Menopause, Misdiagnosis, and Modern Solutions: A Conversation with Dr

This week's episode has been sponsored by Oh My Bod, shifting the evolution of pleasure. Hi, this is Suzanne Noble, and you're listening to Sex Advice for Seniors. And I guess it was a couple of months ago, I was invited to an event which was a preview event for a event coming up in October called PAUSE, which is about the menopause. And it was a preview event featuring panels of healthcare professionals talking mainly about menopausal issues and things that don't often get spoken about when it comes to women and sexual health predominantly. I was completely inspired during this day because firstly, I very rarely meet anybody in the UK who's tackling some of these very challenging issues around our intimate health, but also because the people on the panel were just so absolutely engaging and incredible and just really fun to listen to. Um, and one of them whom I'll never forget because she actually got us all to pretend that we were looking at our vulva and has launched a campaign called Check Your Vulva is Dr. Shirin Lakani. And she's a GP, she's a aesthetic technician. She's the founder of Elite Aesthetics, and she's here with me right now. We're gonna talk about all sorts of things, including the menopause, but also stuff that impacts upon men's sexual health as well. So welcome.

Thank you for having me, Suzanne Noble.

Oh, it's— I'm just so delighted that you could come on the show. So what really led you into this area of looking at our sexual health, both men and women? What was it?

I think, um, one of the reasons I got so heavily involved in it is because it's not very well looked after on the National Health Service, um, women more than men, in fact. So if you look at men's sexual health, there's multiple options available on the National Health Service for erectile dysfunction, whereas if a woman came in with any sort of sexual dysfunction, there wasn't anything to offer. And when I asked my colleagues for advice on what we could offer these patients, particularly when I was doing my training, the responses were things like, oh, um, ask her to relax more, have a glass of wine before sex, or have psychosexual counseling. And to me, that was just, oh my God, what century are we living in? Um, so that sparked a real interest in me, particularly in women's health, but also when I got involved in learning the different treatments available, etc. I was just fascinated about how much there was that we could do for both genders.

Yeah, I always say that to people. I say the issue is that most of these challenges that we face with regard to having pleasure during sex, being able to you know, to just experience all the wonders of sex are solvable. But yeah, nobody gets told. And especially when we get older. Look, I mean, I'm here, like I said to you just before this, I think this is like 160 podcasts later, and I'm still learning stuff all the time. And what I'm learning from the people that I hear from is that they just don't get told anything from their doctors when they go and they say, I'm having really painful sex. It's like, well, you're 64 years old, what do you expect?

Yeah, and I think that is one of the biggest myths I want to quash, because just because you're older doesn't mean that sex is any less important or it should be any less pleasurable. Um, we're sexual beings as humans, we're animals, so sex isn't just about reproduction. Having sexual intercourse releases all sorts of endorphins and starts off enzymes time and hormone cascades, and it's actually really important for our well-being, and it's important for our relationships as well. Just because you're past a certain age doesn't mean you can't be intimate with your partner and have that closeness.

Yeah, well, I know that you started this thing called Check Your Vulva, and, and my slogan is desire doesn't retire.

Oh, that's a fantastic slogan, I love that. But the hashtag behind the Check Your Vulva campaign— so the Check Your Vulva is just one part of it, but it's hashtag know your normal because we're all different as individuals. We've all got different anatomy, we've got different physiology. So my key point that I want to get across to everyone from teenagers upwards is know what's normal for you, know what gives you pleasure sexually from an early age, and then you can explain it to someone else. A lot of the people I see with sexual dysfunction haven't ever explored themselves So how are they supposed to explain to a partner what they enjoy?

Yeah, yeah, yeah. I mean, it's a massive problem of lack of communication. We weren't taught any skill, anything in school with regard to how to talk about sex with your partner, with your parents, with anybody.

Um, and it's still seen as such a taboo.

Well, and, and I think a lot of people then it— the, the repercussions of that is not just that we can't speak with our own partners, but also, as you've said, we can't speak with our doctor. No, we don't know the questions to ask, like, what, what is your normal, right?

Yeah. And conversely, a lot of doctors feel embarrassed communicating with their patients about it. And when you look at the statistics, particularly with things like genitourinary syndrome of menopause, only 7% of healthcare professionals actually ask about it. Yeah, in a menopause consultation. And it's such an important part of life.

Yeah, I mean, it's— it is shocking. I'm sorry, it is— it is shocking that we're at this point in history and we're still— we still haven't normalized the idea that people can have sex at any age.

Yeah, I think it's slowly improving, but we've still got a really long way to go.

I mean, why do you think that this intimate health is overlooked when we talk about aging and wellness?

I think it stems from two factors. So from a patient perspective, like you said, we aren't taught to, taught to talk about sex. We're talking about the mechanisms of it in terms of reproduction and avoiding sexually transmitted diseases and unwanted pregnancies, but we're not taught about the intimacy of it. And also from a medical point of view, it's similar. That's what you're taught about. And, um, you don't really focus on the importance of sexual relations from a medical point of view either. So I think there's embarrassment and reluctance on both sides of the equation to discuss it, and that just adds to the shame and the stigma surrounding it. So people aren't comfortable talking to their healthcare providers. Healthcare providers generally don't want to bring it up with their patients.

Yeah, and I've heard as well that when it comes to the menopause, that most doctors have not received more than— I think the statistic was 6 weeks of training, if that.

So, um, you get a tiny bit of training in medical school, but that's more based on the hormonal changes and like how that all changes, um, throughout time. You're not taught very much about the impact it has on the person because you're told hot flushes and cessation of periods, and that's about it. You're not— um, I don't think we even knew when I was in medical school all the different symptoms that are associated with menopause. And I graduated at a time when the Women's Health Initiative and the Million Women Studies came out, and so HRT was a complete no-no because it was going to kill you and it was going to give you breast cancer. So an entire generation lost out on the benefits of hormone replacement, and an entire generation of medics didn't get the training on it. Yeah.

And I know that one of the things that you specialize in is the O-Shot and the P-Shot to improve sexual function and intimacy, especially for older people who might be dealing with things like, you know, the menopause or erectile dysfunction. Can you just explain? I don't know anything about the O-Shot. I know.

Okay, you know a little bit about the P-Shot, but I know about the P-Shot, but I don't know about the O-Shot. So they're very similar treatments. So the O-Shot is for women, the P-Shot is for men, but both of them involve the use of platelet-rich plasma. So that's when we take blood from the patient, we spin it in a centrifuge, we separate— so we separate the red cells and the platelets and the plasma. And what you're injecting back into the patient is a concentrated solution of platelets. Okay. Now, platelets are what cause your body to heal when you have an injury. So, the easiest way to explain is when you cut your arm and you bleed, and then you get a yellow goo forming at that injury site. Now, that yellow goo is effectively platelet-rich plasma. It's what's there when the platelets get activated. So the first thing they do is they stop you bleeding and a clot forms. And then the next thing that happens is that they attract stem cells into the area to regenerate the tissue. And these stem cells can— they basically adapt to the tissue they're in. So when you cut your arm, you don't grow an ear there, for example, but it's the same platelets all throughout your body that attract the certain stem cells to the area. So when you inject activated platelets into an area of the body, what you're essentially doing is saying, hello, I've been injured here, come and fix me. Because the body is very good at ignoring long-term inflammation, okay? So something that's been going on slowly for a long period of time gets ignored. But when you have an acute injury, the body goes into repair mode. So what you're doing is you're basically tricking the body into thinking you've had an injury there and then in that tissue, so it sends in all the repair mechanisms. And that's how PRP works. Okay, so when you inject into the penis, into the appropriate areas, you can get improvement in blood vessels, you get new nerve formation, you get collagen stimulation. Likewise, when you inject into the vagina and the clitoris in a woman, you get a similar regeneration. So it can help with sensitivity, it can help with lubrication. Um, if you inject in the correct place, it can also support the bladder through the collagen stimulation so that it can improve stress incontinence as well.

Oh wow. And why would you use it as a woman, for example, and not as opposed to, say, taking testosterone?

Um, so testosterone works on libido.

Oh right, okay.

It does have an effect on the tissues as well, locally, if you apply it locally. But the main reason for testosterone is to improve libido and sexual function. Um, but that doesn't totally cover the physical aspects. Of the tissue changes that happen. Um, you can also use localized estrogen as well, um, and that can help rebuild the tissues, but you don't get the same regenerative effects that you do from the PRP. A lot of the time I use them in conjunction. So if I see a woman with genitourinary syndrome of menopause and she's not on topical estrogen, I encourage her to go on it. If I see someone with no libido and they're not on testosterone, again, that's a discussion we have about starting hormones. Um, one place I do get resistance even to localized hormone replacement is in women who've had breast cancer because their treatment gives them GSM sometimes prematurely. Yes. And if it's hormone sensitive, even though localized estrogen has been shown to be safe in the vast majority of women even with breast cancer, there is still a reluctance for them to take it. So the O-Shot can really yourself in that situation.

So you could still— because a friend of mine has had, had this, uh, scenario, and I mentioned going on vaginal estrogen to her, and she's like, oh, I can't go on anything. As soon as she heard the word estrogen, she was, she was basically like, no, no, I can't do anything like that, because her fear of, you know, of taking anything that had any estrogen in it, even though it's microscopic was so overwhelming. So what you're saying is you could substitute the P— the O shot for those women?

Yeah, so those women do tend to come for the O shot even though I try and tell them that local estrogen is safe. Um, and the problem is that not every doctor has caught up with that.

Yeah, yeah.

So I know when I first started telling women, actually, it doesn't matter if you've had breast cancer local vaginal estrogen is safe in the vast, vast majority. I, I'd get strung out, say, no, you can't, it says in the patient leaflet this is going to give you breast cancer.

Well, I mean, I'm sure that you've been following all the discussions going on in the States about this, because there's, there's loads of discussions going on the States about removing the black box warnings on vaginal estrogen because it's putting so many women off taking something that is completely safe for them And I mean, I'm not an expert, but obviously I speak to loads of people who are, so I'm very aware of all the conversations that are going on around this. And it's a real problem because if people see those black box warnings and they see this may cause blah blah blah and a very long list, I mean, look, one of my parents is a bit, you know, is a bit like this. They read every single thing on the box for every medicine that they take. And even if it says that there is a microscopic chance of them, you know, getting anything, there's, there's still fear around that.

So absolutely. And that's human nature, isn't it? So yeah, I think removing that warning would go a long way into helping so many women. Um, but it is about patient choice as well. And even if you give them the information and they're not willing to take it, that is up to them. But there are other options, so Um, PRP treatment is one of them. Radiofrequency microneedling is another treatment I do. The device is called Morpheus8V, and we're getting great results for GSM and other vaginal conditions with that. Um, and then there's other topical things they can use. So they can use non-hormonal lubricants and moisturizers, but there's a lot more stuff coming out. So there are vaginal growth factors and things like that that are non-hormonal, that can improve the condition of the tissues. And actually, one of the treatments I did come across in the States that I brought to the UK is a topical carboxytherapy for, um, that you can put inside the vagina and externally as well. And it's a gel that, um, there's two gels, you mix them together, apply it to the tissue, and it releases carbon dioxide into the tissue. So that improves the blood circulation in the area, and it can help dryness as well.

Amazing, amazing. And, um, I'm assuming that the O-Shot is something that has to be administered by somebody like yourself, because I know with P-Shots sometimes men can do it, you know, can do these things on their own, can't they?

I don't think anyone should be doing any of these treatments on their own. So the P-Shot involves taking blood and putting it in a— yeah, so the P-Shot, you have to take blood and you have to spin it in the centrifuge, so you need the correct equipment to do it. And you need the correct clinical environment to do it in, otherwise you risk contamination, bloodborne viruses, etc. So my personal view is these should only be done by doctors in CQC-registered clinics. So it's a medical procedure, it should be treated as such.

Unfortunately, do they do it? How often do you have to do this?

I was having this discussion earlier about PRP. Not all PRP is created equal. So if you have a treatment with a good quality centrifuge that gives you a great quality platelet, um, platelet-rich plasma, so it's got a high yield of platelets in it, you need fewer treatments than if you went for a lower quality centrifuge. So with the low quality ones, some of them you barely get any platelets in there. So it's like When you're taking paracetamol, if you don't take an effective dose, you're not going to get results. And the dose of the platelets depends on the processing method. Yeah.

And how— and can I ask, how expensive are these sorts of treatments?

Um, so you're looking at, off the top of my head, there's obviously a price difference based on location and the experience of the person doing the treatment. So even in my clinic, there's a price range based on having one of my associate doctors doing it versus having me as the medical director doing the treatment. But you're looking at in the range of, um, around £1,300 to £1,500.

Oh, okay. So it's not, it's not an absurd amount of money if you—

No, it's not prohibitive, but it's, it's not like going down the road and getting a takeaway.

No, I appreciate that. Um, and, and so the P-Shot basically works in a very similar fashion?

Yeah, so the P-Shot, obviously, um, you inject according to the anatomy of where you're treating. So again, it's about, um, improved blood flow, improved sensitivity. Um, you can get an increase in size because of the increased collagen, but that's— I tend to say if you get that, that's a beneficial side effect rather than the main reason to go for it. But, um, it's about improving the function of the tissue.

Yeah. And we were talking about some of the, the treatments that you've done that involve men who have been— who have had some sort of prostate surgery and as a result of that have had or struggling with erectile dysfunction, which is common. Um, and some of your success stories, do you want to talk a bit more about that? Because I know—

yeah, yeah. So I mean, the thing with prostate surgery is— I think it's better now because men get told to do their pelvic floor exercises before the operation, whereas in the past you wouldn't even get told that, because pelvic floor strength is important for men and women. Um, so that's another campaign I want to launch where we teach school kids to do pelvic floor exercises in their PE lessons. I've got, I've got so much I want to do.

Is that— but on the roadmap of campaigns, is that—

yeah.

Let's look, if you can get women to just like know they're normal and to check their vulva, I think that would be— for me, that would be a great accomplishment because, you know, just veering off topic slightly, that was something I never ever ever did, ever.

Yeah.

And I remember probably the first time I looked down there not knowing what it was meant to look like. And I think when you showed us that wall of vulvas at the event that we went to, that was probably one of the first times that anyone's ever seen en masse, you know, a wall of them. And to realize just how different we all are. Right. So if people could just recognize the fact that we are all very, very different in the same way that when men go to the toilet and stand next to another guy in the, you know, in the urinals, they can look and go, oh, right, okay. Bigger, smaller, fatter, thinner, you know, they can see, right? This is, this is mine, that's theirs. Whereas with women, you know, we never— when did you ever look at your friend's vulva?

Like, no, no, exactly. And the only, the only time you would see it is on film or in adult magazines.

Yeah, yeah, exactly.

And they all look the same.

They all look the same. No, that's right, that's right, because they've been auditioned, as we know, for the size and shape. Well, they have actually.

Yeah, you know, or they've been photoshopped.

Well, they've been photoshopped. But anyway, going back to men with—

going back to men with prostate, so importance of pelvic floor exercises. And it's something that I encourage men again to start young and not wait until they've been diagnosed with a prostate problem, because the pelvic floor isn't just important post-prostate procedure. It's actually really important for maintaining erectile health in men as well. Okay, so that's the first thing. Um, so what I did with my patients who were young prostate patients, um, it was good because their doctors actually discussed what could happen afterwards with them. Obviously, there wasn't really a choice in whether or not they have the procedure. It was cancer, so that had to be done. Um, but we had time for them to pre-optimize their pelvic floors. And I've got a device where men can sit on a chair and get supramaximal pelvic floor contractions, and it's the equivalent of 30,000 pelvic floor contractions. Sorry, no, this one's 11,000 in 30 minutes.

Wow.

So you're never going to be able to do that on your own, and the strength of the contraction is much more than you'd be able to do on your own. So we did a course of 10 sessions before the procedure.

Yeah.

And then the patient had the procedure, and then 6 weeks after the operation, once everything had healed, we did another course of 10. And there was no incontinence. There was some erectile dysfunction, but nowhere near as much as expected. And then you can go on and have treatments like the P-Shot to try and improve the function that's there. Yeah, but in terms of preservation of function, it just shows how important it is to get that pelvic floor going.

That's incredible. It's— so is that machine a bit like a TENS machine but for your pelvic floor?

It's like an electromagnetic chair.

Yeah.

And there are in the pipeline, there is more coming out for men Um, I'm actually going to an event in a couple of weeks where they're launching a new device for men's health. So once I've got the details of that, I can let you know. But at the moment, what we've got is it's a chair that you sit on, there's a really strong magnet, and it stimulates the pelvic floor.

And is it pleasurable, painful, somewhere in between?

It's not painful, it's, it's a little bit strange. Yeah, it's a strange sensation, but it's definitely not painful. Some people have described it as pleasurable, and I know when they demonstrated it in the States with women, um, they had women saying that they could climax on the chair.

Wow.

I've never had a patient climax on it, so I don't know how much that is the States and, um, wow, the way they exaggerate things sometimes.

But, and are you one of the few clinics or the only clinic that has one of these chairs? I've never—

um, I was one of the first in the UK to have it, but that was— I got mine a decade ago. So there are more places that have it.

Oh right, that's incredible.

Because there's different brands now as well. There was only one brand when I started.

Sounds really interesting. I mean, because people talk about— obviously they talk about the pelvic floor as being really the key to recovering after prostate surgery. But of course people are lazy, right?

Yes.

Yeah, they don't always want to do their pelvic floor exercises.

It's the same with us. When I had my pregnancies, I didn't want to do my pelvic floor exercises. And if you've got an easy option that's accessible, then why not?

No, exactly. No, it's incredible. And tell me, so this is the other thing that I'm very curious to know about. So one of the conditions that you're known for treating is lichen sclerosis.

Did I pronounce it right? Lichen sclerosis.

Lichen sclerosis. I'm very close enough. What is it?

So it's an inflammatory skin condition that mainly affects the genitals. Um, it affects both women and men, but it affects far more women than men. There's not enough research into knowing what causes it. It's believed to be autoimmune. Um, it can happen at any age, but in women, the peaks of incidence tend to be before puberty or around menopause, so at the extremes of reproductive life. Some women also find they get it after pregnancy when their hormone levels dip. So I think there's a relationship between hormone levels and LS as well. Um, it destroys the genitals. So in men, it mainly affects the foreskin, but it can affect the shaft and the glands as well. In women, it affects the labia minora, it affects the perineum, which is the tissue between the vagina and the anus, and It affects the clitoris, and it— in both genders, it can affect the perianal tissue as well. Now, the problem with it is if it's not controlled, it leads to destruction of the tissue. It can lead to blisters, tearing of the skin, painful intercourse. In men, it can cause a condition called phimosis, where they can't retract the foreskin. In women, it can lead to complete fusion of the labia minora into the majora, but also midline fusion. So I've seen women who've got such small openings that they can't penetrate, and they can just about pee out of it.

That's so— and what's the— how do you treat that?

So on the NHS, the mainstay of treatment is steroid cream, and that's just to control the relapses. So it relapses and then it goes into remission. So when you have a flare-up, you treat it with steroids. Now, that does nothing to improve the condition of the skin. So for women, I like them to be on vaginal estrogen as well, so a localized estrogen cream that they can actually rub into all the areas that are affected, not just put it in the vagina. And I find that improves the tissue quality. But where I've had real success with men and women is with platelet-rich plasma, so the O-Shot and the P-Shot, but we use a modified technique so that we treat all the areas of lichen as well. Um, the other treatment that's been really successful in women is radiofrequency microneedling, so the Morpheus 8. Um, I haven't tried that in men yet, but that's something I'm looking at doing a study on to see if it improves male lichen sclerosus as well. And I don't see why it shouldn't because it's a regenerative treatment and it's a skin condition. So if you're treating the skin and causing it to heal itself, then it should be beneficial.

Yeah. And is this often misdiagnosed as something else? Because it sounds like something that a friend of mine has, and I said, oh, you know, maybe it's— maybe you should go on some vaginal estrogen, maybe you should do this, you know. But it was just painful tearing at that, as you said, at that perineum point.

Yeah.

And, um, small— yeah, small opening. Yeah.

So I'd recommend she goes and sees someone to get a diagnosis. Um, so the gold standard is obviously biopsy, but if there's enough clinical changes, she doesn't have to go through a biopsy to get a diagnosis. Um, the other thing it frequently mistaken for is thrush, because it can cause whitening of the skin.

Yeah.

So when women go to their doctor and say, um, I've got white patches, they'll say vagina. What they mean is vulva.

Yeah.

Um, and that's part of where my campaign comes in to know your anatomy so you can describe things. Um, and they'll say, okay, I've got white patches on my vagina, it's really, really itchy, it's really sore. And the doctor, without examining it, will just go, ah, thrush, canister. And then it doesn't get better, or it'll temporarily get better because it— the course of the disease is it gets better, then it comes back.

Yeah, yeah.

And then they go back again and get another thrush treatment. And I've had women who've been told they've got recurrent thrush and been treated as that for 8 years or more, and then when I examine them, they've got quite late-stage lichen sclerosis. So that's where the idea for Check Your Vulva came into it, because actually, if they looked, they wouldn't know what was normal because they didn't know what it looked like before.

No, no. I mean, it's just yet another sad story in the, in the long line of sad stories that I hear about.

Can I give you, can I give you some hope? Some light at the end of the tunnel? So With treatment, you can get back to a fairly normal lifestyle, and I've had patients who weren't able to have intercourse who, after PRP treatment or the radiofrequency microneedling treatment or a combination of both, have gone on to have pregnancies.

That's amazing.

I've got patients tell me on a daily basis, I can wear jeans again, I'm not constantly thinking about being in pain or discomfort, I can walk, I can exercise.

Yeah.

So there are treatments available. We just have to get the word out there.

Yeah, absolutely. And that's why I'm here to do what I do. And so are you. So we have to keep having more of these conversations. I mean, you know, the issue that I find— I'm actually going next week, I'm going to speak to junior GPs about all of this with a woman who works at St Mary's. I know in sexual function called— you may know her— called Dr. Ali Mears. And she and I are going to do like a little talk together about aging and intimacy issues for a bunch of junior GPs. There's going to be about 60 of them in the room, I've been told.

I think that's fantastic and it's so needed.

And, you know, I just want to do more of that because I just feel like there's not enough places that are making— that are available to have these kind of conversations. And often they're held in isolation or at events like the one that I went to, which was fabulous. But of course there were maybe, what, like maybe 200 people there at the most, right?

Yeah, yeah, that was quite a small event. But the thing is, it's getting this into mainstream health that's a real challenge.

Yeah.

And when I first started doing these treatments, um, I'd get brushed aside as like a sham and it's all witchcraft and there's no evidence behind any of these treatments. But actually, more recently I've had patients, doctors go, actually, I'm really interested by this because they see the results. I've had, um, dermatologists saying, what have you done? Because your condition is so much better. And then the patients tell them and they're like, right, I want to know more about that. Whereas before it'd be like, oh, it's a complete waste of time and money, and they wouldn't even be interested in seeing the evidence behind it.

And are you doing clinical trials alongside the work that you do?

Yeah, it's really difficult in my circumstances to do clinical trials that the NHS will accept because it needs to be done in a really large facility, usually with hospital or university backing. So as a single clinic, it's very difficult to get that level of study. But what we try and do is lots of clinics get together and we all do our own bits and collate the results. And I think that's a way we can get them more mainstream because I did, um, in 2017 I did a case study analysis of PRP and lichen sclerosus. It was mainly to prove to myself that what I was doing was beneficial.

Yeah.

Um, rather than just going by patients saying, oh yeah, it worked for me, I just thought, no, let me just dedicate some time to do a case study of 20 patients and see what their results are and actually see what the success rate is.

Yeah.

And then I've done something similar with the radiofrequency microneedling and lichen sclerosus, which we're hoping to publish imminently. So it's been written up, we're just looking for publication for that.

Oh, that's brilliant, because I know that's the questions that I often get asked in this— what I do on the, on the side with, uh, with FirmTech is, you know, where are the clinical trials, where's the evidence? Um, and I, and I went through a 12-week launch pad program with the NHS a few months ago, which was a real eye-opener in terms of how the NHS works and procurement. And I just think anybody who can do anything within the constraints of the NHS is really quite unbelievable because it's so difficult. And I can see why people like yourself have had to set up your own clinics because, yeah, you know, it's, it's not possible any other way, really. You know, that's, that's just the way it goes. Yeah.

I mean, even like when we're talking about teenagers with acne, it's completely off topic, but in the NHS I see a young girl with cystic acne that was scarring her face, and I'd have to go through the whole rigmarole of putting her antibiotics for 2 years before I could even refer her to a dermatologist, when I know what she needs is Roaccutane, which is a vitamin A tablet.

Yeah.

And it's like, but you're gonna have to wait 2 years before I can do the referral, and then however long the waiting list is for the dermatologist. By then they've scarring, it's too late.

I know, I know.

So it is frustrating.

Yeah, and it is because, you know, unfortunately there's a huge— there's, there's so many people that are, you know, the statistics around— now they call it GSM, they used to call it vaginal atrophy, didn't they?

Yeah.

Um, the statistics of women who have that are, are, are absurdly high. They're something like 50% of all women over 50. I mean, it's a, it's a crazy number. And yet we're still having these same conversations about these conditions, which are— some of them are quite easily treatable, as we talked about earlier.

Exactly. So vaginal atrophy, GSM, affects at least 50% of women. But the thing with that, that side of it is whilst the other symptoms of menopause may improve with time as you go through the barrage of hormonal changes, once everything stabilizes, your hot flushes will go away. Um, but the vaginal atrophy never goes away. It's chronic and progressive unless it's treated. But the treatment is so easy.

Yeah, yeah, no, I know, I know. I'm on all the stuff, so I'm good.

I'm good to go.

Anyway, it's been so lovely to talk to you. I could talk to you for another hour.

I think we're gonna have to do this again because I don't think we've covered half of what I wanted to tell you.

We'll do like part 2. We'll do—

absolutely, I can tell you about my supplements for ED in part 2.

Oh, let's do that, let's do that. We'll schedule in part 2, supplements for ED. I'd like that, let's do that. Anyway, Dr. Sharon, it's been absolutely lovely to talk to you, and I've learned again so much, as I'm sure have my listeners. And have a lovely afternoon.

Thank you, it's been my absolute pleasure! Suzanne Noble Noble— thank you so much! Thank you very much for watching this video on how to be happy at work by Susan Noble Noble. Please subscribe if you like my content. Bye bye now! Pleasure, Suzanne noble noble. Thank you so much.

You're welcome.