor. And the peak prevalence of the infection is in women under the age of 30, and, as I said earlier, those that are actually over the age of 50 going through the menopause. KC: So you say long term use of the pill, what would you describe as long term? GB:  They won't give the pill to obese women, or women who are over the age of 35 or women that smoke, because there are risk factors involved, but to me the pill is a better scenario than getting pregnant, because pregnancy is the biggest risk factor of all. So the pill is a contra-indication, a slight one, but then so is smoking. Smoking is a huge risk. KC: And it's better to stop smoking. It's all relative isn't it? You've just got to take a balanced view, because all drugs have side effects of some kind or another and you've just got to work out whether the benefits are greater than the risks. GB:  If you put somebody on the pill you've got look at their risk factors. You can ask the question about sexual activity, I don't know whether I would. If you get a girl in who wants to go on the combined or contraception pill and she is a smoker and you can talk sexual history to her, you could say “well actually the pill is a risk factor” and you could offer alternative methods of contraception. But there is a way round it.  But as you said quite rightly, smoking is what we need to get rid of first and foremost. KC: Yes, that's a killer for everything, a big no, no! Just touching again on the over 50 age group, which of course is what I fall into and post menopausal women, I don't think women of that age group fully understand why they have suddenly become vulnerable and of course it's because the divorce rate is now much higher within that age group so of course they're changing partners and exposing themselves to the same risk. GB: They are Kathryn yes, you're absolutely right. And I think you've got to look at the screening and the risk factors to women over the age of 50 and then tame the screening programme actually to individual needs and it is all about divorce rate and women becoming more sexually active. Woman today have a lot more sexual freedom and they are very happy to have much fuller and richer lives than our previous generations did. KC:  So just when they thought they could throw the whole thing wide open and say “yippee” now there's no risk of pregnancy and all the rest of it, all of a sudden they've still got to be careful of who they have sexual relations with because this is a sexually transmitted disease, as we've already discussed. GB: And another consideration of course is that men are also becoming more sexually active. We're not taking into consideration what the men are doing as well. Because men have got more money at retirement age haven't they? And they're meeting older women and so that's something else we need to be thinking about really. At what age should we stop doing cervical screening? Should we extend it into the older age group?  I know that some research has been done on that in the last couple of years but that again comes with its own little set of risks because if you start taking smears from women that are over age 65, you've then got the problem that it's difficult to take a smear from a woman who's over 65, because she's got the risk of vaginal atrophy, then you're going to a whole new world aren't you. KC: I'll just explain to our listeners a bit about that. That's vaginal dryness. I'm always standing on my soapbox about this, as you know Gill, because it's not really addressed properly in the doctors surgery, if women ever get that far because it's such an embarrassing subject, it's usually when they go for a cervical smear that the problem arises because the swab can't take the test. GB: Yes, that's right. KC:  But touching on the screening programme, there is a national screening programme in place for cervical cancer, so it sounds to me like there's a fixed age group at the moment, is there? GB:  There is, it's 25 to 65. KC: So it's quite broad then. GB: It is, we stopped screening under 25s, five years ago, although there is some controversy about it, because girls, if they've had early sexual relations and they've had a few partners, they feel that they ought to have a screening test done and it can be quite controversial and it took us a long time to get over to people that this is a screening programme, it's not a diagnostic test and so we have to be looking at signs and symptoms and I see many girls in my clinic, saying to me “please Gill can we please just do the smear test”.  I'm a great believer is educating women so I spend a lot of time showing them pictures and demonstrating exactly why we're doing it, what we're doing and what the outcome is and if they've got symptoms then we look at why. Why have they got bleeding in-between periods, or they might have another infection. It might be that they have missed the pill or the pill packet is out of sync. There are different reasons, so you would then refer these women to the GUM (Genito Urinary Medicine) clinics or the GP who can take swabs from these women to test for sexually transmitted infections and that has to be ruled out. The answer is not to get a woman in when she's 22 to start taking a smear test. KC:  It comes back to this, where we are in society at the moment, that we rush off to the doctor as soon as something is wrong and ask for a magic pill and we've just got to recognise our own bodies more, understand what's going on, and with people like you teaching us how to recognise things, and what we can do about it. GB: That's absolutely right and the cervix doesn't actually mature until the girl is probably 20-21 so if you start taking smear tests under that age you will automatically get an abnormal smear result in most cases. KC: So it's not helpful is it? GB: It's not helpful at all, it creates huge amounts of anxiety within the girl and the mother, or the parents, or whatever. It's a really difficult situation sometimes, but it's educating people, it is all about that and lots of explanations. KC:  Gill, can you describe to us what actually happens in a smear test?  They're called up for a smear test, they go along to the clinic for their appointment, and I know lots of girls and women might be very nervous about what's going to happen next. GB:  I opened my own cytology clinic (cytology: the study of cells), a womens health clinic almost 8 years ago, as an alternative to a GP and the reason I talk about that is because I worked in a nurse-led scenario, on a huge housing estate, looking after many single women and their children, and one of the things I found was that the women were never having their smear tests done because they were so terrified of the smear test, and it could have been due to child abuse or rape or domestic violence, whatever.  And these women were the women not coming for smears and I was very agitated by that because I couldn't understand what the problems were. So I was hell bent on educating them and then several years later I was given this wonderful opportunity. I put in a business plan to my PCT and said “let me have an alternative to a GP practice.” So I opened my own clinic and I went off and did  psycho-sexual training in London and I was able to recognise why these women don't want to have their smears, and as I said earlier it's all based on fear and lack of understanding. So what my clinic offers them is time, and there's comfort and we have long chats, and if they come and they're terrified, it can take up to something like 4-6 sessions to take the smear, but we find out what the problem is. So when they arrive, providing it's a nice normal scenario when women arrive for their smear, you explain the procedure, you do a sexual history, you talk about their menstrual cycle, the children that they have. You talk about what contraception they're using and I always ask the question “do you know why we take the smear?” and 90% of them will say ”well it's a test for cancer”, but of course it isn't a test for cancer, it's a screening programme. And then I will bring out my little pictures, I'm a great one for pictures, and show them where I'm taking the smear from, what's happing in that little corner and what the results are likely to be. And then I'll explain that they will have a letter from me, or their GP, or the screening programme, very quickly, to tell them what the result is. I show them where they have to lie, it's all very private and confidential and then the smear is taken and it's a very easy insertion of a speculum and then you just quietly take cells using a very soft brush. The cells are put into a pot and they are sent off to the laboratory.  It's a great opportunity for women to discuss all areas of their sexual life if they want to, anything they are unsure about. KC: I think that's very helpful Gill, because I think so many women think that when you're going for the cervical smear, as you said, we think it's to see if we've got cancer or not, but you're just testing for abnormal cells, and when you find those abnormal cells you can take action to clear those abnormal cells. It's not cancer. GB: I always say to women if you found a lump either in your breast, or your nose, your ear or wherever, you'd go and show somebody. But down there you can't see a damn thing, you know you can't see anything, so we take cells to have a look at what the changes might be. It's a screening programme, it's excellent. Well worth doing. KC:  And you've also explained in there, you get people that don't turn up for their appointments? GB:  Oh yes, the DNA (did not arrive) rate in my clinic is pretty high actually, so we have shortened appointments, but women get very fearful, of course if women have got their period it's not useful to take it then, and you can't take a smear on anybody who has just had a baby, you have to wait till they are 3 months post natal, because hormones need to go back (to normal), but culturally women don't agree with it, there are certain cultures that don't think it's a good idea. And of course many cultures are not sexually active and don't want to have smears and we have to recognise that as professionals, it is a screening programme, it's patient choice isn't it? And it's about recognising that the opportunity's there and if you want to take it you can, so professionals have to be very careful that we're not forcing the issues, if you understand what I mean? KC:  Yes quite, but it's in your own best interest to take part really isn't it? GB:  That's right, absolutely. KC:  And finally Gill, you've mentioned the HPV, the human papilloma virus as being a major cause of cervical cancer. Would you like to say something about the vaccination that is now available and how it helps, etc? GB: Yes, it came out about 2007, 2008 I think. There were two types of vaccines. As we said earlier, one of them looked at four different types of virus and the other one, two. And we chose Cervarix, because, although it covers two viruses it was the one that has had the longest evidence from America, it's now up to 8 years, whereas the Guardasil didn't have the amount of evidence.  A lot of people thought it was about  costing, which one we would use, but in fact it wasn't, it was just that the Cervarix had a longer evidence-base against it in America, so that's why it was chosen. It's actually given to young girls between the ages of 12 and 13 and they get three doses over a six month period. They (the researchers) are constantly looking up all the information on this file, the evidence goes on all the time in America. KC:  I think I'd like to add in there, if the girls miss that vaccination at 12 or 13 is it recommended that they have it later on, or what happens then? BG: They can have catch up on it. It was recognised I'm sure that it was not cost effective to run a national vaccination programme for women over the age of 18, which is because as soon as the woman has started to have a sexual life is at risk of catching the virus anyway. And women not covered by the vaccination programme will still be invited to be screened routinely as part of the programme. Tests for HPV vaccination exist but these are primarily for use for research purposes and not normally available on the NHS, but I know that there's a lot of work being carried out on that. KC: And I also think another key area is what you've just said, that those girls that are invited for vaccination aged 12 & 13 will also be on the screening programme at the relative time later on, it doesn't mean just because they've had the vaccination they don't need screening any more, I think that's very important too. GB: Yes. It's my granddaughters that will be the beneficiaries, I feel, of all of this, it's not going to be immediate. It doesn't mean to say that were going to stop taking smears because of the vaccine. The largest bonus for me is that it's the first vaccine against cancer and that's got to be a real bonus hasn't it? KC: Definitely, yes. GB: Absolutely. KC: Something that can really help and my very last question to you today Gill, is to do with sexual discrimination!  The HPV virus as we know is a sexually transmitted infection and it seems to me that what's good for the gander is good for the goose, so why aren't the boys in on the vaccine programme? GB:  Well I think the thing to remember is that because it's a relatively new vaccine, there's insufficient evidence to know what would happen to boys. There's also a cost issue as well, but also vaccinating the girls will also reduce the transmission to the boys won't it? So there is that school of thought. And this should lead to the reduction in rarer forms of cancer caused by HPV in both boys and girls, so I think with all of this, cost is the thing. I'm sure in America they'd love to vaccinate the boys and yes if it goes out there it will probably come over here, but at this point in time it's still very new and we're still learning a lot, but you're quite right as far as sex discrimination is, why not? Perhaps we should have given it to the boys first? KC: Listening to you speaking perhaps the boys need a slightly different vaccine, because of course they don't have the same hormone structure as girls. It may be a whole different ball game for them altogether. GB: Yes that's right, but certainly vaccinating the girls will reduce the rarer forms of the cancer, which is the big bonus isn't it? KC: That's brilliant. Thank you so much for that Gill, we've covered so much today and I think I must just reinforce to tell everybody to turn up for their cervical smear when they're called forward. GB: I have a very good motto actually you know: ‘never fear to have a smear'. KC: I like that. GB: It's not as painful as people think; it's just that it is about looking after yourself. KC:  And not worrying unnecessarily. GB: That's right, absolutely. KC: Well, thank you very much Gill. GB: Thank you Kathryn. KC: It's just been brilliant speaking to you and I'm sure that this information that we've discussed this morning will be of help to a lot of women. For further information on this subject please go to http://cancerhelp.org.uk [http://cancerhelp.org.uk/] and http://www.patient.co.uk/health/Cancer-of-the-Cervix.htm [http://www.patient.co.uk/health/Cancer-of-the-Cervix.htm]. For more information on any aspect of menopause, please visit http://www.simplyhormones.com [http://www.simplyhormones.com/]. This interview was brought to you by Kathryn Colas of SimplyHormones.com Average Rating: 4.6 out of 5 based on 224 user reviews.

#3: The Pill is it right for you?

Listen to Alexandra Pope discussing HRT, The Pill; their toxicity and what is the tsunami of menopause? Such powerful information – if only I knew then… [http://simplyhormonespodcast.com/wp-content/uploads/Alexandra-Pope1-144x150.jpg] [http://simplyhormonespodcast.com/wp-content/uploads/Alexandra-Pope1.jpg] Transcript of INTERVIEW with KATHRYN COLAS and ALEXANDRA POPE Hello, Good morning. It's Kathryn Colas here from http://www.simplyhormones.com and I'm here today with Alexandra Pope. Now Alexandra, together with Jane Bennett wrote a book called: ‘The Pill, are you sure it's for you?' And I think it's absolute reading for everyone. Alexandra is also featured in a documentary called The Moon Inside You which has already been seen in a number of countries. Some background to Alexandra is that she was originally a teacher of English in both the UK and Australia before training as a psychotherapist and in Psychosynthesis resulting in 20 years of private practice in Australia. She now continues in the UK and Europe, running private and public workshops on menstrual cycle education. Kathryn Colas: Now, Alexandra, Good morning to you… Alexandra Pope:  Good morning to you, Kathryn. It's lovely to be talking to you like this. KC: Thank you, yes, we have been trying to do this for ages, haven't we AP: We have indeed KC: I'd like to start with your book, Alexandra, The Pill, are you sure it's for you. Now I've read your book and found it so informative. Tell me, what prompted you to research this subject  and write a book, together with your co-author Jane Bennett and what's your connection with Jane? AP: Well, I'll begin with my connection to Jane. Jane and I have been friends for a number of years. This is in Australia and we both share a passion for menstrual education and Jane was particularly focused on girls work and has written a book in that area, you know, preparing girls for their first period and I, of course, was doing all the women's work and so we would often rave about our favourite topic and we would also bemoan the low status that menstruation has, you know, that it just seems such a negative in our culture and we are just passionate about transforming that and what brought us to The Pill, was that Jane, herself, is a teacher of natural fertility management which is teaching women how to chart their cycles for birth contraception and conception purposes and so that is her area of expertise and she has written in that area and works with a very well-known Australian woman, Francesca Naish and then of course I was doing the menstrual work and women often use the pill for dealing with menstrual problems. Both of us were tracking the research, you know, as it would come out, it would be in the press and would be more research on the dangers of the pill and always this research was dismissed as it's not, you know women, don't really have to worry and oh, yes, yes that it causes and potentially causes this cancer and that cancer and don't worry, keep on taking it. KC;  It never seems to make the national press does it AP: It never seems to cause any kind of wake up. My God, this is a drug that is having all these side effects. It seems to have some sort of diplomatic immunity from any kind of questioning and the medical profession, generally speaking, there are individuals but they don't speak out. We know of them because women have told us and individual doctors have spoken with us but in general the medical profession sees the pill as entirely safe that the jury is in. It's safe. Women don't have to worry; they can go to sleep now on contraception, you know; take the drug, don't worry, that's contraception solved. Big tick there let's go on and do something else and actually, Jane and I are saying, no, no, no! The research is compelling. And anyway, it's a drug, you know and all drugs have consequences and you're shutting down a really vital system in women – the menstrual cycle. You can't shut down a cycle and not have consequences. KC; Absolutely, yes AP: So Jane and I were getting more and more apopleptic and with rage and then, one day, we looked at each other and said: why don't we write a book on the pill because no-one was writing on it. No-one was speaking out and we looked at each other and said: Oh, we should do it and then we both went,   oh, no, not another book! Ha, ha, ha and how do we find a publisher and so on, but of course the book wouldn't let us go. You know how it is. And of course the rest is history. KC: Yeah, and you say in your book: a woman who appreciates her menstrual cycle can deepen knowledge of herself, build self-esteem and develop high sensitivity and so thereby, contrary to that, by ignoring this monthly function it's more or less declaring that we keep saying to ourselves that we're unclean and that has the opposite effect which results in, you know, bad health and low self-esteem, yes, absolutely. But we don't seem to have the knowledge to embrace the menstrual system, do we. We've totally ignored it for so long. AP: We have, indeed. It's really interesting. I mean, there's a huge cultural taboo around really valuing the cycle and I love when I run workshops, I love to begin with a silly example to try and make a point. Imagine going to your doctor and your doctor says: Ah, you should ignore your circadian rhythm, that's your day/night rhythm, you know it's such a waste of time, you having to sleep eight hours a night, you could be doing so much more. You know, take this drug, you know you can stay awake all the time, you know it's so much better and you would think your doctor was seriously mad. You know you'd probably be reporting them to the Medical Council. So, how come, we women have got caught up in this thinking that the menstrual cycle is somehow expendable, that there are no consequences to shutting it down and we are talking about our fertility system. This is our capacity for creating life. This, surely, has to be the most awesome cycle on the planet! KC: That's right. And I suppose it's very difficult to have a balance because when you look at young women, just starting out in life and not necessarily being promiscuous but certainly being sexually active and as a mother I know I feel very protective of my own daughter and that I would rather she were on the pill at this stage because I think their education and being up front with boys and saying, you know, have you got a condom and all the rest of it, it just ain't gonna happen, is it. I feel quite strongly that it benefits younger women until they start to understand more. AP: What you bring up, Kathryn is a really huge and very important issue and we do address this in the book. You know, how do we deal, how do we approach our teenage daughters. And, obviously there are no clear cut answers and one of the themes of our book is really empowering women to make their own choice. So we're not preaching: you should do this, or you should do that, so just some thoughts around this. As long as we have a culture, Kathryn, that doesn't value the cycle and doesn't empower women around the cycle, girls aren't going to value it, so we do need a cultural shift, so essentially, it's not something that's going to happen overnight but this is our high dream for Jane and I. Our high dream is that girls are firstly given wonderful preparation for their first period and it's not just plumbing, you know. It's actually more emotional as well as all the technical stuff. It's really dealing with their feelings and giving them a really positive message and we've really done a lot of work on this in Australia in this area and it's really exciting what we've seen in girls, with this. We've also done mother and daughter work around this and it's so empowering. So, girls really get this lovely bond with their mothers instead of this negative thing around menstruation and its' so important, that and once a girl is menstruating the girl needs another level of education which is to teach her about her cycle as a self-care tool, so we're not even talking sex, although sex is going to come up, obviously but it's about teaching the cycle as a self-care tool, so Jane has been doing a lot in this area to teach girls how to chart their cycles. You know, how to read the signals and signs of their bodies and to teach this as personal development tool, as a fundamental personal development tool for girls. And then, research time and again shows that when girls are properly educated around their bodies and around sexuality, they start having sexual activity later. So, education in itself is a very powerful means of prevention, here. And then, you know, our feeling is that girls should have body literacy  so that's our emphasis and then when you come to have the conversation about contraception, yes, you talk about the full range and the truth is, girls have to use condoms anyway for protection against STD's (STI's sexually transmitted infections). They've got to get the message, you've got to use a condom. Now if they're more conscious about their cycles they're going to have more self-esteem, more confidence to be able to take care of themselves . I'm not saying it's 100%. Nothing is 100% and what we have to emphasise here is that the pill, whilst it looks like something really safe, it's not 100%. You know if girls forget to take it for one, two or three days, they have the same protection as a condom. Finally. I mean the other key thing here is, some people would then suggest, well give them an implant, you know or the injection then there's no problem with them forgetting but the health hazards, the health consequences are awful, Kathryn and the earlier you go on the pill and these other hormonal forms of contraception, the bigger the consequences are going to be, especially further down the track, so we feel education, education, education in a really wholesome, menstrual affirming, woman affirming, girl affirming way and then let the girls make their choices. KC: Yes, I think you're absolutely right and what brought me into this, as you know, I deal with the other end of the cycle, I'm dealing with menopause and it was as a result of my own research into that, that took me back into women in their 20's and 30's with PMS and then, of course with my own daughter beginning the cycle, she and I both understood it more because she was just beginning and I was just ending, so the whole thing clicked and that took me into schools and I thought, why aren't we educating more at that level and even boys to getting them understanding, what's going on in women's lives with these hormones and then, perhaps we'd all have a safer passage right through to the end but that links me nicely in with menopause, Alexandra, because as you know, I created my own website, www.simplyhormones.com [http://www.simplyhormones.com/] to raise awareness of the trials and tribulations of menopause and in the light of ‘the million womens study' a few years ago, now, on HRT, I wanted to ask you: what are your thoughts on the pill and HRT. Do they share any common ground? I know that HRT is not a contraceptive and women must understand that, that just because they're on HRT they could still become pregnant but what are your thoughts, you know, comparing the two? AP:  Um, they share a common ground in the sense that they are both delivering synthetic hormones to a woman's body. And so, they will have similar kinds of side-effects. They will have side-effects because they are potent drugs. They are both listed as a class 1 carcinogen by the World Health Organisation. This means that they are cancer causing and they're in the same category as asbestos and tobacco. Now, I've re-checked that just recently, because… KC: Good grief! It sounds unbelievable, actually, doesn't it. AP: I know and I thought to myself my God, why isn't that statement out there? And then I started to doubt myself and I thought, no, no., I shall go back and check it and there it is and it is a known carcinogen. You know, it's a drug, it's a potent drug and I think the thing is, they both give the message to the female, to women, that the menstrual cycle is a problem… KC: Alexandra, what do you mean by that? AP: What I mean is that women see and actually this is also the message that's now being given out by the medical profession more and more, sadly, that the menstrual cycle is a problem in women in that it, ah, it's quite an interesting question, actually. It's seen as a limitation or a weakness to a kind of normal successful, healthy life and if women didn't have a menstrual cycle, they could be as successful as men. KC:  I think that is the picture that is being painted, isn't it? I don't know what the stats are but there are a lot of women out there, certainly that I know of, that are taking a particular pill and they don't menstruate at all. I spoke to one woman who hasn't menstruated for years, and she thinks it's great. AP:  Oof! Oof! oof! I feel for her body when I hear that. Yes, it's a real problem this. I mean, historically, the menstrual was seen as a limitation, that it weakened us, that menstruation weakened us and that therefore we were not fit for high office, you know whether it was economical, political, or business, or whatever and then, you know,  feminism came along and started to shift that and the message we got with feminism was that women could do anything they want whenever they want and I think that's a fantastic message and I think that message is still true today and what I'm introducing here is the notion that, yes, we have a menstrual cycle and this menstrual cycle can be a huge asset in all sorts of different ways but counter to that we are also getting the return of this old message that menstruation weakens us, that the menstrual cycle is a problem and that menstruation causes all sorts of health problems, you know, weaknesses and I think the weakness is not that menstruation weakens us it's the thinking we have around this that weakens us and the moment that a woman starts to appreciate her menstrual cycle and the different kinds of assets and powers she can tap into, it would be like the lights going on inside her, it's a whole new kind of world or consciousness that she can open up to within herself. Yes, that's really what I'm kkkkkk at here. KC: And also you were mentioning back on an historical note and actually it's not that long ago when they were locking away women going through menopause because they were declared ‘nuts' and they were locked in menstrual, no, lunatic asylums. AP:  Yes, Mental asylums, yes ha ha ha KC:  It might just as well have been menstrual asylums AP:  You know it might just as well have been. You know, I didn't know that about menopause. I do think that actually many women who are highly sensitive, you know, almost intuitive, probably historically really suffered at menstruation because that aspect of them was never valued and they would have appeared highly, kind of, out of it; because menstruation is a natural ‘high'. We do go into an altered state of consciousness but because women are not initiated into that language about their bodies, I think that women can appear to kind of ‘lose it' and, certainly in more restrictive times, you know, any woman that was full of herself and ecstatic in any way was nothing but trouble, a disturbance and I really fear that many women were put away because they were natural ecstatic and no-one knew how to care for that and I think they would have gone mad and I think I would have gone mad, too, living in that kind of environment. KC:  It's that fear and ignorance, isn't it? About anything that you know little about you lock it away to keep it out the way because you don't know enough about it and certainly as you were saying, women don't understand their own bodies properly so they felt so out of it, too that they were in a different place and didn't know how to deal with it. You sometimes lose contact with the daily world, don't you? AP:  Yes, if you repress something in you, it's going to turn up as trouble in some way. And, yes, I think you said it well. KC: Yes, I'd like to move on, back to your book, actually, I particularly like your chapter on ‘the natural way to menstrual wellbeing', can you tell us something about that? AP: Yes, I'd love to. Now, I present a very different approach to menstrual health and it's actually connected to what I was saying earlier about getting in tune with your cycle rather than seeing it as a problem and in many ways, menstrual problems are exacerbated because women are fighting their cycles. You know, they are trying to remain the same all the time and they're not in tune with that inner rhythm. So my approach to menstrual health is based on re-connecting with the power of your cycle with the real intelligence of your cycle. Now, what does that mean? It's very simple… I encourage women to chart their cycles on a daily basis. What I'm looking for here is your energy, your mood, your feelings and to just make a note, each day, of what comes up for you and it's also great to have a journal where you're charting your dream results as often you have very significant dreams at particular times of the month, and then, as you do that, as you start to get in touch with your cycle, you start to see a pattern and the pattern goes something like this, although each women will have her own version of it. But the pattern is a little bit like the seasons of the year and I talk about the inner seasons of your cycle and in the first half of your cycle after you come out of menstruation, the pre-ovulatory time, say from day 5 – day 10 or 11. I talk about that as the ‘inner spring' and women will generally notice a greater aliveness, energy, and motivation, and more focus and clarity and that's as it is, the nature of spring. You have this natural growth happening, a natural motivation and ride it, surf it, get the most out of it. You have this amplified talent, of course you do anything at any time but capitalise on this time. Ride the wave and then as you come up to ovulation, this is the summer of your cycle. This might be from, I'm talking of an average cycle of 28 days and everyone will have their own version, as I said, but let's say from day 11 to day 19 or so, something like that, day 11, 12. It's a bit like the summer which we're in right now and, you know, the summer energy is very kind of out there. Women feel most sexy and gorgeous at that time, you have a natural energy to connect with the world. Your focus is on the outer world and here, we create harmony. As one woman said ‘we hold court' at this time. Yes, you're totally ‘queen' of your queendom. Your riding high. This is ‘superwoman' territory. It's very creative in the sense that it's very productive. You know, in the first half of the cycle you initiate, in the spring you initiate. In the summer you fulfil that. You really fulfil it. So you really produce things. You know it's like nature producing all this wonderful food for us. So that's what you do and then as the wheel turns, as your cycle turns, you come into the pre-menstrual stage which may be from day 19 or day 21, something like that. I'm being very loose with dates here until about day 26 or so and here, just as the energy changes as you come into autumn and you feel yourself pulling inwards a bit and closing down, that's what's happening pre-menstrually and you have a different kind of power, here. A very gutsy power, it's very insightful, you can see into things. Your energy is dropping a little and this is normal. If you have extreme fatigue, that is not normal and you need to rest. But the pre-menstrual phase gives you feedback, so I call it ‘feedback time'. I call the summer of your cycle ‘having it all'. Ha ha. And the Spring phase is ‘new beginnings'. So you have New Beginnings, Having it All and now this is Feedback Time. This is the ‘get real' time. So you have real insight here and this is where you kind of clean up and edit and sort out and refine, so this is really where you polish what you do and this is the difficult phase because in any creative project you have to stand back and go ‘ OK. I've got a lot of stuff here, what's working and what isn't working?' and this is where you have to cut stuff out and our critical energy comes up here most strongly and a lot of the pre-menstrual stuff is that women not knowing how to handle that negative, that critical energy that can become really negative and destructive, if you don't know how to use it. So, in my work I teach women how to manage that. KC: We just lash out and have a row with somebody, don't we AP: That's right, we do. Now, that energy behind that is actually really positive and you've got to learn how to use it. You may need to speak very strongly but it's not a licence to abuse people, KC:  No! AP:  So, learning how to manage that energy is a very important part of my work and then, as you pull into menstruation and this energy of pulling in can happen a day or two before you bleed. You'll actually much more vulnerable, like you don't want to do anything, or socialise, and you'll often go off to a very kind of quiet, detached, still place or, you could go to a place of quite a dark place, for women who have difficulties, for women who have difficulties, a kind of anxiousness and so on. KC:  You certainly don't want to communication, I know that for sure AP:  Isn't that fascinating, we so don't. And this is wisdom at work, you know. You actually, this is about you pulling into yourself, now. It's not about the world, so you think about, this is our inner winter and if you think about winter, we want to hunker down by the fire place, don't we? Well, that's what you're doing in your own spirit, now. You're wanting to hunker down, deep into your own being and just saying ‘no' to everybody else. And this is really healthy. If you want to have it all, you've got to have a time where you do nothing, where you can completely chill and you say ‘no' to everybody else and you put all your juice into you. So, the winter time of the cycle is ‘you' time, ‘me' time; where I take care of myself absolutely. And when you start to co-operate with that rhythm it just transforms your experience of yourself and of your symptoms and a lot of symptoms fall away, or are eased considerably. Women generally feel more confidence in themselves, more dignity and a greater capacity, then, to take care of themselves, which is turn means you have more motivation to do all the other health practices that I will now mention and there are many things you can do to heal your symptoms but the first remedy is to restore, is the wisdom of your cycle, cycle awareness, is the first remedy; to be aware of your cycle and to respond accordingly. So that's the first remedy, the second, and these are not in any particular order, the next remedies but diet and the state of your digestion are crucial. This is non-negotiable, you've got to have a good healthy diet and there's plenty of good information out there and it's in my books as well but, essentially, it's real food, cutting the junk basically and eating real wholesome, whole, fresh foods; mineral rich, you know and to have good quality protein and, really to get rid of the junk. To get rid of white flour, white sugar and so on. And then, the other crucial area, I think, is environmental. There's so much environmental pollution out there; there's so much junk we put on our bodies, the chemicals we use in our houses to clean. Now a lot of the pollution we can't control, like air pollution, you know out on the roads, and so on. But control what you can control in your own home. Make your own home as clean and green as you can and there are so many good products today that do not have toxic chemicals in them, so we've got no excuse there. And yes, it is a little more expensive but you can use things like bicarbonate of soda. KC:  Yes, that's brilliant, I use that AP:  I use it for everything KC:  All these old-fashioned remedies… AP:  And there's so much good information out there on the web, on that, so in a way, you have no excuse, now. KC:   Actually what I noticed is, I changed my soap powder to a more natural version. I'll give you the name, it's Ecover, I went to and as a result of using that, I've really noticed, it's like when you come up to somebody and you know they've been smoking, you can smell it on their clothes and you can smell the other generic brands of washing powders, they stand out and all you can smell is the washing powders and, you know, I don't want to be near these people because all you can smell is the soap powder and you go into their homes and their homes stink of soap powder and it's so off putting. You change the powder you use to a less toxic one, it's amazing your sense of smell completely changes. AP:  That's very illuminating, I totally agree with you. It really, you will be quite shocked when you get rid of the chemicals and not just the soap powder but all the other cleaning agents, will really shock you how shock that acrid, chemical smell is. And I go into more detail in my books on the environmental stuff, but again, there's so much information out there today, people can easily access that for free on the internet. And the other area is ‘structural exercise' and the structure of your body and I'm afraid exercise is non-negotiable, you have to do it, you absolutely have to do it and preferably outside in natural light, as well, as much natural light as you can get because we need vitamin D and I think it is probably important to supplement with that but I'm not a practitioner so I can't, you need to see a practitioners. So, yes, get out and get natural light and exercise, it's just fantastic but also things like yoga and pilates, anything that strengthens your core muscles and your core, is critical and then you may need to work with a massage practitioner, you know, chiropractor, osteopathy, that sort of thing because there may be structural issues going on with your pelvis that are causing menstrual problems and the one remedy I recommend to every woman with menstrual problems, almost regardless of what their problem is, I recommend Maya abdominal massage and there aren't a huge number of practitioners but the beauty of this is, that once you've had a session you can do it for yourself, they teach you how to do it yourself but it's really good to have a few sessions with somebody but even just one and you start doing it for yourself. I'm very big on all the things you can do for yourself. KC:  And this is just as it sounds, is it, it's just abdominal massage AP:  Yes it is abdominal massage and it's very effective. God, you know if I had menstrual problems today, that would be my first port of call, beyond all the stuff I'd be doing for myself. KC: Actually, I remember this, and sorry for interjecting here, Alexandra, when my mother-in-law, when my kids were small and they had abdominal problems, she would just lay them down, put some oil on their tummies and massage it and I learnt that from her and it helped. Now whether it was just psychological or she actually knew what she was doing, I have no idea but I picked up on that and I used to do it on my kids when she wasn't around but, yes, I totally believe in what you're saying about that and we stop doing it when we get older. I certainly didn't do it to my teenage daughters but they could learn to do it themselves. AP:  They could indeed and it just releases a lot of stress and tension, I think. Yes, I can't recommend it more highly. So we've talked about diet, we've talked about environment, we've talked about structural stuff. Now with women who have extreme menstrual problems it's going to be necessary to work with a natural health practitioner and, you know, I've already mentioned chiropractors and osteopaths and massage therapists but also they may need to work with Chinese medicine, is very good; Ayurvedic medicine, naturopathy, homeopathy, you know, different strokes for different folks. I got a lot out of Chinese medicine to strengthen me but it was chiropractic work that made a huge difference to my pain and it was also the self-care stuff that made a difference to releasing the pain, along with the Chinese medicine nourishing me but naturopathy has a lot to offer as does homeopathy and, you know you may be drawn to a particular practitioner who happens to be a homeopath or a naturopath but there are lots of good things out there, but they are not a substitute for your own self-care and there is so much you can do for yourself.  I really want to emphasis that. So that's my natural approach, Kathryn, to menstrual health KC:  I think it's brilliant and I think when you first hear about it, you think, oh, god, here we go again, more form filling but you describe it so easily and you can understand it so quickly you feel better already just hearing you say the words AP:  Well do you know something? I got the most lovely feedback from a woman in Ireland. I had just been in Ireland and I got coverage in the Irish press, in the three main newspapers and each of the papers spoke about, you know, my approach; the seasons, getting in touch with the seasons, every cycle and one woman, she didn't even come to a workshop or she hadn't even read my book yet but she just thought ‘I'm gonna try this' and I just got this email from her saying ‘I've done it for two cycles and already my insomnia has cleared up and I'm not eating packets of chocolate biscuits five days, for five days before my period'. How cool is that! All I wanted to say was, yeeees! How cool is that! And she's just done that off her own bat, you know, with no more input from me, you know. Isn't that amazing? KC:  It is, you've just got to ignore the rest of the world and do it for YOU. You are important. Do it! AP:  Yes! And then you just release all this energy inside and inspiration and in the end it isn't, ah, you know, another job to do, it becomes, like, ah, yes, what I might open up to and discover and then you release energy. It's energising, you know? Yes. KC:  And all of that to me, that obviously leads on to a better experience going through menopause because you've already gone through this process of understanding yourself better, so, surely, that should be a better passage through menopause? AP:  That is absolutely the punch line, Kathryn, really. I can't emphasis this more strongly. I think the crisis we are experiencing around menopause is because women have not been grounded in their menstrual cycle. When you have worked with your cycle over many years and, you know, you're intimately connected with it, you are intimately connected to yourself. You'll be practicing really good health care and you will understand the nature of the psychological passage at menopause and you are probably going to be a whole lot healthier because you have been more in touch with yourself. You are just going to be more empowered and it just then becomes the next transition and you have already worked with transitions through working with the cycle. It's, you know, really, when I think about menopause, I, women ask me about help at menopause and I just want to tell them to come to my menstrual workshops. I could achieve that information before I go on to talk to them about menopause. KC:  Absolutely, yes. The way I see it at the moment is that menopause is a huge metamorphosis but it doesn't need to be if women are practicing understanding their bodies at a younger age then it's an easier transition, an easier metamorphosis and it's not a huge problematical thing that causes so many challenges at home and in the workplace. AP:  Yes, exactly. And women would be able to ride it better. They'd be able to get the juice out of it because there is a transition, you are being changed but women don't know about that and if they knew about that, it's just, it's like being given the rule book, not the rule book, the instruction manual. And they're coming at it with no instruction… KC:  Yes, as we always are, isn't it. We more or less make it up as we go along because nobody understand us enough and now you're telling us what to do and I think that's just brilliant. Because what I've been finding, what I keep telling women now is stop all this multi-tasking… AP:  Yes! KC:  We wear multi-tasking as a badge of honour because, hey, we've got something over the guys, look, we can do all of this stuff all at the same time and all you're doing is causing problems to your own health. The sooner you realise that, the better off you will be and start asking your partner, saying, look, so and so's coming up, I've got an important meeting but I've got the kids to deal with can you help? Or what can be do about it? Share this home life that you have with your partner and I'm sure, it's only because we don't ask the question because we think, oh, I'd better not ask because, because, there'll be a row. You don't know that til you ask the question. And that certainly happened to me and as soon as I started opening up, and said, oh, look, this is happening, can you help – of course I can, there's no problem. AP:  That is very wise, that is absolutely it and if, you know, if women had been in touch with their cycles, each month they would have been practicing the very thing that you have been talking about; because ovulation time is multi-tasking time. That's the superwoman time, you can do it. And then, menstruation is when you drop it all and you just take care of yourself and renew yourself. Now women are not renewing themselves on a monthly basis, they are trying to keep going the same as before and that is a recipe for disaster and then, of course, the real disaster happens at menopause, that's when it all comes to a head, so if a woman is practicing it on a monthly basis then menopause isn't going to be a breeze. KC:  Yes, absolutely, because at the moment it's like a tsunami, it just builds up and builds up until it eventually you can't, literally can't cope and in my case have a nervous breakdown, so, you know there's got to be a better way. AP:  There so has to be, Kathryn and I just think what you're doing is magnificent, it's just so vital. I mean even just that statement about multi-tasking, that is radical and the impact of that is huge. KC: Yes. You think so? AP:  Yes, absolutely, absolutely, it's nuts that we just keep going, we women have to ask for help KC:  Yes, and not be afraid to. I'm talking to women, I go into business now and am talking to women and mixed audiences and what I've noticed and I don't know why it took me so long to pick up on this but of course, if you're in the workplace, whatever job you're doing, you're never going to stick your hand in the air and say ‘Excuse me, I can't cope'; you carry on and try to deal with it and make your, you know, grind yourself into the ground even further, so I think with people like yourself and myself, talking to women to get them to think about themselves more, then perhaps we won't find ourselves in this awful place of not being able to do what we thought we could do and feeling totally rejected, loss of confidence, self esteem, the whole three yards and feeling depressed about it. There's got to be a better way, hasn't there? AP:  I really think so and I think that there's something that we should really think about putting together, there, just around this, you know. I think there's a really core message there that would just transform women's lives and in the workplace particularly, I'm thinking. KC:  Yes, yes. Because men do want to help, I get a lot of emails… AP:  Oh, yes. The vast majority; I mean, there's always going to be someone who doesn't, you know, it's the same with women but in my experience, men are completely bewildered, they're shut out and actually they, in the main, they want to be able to do something but they just do not know what to do. KC:  Yes, and anything they suggest, they are just rejected because they don't know how to approach it and of course, the woman is in such a mood at that time that she thinks everybody's against her and just, you know ‘ get out of my sight, I don't want to talk to you, you don't know what you're talking about …' AP:  That's right, yes. That's very similar to what happens pre-menstrually, so what you're talking about at menopause, it's laid out monthly, pre-menstrually… KC:  It does, and at menopause it's played out every day, that's the problem AP:  Every day, instead of a few days, monthly but if we'd understood the pre-menstrual stuff then we wouldn't have that fall out. KC:  Yes, I'm absolutely convinced that you're right on that, Alexandra So, just bringing our conversation, here to a close, would you like to tell us a bit about your other work that you do, Alexandra? AP:  Yes, I'd be delighted to, Kathryn and one aspect of my work is menstrual health and we've just been talking about that, but actually my work has relevance in all areas of women's lives, women's leadership, women coaching, counselling and therapy, education. I want to restore the intelligence of the cycle, you know, there's a core kind of practice in any kind of work with women, you know, to develop mental work, leadership work, counselling work, it's just a wonderful ground, foundation for anything, so I'm, so what I'm developing is a training programme, a course, called The Woman's Quest Apprenticeship, that would be over a year, where I would basically, I'm working with women, well, it's open to women who want to go on a personal development journey, spiritual development journey, it's both those, but it's also for women who want to take this material and use it in their work in some way. So you might be a coach, you might be a counsellor you might be a healer, a naturopath, you know, whatever, or you may be want to work with girls and teenagers because that, we're just crying out for people to take on that work, to properly prepare girls for this work for their menstruating years, so I'm offering a year long programme that would be three residential workshops over 3 ½ days and then mentoring in groups, you know on-line stuff and the three themes are ‘healing, creativity and spirituality'' that we would be working with and so it's open to any woman who has done some work on herself already and you really need to apply to me but if you've already done a workshop with me you've already had a taster and it's particularly for women who want to work with this in some way with the training in it. KC:  I think that's excellent work, yes, sounds brilliant, yes. AP:  It's very exciting KC:  Yes, and in a way, you probably feel like me that, you're not exactly fighting a losing battle but it's very difficult being one man, as it were, just going out telling the tale. We need a whole lot more of us, don't we. AP:  Yes, exactly, and I feel it growing, actually because I've been doing this work for quite some time with people around the world. In fact I just got an email from a woman in Chile, this morning, saying she wants to run menstrual workshops and she wants some guidance. So I wrote back and said I'd be delighted to mentor you.  The other thing, also, is that I'm wanting to develop some on-line programmes so that if you're living, you know, not close to me, then you'd be able to still participate in this work and the other thing that I have with my colleague Shani Hugo is the Women's Quest community site that any woman can join. You do need to be invited so you need to email me first, but this is a community, and on-line community where women are sharing their experiences and discoveries, whatever, around this work and I want to see, you know, thousands and thousands of women, talking and raving and sharing and, you know. That's our vision on that and eventually I want to work towards, Shani and I would like to create a centre where, a place that's held in perpetuity, actually, for this work, where it is exclusively focussed on restoring the wisdom of the menstrual cycle and then its application in, as I've said, leadership, therapy, healing, fertility, birth; that's another area I didn't mention. Girls education and we develop people who are experts in these different areas, working with the cycle, as a core element of any of these things. KC:  Yes, well I feel that's absolutely fantastic and I wish you all the best with your continuance of that because I see we get books every now and again coming out about different areas of menstruation but to actually have a programme that people can attend either virtually or in person, I think that shows great insight and I hope it becomes very successful and others see it in the same vein. AP:  Yes, thank you. It will, you know. I decided, this life time, we're going to crack this one. KC:  Yes, definitely. That's absolutely brilliant. Well thank you so much for talking to me today, Alexandra and let's set the world alight! AP:  Yes, absolutely! Absolutely! Ha ha ha. KC:  I so thoroughly enjoyed talking to Alexandra Pope, we covered so much ground, didn't we. You'll find both Alexandra's and my contact details at the end of this transcript and thank you for listening, this is Kathryn Colas of SimplyHormones, signing off. Bye for now. Alexandra Pope: Co-author of ‘The Pill: Are you sure it's for You?' is available from Amazon. Do go to Alexandra's website: http://www.wildgenie.com [http://www.wildgenie.com/] and you can email Alexandra: genie@wildgenie.com [genie@wildgenie.com] Kathryn Colas: You'll find lots of information on menopause, including my own personal journey at http://www.simplyhormones.com [http://www.simplyhormones.com/]. Sign up for my Newsletter: http://www.simplyhormones.com/cc.asp [http://www.simplyhormones.com/cc.asp]and do watch ‘Menopause: The Movie' highlighting how relationships are affected at menopause; here's the link: http://www.simplyhormones.com/video.asp [http://www.simplyhormones.com/video.asp] and do join me on my blog for my own views on what's going on in the world: http://www.simplyhormonespodcast.com [http://www.simplyhormonespodcast.com/] – feel free to comment on my ramblings and podcasts. Last but not least, you can contact me: kathryn@simplyhormones.com [kathryn@simplyhormones.com] . Average Rating: 5 out of 5 based on 268 user reviews.