The One About Hormones - POI, PMDD, Endometoriosis + PME: Dr HANNAH SHORT

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One of the most debilitating things about

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it is that it's cyclical.

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So it comes around month in month out.

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A lot of women will say, "My period arrives and I feel myself again".

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Or maybe a couple of days afterwards they feel themselves again, and then they

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kind of think, "Did it really happen?

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Was it really that bad?"

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And then you start doubting yourself and you go to a medical

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practitioner and some doctors haven't heard of P.M.D.D., for example.

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And they'll say "Well, not really sure, I think you might have mild P.M.S."

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or, you know, things like that.

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And so there's a bit of - not intentional I think- but medical

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gaslighting that can go on with severe forms of premenstrual disorder.

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And also to have a diagnosis of P.M.D.D., there shouldn't really be any other

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underlying mental health or psychological diagnosis, but often they come hand in

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hand because if you struggle with severe premenstrual symptoms month in, month out,

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you are gonna become depressed because it feels quite hopeless because you feel

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whatever you do, you feel horrendous.

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And so even if you do feel okay for two weeks, three weeks, a month,

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you know this and it is exhausting.

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I've had women say they just can't face going through it every month.

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And so it's not uncommon to have kind of concurrent depression or

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anxiety alongside those changes.

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So when I see women, I often say, well, "look at their notes."

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So sometimes there's a referral letter or they sometimes refer themselves

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in, but they will have on their notes that they have depression or anxiety.

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But it's always important to say, "Okay, what came first?"

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Because often it's the depression and anxiety have arisen after their mood

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changes have just been going on for several years and it's like a feeling of

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hopelessness because whatever they do, they find themselves in this situation.

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But there's definitely help and advice out there.

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Having a baby is meant to be the most joyful time of your life.

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But for many mums and dads, it can be the hardest and at

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times the darkest of places.

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Welcome to Season 2 of Blue MumDays, the podcast for anyone

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struggling with parenting.

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All the stories shared here are from the heart.

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These are real conversations and may be triggering, so

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please listen with discretion.

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Today's episode covers feelings of suicide.

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We will also signpost you to help in the show notes.

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Thank you.

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Today's guest is Dr.

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Hannah Short.

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Hannah is a G.P.

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specialist in menopause, Premature Ovarian Insufficiency (or P.O.I.)

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and premenstrual disorders.

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She is recognised by the British Menopause Society, the International Association for

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Premenstrual Disorders, and the National Association for Premenstrual Syndromes.

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Hannah has a particular interest in induced menopause, Premature

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Ovarian Insufficiency and hormone sensitivity disorders.

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She is a member of the I.A.P.M.D.

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Clinical Advisory Board and the Surgical Menopause Advisory Committee,

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and has previously worked as a volunteer doctor for the DAISY Network.

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They are a charity dedicated to girls and women diagnosed with P.O.I.

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Hannah has personal experience of premature surgical menopause, which

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drives her passion and informs her work.

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She is co-author of 'The Complete Guide to P.O.I.

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And Early Menopause'.

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Hi Hannah.

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Thank you so much for joining us today.

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Welcome to Blue MumDays.

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Thank you, Vikki.

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Nice to be here.

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First of all, can you explain to us what P.O.I.

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is, for those of us who aren't familiar with it?

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So Premature Ovarian Insufficiency or P.O.I.

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is now the preferred name for early menopause below the age of 40.

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But it's not quite as straightforward as that.

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So menopause normally indicates like a permanent state, whereas,

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you know, over your ovaries are no longer going to function,

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you're not capable of conceiving.

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In actual P.O.I., there's fluctuating ovarian activity, but there is

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reduced fertility in these girls and women who are affected.

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And you can have menopausal symptoms and issues relating to oestrogen deficiency.

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It's also related to early menopause, which means your periods

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are much more likely to stop.

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But generally it's used as an umbrella term for anybody who falls into

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that category or their periods have stopped or they've had their

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ovaries removed below the age of 40.

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Sorry, there's not a very succinct answer to it because it's, it's not a

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very really straightforward explanation, but I hope that explains it a bit!

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Thank you.

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And how common is this would you say in the UK?

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So we used to think it was, um, one in a hundred women,

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below the age of 40, but recent estimates suggest it may be up to

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3- 4% of women on a global level.

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I mean, the percentages are greater in the 30-40 age group than they

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would be in the 20-30 or under 20.

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But there are some teenagers and even kind of tweens who can be affected.

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Their periods may not start, they may never have normal ovarian function.

VIKKI: 00:04:50

Oh my goodness.

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So actually that's a lot more common than I thought it would be.

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Yeah.

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And yet it's, it's not talked about or very understood what it is.

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It isn't at all.

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And I think, you know, women are constantly told they can be too

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young for menopause or, I mean, the words premature menopause and P.O.I.

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used intermittently even though they're not always the same thing.

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But essentially the, the health risks and the concerns are very similar

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and it often means that if it's not recognised, girls and women don't get

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the treatment and the support they need.

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So yeah, we need to rate, raise awareness basically.

VIKKI: 00:05:22

It's It's amazing you say that because I know so many of my peers and

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friends who are feeling like they're going through perimenopause and you

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know, in their mid forties, they're being told, "Oh no, you're still

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too young for that" and yet you kind of know when things are different.

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But that's, it's crazy really that we're telling women

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they're too young in the mid forties because any age after the age of 45,

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if you actually stop your period, so you're fully menopausal- is considered

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within the normal age range, and you can, your perimenopause can start

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10 years before your final period.

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So it's not unusual to have perimenopausal symptoms in your late thirties.

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That's not to say women will always need treatment or medical

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support, but it's not unusual.

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And perimenopause is different to P.O.I.

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and this is where it can get a little bit complicated.

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But yeah, we shouldn't be telling women that.

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I mean, we've got guidelines -if women have or they're concerned they're

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having menopausal or perimenopausal symptoms over 45, we don't worry

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about doing things like blood tests.

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Um, we just treat them clinically.

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But under 45, we, we normally would do blood tests to rule out other conditions

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and certainly under the age of 40.

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So everyone should be taken seriously really.

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Thank you for that.

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And obviously, gosh, we could do a whole, a whole episode on its own, on

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perimenopause and, and the menopause.

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But one of the reasons that I wanted to speak to you today for this is,

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is because there is so much about women's hormones and we're so affected

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by hormone fluctuations and that can really affect things like mood.

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If we stay with P.O.I.

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for a moment, what sort of treatments are available for anybody going through that?

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So in P.O.I., if you've got loss or reduced ovarian function,

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you're not producing normal amounts of oestrogen which is really important for

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things like your bone health and your heart health and your brain health,

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and also your general wellbeing.

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So first line treatment is Hormone Replacement Therapy (H.R.T.) to bring

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the levels back up to where they should be at the premenopausal age.

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And there are guidelines for this.

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So that's really what we should be doing, whether or not a

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girl or woman has symptoms.

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So not everybody will struggle with oestrogen deficiency or menopausal

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symptoms, but then maybe their periods have stopped and if other

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courses have been ruled out, then that's something we need to look at.

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I mean, there will be some women who have a P.O.I.

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or entered a premature menopause because of cancer or something like that,

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which means that sometimes that's not really what we'd be offering, if it's

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an oestrogen appended cancer, but each case has to be viewed on its own merits

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and we look at risks and benefits, and there are other treatments we can use

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to support women who can't take H.R.T.

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My mum, bless her, had breast cancer that was related to H.R.T.

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23 years ago.

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And obviously H.R.T.

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has changed a lot since then.

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But I must admit, sort of with my own experience going through menopause,

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I've always been wary of taking it because of my mum's situation.

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If somebody was considering taking H.R.T.

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what would you say to them in terms of its efficacy and its safety these days?

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Well, in terms of P.O.I.

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there's no increased risks.

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You know, if you haven't had an oestrogen dependent cancer, there's no increased

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risk, because all you are doing is replacing the hormones that would

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naturally be there if your ovaries were functioning as we'd like them to do so.

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So there's no increased risk of things like breast cancer and it reduces your

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risk of things like heart disease, dementia, osteoporosis, diabetes.

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So it does a lot of good health prevention as well, and it's

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really important for health.

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In women of natural menopause age, the benefits usually

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outweigh the risks as well.

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And there's a lot of hype around the breast cancer risk, because it's

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not as black and white as "H.R.T.

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causes breast cancer."

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We don't actually have good evidence that it causes breast cancer.

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It may be what we call a promoter of oestrogen positive breast cancer

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and it can encourage the cells growth if they're already there.

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But it's not like smoking where we know that actually smoking

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damages the DNA and can trigger cancer in the lungs, for example.

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And there are other things that are far more likely to increase

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your risk of breast cancer, such as not exercising at all.

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So, you know, doing two and a half hours of exercise a week hugely

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reduces your risk of breast cancer, whether or not you take H.R.T.

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If you are overweight or obese, that puts you in a higher risk

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category- far more risky than if you take a small dose of H.R.T.

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Drinking more than two units- so a glass of wine every night- again

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is more risky than taking H.R.T.

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So it's looking at every person and seeing 'do their benefits outweigh the

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risks?' You know, do they need H.R.T.

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to help manage symptoms, to reduce long-term health risks?

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I'm not saying everybody should be on it at all, but I think a lot of women

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are unnecessarily scared of HRT and it can be a real game changer in terms of

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how well women feel and can actually reduce the risk of harm later in life.

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So when there were the big scares around 20 years ago, around H.R.T.,

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A lot of women stopped H.R.T.

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overnight, doctors stopped prescribing it.

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And actually, if you look at the statistics, rates of heart disease

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and stuff went up hugely after that.

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Obviously we don't say "start H.R.T.

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to reduce your risk of that" unless you fall into the P.O.I.

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category.

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You would normally prescribe it if there are symptoms and,

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and things like that as well.

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But there, there were harms associated with that mass stopping of H.R.T.

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So yeah, for most women, the benefits outweigh the risks

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if, if it's needed for them.

VIKKI: 00:10:42

Thank you.

VIKKI: 00:10:43

That's so beautifully put, and funnily enough, I'm I gotta get

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straight on the blower to my G.P.

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then after this- see if I can get rid of the night sweats and the hot flushes!

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Um, but thank you.

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That's, that's really put my mind at rest in terms of, looking into H.R.T.

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I mean, I'm really looking forward to speaking to you

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about things like P.M.D.D.

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and P.M.E.

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And I would love to speak to you about postpartum rage, postnatal rage or the

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effect of hormones on feelings of, anger.

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But first of all, do you mind telling us about what brought you

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into this area, this specialism?

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I mean I've always been interested in women's health,

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and I've always been interested in like psychology and psychiatry.

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And when I went to medical school, I wasn't quite sure

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what I would end up doing.

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Initially I did do psychiatry training and then I was slightly frustrated

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with the way the services worked, and then I felt I'd have more of

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an impact in General Practice.

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And so I went back to do my G.P.

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training and I think it was in general practice that I started noticing, I don't

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know, so many symptoms that women came to see us about, especially as a female G.P.

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There was an element of, of hormonal influence, even if it wasn't directly

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what they were consulting me about.

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And I've also always had my own issues.

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So I've always struggled with periods.

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I had terrible painful periods from when they started to when I was 13.

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I'd miss school, I missed weeks at university, I've lost a job because of

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it, because I went to medical school school late, not only when I was 27 and

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prior to that I, I worked in kind of administrative and then finance roles.

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I lost a job in London because I was an unreliable employee.

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And because I had to call in because I was so debilitated by my symptoms.

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And I was diagnosed with endometriosis when I was in my early twenties.

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And then together with that, I also struggled with premenstrual mood changes,

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which were quite significant and got worse as I entered medical school and my junior

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doctor training, which can be quite brutal because you don't have a regular routine.

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You're working crazy hours, you don't eat well, you don't sleep well.

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We basically don't do anything we tell our patients to do because

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the rota makes it impossible.

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And I think that just made everything so much worse.

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But I used to have incredible anxiety and really crashing low

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mood before my period arrived.

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And everything felt quite unmanageable, especially

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because I had irregular periods.

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I never had regular cycles, so I couldn't even predict when I was gonna feel okay.

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And most of the time I didn't feel okay because premenstrually,

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psychologically I struggled.

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And then when my period arrived, physically I struggled.

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So it was probably only a handful of days a month where I felt relatively okay.

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I tried various treatments.

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I mean, I had several surgeries for the endometriosis, which was

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successful in the short term but ultimately didn't resolve the pain.

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I tried alternative medicines and, you know, complimentary therapies including

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acupuncture, reiki, homeopathy, I mean, everything -changing my diet.

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And I only kind of got minimal relief at best.

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And ultimately it was recommended that I have my ovaries

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removed and a hysterectomy.

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I'd obviously tried a lot of the medical treatments, like different

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contraceptive pills and stuff well before that, and painkillers and things.

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And so that's what happened at 35.

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I had a premature surgical menopause, so all of my reproductive organs

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were removed and then plunged straight into surgical menopause.

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And it was that, that really opened my eyes, although I was well aware of issues.

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But when I realised how poorly we managed women in menopause, particularly

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those of us who don't have a natural menopause at the natural age of,

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you know, mid forties or upwards.

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I suppose it ignited my passion and I thought, well, what, what can I do?

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And it's just developed from there.

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I've done further training in menopause and work around in the premenstrual

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disorder space and yeah, there we go!

VIKKI: 00:14:33

Oh my goodness, what an experience that you went through.

VIKKI: 00:14:36

I mean, it's wonderful for the women that you treat that you took such a negative

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personal experience and created something so positive and compassionate out of that.

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Are you happy to talk about how you felt going through something

VIKKI: 00:14:51

so extreme at such an early age?

DR HANNAH SHORT: 00:14:55

To be honest, I felt so ill before the surgery

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that I was pretty desperate.

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And I actually wrote a letter.

DR HANNAH SHORT: 00:15:02

I found it the other day and then I felt slightly mortified when I read it!

DR HANNAH SHORT: 00:15:05

But a letter I wrote to my gynaecologist basically begging him to give me the

DR HANNAH SHORT: 00:15:09

surgery because I naively thought having the surgery would put me

DR HANNAH SHORT: 00:15:13

in a position where I felt like a "normal" in inverted commas woman.

DR HANNAH SHORT: 00:15:17

And I would have some add- back hormones because I'm lucky that I didn't have

DR HANNAH SHORT: 00:15:20

any reason not to have the hormones and I'd just kind of go on my way.

DR HANNAH SHORT: 00:15:24

I knew it would take a while to get my energy back and to feel

DR HANNAH SHORT: 00:15:27

well, but I didn't anticipate how difficult it would be post-op.

DR HANNAH SHORT: 00:15:31

And although I've never regretted the surgery because I'm lucky that my pain

DR HANNAH SHORT: 00:15:35

pretty much disappeared with that.

DR HANNAH SHORT: 00:15:38

And my premenstrual changes- you know, the mood changes, obviously I

DR HANNAH SHORT: 00:15:41

wasn't having periods- I felt a lot better and more stable mood-wise.

DR HANNAH SHORT: 00:15:45

I struggled with absorbing H.R.T.

DR HANNAH SHORT: 00:15:47

for example.

DR HANNAH SHORT: 00:15:48

I felt really quite unwell from the physical menopause symptoms that I had.

DR HANNAH SHORT: 00:15:54

Eventually that was sorted.

DR HANNAH SHORT: 00:15:55

You know, I worked with a good gynaecologist and my G.P.s were

DR HANNAH SHORT: 00:15:58

supportive and eventually found a regime.

DR HANNAH SHORT: 00:16:00

But it also forced me to look at things like diet and lifestyle and actually

DR HANNAH SHORT: 00:16:05

do the things that I knew would help me, intellectually, but I hadn't

DR HANNAH SHORT: 00:16:08

really been putting into practice, because that's been fundamental.

DR HANNAH SHORT: 00:16:12

And it's only further down the line that I kind of, things like not having

DR HANNAH SHORT: 00:16:15

children kind of really hit me because at the time I thought, well, "I'm

DR HANNAH SHORT: 00:16:18

too"- I don't know- "I'm too unwell to even consider having a child".

DR HANNAH SHORT: 00:16:22

And I found that's the hardest thing for me in the latter years.

DR HANNAH SHORT: 00:16:25

And it's not so much, or at least not always, not physically having a

DR HANNAH SHORT: 00:16:28

child, but it's also the way you're treated as a woman without children.

DR HANNAH SHORT: 00:16:33

I think that's one of the biggest things, you know, and I think this

DR HANNAH SHORT: 00:16:35

applies to whether you are somebody who considers themselves childless

DR HANNAH SHORT: 00:16:38

or if you're somebody who's child free, you are treated differently.

DR HANNAH SHORT: 00:16:42

And I don't think people appreciate that unless they've had that experience.

DR HANNAH SHORT: 00:16:46

So that's been my hardest thing for me in recent years I think,

DR HANNAH SHORT: 00:16:50

and feeling quite isolated.

VIKKI: 00:16:51

Yeah, I totally understand what you're saying because I know friends who

VIKKI: 00:16:55

have chosen not to, to become mothers.

VIKKI: 00:17:00

You know, it doesn't mean that they're callous and it doesn't

VIKKI: 00:17:03

mean that they hate children.

VIKKI: 00:17:05

It's just that they've decided for them, it's not how they want to go

VIKKI: 00:17:09

on to, you know, to live their lives.

VIKKI: 00:17:12

And they are very much treated differently and castigated because of that decision.

VIKKI: 00:17:19

And I mean, it must have been incredibly hard as well.

VIKKI: 00:17:23

Like, you know, I find it hard enough having gone through menopause when my

VIKKI: 00:17:28

friends and I, we're all a similar age, and we're all going through it together

VIKKI: 00:17:33

and going, "Oh my God, how come our mums have never talked about all of this?

VIKKI: 00:17:38

It's such a ballache!"

VIKKI: 00:17:40

But to go through that independently and at the age of 35.

VIKKI: 00:17:45

And I'd imagine if it's a surgical menopause, is that more brutal?

VIKKI: 00:17:51

Is that more extreme?

VIKKI: 00:17:53

That must have been a very difficult thing to go through

VIKKI: 00:17:55

when you are still so very young.

DR HANNAH SHORT: 00:17:59

I mean, yes, it was, I suppose I had the advantage over some

DR HANNAH SHORT: 00:18:02

women in that I understood and like, because this isn't always explained

DR HANNAH SHORT: 00:18:06

to women, when they go through certain procedures, what's going to happen.

DR HANNAH SHORT: 00:18:10

And I think because I am a doctor and I really researched it and

DR HANNAH SHORT: 00:18:13

I was lucky that I had a, a very compassionate and knowledgeable

DR HANNAH SHORT: 00:18:17

clinician kind of guiding me through it.

DR HANNAH SHORT: 00:18:19

I was aware of certain things and I knew that it could be brutal, but because you

DR HANNAH SHORT: 00:18:23

have your ovaries removed and you go from being premenopausal with premenopausal

DR HANNAH SHORT: 00:18:27

hormone levels over to being surgically menopausal and having, you know, drop a

DR HANNAH SHORT: 00:18:31

huge drop in your levels, right overnight.

DR HANNAH SHORT: 00:18:34

But I was prepared in that I was given H.R.T.

DR HANNAH SHORT: 00:18:36

straight away.

DR HANNAH SHORT: 00:18:37

Often women are told whatever age they are, "Oh, just wait a few

DR HANNAH SHORT: 00:18:40

months, you might not need it."

DR HANNAH SHORT: 00:18:41

Which should never be the case because I think your body almost goes into

DR HANNAH SHORT: 00:18:44

like a form of shock because you've removed part of the endocrine system.

DR HANNAH SHORT: 00:18:48

And it can even in women who've actually been through a natural menopause, even

DR HANNAH SHORT: 00:18:52

as somebody who's 52, whose period stopped three years ago, if some reason

DR HANNAH SHORT: 00:18:56

they need that ovaries removed, and they go into actual surgical menopause,

DR HANNAH SHORT: 00:18:59

they will notice a difference most of the time because the ovaries don't

DR HANNAH SHORT: 00:19:03

become non-functional after menopause.

DR HANNAH SHORT: 00:19:05

They're still producing small amounts of hormones and we think that they

DR HANNAH SHORT: 00:19:08

do much more than that as well.

DR HANNAH SHORT: 00:19:11

But there's been a lack of research -as there often has been in women's

DR HANNAH SHORT: 00:19:14

health- so, it's a huge change and it really was kind of challenging.

DR HANNAH SHORT: 00:19:19

And I do remember having a surge of, I suppose it was been an adrenaline surge

DR HANNAH SHORT: 00:19:23

like a couple of days after surgery, which I think a lot of women describe.

DR HANNAH SHORT: 00:19:26

And it, it did feel like my body was going, "What the hell has just happened?"

DR HANNAH SHORT: 00:19:29

And I did think, I felt like I was gonna have a panic attack and then

DR HANNAH SHORT: 00:19:33

things kind of calmed down and, um, it, it was, it was challenging, but I

DR HANNAH SHORT: 00:19:38

knew that it was gonna be difficult.

DR HANNAH SHORT: 00:19:40

And I do worry more for women who don't have that knowledge or understanding

DR HANNAH SHORT: 00:19:44

because they haven't been given it and it hasn't been explained clearly to them.

DR HANNAH SHORT: 00:19:47

Because I think women need to know it's not the same as natural menopause.

DR HANNAH SHORT: 00:19:51

We shouldn't treat it the same.

DR HANNAH SHORT: 00:19:52

You'll always be in surgical menopause.

DR HANNAH SHORT: 00:19:54

You don't get through it.

DR HANNAH SHORT: 00:19:55

It's not like with natural menopause, often things improve over months to

DR HANNAH SHORT: 00:19:59

years and if, women are on hrt, most people won't take it lifelong.

DR HANNAH SHORT: 00:20:03

Some may need to for various reasons, but most don't.

DR HANNAH SHORT: 00:20:06

In surgical menopause, you nearly always need to or you may wish to.

DR HANNAH SHORT: 00:20:10

Um, but because it is a hormone, a true hormone deficiency,

DR HANNAH SHORT: 00:20:14

it's not a natural transition.

DR HANNAH SHORT: 00:20:15

And I think natural menopause takes several years for your

DR HANNAH SHORT: 00:20:18

hormones to kind of levels fall.

DR HANNAH SHORT: 00:20:20

And yet in surgical menopause, things just literally drop off a cliff overnight.

DR HANNAH SHORT: 00:20:24

So,

VIKKI: 00:20:26

Wow.

VIKKI: 00:20:26

Yeah.

VIKKI: 00:20:27

So what, what sort of symptoms were you getting then through surgical menopause?

VIKKI: 00:20:31

Was it, slightly better because you were on H.R.T.

VIKKI: 00:20:35

straight away, so it wasn't as extreme?

DR HANNAH SHORT: 00:20:37

Well, I didn't really absorb it straight away, so I was taking

DR HANNAH SHORT: 00:20:40

what I thought was a decent dose of H.R.T.

DR HANNAH SHORT: 00:20:42

and it was a gel I was applying through my skin.

DR HANNAH SHORT: 00:20:44

And I was only absorbing minimal amounts.

DR HANNAH SHORT: 00:20:46

So I've never really struggled with hot flushes and vasomotor symptoms,

DR HANNAH SHORT: 00:20:51

so like night sweats and things.

DR HANNAH SHORT: 00:20:52

Very occasionally get the odd night sweat and there's around 20% of

DR HANNAH SHORT: 00:20:55

women who don't get those symptoms.

DR HANNAH SHORT: 00:20:57

And I think often they're missed because people assume you have

DR HANNAH SHORT: 00:21:00

to have those symptoms to be perimenopausal or menopausal.

DR HANNAH SHORT: 00:21:03

It was more things that I had severe joint pain, like really severe joint pain,

DR HANNAH SHORT: 00:21:08

terrible insomnia, heart palpitations, quite severe dryness in terms of skin.

DR HANNAH SHORT: 00:21:13

My skin also changed.

DR HANNAH SHORT: 00:21:15

I kind of developed rosacea, because you have a lot of autoimmune or

DR HANNAH SHORT: 00:21:18

immune system changes with- you know, when you're thrown into menopause.

DR HANNAH SHORT: 00:21:22

And that was really upsetting for a while because I just had an awful rash

DR HANNAH SHORT: 00:21:26

on my face and nothing seemed to kind of calm it down, terribly kind of dry eyes.

DR HANNAH SHORT: 00:21:30

I would have waves of anxiety, but it's something I've lived with most of my life.

DR HANNAH SHORT: 00:21:36

Um, but they could be more extreme and I think that that may be kind of part

DR HANNAH SHORT: 00:21:41

of the same thing that goes on when women have hot flushes, but you just

DR HANNAH SHORT: 00:21:45

don't have that hot flush at the end.

DR HANNAH SHORT: 00:21:47

Because hot flushes are generally associated with a surge

DR HANNAH SHORT: 00:21:49

in adrenaline and cortisol.

DR HANNAH SHORT: 00:21:51

And often women will say that they feel a wave of panic before a hot flush comes up.

DR HANNAH SHORT: 00:21:55

That doesn't happen to everybody, but there's something going

DR HANNAH SHORT: 00:21:57

on there with that as well.

DR HANNAH SHORT: 00:21:59

So yes, I, I would get those symptoms.

DR HANNAH SHORT: 00:22:02

Um, bladder symptoms like needing to rush to the loo, or constantly feeling like

DR HANNAH SHORT: 00:22:06

I'm getting the beginning of a U.T.I.

DR HANNAH SHORT: 00:22:08

(urinary tract infection), but nothing ever being there.

DR HANNAH SHORT: 00:22:10

Oh, headaches.

DR HANNAH SHORT: 00:22:11

Yeah.

DR HANNAH SHORT: 00:22:11

Quite severe migraines and headaches as well.

VIKKI: 00:22:15

It sounds like the whole jamboree of...

VIKKI: 00:22:18

who'd be a woman?!

DR HANNAH SHORT: 00:22:20

I know, I know It

DR HANNAH SHORT: 00:22:24

It wasn't fun.

VIKKI: 00:22:25

And thank you so much for being so open and talking so bravely

VIKKI: 00:22:29

about, about your symptoms because I'd imagine there are so many listeners now

VIKKI: 00:22:35

who are listening to this and going, "Wow, finally I feel seen and heard"

VIKKI: 00:22:40

because of what they're going through.

VIKKI: 00:22:41

Do you mind me asking you, did you go through a period of grief about not

VIKKI: 00:22:46

being able to be a biological mother?

VIKKI: 00:22:49

Or is it something that you felt you came to terms with quickly?

DR HANNAH SHORT: 00:22:54

I think.

DR HANNAH SHORT: 00:22:55

I have definitely had some feelings I suppose I would describe as grief, but

DR HANNAH SHORT: 00:22:59

to be honest, a lot of it was more to do with feeling like I'd lost a lot

DR HANNAH SHORT: 00:23:03

of what should have been my healthy youth to illness and to my hormones.

DR HANNAH SHORT: 00:23:08

Because I just think back to my late teens and early twenties and I was somebody

DR HANNAH SHORT: 00:23:13

who had to go home, you know, night out.

DR HANNAH SHORT: 00:23:14

I'd go home cause I was in absolute agony or I was so fatigued and,

DR HANNAH SHORT: 00:23:19

you know, I missed out on a kind of adventure sports holiday that

DR HANNAH SHORT: 00:23:22

I planned with loads of friends.

DR HANNAH SHORT: 00:23:24

And I had to stay at home because I just couldn't move because of

DR HANNAH SHORT: 00:23:27

the pain with my endometriosis.

DR HANNAH SHORT: 00:23:29

So things like that, I think I grieve more in some ways cause I didn't have,

DR HANNAH SHORT: 00:23:33

it's not like I look back at my twenties and think, "Oh, I was young, free."

DR HANNAH SHORT: 00:23:36

I mean, I know not everybody is, there's plenty of people who are

DR HANNAH SHORT: 00:23:39

dealing with far worse things, but that's what I struggled with.

DR HANNAH SHORT: 00:23:42

And also the fact that I would never have those years back.

DR HANNAH SHORT: 00:23:45

The grief around children, I mean, I suppose I was never- I was always

DR HANNAH SHORT: 00:23:48

slightly ambivalent about being a mum.

DR HANNAH SHORT: 00:23:50

It was never something I thought "I have to have children."

DR HANNAH SHORT: 00:23:53

And so it surprised me somewhat that like as time has gone on, I

DR HANNAH SHORT: 00:23:57

felt a bit more grief around that.

DR HANNAH SHORT: 00:23:59

But it's sporadic.

DR HANNAH SHORT: 00:24:01

And I think some of it's to do more with having the choice taken away from me.

DR HANNAH SHORT: 00:24:04

So people will say, "Well, you chose to have your ovaries removed", but it

DR HANNAH SHORT: 00:24:07

didn't really feel like I had a choice.

DR HANNAH SHORT: 00:24:09

So, um, and I'm lucky my husband didn't want children, or at least

DR HANNAH SHORT: 00:24:14

is not upset by not having children.

DR HANNAH SHORT: 00:24:16

And so I had, because that would've been difficult I think,

DR HANNAH SHORT: 00:24:18

if he had been desperate for us to have biological children.

DR HANNAH SHORT: 00:24:22

And we have two cats who we love to bits and I know they're not the

DR HANNAH SHORT: 00:24:25

same as, you know, biological human children, but I dunno, it's just lovely

DR HANNAH SHORT: 00:24:28

to have them around and, and things.

DR HANNAH SHORT: 00:24:31

It's, yeah, I don't know.

DR HANNAH SHORT: 00:24:33

It's hard to answer it really, because I think there are lots of benefits to

DR HANNAH SHORT: 00:24:37

life without children, but I think.

DR HANNAH SHORT: 00:24:40

I don't know.

DR HANNAH SHORT: 00:24:40

It's hard to compare the two lives, isn't it?

DR HANNAH SHORT: 00:24:42

Because all of us will only live one, if you see what I mean, you either have

DR HANNAH SHORT: 00:24:45

children or you don't have children.

DR HANNAH SHORT: 00:24:47

And I think they're just different paths and there are benefits

DR HANNAH SHORT: 00:24:50

and disadvantages to both.

DR HANNAH SHORT: 00:24:51

And I think I now try and frame it and think, well what's the benefit?

DR HANNAH SHORT: 00:24:55

You know, I am more flexible.

DR HANNAH SHORT: 00:24:56

I can make different decisions that I wouldn't have been able

DR HANNAH SHORT: 00:24:59

to make if I hadn't had children.

DR HANNAH SHORT: 00:25:01

But occasionally it really hits me.

DR HANNAH SHORT: 00:25:02

And that seems to come out of nowhere, so I don't really know what that's about.

DR HANNAH SHORT: 00:25:06

But...

VIKKI: 00:25:07

I can really relate as well- you were talking about your grief and

VIKKI: 00:25:11

not having those youthful years, you know, those carefree years of going

VIKKI: 00:25:15

out because, certainly speaking from my own experience of postnatal depression

VIKKI: 00:25:21

and also from a lot of the incredible guests that I've spoken to during the

VIKKI: 00:25:25

course of this podcast, is a sense of grief and loss about the early years of

VIKKI: 00:25:30

motherhood that we felt, or certainly what we perceived it should have been like,

VIKKI: 00:25:37

versus the reality and how dark it was.

VIKKI: 00:25:42

You know, certainly for the first year of Stanley my son's life- and my God, I love

VIKKI: 00:25:47

that little boy so much- but it was the worst year of my life without a doubt.

VIKKI: 00:25:51

And I still get a sort of pang sometimes on his birthdays.

VIKKI: 00:25:55

And, um, I know one of my other guests, Christine felt exactly the

VIKKI: 00:26:00

same, that sort of grief of what, what it "should" have been like.

VIKKI: 00:26:04

But again, it's that sort of perception, isn't it?

VIKKI: 00:26:07

But I think it's, I think it's okay for us to grieve things.

VIKKI: 00:26:11

And I think it's, probably good to have those feelings and let them

VIKKI: 00:26:15

out rather than bottle them up.

DR HANNAH SHORT: 00:26:17

It sounds like you had a very difficult

DR HANNAH SHORT: 00:26:19

time and I think unfortunately so many women do, don't they?

DR HANNAH SHORT: 00:26:23

And I think women are sold a lie about a lot of stuff in life.

DR HANNAH SHORT: 00:26:27

It's only in recent years, people are starting to talk more openly.

DR HANNAH SHORT: 00:26:30

And I think this is where there's the power of things like

DR HANNAH SHORT: 00:26:32

podcasts and social media...

DR HANNAH SHORT: 00:26:33

I mean, there's a lot of downsides to social media.

DR HANNAH SHORT: 00:26:35

But I think the fact that it can connect people who have similar

DR HANNAH SHORT: 00:26:39

experiences, whereas otherwise people would've been kept in the dark

DR HANNAH SHORT: 00:26:42

and felt alone for so much longer.

DR HANNAH SHORT: 00:26:44

I think that's brilliant.

DR HANNAH SHORT: 00:26:46

So I mean, that's one of the reasons I chose to, I suppose be open about my

DR HANNAH SHORT: 00:26:50

own experience, even as a clinician, because some doctors warned me against it.

DR HANNAH SHORT: 00:26:53

But I just think, well, doctors are just human.

DR HANNAH SHORT: 00:26:57

We're not special because we trained as doctors.

DR HANNAH SHORT: 00:26:59

We all have similar experiences in terms of, you know, our emotions and

DR HANNAH SHORT: 00:27:03

feelings and, and everything else.

DR HANNAH SHORT: 00:27:05

So it's misinformation to think doctors are never sick, or, you

DR HANNAH SHORT: 00:27:10

know, not affected by the same things that we treat our patients for.

VIKKI: 00:27:13

Yeah, it's funny, we, sort of tend to put doctors on pedestals,

VIKKI: 00:27:17

and it takes a lot of bravery for you to come forward and sort of admit to

VIKKI: 00:27:20

having something like anxiety, but it's incredibly life affirming to know

VIKKI: 00:27:27

that everybody gets affected and it's indiscriminate, it doesn't matter who

VIKKI: 00:27:30

you are or what you do for a living, you know, and it's part of being a human.

DR HANNAH SHORT: 00:27:36

Definitely.

VIKKI: 00:27:37

Can you explain to me what some of the, the premenstrual disorders

VIKKI: 00:27:42

are because one of the reasons I got in touch with you was because

VIKKI: 00:27:46

I recently found out about P.M.D.D.

VIKKI: 00:27:49

and P.M.E.

VIKKI: 00:27:51

Maybe if we talk about P.M.D.D.

VIKKI: 00:27:52

first, and I know it's certainly something that I could relate to.

VIKKI: 00:27:57

And probably my mum, so if you're listening, "Hi mum,

VIKKI: 00:28:00

have a listen to this bit!"

VIKKI: 00:28:02

But I know that both of us felt terribly bleak and dark before our periods and

VIKKI: 00:28:08

I didn't realise that that was a thing, that it could be a medical condition.

DR HANNAH SHORT: 00:28:15

Yeah, and I think, again, a lot of women just aren't aware of it.

DR HANNAH SHORT: 00:28:18

Again, there's been more awareness in recent years with social media

DR HANNAH SHORT: 00:28:22

campaigns and things like that, but I mean, when I had my surgery,

DR HANNAH SHORT: 00:28:26

it wasn't even termed P.M.D.D..

DR HANNAH SHORT: 00:28:28

And I, I do wonder if I had P.M.E.

DR HANNAH SHORT: 00:28:30

- which stands for Premenstrual Exacerbation- of anxiety

DR HANNAH SHORT: 00:28:33

and things like that.

DR HANNAH SHORT: 00:28:34

But I was told I had a severe premenstrual disorder.

DR HANNAH SHORT: 00:28:37

And essentially, P.M.D.D.

DR HANNAH SHORT: 00:28:39

stands for Premenstrual Dysphoric Disorder and it affects around 5-8% of women of

DR HANNAH SHORT: 00:28:44

menstruating age and also trans men.

DR HANNAH SHORT: 00:28:45

So anybody who's born with ovaries can be affected by this condition.

DR HANNAH SHORT: 00:28:50

And it's a condition of hormone sensitivity.

DR HANNAH SHORT: 00:28:52

So it's not that there's an imbalance of hormones, it's just that the

DR HANNAH SHORT: 00:28:56

brain reacts or overreacts to changes in hormone levels and has an

DR HANNAH SHORT: 00:29:00

abnormal response to normal hormonal changes such as the menstrual cycle.

DR HANNAH SHORT: 00:29:04

So I think a lot of women will have heard of P.M.S.

DR HANNAH SHORT: 00:29:07

or P.M.T.

DR HANNAH SHORT: 00:29:08

and that's kind of, you know, a lot of jokes are made about it,

DR HANNAH SHORT: 00:29:11

although it's not particularly funny.

DR HANNAH SHORT: 00:29:12

And I suppose that's the kind of milder sister really of P.M.D.D.

DR HANNAH SHORT: 00:29:16

and affects around 30-40% of women.

DR HANNAH SHORT: 00:29:19

And that's where you kind of get mood and physical changes in the

DR HANNAH SHORT: 00:29:22

lead up your period, because I think most women will be aware that their

DR HANNAH SHORT: 00:29:27

body and brain changes throughout the menstrual cycle, but it wouldn't

DR HANNAH SHORT: 00:29:30

necessarily be in a problematic way.

DR HANNAH SHORT: 00:29:32

They might just be aware that, I don't know, their vaginal discharge is slightly

DR HANNAH SHORT: 00:29:36

different at different points in the month, or their breasts are slightly

DR HANNAH SHORT: 00:29:39

fuller at one point in the month, or their sex drive is higher at one point.

DR HANNAH SHORT: 00:29:43

I mean, you know, they're aware of these changes.

DR HANNAH SHORT: 00:29:45

They don't constitute a clinical disorder.

DR HANNAH SHORT: 00:29:47

But because we're cyclical creatures, you start to be aware of these changes.

DR HANNAH SHORT: 00:29:52

But the women with P.M.S.

DR HANNAH SHORT: 00:29:53

will say maybe their mood, they will be a little bit more tearful or more

DR HANNAH SHORT: 00:29:56

likely to cry or have an argument with their partner or have headaches

DR HANNAH SHORT: 00:30:00

or breast pain in the lead up.

DR HANNAH SHORT: 00:30:02

And they may go to their G.P.

DR HANNAH SHORT: 00:30:04

and ask for some advice.

DR HANNAH SHORT: 00:30:05

And sometimes things like diet and lifestyle changes

DR HANNAH SHORT: 00:30:07

can make a big difference.

DR HANNAH SHORT: 00:30:08

Sometimes the contraceptive pill, which evens out hormonal changes

DR HANNAH SHORT: 00:30:12

and things like that can help.

DR HANNAH SHORT: 00:30:14

But these women who have P.M.S., they're not gonna fall into the P.M.D.D.

DR HANNAH SHORT: 00:30:17

category, which is where there's serious disruption to your personal life.

DR HANNAH SHORT: 00:30:21

And P.M.D.D., it's where it's, it's more really a matter of degree.

DR HANNAH SHORT: 00:30:24

And if you feel that your symptoms are so debilitating, so, you know,

DR HANNAH SHORT: 00:30:28

profound depression, very severe anxiety, rage, mood swings, suicidal

DR HANNAH SHORT: 00:30:34

thoughts, um, you know, feelings of hopelessness and despair.

DR HANNAH SHORT: 00:30:38

It may be, you know, women feel they can't go to work, or if they do go

DR HANNAH SHORT: 00:30:41

to work they're constantly worried they're gonna do something wrong

DR HANNAH SHORT: 00:30:44

and try and put on a brave face.

DR HANNAH SHORT: 00:30:46

But it's a real effort for them to kind of try and act normally, as it were.

DR HANNAH SHORT: 00:30:50

And then these symptoms, you know, they are significant.

DR HANNAH SHORT: 00:30:54

That's when you'd have this diagnosis of P.M.D.D.

DR HANNAH SHORT: 00:30:56

And they need to arise in the luteal phase of the cycle.

DR HANNAH SHORT: 00:30:59

So that's after ovulation, generally in the two weeks or

DR HANNAH SHORT: 00:31:02

one week before your period.

DR HANNAH SHORT: 00:31:04

And then they should get better when your period arrives.

DR HANNAH SHORT: 00:31:07

But, um, we know that there are genetic links.

DR HANNAH SHORT: 00:31:09

So you said your, you felt that your mum may have struggled with this as well.

DR HANNAH SHORT: 00:31:12

There are at least a couple of genes that have been identified,

DR HANNAH SHORT: 00:31:15

which seem to be more common.

DR HANNAH SHORT: 00:31:17

These in particular variants that are common in women with P.M.D.D.

DR HANNAH SHORT: 00:31:21

And they kind of affect the way the brain processes, you

DR HANNAH SHORT: 00:31:24

know, oestrogen and serotonin.

DR HANNAH SHORT: 00:31:26

And also the breakdown products of progesterone as well.

DR HANNAH SHORT: 00:31:29

Because all of these things play a role in our kind of brain chemistry

DR HANNAH SHORT: 00:31:33

at different points in the month.

VIKKI: 00:31:35

Wow.

VIKKI: 00:31:35

I can so relate to that because religiously about a week before

VIKKI: 00:31:41

my period would come, I would feel very hopeless, very, very dark and

VIKKI: 00:31:47

despairing and sometimes that I didn't want to be around anymore.

VIKKI: 00:31:52

And even if I knew my period will probably come in a week's time, the

VIKKI: 00:31:58

blackness would be so black that it, that wouldn't make a difference to me.

VIKKI: 00:32:03

And it would feel like the reality was this and that, you know, "I'm a terrible

VIKKI: 00:32:08

person" or "life is just terrifying".

VIKKI: 00:32:12

And then within a week, bam, period would come and it would feel like

VIKKI: 00:32:16

resurfacing from being underwater.

VIKKI: 00:32:19

So yeah, this, wow.

VIKKI: 00:32:21

I'd, I'd love to know if, if this is resonating with any of my listeners and

VIKKI: 00:32:26

to know that potentially, it might be something that you could be helped with,

VIKKI: 00:32:31

would be an incredible comfort to some.

DR HANNAH SHORT: 00:32:34

One of the most debilitating things about

DR HANNAH SHORT: 00:32:35

it is that it's cyclical.

DR HANNAH SHORT: 00:32:37

So it comes around month in month out.

DR HANNAH SHORT: 00:32:39

A lot of women will say, "My period arrives and I feel myself again".

DR HANNAH SHORT: 00:32:43

Or maybe a couple of days afterwards they feel themselves again, and then they

DR HANNAH SHORT: 00:32:46

kind of think, "Did it really happen?

DR HANNAH SHORT: 00:32:47

Was it really that bad?"

DR HANNAH SHORT: 00:32:49

And then you start doubting yourself and you go to a medical

DR HANNAH SHORT: 00:32:51

practitioner and some doctors haven't heard of P.M.D.D., for example.

DR HANNAH SHORT: 00:32:55

And they'll say "Well, not really sure, I think you might have mild P.M.S."

DR HANNAH SHORT: 00:32:59

or, you know, things like that.

DR HANNAH SHORT: 00:33:00

And so there's a bit of - Not intentional I think- but medical

DR HANNAH SHORT: 00:33:03

gaslighting that can go on with severe forms of premenstrual disorder.

DR HANNAH SHORT: 00:33:07

And also to have a diagnosis of P.M.D.D., there shouldn't really be any other

DR HANNAH SHORT: 00:33:12

underlying mental health or psychological diagnosis, but often they come hand in

DR HANNAH SHORT: 00:33:16

hand because if you struggle with severe premenstrual symptoms month in, month out,

DR HANNAH SHORT: 00:33:20

you are gonna become depressed because it feels quite hopeless because you feel

DR HANNAH SHORT: 00:33:24

whatever you do, you feel horrendous.

DR HANNAH SHORT: 00:33:27

And so even if you do feel okay for two weeks, three weeks, a month,

DR HANNAH SHORT: 00:33:30

you know this and it is exhausting.

DR HANNAH SHORT: 00:33:32

I've had women say they just can't face going through it every month.

DR HANNAH SHORT: 00:33:36

And so it's not uncommon to have kind of concurrent depression or

DR HANNAH SHORT: 00:33:40

anxiety alongside those changes.

DR HANNAH SHORT: 00:33:42

So when I see women, I often say, well, "look at their notes."

DR HANNAH SHORT: 00:33:46

So sometimes there's a referral letter or they sometimes refer themselves

DR HANNAH SHORT: 00:33:49

in, but they will have on their notes that they have depression or anxiety.

DR HANNAH SHORT: 00:33:52

But it's always important to say, "Okay, what came first?"

DR HANNAH SHORT: 00:33:55

Because often it's the depression and anxiety have arisen after their mood

DR HANNAH SHORT: 00:33:58

changes have just been going on for several years and it's like a feeling of

DR HANNAH SHORT: 00:34:03

hopelessness because whatever they do, they find themselves in this situation.

DR HANNAH SHORT: 00:34:07

But there's definitely help and advice out there.

DR HANNAH SHORT: 00:34:10

there's the organisation that I'm on the clinical advisory board for, I.A.P.M.D.

DR HANNAH SHORT: 00:34:15

They have some fantastic patient information- sections on there that talks

DR HANNAH SHORT: 00:34:19

about what this condition is, including all the treatment options and peer support

DR HANNAH SHORT: 00:34:24

and they do awareness raising campaigns.

DR HANNAH SHORT: 00:34:27

They've also got a section for professionals, so doctors and

DR HANNAH SHORT: 00:34:29

psychologists and scientists and things like that.

DR HANNAH SHORT: 00:34:31

And looking at all the latest research and evidence because I mean, unfortunately

DR HANNAH SHORT: 00:34:36

a third of people with P.M.D.D.

DR HANNAH SHORT: 00:34:38

do attempt to take their own life during a crisis.

DR HANNAH SHORT: 00:34:41

I mean, so it is, it is a mental health, emergency in that sense.

DR HANNAH SHORT: 00:34:44

Mind have got something on their website about P.M.D.D.

DR HANNAH SHORT: 00:34:47

as well, because like you said, even if you have this awareness this is to do

DR HANNAH SHORT: 00:34:52

with a phase of your menstrual cycle when you're in it, it doesn't feel like that.

DR HANNAH SHORT: 00:34:55

It feels like it's always gonna be like that.

DR HANNAH SHORT: 00:34:57

And people worry that other people around them are getting fed up with them, that

DR HANNAH SHORT: 00:35:01

they'd be better off without them.

DR HANNAH SHORT: 00:35:03

And it's, yeah...

DR HANNAH SHORT: 00:35:05

Treatment is out there.

DR HANNAH SHORT: 00:35:06

I have to say, it's not always easy to find the right thing immediately,

DR HANNAH SHORT: 00:35:10

but there are treatment guidelines that are accessible to all doctors.

DR HANNAH SHORT: 00:35:14

They may not always be aware they're there, but the Royal College of

DR HANNAH SHORT: 00:35:17

Obstetricians and Gynaecologists do have treatment guidelines, and you start with

DR HANNAH SHORT: 00:35:22

quite basic, low level interventions, but they do go right up to, I suppose,

DR HANNAH SHORT: 00:35:26

the treatment I ultimately had, which was removal of the endocrine system

DR HANNAH SHORT: 00:35:29

or your reproductive endocrine organs.

DR HANNAH SHORT: 00:35:32

I wouldn't recommend that unless it's absolutely needed, because there

DR HANNAH SHORT: 00:35:35

are other repercussions with that.

DR HANNAH SHORT: 00:35:37

Sometimes that's necessary.

DR HANNAH SHORT: 00:35:38

And I think one thing to say though is it's not a cure because you still

DR HANNAH SHORT: 00:35:43

have a hormone sensitive brain.

DR HANNAH SHORT: 00:35:45

I think some women are told that if they have the surgery, that

DR HANNAH SHORT: 00:35:49

actually your ovaries are gone.

DR HANNAH SHORT: 00:35:51

So you should be fine.

DR HANNAH SHORT: 00:35:52

But actually the issue is in the brain.

DR HANNAH SHORT: 00:35:54

It's not the ovaries, it's the brain's response to the

DR HANNAH SHORT: 00:35:57

ovaries' hormonal production.

DR HANNAH SHORT: 00:35:59

And so women need to be told that.

DR HANNAH SHORT: 00:36:00

It just becomes easier to manage if your ovaries have removed, because

DR HANNAH SHORT: 00:36:04

you can then have some element of control if you have add- back H.R.T.

DR HANNAH SHORT: 00:36:08

for example.

DR HANNAH SHORT: 00:36:09

But before you get to that stage, there are lots of other things you can do.

DR HANNAH SHORT: 00:36:12

And we use S.S.R.I.s, which are a form of antidepressant, but they can just be

DR HANNAH SHORT: 00:36:17

used in the luteal phase at a low dose.

DR HANNAH SHORT: 00:36:19

And to be honest, that that's got the most evidence for efficacy for patients.

DR HANNAH SHORT: 00:36:23

And I've seen patients who have gone from feeling hopelessly suicidal every

DR HANNAH SHORT: 00:36:26

month to feeling "normal" or they don't really notice their symptoms

DR HANNAH SHORT: 00:36:31

and they're much more manageable.

DR HANNAH SHORT: 00:36:33

But they don't have the side effects associated with long term S.S.R.I.

DR HANNAH SHORT: 00:36:37

use.

DR HANNAH SHORT: 00:36:37

I personally often use very low doses because it works in a different way than

DR HANNAH SHORT: 00:36:40

when we are using it for, you know, things like clinical depression and things.

DR HANNAH SHORT: 00:36:44

But there's also hormonal treatments like certain contraceptive pills can

DR HANNAH SHORT: 00:36:47

be particularly helpful because that suppresses the natural ovarian cycle

DR HANNAH SHORT: 00:36:51

and gives you add- back hormones.

DR HANNAH SHORT: 00:36:54

But the, the only problem with P.M.D.D is women are hormone-sensitive

DR HANNAH SHORT: 00:36:57

and sometimes don't get on well with the particular pills.

DR HANNAH SHORT: 00:37:01

And this is why you probably, if you are at the more extreme end of this group

DR HANNAH SHORT: 00:37:04

of women, then you probably need to see someone with expertise in that area and

DR HANNAH SHORT: 00:37:09

might need referrals somewhere because it may be beyond the scope of your G.P.

DR HANNAH SHORT: 00:37:13

for example.

DR HANNAH SHORT: 00:37:14

But there is the help out there.

VIKKI: 00:37:16

This does sound extremely complex and I think when we spoke

VIKKI: 00:37:21

briefly before Hannah, I think, did you say 75% of women are felt to

VIKKI: 00:37:27

have issues with their hormones?

DR HANNAH SHORT: 00:37:30

No, I think I might have been saying that most women are

DR HANNAH SHORT: 00:37:33

aware that they have changes at some point, you know, around their cycle.

DR HANNAH SHORT: 00:37:37

But it depends.

DR HANNAH SHORT: 00:37:37

I mean, it wouldn't surprise me if around three quarters of women

DR HANNAH SHORT: 00:37:41

had issues in some way relating to their hormones, whether it's P.M.S.,

DR HANNAH SHORT: 00:37:45

P.M.D.D., if it's peri-menopause, or, you know, or is it more to do with

DR HANNAH SHORT: 00:37:49

endometriosis, which, you know, the symptoms are driven by hormonal changes.

DR HANNAH SHORT: 00:37:53

I mean, if we look at the stats for menopause, around 75%

DR HANNAH SHORT: 00:37:56

of women will have symptoms.

DR HANNAH SHORT: 00:37:59

So I think the lucky quarter of women who don't really have symptoms, they

DR HANNAH SHORT: 00:38:02

may be the ones who've been quite lucky throughout their reproductive life.

DR HANNAH SHORT: 00:38:05

So I think, yeah, if we are looking at it like that, it probably is around

DR HANNAH SHORT: 00:38:09

three quarters of women who will have some kind of issue relating to

DR HANNAH SHORT: 00:38:12

reproductive lives and menstrual cycle.

VIKKI: 00:38:15

What was interesting in particular when you were

VIKKI: 00:38:18

talking earlier about P.M.S.

VIKKI: 00:38:20

and P.M.T.

VIKKI: 00:38:21

and how dismissive women are made to feel if you're going through it.

VIKKI: 00:38:26

And it's the same with menopause, that it's like, "Oh, she's going

VIKKI: 00:38:29

through the change" or, , "Oh, she must be on, having her monthly".

VIKKI: 00:38:33

And it's always done in very dismissive terms and belittling terms

VIKKI: 00:38:37

when actually it does have a huge effect on you - how you present

VIKKI: 00:38:42

and how you feel about yourself and everything on a regular basis.

VIKKI: 00:38:48

So you've talked about endometriosis- you know, it's a term I understand, but

VIKKI: 00:38:53

I don't fully comprehend what's involved.

DR HANNAH SHORT: 00:38:56

Okay, so it's a condition where there are cells

DR HANNAH SHORT: 00:38:59

similar to the lining of the womb are found outside of the womb or uterus.

DR HANNAH SHORT: 00:39:04

So they can be found on the outside on the fallopian tubes or the

DR HANNAH SHORT: 00:39:07

ovaries, but also within the pelvis or on the bladder or on the bowel.

DR HANNAH SHORT: 00:39:10

In some rare cases they've been found in the lung or in the brain.

DR HANNAH SHORT: 00:39:14

And the problem is these cells act like the lining of the womb.

DR HANNAH SHORT: 00:39:17

And so they respond to menstrual, hormonal changes and they bleed in

DR HANNAH SHORT: 00:39:22

response to hormonal changes as well.

DR HANNAH SHORT: 00:39:23

So you can get internal bleeding.

DR HANNAH SHORT: 00:39:25

You know, some women have coughed up blood during their periods, if they

DR HANNAH SHORT: 00:39:28

had endometriosis in their lungs.

DR HANNAH SHORT: 00:39:30

That is quite extreme so most women wouldn't get that.

DR HANNAH SHORT: 00:39:33

But some women will, for example, when they open their bowels, would pass blood.

DR HANNAH SHORT: 00:39:36

And it's not because they've got piles or they've, you know, got a

DR HANNAH SHORT: 00:39:39

fissure or something, it would be entirely related to their period.

DR HANNAH SHORT: 00:39:43

You know, the internal pelvic organs can become fused together so the

DR HANNAH SHORT: 00:39:47

bowel can get stuck to the uterus.

DR HANNAH SHORT: 00:39:48

They can, and you get all these adhesions, which are formed, so

DR HANNAH SHORT: 00:39:51

you can get what's called a frozen pelvis, where there's lots of kind

DR HANNAH SHORT: 00:39:54

of like scar tissue in your pelvis.

DR HANNAH SHORT: 00:39:56

And obviously it can lead to repercussions of things like fertility

DR HANNAH SHORT: 00:39:59

issues, particularly if you've had big cysts or stuff on your ovaries.

DR HANNAH SHORT: 00:40:04

So, yeah, pain is one of the most common symptoms, but it can, can cause

DR HANNAH SHORT: 00:40:08

you know, severe, you know, other symptoms like bloating and there's

DR HANNAH SHORT: 00:40:12

obviously an associated mood changes, but I suspect that's more to do with

DR HANNAH SHORT: 00:40:16

the response to the physical symptoms.

DR HANNAH SHORT: 00:40:18

Although having said that, it's got inflammatory and we think

DR HANNAH SHORT: 00:40:21

autoimmune roots and we know that the inflammation there has effects on the

DR HANNAH SHORT: 00:40:26

brain, which can trigger depression.

DR HANNAH SHORT: 00:40:27

So there may be something else going on there as well.

VIKKI: 00:40:31

I'm very lucky that I've never had chronic long-term pain, but

VIKKI: 00:40:35

I'd imagine that if you're in that situation, that also affects your mood

VIKKI: 00:40:41

because it's exhausting and it gets you down, living in pain like that.

VIKKI: 00:40:45

And for anybody that's struggling with endometriosis at the moment, is

VIKKI: 00:40:51

there anything that they can be doing to sort of help themselves or is it

VIKKI: 00:40:56

a question of going to see the G.P.

VIKKI: 00:40:58

first and foremost?

DR HANNAH SHORT: 00:41:00

I think if you're struggling with pain that's related

DR HANNAH SHORT: 00:41:02

to your periods or symptoms that are coming that seem to be associated

DR HANNAH SHORT: 00:41:06

with your menstrual cycle then yes, definitely go to your doctor.

DR HANNAH SHORT: 00:41:09

One good thing would be to track your symptoms to see if there is a pattern.

DR HANNAH SHORT: 00:41:13

Um, I mean, endometriosis is a slightly tricky one because you

DR HANNAH SHORT: 00:41:16

can't formally diagnose it really without having a laparoscopy,

DR HANNAH SHORT: 00:41:20

you know, a surgical procedure.

DR HANNAH SHORT: 00:41:22

Occasionally do MRI scans and if they've got like a big cyst on your

DR HANNAH SHORT: 00:41:25

ovary, then that might be enough to say, "Yes, you've got this".

DR HANNAH SHORT: 00:41:28

But often you can have microscopic disease, which means that you

DR HANNAH SHORT: 00:41:31

wouldn't necessarily see it on a scan, but because of where it is, it

DR HANNAH SHORT: 00:41:34

could be triggering severe symptoms.

DR HANNAH SHORT: 00:41:36

So there's different grades of endometriosis, but weirdly, what

DR HANNAH SHORT: 00:41:39

would look, if you were looking at it from a surgical point of view, 'mild'

DR HANNAH SHORT: 00:41:42

could have horrendous symptoms, but you could have severe endometriosis,

DR HANNAH SHORT: 00:41:46

but that may not be bothering you.

DR HANNAH SHORT: 00:41:47

But for example, could be found during investigation for

DR HANNAH SHORT: 00:41:50

fertility treatment, for example.

DR HANNAH SHORT: 00:41:52

Again, there are guidelines for doctors to help treat women with

DR HANNAH SHORT: 00:41:56

endometriosis and referral and, and surgery isn't always needed because

DR HANNAH SHORT: 00:42:01

there are risks that come with surgery.

DR HANNAH SHORT: 00:42:03

You know, the contraceptive pill, again, can sometimes be helpful.

DR HANNAH SHORT: 00:42:06

Sometimes dietary changes- having a fiber rich diet can be helpful,

DR HANNAH SHORT: 00:42:10

because of changes to do with a gut microbiome and the way our body

DR HANNAH SHORT: 00:42:13

deals with the breakdown products of oestrogen and things like that.

DR HANNAH SHORT: 00:42:16

Um, but it, it's hard.

DR HANNAH SHORT: 00:42:19

There are, you can be put into a chemical menopause to shut down your

DR HANNAH SHORT: 00:42:22

ovarian function and to see if that gives relief from the symptoms as well.

DR HANNAH SHORT: 00:42:27

I mean, I think if anybody is struggling with what they think may be

DR HANNAH SHORT: 00:42:30

endometriosis, look at Endometriosis U.K.

DR HANNAH SHORT: 00:42:32

That's a UK charity and that's got lots of information and support there.

DR HANNAH SHORT: 00:42:36

But I think if you're having painful periods interfering with

DR HANNAH SHORT: 00:42:39

your life and doesn't just go away with a little bit of paracetamol

DR HANNAH SHORT: 00:42:41

or ibuprofen, that's not normal.

DR HANNAH SHORT: 00:42:44

Women are told it's normal, you know, "It's just period pain", but it isn't.

DR HANNAH SHORT: 00:42:48

And yes, treatment is, kind of needed, but I suppose just don't be fobbed off

DR HANNAH SHORT: 00:42:52

if you're not immediately referred to a gynaecologist and stuff because there

DR HANNAH SHORT: 00:42:55

are conservative measures that can help.

DR HANNAH SHORT: 00:42:57

And actually you don't want to have surgery unless you need it.

DR HANNAH SHORT: 00:43:00

And if other things improve that your G.P.

DR HANNAH SHORT: 00:43:02

can help you with, then that's really the route to go down.

VIKKI: 00:43:04

That was incredibly helpful, thank you Hannah.

VIKKI: 00:43:07

As ever with the podcast I'll be putting full support links in the

VIKKI: 00:43:12

show notes, so to organisations like Endometriosis U.K., I.A.P.M.D.

VIKKI: 00:43:18

and also Mind, in terms of P.M.D.D.

VIKKI: 00:43:23

I'd love to talk to you as well about rage, because it's something that keeps

VIKKI: 00:43:27

coming up time and time again with listeners who have experienced tremendous

VIKKI: 00:43:32

anger, in the postnatal period.

VIKKI: 00:43:35

It's not something that I can relate to myself, but it does seem

VIKKI: 00:43:38

to be a 'thing', postnatal rage.

VIKKI: 00:43:41

Can you talk to us about that, what causes it and how it manifests

VIKKI: 00:43:47

and what can be done to sort of help people going through that.

DR HANNAH SHORT: 00:43:51

Well, I don't have much experience personally

DR HANNAH SHORT: 00:43:53

with patients with postnatal rage.

DR HANNAH SHORT: 00:43:55

Not because I'm saying it doesn't exist, because I understand it does.

DR HANNAH SHORT: 00:43:59

But I see this a lot with premenstrual disorders and P.M.D.D.

DR HANNAH SHORT: 00:44:02

And I suspect it's the same thing that is going on there because our brains

DR HANNAH SHORT: 00:44:06

are profoundly affected by hormonal changes, and we all have differing

DR HANNAH SHORT: 00:44:10

degrees of hormone sensitivity.

DR HANNAH SHORT: 00:44:12

So the way our brains process the hormones or the breakdown products will

DR HANNAH SHORT: 00:44:16

react to them is gonna be different.

DR HANNAH SHORT: 00:44:18

So when we see this in women with P.M.D.D.- and I suspect that there is

DR HANNAH SHORT: 00:44:23

similarity with the postnatal rage- is when there's issues with the brain

DR HANNAH SHORT: 00:44:28

dealing with the breakdown products of progesterone and particularly, so there's

DR HANNAH SHORT: 00:44:31

something called allopregnanolone, which is a breakdown product.

DR HANNAH SHORT: 00:44:34

And normally this would produce a calming kind of sedative- like effect,

DR HANNAH SHORT: 00:44:38

but that doesn't happen in women with severe hormone sensitivity.

DR HANNAH SHORT: 00:44:42

In fact, it seems to induce kind of more anxiety and rage

DR HANNAH SHORT: 00:44:45

and things like that as well.

DR HANNAH SHORT: 00:44:47

So I think there's probably something going on there and the

DR HANNAH SHORT: 00:44:51

way that the hormone changes and that withdrawal of hormones as well.

DR HANNAH SHORT: 00:44:56

So it is quite a complex topic and I'm just trying to think how best to describe

DR HANNAH SHORT: 00:44:59

it without kind of confusing as well!

DR HANNAH SHORT: 00:45:03

Hormone disorders like P.M.D.D.

DR HANNAH SHORT: 00:45:05

are often to do with steroid hormone withdrawals.

DR HANNAH SHORT: 00:45:08

So it's that big change, that big drop off that triggers those mood

DR HANNAH SHORT: 00:45:11

symptoms because it affects the other neurotransmitters in the brain.

DR HANNAH SHORT: 00:45:13

And the same thing happens postnatally.

DR HANNAH SHORT: 00:45:15

So you go from high levels of oestrogen and progesterone to kind of, they

DR HANNAH SHORT: 00:45:20

bottom out when you deliver the baby.

DR HANNAH SHORT: 00:45:21

And it will really depend whether you breastfeed or not, when you, menstrual

DR HANNAH SHORT: 00:45:25

cycles commence and stuff because if you are breastfeeding, then there's

DR HANNAH SHORT: 00:45:28

often, you know, suppression of your menstrual cycle and you don't start

DR HANNAH SHORT: 00:45:31

having periods until you stop often.

DR HANNAH SHORT: 00:45:33

But all of these things, if you have got a brain that's primed

DR HANNAH SHORT: 00:45:36

to hormone sensitivity could trigger symptoms like rage.

DR HANNAH SHORT: 00:45:39

And I mean there, there have been drug trials looking at this and I think

DR HANNAH SHORT: 00:45:43

there's something in the states, which is looking at some of those molecules

DR HANNAH SHORT: 00:45:48

similar to allopregnanolone in which is going to be used in treatment of

DR HANNAH SHORT: 00:45:51

things like postnatal mood disorder.

DR HANNAH SHORT: 00:45:54

They did do something in P.M.D.D..

DR HANNAH SHORT: 00:45:56

Unfortunately, it wasn't as successful as they hoped it would be, but there

DR HANNAH SHORT: 00:45:58

were some changes, but they weren't significant enough to say, "Yes, we

DR HANNAH SHORT: 00:46:01

should all be doing this" essentially.

DR HANNAH SHORT: 00:46:04

But I think it's a real phenomenon.

DR HANNAH SHORT: 00:46:05

Again, I suppose it's going to be speaking with somebody who's an

DR HANNAH SHORT: 00:46:08

expert in hormone sensitivity.

DR HANNAH SHORT: 00:46:12

I mean, the way that I talk about managing premenstrual symptoms

DR HANNAH SHORT: 00:46:15

that are similar to the postnatal rage, it's about one, managing

DR HANNAH SHORT: 00:46:20

the kind of hormonal fluctuations.

DR HANNAH SHORT: 00:46:23

And that can be done in various ways.

DR HANNAH SHORT: 00:46:25

Whether it's it's with further suppression of hormones or is it, adding

DR HANNAH SHORT: 00:46:29

hormones, whether it's kind of in form of contraception or hormone therapy.

DR HANNAH SHORT: 00:46:33

And the other thing is changing the brain's response to that.

DR HANNAH SHORT: 00:46:36

So anything we can do to calm the autonomic nervous

DR HANNAH SHORT: 00:46:38

system down can be helpful.

DR HANNAH SHORT: 00:46:40

So things like exercise- appreciate that could be quite hard postnatally

DR HANNAH SHORT: 00:46:44

when you're dealing with lots of stuff, and especially if you're

DR HANNAH SHORT: 00:46:46

feeling really, really low.

DR HANNAH SHORT: 00:46:47

Um, maybe a psychiatric drug like S.S.R.I.s, because that stabilises

DR HANNAH SHORT: 00:46:52

the neurotransmitters again in the postnatal period, as it

DR HANNAH SHORT: 00:46:55

does in the premenstrual period.

DR HANNAH SHORT: 00:46:57

Um, anti-inflammatory diet - this isn't gonna be enough in itself, but all

DR HANNAH SHORT: 00:47:02

these things can kind of be supported.

DR HANNAH SHORT: 00:47:04

So kind of having a diet rich in plants and micronutrients.

DR HANNAH SHORT: 00:47:07

Things like meditation.

DR HANNAH SHORT: 00:47:09

There was a study at University of Chicago looking at mindfulness based

DR HANNAH SHORT: 00:47:12

cognitive therapy, and it showed levels of inflammation, in women with P.M.D.D.

DR HANNAH SHORT: 00:47:17

significantly decreased after 16 week course of that.

DR HANNAH SHORT: 00:47:20

So all of these things can have a...

DR HANNAH SHORT: 00:47:22

they might feel like, "Oh, what are they going to do?"

DR HANNAH SHORT: 00:47:25

but they can have a profound effect.

DR HANNAH SHORT: 00:47:27

I think it's realistically how can we help women to do these things?

DR HANNAH SHORT: 00:47:30

When you're struggling with a newborn or if you're premenstrual and your

DR HANNAH SHORT: 00:47:34

mood are so low, how do you do the things that are gonna help you?

DR HANNAH SHORT: 00:47:37

And I think then it's better, you know, to seek the support of someone who can

DR HANNAH SHORT: 00:47:41

give you the medical support that then enables you to do the things you need to

DR HANNAH SHORT: 00:47:44

do, in a self-care kind of way as well.

VIKKI: 00:47:47

Yeah.

VIKKI: 00:47:48

And with things like breathing exercises, would that be helpful

VIKKI: 00:47:51

in terms of where you were talking about calming the nervous system?

DR HANNAH SHORT: 00:47:56

Certainly all of that stuff is, is going to be really helpful.

DR HANNAH SHORT: 00:47:59

I suppose sometimes the way it can be presented, "Oh, just do a few

DR HANNAH SHORT: 00:48:02

breathing exercises and it'll help!"

DR HANNAH SHORT: 00:48:04

But actually if we go back to, um, kind of looking at, actually what

DR HANNAH SHORT: 00:48:07

happens , it's the feedback that your brain gets when you naturally slow your

DR HANNAH SHORT: 00:48:11

breathing down, it gives the signal that you're kind of safe and so your

DR HANNAH SHORT: 00:48:15

journal output kind of calms down.

DR HANNAH SHORT: 00:48:17

And some of your physical symptoms can kind of get better as well.

DR HANNAH SHORT: 00:48:20

And then that has a knock on effect psychologically.

DR HANNAH SHORT: 00:48:22

So there is a reason why these things are recommended, but

DR HANNAH SHORT: 00:48:25

it's not always explained why.

DR HANNAH SHORT: 00:48:27

Um...

VIKKI: 00:48:27

It's funny, yeah, I'd read things when I was trying to help myself

VIKKI: 00:48:30

and it would be like "Go for a walk!"

VIKKI: 00:48:32

Or "Breathe!"

VIKKI: 00:48:33

And I've recently trained as a children's anxiety coach and when you actually

VIKKI: 00:48:39

learn the rationale behind it and how it can actually calm the amygdala

VIKKI: 00:48:43

response and it, makes you realize that, "Ah, there is an actual point to it.

VIKKI: 00:48:48

It's not just airy fairy take a few deep breaths and you'll feel better."

DR HANNAH SHORT: 00:48:53

I know.

DR HANNAH SHORT: 00:48:53

Well, I think that it's like when you talk about diet and lifestyle and the

DR HANNAH SHORT: 00:48:55

thing, well, everyone knows, "Yeah, exercise is good for you, should eat

DR HANNAH SHORT: 00:48:58

some fruits and veg, but do we know why?

DR HANNAH SHORT: 00:48:59

And I mean it's, when you look at the reasons why, it makes much more sense.

DR HANNAH SHORT: 00:49:03

And in terms of dietary recommendations, there's no postnatal diet, there's

DR HANNAH SHORT: 00:49:07

no premenstrual diet or menopausal diet, but there are dietary patterns

DR HANNAH SHORT: 00:49:11

associated with general better health in terms of wellbeing in

DR HANNAH SHORT: 00:49:14

the moment and long term health.

DR HANNAH SHORT: 00:49:16

And that's generally one that is rich in fruits, vegetables, you know, beans,

DR HANNAH SHORT: 00:49:20

pulses, whole grains, because that's an anti-inflammatory diet pattern.

DR HANNAH SHORT: 00:49:23

So inflammation is often behind these unpleasant symptoms

DR HANNAH SHORT: 00:49:27

at what the cellular level.

DR HANNAH SHORT: 00:49:28

And so if we can do everything to kind of minimise that, that will help.

DR HANNAH SHORT: 00:49:33

But there are so many challenges though aren't there in the postnatal

DR HANNAH SHORT: 00:49:35

period or in the premenstrual period.

DR HANNAH SHORT: 00:49:37

And it's easier said than done I think sometimes, but if people can

DR HANNAH SHORT: 00:49:41

understand why it's recommended, I think that goes halfway to helping.

VIKKI: 00:49:45

That statistic you were saying about the meditation,

VIKKI: 00:49:48

that's incredible to hear.

VIKKI: 00:49:50

And um, I was just gonna say for any listeners who haven't necessarily

VIKKI: 00:49:54

come across it, in Season One of Blue MumDays, there is a special 15 minute

VIKKI: 00:49:59

'Loving Kindness' Meditation that Poonam Dhuffer of YSM8 created for listeners.

VIKKI: 00:50:06

And that is something that you can listen to at any time of the day.

VIKKI: 00:50:09

If you've never meditated before, you don't need to do anything-

VIKKI: 00:50:13

just close your eyes and listen.

VIKKI: 00:50:15

Um, and one of the things that I really struggled very, very badly

VIKKI: 00:50:19

with when I had my PND was insomnia.

VIKKI: 00:50:23

so, as you were saying, you also had terrible insomnia, Hannah, and

VIKKI: 00:50:28

I found that listening to something like a podcast late at night or in

VIKKI: 00:50:32

the middle of the night when you're going through that panic of like,

VIKKI: 00:50:34

"I've got to sleep and I can't sleep!"

VIKKI: 00:50:37

Even if you can listen to it at that time, you know, it'll hopefully,

VIKKI: 00:50:42

as you say, calm the nervous system and if you drop off to sleep while

VIKKI: 00:50:46

listening, even better because, it's just there to sort of help you.

VIKKI: 00:50:51

There's no right or wrong to meditating.

VIKKI: 00:50:52

It's just listening and being in the moment and listening to the words.

VIKKI: 00:50:57

And, um, I really hope that some of you out there get some sort of

VIKKI: 00:51:00

solace from doing it or, you know, a bit of a reset and a recharge.

VIKKI: 00:51:06

But it's incredible how.

VIKKI: 00:51:08

at mercy of the hormones we are, especially as, as women.

VIKKI: 00:51:12

And, and one thing I noticed about when I was looking at your website

VIKKI: 00:51:15

is that you are pretty much fully booked for the next X months.

VIKKI: 00:51:20

And that goes to show how much need there is for helping women

VIKKI: 00:51:24

go through these experiences.

DR HANNAH SHORT: 00:51:27

Yeah, no, I know.

DR HANNAH SHORT: 00:51:28

And I think we're hugely underserved and at the moment, I mean, it's not

DR HANNAH SHORT: 00:51:31

just to do with Covid because these issues were there before, but I think

DR HANNAH SHORT: 00:51:35

it's one of the problems is it's not recognised, I think, as to how many

DR HANNAH SHORT: 00:51:39

women are affected and how profound the symptoms can be and how debilitating

DR HANNAH SHORT: 00:51:44

because there's a lot of silence and I think, again, there's still some stigma

DR HANNAH SHORT: 00:51:47

and taboo out there, particularly when it's to do with, I don't know, you

DR HANNAH SHORT: 00:51:51

know, menstrual related problems, birth, you know, basically gynaecological

DR HANNAH SHORT: 00:51:56

issues together with mental health.

DR HANNAH SHORT: 00:51:58

It's like a double whammy.

DR HANNAH SHORT: 00:52:00

And I think women are very good at kind of putting up with stuff, hiding

DR HANNAH SHORT: 00:52:03

stuff, masking stuff, and often not asking for help until it's too late.

DR HANNAH SHORT: 00:52:06

And when they do, let's say, not necessarily getting

DR HANNAH SHORT: 00:52:08

the right kind of support.

DR HANNAH SHORT: 00:52:10

And I think one real crying shame is that commissioners in the NHS don't seem to

DR HANNAH SHORT: 00:52:14

see the value in planning these services.

DR HANNAH SHORT: 00:52:16

So if anything, they're kind of reducing access to things like menopausal health.

DR HANNAH SHORT: 00:52:22

You know, there are no real premenstrual clinics.

DR HANNAH SHORT: 00:52:24

They kind of sneak in under general gynaecology or menstrual clinics.

DR HANNAH SHORT: 00:52:28

And in terms of kind of provision for perinatal psychiatry, it's

DR HANNAH SHORT: 00:52:32

really inadequate, particularly in the area where I am.

DR HANNAH SHORT: 00:52:35

But I mean, it varies hugely in different parts of the U.K.

DR HANNAH SHORT: 00:52:39

I mean, most of the women I see, they come to see me because they

DR HANNAH SHORT: 00:52:43

just cannot get access elsewhere.

DR HANNAH SHORT: 00:52:46

And they're desperate, but they often want to be referred back into the N.H.S.

DR HANNAH SHORT: 00:52:48

I was doing an NHS menopause and premenstrual clinic, alongside

DR HANNAH SHORT: 00:52:52

a gynaecologist for a year, but then they decommissioned the post.

DR HANNAH SHORT: 00:52:55

They said it wasn't needed, even though me and the gynecologist like, well, there is,

DR HANNAH SHORT: 00:52:59

there's, there was a huge waiting list.

DR HANNAH SHORT: 00:53:01

But I think it's just shortsighted because the interest, they want to

DR HANNAH SHORT: 00:53:05

see kind of immediate outcomes and obviously these things don't, things

DR HANNAH SHORT: 00:53:08

don't change overnight, and I don't think they recognize the repercussion

DR HANNAH SHORT: 00:53:12

for re referrals everywhere else.

DR HANNAH SHORT: 00:53:13

So a lot of premenstrual stuff ends up in psychiatry, whereas it.

DR HANNAH SHORT: 00:53:19

You know, really should be.

DR HANNAH SHORT: 00:53:20

We, a lot of it we should be able to manage within the community and stuff.

DR HANNAH SHORT: 00:53:23

But psychiatry don't get that training most of the time in the U.K.

DR HANNAH SHORT: 00:53:27

as well.

DR HANNAH SHORT: 00:53:27

In menopause women are inappropriately referred to cardiology, to rheumatology,

DR HANNAH SHORT: 00:53:31

to, you know, muscular skeletal services.

DR HANNAH SHORT: 00:53:34

And actually if everybody could kind of take a holistic viewpoint and think,

DR HANNAH SHORT: 00:53:37

"Okay, what's actually going on here?"

DR HANNAH SHORT: 00:53:40

We don't need to do all of this stuff.

DR HANNAH SHORT: 00:53:41

And actually we could manage this stuff better.

DR HANNAH SHORT: 00:53:43

But yeah, , I don't think that if they could realise ultimately in the long run

DR HANNAH SHORT: 00:53:47

they'd save money and time and lives and, you know, women would do a lot better.

DR HANNAH SHORT: 00:53:54

So yeah, unfortunately there is a big demand and I wish I could see more women.

DR HANNAH SHORT: 00:53:59

And I know my colleagues who do similar clinics are the same.

DR HANNAH SHORT: 00:54:02

Um, so yeah.

VIKKI: 00:54:05

Do you have any advice for women who are listening and just suddenly for

VIKKI: 00:54:10

the first time feeling, "Wow, I think this might be something that's affecting me."

VIKKI: 00:54:16

What advice would you give to them?

DR HANNAH SHORT: 00:54:18

I think look at the I.A.P.M.D.

DR HANNAH SHORT: 00:54:20

website and also the Primary Care Women's Health Forum.

DR HANNAH SHORT: 00:54:24

You go onto the website and there's either a link for healthcare

DR HANNAH SHORT: 00:54:27

professional or for patients.

DR HANNAH SHORT: 00:54:29

We've got like a patient information leaflet on there that talks about things

DR HANNAH SHORT: 00:54:31

that you can do to help yourself and maybe how to go approach your G.P.

DR HANNAH SHORT: 00:54:36

But really what you need to do is start tracking symptoms.

DR HANNAH SHORT: 00:54:38

So you can do that via an app, you can do it by a paper diary, but have some

DR HANNAH SHORT: 00:54:42

clear things showing that your, your symptoms change or your wellbeing changes

DR HANNAH SHORT: 00:54:46

because that we didn't really touch on P.M.E., which is the premenstrual

DR HANNAH SHORT: 00:54:49

exacerbation, which is slightly different.

DR HANNAH SHORT: 00:54:52

That would need slightly different management, and that's where underlying

DR HANNAH SHORT: 00:54:54

disorders- so you may have a chronic depression or anxiety- but it could

DR HANNAH SHORT: 00:54:57

be something like migraine or asthma or something, or epilepsy, that

DR HANNAH SHORT: 00:55:01

gets worse in the luteal phase.

DR HANNAH SHORT: 00:55:03

Then if you can see that things get worse, but, and then improve with

DR HANNAH SHORT: 00:55:07

your period again, that needs to be picked up and managed appropriately.

DR HANNAH SHORT: 00:55:11

But the key thing is tracking your symptoms.

DR HANNAH SHORT: 00:55:13

I suppose arming yourself with the knowledge and having a little bit

DR HANNAH SHORT: 00:55:16

more understanding, knowing about the guidelines that are out there.

DR HANNAH SHORT: 00:55:20

I know it's hard because I find it hard as a doctor myself to go to a professional

DR HANNAH SHORT: 00:55:24

and say, "I know there are guidelines", but you know, if there's ways you can do

DR HANNAH SHORT: 00:55:28

that without kind of, you're not gonna cause offence or anything like that,

DR HANNAH SHORT: 00:55:31

but just say, you know, even if you say something like, "I understand there are

DR HANNAH SHORT: 00:55:34

guidelines" and if they have the name of those guidelines, their G.P.- If they're

DR HANNAH SHORT: 00:55:37

not familiar with it- can look it up.

DR HANNAH SHORT: 00:55:40

I know some patients get really disheartened when G.P.s look things up,

DR HANNAH SHORT: 00:55:43

but to be . Honest, there are so many guidelines you're supposed to know, and

DR HANNAH SHORT: 00:55:47

we just can't keep them all in our head.

DR HANNAH SHORT: 00:55:49

So if you have a G.P.

DR HANNAH SHORT: 00:55:50

who wants to help, even if they're not that knowledgeable at that

DR HANNAH SHORT: 00:55:53

point, I think stick with that G.P.

DR HANNAH SHORT: 00:55:55

because they will help their learning and then they

DR HANNAH SHORT: 00:55:57

can help support you as well.

VIKKI: 00:55:59

Brilliant.

VIKKI: 00:55:59

And if we could just touch on PME for a moment before we wrap up.

VIKKI: 00:56:05

So that is premenstrual exacerbation and I'm I right in thinking that is

VIKKI: 00:56:10

where you have an existing symptom that worsens during your menstrual cycle.

DR HANNAH SHORT: 00:56:17

Mm-hmm.

DR HANNAH SHORT: 00:56:18

Yeah.

DR HANNAH SHORT: 00:56:18

So when we are looking at P.M.D.D.

DR HANNAH SHORT: 00:56:21

I know we talked a bit about the overlap with things like depression and things

DR HANNAH SHORT: 00:56:24

like that, which can occur, but if you're looking at it classically, you would be

DR HANNAH SHORT: 00:56:27

symptom free for the first two weeks of your cycle, so when your period's there.

DR HANNAH SHORT: 00:56:30

And then symptoms will start at some point after ovulation.

DR HANNAH SHORT: 00:56:33

So either immediately, or sometimes it's a bit later, and then they get better.

DR HANNAH SHORT: 00:56:37

So for half the month, essentially you're symptom free, but up to two weeks a

DR HANNAH SHORT: 00:56:41

month, you're debilitated by the symptoms.

DR HANNAH SHORT: 00:56:44

With P.M.E., you're probably never a hundred percent symptom three.

DR HANNAH SHORT: 00:56:47

So you could have, I don't know, O.C.D., you could have I don't

DR HANNAH SHORT: 00:56:51

know, a bad depression or anxiety.

DR HANNAH SHORT: 00:56:54

And I said there can be physical symptoms, so things like migraine as well.

DR HANNAH SHORT: 00:56:57

But you notice that these markedly change in the lead up to your period.

DR HANNAH SHORT: 00:57:01

Then the issue is, you know, actually this is what we call premenstrual

DR HANNAH SHORT: 00:57:04

exacerbation of an underlying disorder.

DR HANNAH SHORT: 00:57:07

And although things never can entirely improve, most of the time

DR HANNAH SHORT: 00:57:09

it may be much more manageable, when you're not in that luteal phase.

DR HANNAH SHORT: 00:57:13

So the way that that is treated is slightly differently to P.M.D.D.

DR HANNAH SHORT: 00:57:16

is that you first look at the underlying condition and make sure that your

DR HANNAH SHORT: 00:57:19

treatment is optimised for that.

DR HANNAH SHORT: 00:57:21

If it is and there's nothing else that can be done or added,

DR HANNAH SHORT: 00:57:24

actually, that's when you'd kind of probably go more down the P.M.D.D.

DR HANNAH SHORT: 00:57:27

pathway and look at that and things like suppressing the

DR HANNAH SHORT: 00:57:30

menstrual cycle and looking at the other things we've discussed.

DR HANNAH SHORT: 00:57:33

One of the things I don't think we did talk about was

DR HANNAH SHORT: 00:57:36

psychological support, so C.B.T.

DR HANNAH SHORT: 00:57:39

and things are recommended in the guidelines.

DR HANNAH SHORT: 00:57:42

I think again, one of the issues is access and there aren't that many women or

DR HANNAH SHORT: 00:57:45

psychologists who specialise in this area.

DR HANNAH SHORT: 00:57:47

But it can be incredibly helpful to get support from somebody who does have

DR HANNAH SHORT: 00:57:52

knowledge in this area, because if you can kind of help to train your brain to

DR HANNAH SHORT: 00:57:57

have, you know, or to respond in different ways to, to the negative messages you're

DR HANNAH SHORT: 00:58:01

given at certain points during the month, that can be hugely instrumental in

DR HANNAH SHORT: 00:58:04

recovery and managing symptoms long term.

VIKKI: 00:58:08

Thank you.

VIKKI: 00:58:09

I just feel so educated on the subject now and my heart goes out to anybody

VIKKI: 00:58:13

that's been affected by these things.

VIKKI: 00:58:16

And when you were talking about the P.M.D.D.

VIKKI: 00:58:18

symptoms, I, I just wanted to weep because for so many years after the PND, I would

VIKKI: 00:58:25

still go to work and just feel desperate for so much of the time and realising that

VIKKI: 00:58:32

that might have been to do with my cycle.

VIKKI: 00:58:34

Because you question yourself, don't you?

VIKKI: 00:58:37

And you think, "Am I going absolutely mad?

VIKKI: 00:58:40

And why can't I just cope with life in a way that everybody

VIKKI: 00:58:46

else seems to be able to cope?"

DR HANNAH SHORT: 00:58:48

Yeah.

DR HANNAH SHORT: 00:58:48

No, it's tragic, isn't it?

DR HANNAH SHORT: 00:58:49

And I think unfortunately, you're not alone in that because.

DR HANNAH SHORT: 00:58:53

I mean, I struggled for so long.

DR HANNAH SHORT: 00:58:55

I think one of my, the issues was with me that I never had the regular

DR HANNAH SHORT: 00:58:58

periods and I couldn't sometimes disentangle what was the endo and what

DR HANNAH SHORT: 00:59:01

was the more premenstrual symptoms.

DR HANNAH SHORT: 00:59:03

But I do remember feeling utterly hopeless and we see that.

DR HANNAH SHORT: 00:59:08

And, and like you said, you didn't have that experience of rage,

DR HANNAH SHORT: 00:59:10

And I thankfully didn't, but I felt like I had everything else.

DR HANNAH SHORT: 00:59:13

Some women, you know, that the rage is the worst thing for them.

DR HANNAH SHORT: 00:59:16

And I, I'm, so I wish I could kind of give you more certainty in terms of the

DR HANNAH SHORT: 00:59:20

postnatal side, but I can only think that it is driven in the same way that

DR HANNAH SHORT: 00:59:25

you know, the same kind of underlying mechanism because it's certainly something

DR HANNAH SHORT: 00:59:28

we see and it is to do with things like that steroid hormone withdrawal and the

DR HANNAH SHORT: 00:59:32

brain's response to hormonal changes.

DR HANNAH SHORT: 00:59:36

But yeah, we need there to be more awareness and amongst clinicians,

DR HANNAH SHORT: 00:59:39

but, but there is help out there.

DR HANNAH SHORT: 00:59:41

I so I hope people kind of get that message, even though I, I know

DR HANNAH SHORT: 00:59:44

it can be quite, quite a complex and there is no easy answer, but

DR HANNAH SHORT: 00:59:48

generally things can improve, so

VIKKI: 00:59:51

And it's, it's worth sort of unpicking to try and

VIKKI: 00:59:53

find out what, what's going on.

VIKKI: 00:59:56

And I'm sure this has been a very reassuring listen, so thank you.

VIKKI: 01:00:00

And if you are in particular sort of affected by postnatal rage, please do

VIKKI: 01:00:05

get in touch with me because I'll do my best to find an expert in that area.

VIKKI: 01:00:10

So we could do like proper Q+A with them, because I can imagine it's a

VIKKI: 01:00:15

very, very hard thing to, to go through.

VIKKI: 01:00:17

And also, you know, even more taboo because people don't speak about those

VIKKI: 01:00:22

things and women are never expected to be, or allowed to show rage.

DR HANNAH SHORT: 01:00:28

No,

VIKKI: 01:00:29

Or anger, let alone when you are a parent.

VIKKI: 01:00:32

So, um, please don't feel that you are alone and it's not you.

VIKKI: 01:00:36

It's, it's something that's happening to you to cause that rage.

VIKKI: 01:00:40

So you mustn't feel guilt about it.

VIKKI: 01:00:42

But, I will do my best to find somebody who can advise on that subject.

VIKKI: 01:00:47

But for now, thank you so much Hannah.

VIKKI: 01:00:49

That's been, it's such an incredible, conversation with you and I really

VIKKI: 01:00:54

appreciate you taking out time out of your incredibly busy schedule.

VIKKI: 01:00:58

And, um, I'll obviously put links to your, your website as well if somebody needed

VIKKI: 01:01:04

to get in, in touch with you direct.

VIKKI: 01:01:06

But,

DR HANNAH SHORT: 01:01:06

there are some links on there as well.

DR HANNAH SHORT: 01:01:08

I mean the process of updating the website, so in the next, by the end

DR HANNAH SHORT: 01:01:11

of the year it should be the new shiny updated one cause it's quite

DR HANNAH SHORT: 01:01:13

old at the moment and putting more links in so people can link directly

DR HANNAH SHORT: 01:01:17

to things like the P.M.S., P.M.D.D.

DR HANNAH SHORT: 01:01:19

guidelines, things like the DAISY network, which is for P.O.I.

DR HANNAH SHORT: 01:01:23

And everything like that.

DR HANNAH SHORT: 01:01:23

could help a bit more.

VIKKI: 01:01:25

Thank you so much!

DR HANNAH SHORT: 01:01:26

You're welcome- thank

DR HANNAH SHORT: 01:01:26

you for having me,

VIKKI: 01:01:28

if you've enjoyed this episode of Blue MumDays, please like and subscribe.

VIKKI: 01:01:33

It really does make the difference in helping other people find it,

VIKKI: 01:01:37

and that means helping more parents.