The School of Womanhood: Hormones, Menstrual Cycle, and Mental Health

Do you ever wonder how much you truly understand your menstrual health and its impact on your overall well-being? Our latest webinar at the School of Womanhood promises to shed light on this essential topic, featuring insights from experts like Gemma Poole, a dedicated midwife and NHS entrepreneur, Laura Spence, founder of Neuronatal, and Julie Hammond, a passionate GP currently writing a book on postpartum recovery. We explore the often overlooked link between menstrual cycles, hormonal balance, and mental health, providing you with the knowledge to make informed decisions about your healthcare.

Join us as we navigate the complexities of postnatal hormonal changes and the unique challenges faced by neurodivergent women. Discover practical strategies such as symptom tracking, meal planning, and self-advocacy to manage hormonal fluctuations and mood swings effectively. Our guests share their expertise and lived experiences, offering practical advice to help you document your menstrual cycles and communicate more effectively with healthcare providers, ensuring you receive the support you need during these critical phases.

Finally, we tackle the impact of hormonal changes in professional settings and the importance of supportive workplace policies. Learn from our panel on how to foster open dialogues with employers and create an empathetic environment for women experiencing menstrual and menopausal symptoms. This episode is packed with valuable insights and actionable tips, aimed at empowering you to take control of your health and thrive both personally and professionally. Don’t miss out on this enriching conversation designed to elevate women's health and well-being.

Outro

Transcript

Speaker 1: 1:48

One minute Silence, silence, silence, silence, silence, silence. Thank you for joining us at the School of Womanhood and we welcome you this evening. First of all, I'd like to introduce the concept. Why the School of Womanhood? It is something that the participants the panel this afternoon this evening discussed extensively over the last few months because of some observations that we've made gaps in information when it comes to women's health, things that one assumes are known and should be known by the vast majority of women, which ultimately have an effect on the care and the support women receive in our healthcare systems or whenever they engage with the medical profession, our healthcare systems, or whenever they engage with the medical profession. So we thought it would be extremely important to provide those answers, those information, and to empower women to ask the right questions, because it is impossible to ask the right question if you don't have the right information to start with. So that's what the support of women is about.

Speaker 1: 4:07

Today is our first webinar. It's going to be the first in a long series of webinars where we'll answer your questions, from fibroids to PCOS, to mental health during your pregnancy, if you're low or divergent, what it means to be gaining weight, if you're trying to have a baby, and so on and so forth. So the list is endless. At the end of the day, you will be empowered to ask those questions to take care of your health and, hopefully, change the course of your well-being as a woman. So, without further ado, let me introduce you to the panel. Uh, we have jimma paul, who is a midwife and an nhs entrepreneur. We have laura spence, who is an old-adventured uh midwife but also run her own have Laura Spence, who is a no Direction midwife but also run her own company. And Julie, who is a GP in the NHS and also has a company providing healthcare services. But who else to present themselves better than the panel? So I'll start with Gemma.

Speaker 2: 5:09

Hello and welcome everybody. Thank you so much, josiane. My name is Gemma Paul, I am a registered midwife and I am also the CEO of the Essential Baby Company and the Essential Baby Co in the community CIC. Today I will be taking a look at women's health in terms of a midwife affected, but also a mother of two young children and somebody who is an advocate for the invisible woman, as, shall we say, the women who are long forgotten about in healthcare services, and amplifying their voices to ensure that their needs and their ideas, their hopes and desires are reflected upon in the healthcare sector, in the NHS and globally as well. So I welcome everybody today and I hope that you all get something out of it. So I'll pass you over to Laura.

Speaker 3: 6:06

Thank you very much, gemma and Josiane. My name is Laura Spence and I too am a registered midwife and the founder of a company called Neuronatal. I am a late diagnosed ADHD female and was diagnosed at the tender age of 37, which I believe is the average age for a diagnosis of a woman in this day and age. I also have some children, three of them, one who is 15 years old, and that is challenging. She is autistic, she has ADHD and lots of associated physical health conditions along with that.

Speaker 3: 6:49

So I am bringing with me lots of lived experience, lots of hyper focus into all of the literature that's out there around the intersection of women's health and neurodivergent conditions, particularly in the perinatal phase. I am also just about to graduate in a master's of perinatal mental health and my research was centred around the experiences of postnatal women with ADHD in the context of early parenting. So it's a topic very close to my heart, but also a massive advocate for women's health in general. So I really hope that this is beneficial and hello to everyone who's here this evening. Thank you very much and I'll hand over to the lovely Julie.

Speaker 4: 7:35

Thank you, laura, and thank you so much again everyone who's joined us today, and I really hope that you find this session to be informative. So, hi, my name is Julie. I'm a GP based in I say Kent and London because I have my salaried role in Kent, but also contract or locum around different practices in London, so I get to see a wide variety of patients from all sorts of backgrounds, and I have various leadership roles within the NHS and health webinar and also a trustee at some different charities as well, and my main passion is health equity, women's health and also mental health as well, um. So, in terms of women's health, I've been doing a lot of work in that region recently.

Speaker 4: 8:15

I'm currently writing a book on, I would say, postpartum recovery, so that first year after giving birth, which is not really spoken about it what's been focused on? Baby's recovery, how babies do, but I don't really focus on how mothers healing and how mothers are recovering, the different things that they can go through. So that's one of the things I want to bring to light. So it's almost going to be all the taboo topics. This is what I love discussing all the taboo topics that not that I'm often not um discussed or just brushed aside to people suffering in silence.

Speaker 4: 8:42

I really want to bring it to the forefront um again, as something else I'm also working on as well, again in in the same room as Gemma, which is why we're both doing this. Initially was basically pregnancy health education just trying to make sure that everyone has access to the information that they need so that they can feel confident in advocating for themselves when they're speaking with healthcare professionals, so that they understand the language and they can also use the language in their consultations as well. So these are all the things that we're passionate about and that we really want to just make sure is transmitted today from this webinar. So thank you so much again, everyone who joins us.

Speaker 1: 9:17

Fantastic, Thank you so much for introducing yourself, so I'll start straight away with a question. What's your? From your experience, you know in your various lines of work, what do you think is the understanding of women of the link between menstrual health and hormone? Balance or imbalance? Can you provide some sort of sense of what people think or not? Maybe starting with Gemma?

Speaker 2: 9:52

yeah, it's a really good question actually, and it wasn't one that I would initially go to answer, because, as a midwife, you seem to forget about the menstrual system and the cycle because you're already pregnant, and so when we learn about this in the classroom, it's very much a a cut and dry this is what happened in your cycle and now you're pregnant.

Speaker 2: 10:10

But then we heavily involve ourselves in the education around the pregnancy and the conditions around pregnancy, so linking the two. As a health care professional, we don't really do that, but it's something that currently has been on my mind for for quite some time, because I've got two young girls now. Um, my, my oldest girl is nine and she is pre going into that menstrual, you know journey, and it wasn't until she was about eight and some of her friends at school actually started their periods at nine in the classroom that I thought, oh, actually I don't know enough to equip myself as a mother to tell my daughter, and I don't know enough as a midwife to equip somebody else in the postnatal period of what to expect and what does that mean. So doing this um has allowed me to deep dive into that. So, in terms of professional um understanding it was. It was pretty much zero as a midwife going through my education and I don't know if that was the same for the the other two as well. But that's on the panel yes, that's fascinating.

Speaker 1: 11:32

So, julie, I'd like to to to hear your perspective from a GP point of view, because the GP is the first point of contact primary care no, absolutely so.

Speaker 4: 11:42

I feel definitely not enough is understood in terms of the link between the hormones and menstrual health, just because, again, hormones and emotional health intertwines for everything from your mental well-being, um, when people notice that maybe a few days before the period, that's when they really struggle with symptoms of anxiety and depression, which again, is quite common, as the level of progesterone, one of the hormones your body, rises and in that later part of your period, um, again, people don't really understand that. Oh yeah, before my period I was a bit moody, or that's when I really struggled. That's when I find that I actually had someone who, again, just in terms of what Laura, her expertise had a patient with ADHD who told me that her condition, that before her period she really really struggled, she can't do anything, that's a period that she really finds difficult. So that's, that's a period that's really difficult. So that's something that's seen in one hand.

Speaker 4: 12:30

On the other side of things is that now there seems to be a move towards, um, natural conception, people not wanting to maybe be on contraception as much as well, rightly or wrongly, it's debatable, but there's, there's a move. So I think people just really need to understand. Okay, yes, you're not going to go on contraception, but do you really understand your body? Do you really understand when it is you're fertile? Um, because, again, there's all these little signs in our bodies that once you're, once you're aware of it, you can actually predict when you're going to be ovulating or when you're on your fertile window. But if you're not familiar with this or you have irregular periods, then perhaps not being on contraception is not the best thing for you, because you can't necessarily follow the natural family planning route so that's something I've also noticed as well, and in terms of other conditions, like the relationship between, like PCOS and menstrual cycles, and even things like weight, which I think we're going to discuss again a bit later.

Speaker 4: 13:23

All of these things are all intertwined and, yeah, it's something that I enjoy talking to my patients about, um, and just educating them and say, hey, yes, I'm not going to push contraception on you, but did you know this? Did you know that perhaps when you're feeling a bit more frisky, that is a sign that, yes, you're. You know your levels, your estrogen levels higher, your testosterone levels a bit higher, because your body is actually telling you okay, the egg is ready here now for fertilization, so let's go. Let's go and do this.

Speaker 4: 13:50

But my patients don't realize like, oh yeah, I didn't know how I'm like, well before you felt pregnant because you're a bit more horny, because, again, your hormones are just that way inclined. So, again, I think if women understood this, they'll be like okay, nope, this is not the time window, I don't want to get pregnant. So let me make sure that, yes, I'm feeling a bitisky, but this is the time where you use extra precautionary condoms so you don't have to use hormones, you can use condoms. This is the time we are definitely to make sure we're using a condom or avoid sex altogether. So, again, these are conversations. I love having Again two big topics, but things that need to be discussed.

Speaker 1: 14:24

So, Laura, is this expression oh, it's the hormones. Is it the hormones, though?

Speaker 3: 14:32

Well, that's a very good question, and I think you know that. Oh, she's so hormonal. That is such a flippant, overused term and I think it's wildly underestimated in the sense of neurodivergent females. Wildly underestimated in the sense of neurodivergent females. There is lots of new research coming out that highlights the fact that neurodivergent women, neurodivergent people who have periods, are far more sensitive to the experiences of those fluctuations in their hormones. So if, for example, we take the average typical menstrual cycle, which we would class as being over 28 days in the first two weeks of that phase, so usually between days 10 to 14 days prior to ovulation, what you tend to see, if you were to look at the patterns of your hormones, is that your oestrogen levels start to rise as you're approaching ovulation, which we think is roundabout halfway. Because your oestrogen levels are rising. So too, then is your dopamine level, and your dopamine is a neurotransmitter for estrogen and the two work really well together and it's within that sort of two week window that you might find your mood is better. You sort of energized and you could take on the world. You're sort of energised, you can take on the world, you're really productive. Your executive function, which is things like how organised you are, how motivated your emotional regulation are all spot on that first two weeks. But then what happens? Once your body has released that egg and ovulation is done, your hormone levels then start to fluctuate, in the sense that they decrease. So your estrogen levels begin to decrease, therefore, so does your estrogen level sorry, your dopamine level. And as that starts to decrease, then obviously, as we're approaching the bleeding section of your menstrual cycle, usually and certainly for me, and I know this is the experience for many other neurodivergent women as you're approaching your bleed, because my dopamine level is getting lower, because my estrogen level is lower, my mood regulation is a disaster. I become sometimes I have thoughts of suicide. I have just really low mood, low motivation. I'm crying a lot. I become really forgetful. That's the week that you'll find my car keys in the freezer, the milk in the microwave. I'm more likely to probably crash my car, miss appointments, be late for things just because I'm all over the place. Um, but then once the bleed comes, maybe a day or two after I'm born again, it's like you're a whole new person. You've been recharged, ready to take on the. You know, here we go for this kind of two and a half at a push, maybe three weeks, and it's challenging and I know the facts of this, but it still catches me by surprise every single month and I think, my God, I think I'm bipolar. What's the matter with me? Last week, life was great. This week it's terrible. I think I'm bipolar. What's the matter with me? Last week, life was great. This week it's terrible. Um.

Speaker 3: 18:11

So I mean, I think a lot of the battle is knowing that information so that when you are in the thick of that kind of week three coming into week four, when your period is about to start, just knowing that you're not mental is really beneficial because you can rationalize with yourself then, rather than feeling broken, wildly misplaced in life and kind of sitting on the periphery of normality, um. So I think it's it's really powerful to just have hold of that information and see how that because obviously lots of neurotypical women will also experience hormonal fluctuations, probably just not to the the extreme, um. I know we touched on, um things like polycystic ovarian syndrome, um, but for example, neurodivergent women are more likely to experience premenstrual dysphoria disorder and which is pmdd and that's um, that sort of extreme of your symptoms, of your menstrual cycle, and so it's all very interesting how it intersects gosh it is.

Speaker 1: 19:22

You know that because you've looked into it, because you've experienced it, because you're so, you've equipped yourself. Yeah, and yet, even with all that information, you still find yourself struggling. So immediately I think what if you don't know? What if you don't know? So how can the medical staff, or how can the patient, how can then, how can they have a, a constructive conversation where the root cause is discussed rather than the manifestation of the symptoms? And my question would go to Julie how do you, as a GP, tackle for want of a better word a patient who presents those symptoms and might not quite understand what is happening to them?

Speaker 4: 20:14

so I always say, especially people saying okay, yeah, there's a big fluctuation, my hormones, my moods or my symptoms always say keep a diary, so important. So again, you're the expert of your own body, so no one knows what's going on with your body better than you do. So when I'm taking history, I so no one knows what's going on with your body better than you do, so when I'm taking a history, I'm literally asking you what's going on so I can try and get an understanding as well. So it's someone who keeps a diary where they monitor things like so again, even things like the flow map, for instance, it allows you to monitor daily. Okay, oh yeah, today I was feeling a bit sad, or today I had a bit of acne, today I was, you know, I was feeling really energized.

Speaker 4: 20:49

I was happy Today, I was a bit horny, all of these things. When you document all of this information, you really start to see some trends and you start to especially if you have maybe more regular cycles, you can start to pick up on patterns. So you know that.

Speaker 3: 21:00

Okay, even the algorithms are so clever that they can actually pick up and be like yes, you're about to head into this phase of your menstrual cycle.

Speaker 4: 21:08

Um, based on previous patterns, this is what you may expect. And then they even start coming up with like suggestions and how you can actually counteract that. So keeping a diary just allows you to fully understand what's going on. And then, when you do go to the GP, rather than just not, rather than it's not, it's not my fault at all, but instead of just coming and just be like, oh yeah, this is happening. You can't haven't got quite got the words we actually can say. You know what? I've noticed that for the last three months I'm monitoring my cycles. Between this day and this day, this is what's happening. Um, do you know why that is? And when they ask the doctor that, and then, doctor, even if you weren't thinking that before, all of a sudden your mind starts to activate, you're like oh, wow, okay, this person knows what they're talking about.

Speaker 4: 21:45

They've really monitored things. Okay, let's actually sit down, and then that's when I start getting excited and bringing up graphs and being okay, yes, this is exactly what's happening, these are your hormone levels, so you can actually start to follow it yourself and you can really just become an expert with your own body. So I think, definitely keep a diary, keep a note all your symptoms, everything that you're going through, so that when you do go and present to the gp, you know exactly what's going on. You can articulate yourself in the best way possible.

Speaker 1: 22:12

Thank you. So Gemma, your midwife, the focus would be prenatal, postnatal I would imagine that prenatal or immediately after postpartum the hormone levels are still high. So basically, a woman, based on the explanation that Laura has just provided and also the comments from Judy, is in that high phase. Everything is glorious and so on and so forth, but, as we know, there's a cliff edge almost instantly after you hold that baby, and so on and so forth. What's your experience of women actually who may not know that their cliff edge would be sharper because of neurodiversity or adhd or what have you? And how is that actually perceived? Because it's very easy to say it was post birthbirth trauma or what have you. But what does that actually mean from that point of view.

Speaker 2: 23:07

Yeah, good question, and I think we've kind of normalized this to the baby blues, if you like. But not knowing what your body is going to do is like going into a storm with a blindfold on you don't know what you don't know. Going into a storm with a blindfold on you don't know what you don't know. So, like Julie was saying, and what Laura was saying as well, is having that understanding of what your body is doing, having that notebook of what's going to happen beforehand, so you know how your body reacts to your cycle. So know yourself, because health care professionals do not know this information. So do not go to a health care professional, be that um, a gp, a midwife, consultant, thinking that they understand how neurodivergent diagnosis interacts with hormones and pregnancy, because we're not. We don't know. The only people that do know is who have gone out to to research and do further um education, such as Laura with her master's and Julie um with her women's health um qualifications and with myself with the research around maternity and neurodivergence as well. So, first of all, be your own advocate and be your own professional. So you need to be partners in your own care in terms of that cliff edge, so understanding where that comes from. So with your hormones it's kept at a level because your placenta is is there, okay. So as soon as you birth your placenta, that hormone kind of factory, if you like, goes. So that's where your cliff edge goes and that has to happen. So you release something, um, to milk. So it's kind of like a switch for your body to say prolactin. You need to now produce some milk because we've birthed the placenta, we've birthed the baby. Now your body doesn't know if you've birthed one, two or three babies or four, five, six. It just knows that it's expelled the placenta out of the womb and it's contracted. That then has a cascade effect on your hormones.

Speaker 2: 25:31

So a lot of women will say I haven't got any milk and I can't breastfeed. Or they get really, really tearful around day three when their milk comes in. And you can buy that by can by the number of hours. I always say to women you're going to get really teary at day three to day five. Tell the visitors just don't come round, put a sad movie on or put a happy movie on and just cry because it's normal. Okay, that is normal. What's not normal? If that goes on for two weeks and more, if you feel like you are not connecting with your baby, if you're feeling like there's no enjoyment in life and you're disconnected with your baby, then that's not normal but definitely is a hormonal change in your body that will make you feel like you just want to cry at everything Happy, sad, everything else.

Speaker 2: 26:31

So knowing that and being prepared for that is like being prepared for an exam. You know you've got a better chance of success and also, especially if you've got a neurodivergent diagnosis, you know knowing what your needs and preferences are and having that diary, knowing that you have self-reflected and you've had time to think about, can put those support networks in um. That for me as a midwife is gold dust, because if you don't come with that, I am trying to figure out what your needs are and I don't have a clue. So understanding how you and your body reacts to hormones and how you react to your and how you live with your diagnosis is something that you can bring to the table.

Speaker 2: 27:33

What I can do is make sure that I have all the support and networks and then we can link them together so clearly communicating what your plans are, even if you don't verbally, if you're not able to verbally communicate that. You can write it down or bring a supportive person with you who knows you a little bit more and then educate your maternity team Because, like I said, we don't know. You are the best person to know that. And so that's just a little few tips from a midwife's point of view that you can do to bring your whole negative experience because you're not listened to or you didn't get the advice and guidance that you needed, or your sensory accommodations wasn't adhered to and it wasn't tailored towards what you would feel more comfortable at understand who you are, how your hormones react and then come with all of that in your diary or written down so you can be a partner in your care, can I?

Speaker 4: 28:55

just answer sorry. So, yes, this is like jim and laura. Um, mainly that I found for my last pregnancy that the periods afterwards it's not really planned for. They always talk about birth, and Laura, mainly that I found on my last pregnancy that the period afterwards is not really planned for. They always talk about birth and plan but never talk about what's your plan after baby's born, because that's the time where you need the most support. But you only maybe see your midwife once or twice. If you're considered to be a straightforward pregnancy, maybe your health is dependent on how much you need to engage with them. You might see them once and then at six weeks and then you see your gp at six to eight weeks. If your gp, that's another story. So is that something that's been offered a lot more? Just again because I work in primary care, sometimes in tandem, where we don't always cross paths but I just wanted to find out. Is that something that you both?

Speaker 3: 29:44

discuss um. Can I jump in here, please? Please do. Yeah, I think, um, you know the power of social media now, um, there's a lot more people talking about that.

Speaker 3: 29:55

Post-natal planning, um, and I mean this is I mean it's useful for anyone that's having a baby, specifically for those who are neurodivergent, because very quickly things feel out of your um, you know, out of the things that you had learned to cope with your whole life. But it's important for everyone to know this type of thing because currently, you know, coming through maternity services, there's a huge generation of women who have been neglected in the research and actually might not know yet that they have a neurodivergent condition and therefore, you know, might be sitting there tonight listening to this oh, that doesn't apply to me, but actually you don't know, because that postnatal period is one of the um, the main periods in your life that women might get a diagnosis, because actually things feel very overwhelming. You've got, you know, you're sleep deprived, you're physically and emotionally recovering from the birth, you might have other children. There are a lot of things to organize, aren't there, in terms of um having a baby, getting it registered, and those people want to come and visit and you're keeping a track in the weight and how many times the baby's feeding and you're sorting out the house, and there's a lot of expectations on mothers to be able to perform in a certain way according to those societal expectations. Sometimes neurodivergent women struggle to conform to those things because they don't feel as important. But what comes with that then is that reinforced sense of inadequacy, almost um. So postnatal planning is really beneficial for everyone, but especially neurodivergent women.

Speaker 3: 31:38

Things like you know, in those last couple of weeks, maybe if you're finishing work at 38 weeks, I don't know whenever that might be instead of sort of sitting at home wishing the time away like we all do, I wish this baby would just hurry up. I wish the baby would just hurry up. Use that time really wisely to meal plan, you know, batch, cook, put stuff in the freezer, get in the big cook lasagna and make sure that you've got people on standby. Maybe, I don't know, relatives coming to visit. Assign them a task like doing the laundry, doing the ironing, because you will really benefit from just sitting there having skin to skin, cuddling your baby. You don't get that time back and actually, if you can allocate specific tasks to specific people that are in your network or your village that it takes to raise the children? Um, it's really beneficial to lean on those people. Um, yeah, just a bit of a handy tip so that brings that's brilliant.

Speaker 1: 32:43

It's brilliant. And that brings a a point that let's go back. What if I'm not pregnant? What if I'm in my 20s? I go through all those little swings. I have not been diagnosed, most likely, so I don't know that I have it.

Speaker 1: 33:01

From a hormonal point of view, how do I cope with what I go through? Because, most likely, I suspect there's something, but there's no official diagnosis of what that thing is. So, whilst hopefully that diagnosis, whilst waiting for that official confirmation of what's going on, diagnosis, whilst waiting for that official confirmation of what's going on, how do I spot the signs? And if I manage to spot the signs, how do I arrange my lifestyle? How do I equip myself to manage those different fluctuations in my menstrual cycle, in my mental health, in my moods and so on and so forth? And, perhaps even more important, because, at age, social life is so important how do I make sure that my network around me supports me effectively, not just by feeling sad or sorry for me, but effectively in managing these hormonal swings and the effects of those? We'll have to equip the society as well as us, to help us through this.

Speaker 3: 34:17

So, laura, I think so I. First of all, I'm a massive advocate for people self-identifying as being neurodivergent because currently, as we know, within the nhs services that are completely oversubscribed, there are long, long waiting lists for people. You know some waiting seven, eight years. I waited eight years for my daughter's diagnosis, um, which I think is really challenging for people, and in the meantime, it is completely valid for you to say I identify as being neurodivergent. I can't do much about it at the moment, unless you have loads of money and want to pay to go private. But even then NHS health professionals will query that diagnosis because it seems as if you've bought it. Now, most people that I know are not going to spend money of that amount on something that they are not already 99% sure that fits them. Because why? Why would they do that? Um? So I think that's the first thing that I would say self self-diagnosis or self-identifying as being neurodivergent is really important. Um. Educating yourself, first and foremost, so that you know how that, that um diagnosis or how that fits your life and how that intersects with the environment around about you and the people that are around about you, um, and then using that education that you've learned for yourself, to educate those in your immediate network to say this is the things that I'm struggling with, this. This is the patterns I've noticed, because Dr Julie told me to write it down in the diary and this is what's happening and that's just how I identify.

Speaker 3: 36:12

So I run a local support group for late diagnosed neurodivergent women here in the Channel Islands and one of the things that we talk about is the wooden spoon analogy. I'm sure you've probably heard of it, but imagine that you are starting your day every day with 10 wooden spoons. Every time you feel yourself overreacting to something or getting emotional about something, or the kids are taking ages to get their shoes on, and you're running late. Every time that you're having a reaction, you're giving away one of your spoons. So the spoons essentially, um, they emulate your, your mood or your energy levels and and that's what you're spending all of the time. So sometimes I've spent all my wooden spoons and it's not even 11 o'clock because I've just been so up to here, and that's more likely to happen in that week that leads up to my period.

Speaker 3: 37:09

I think things like um. So you, um, julie, talked about the flow app. Um, it's a really good app. We're not pushing one app over the other. I use I use a different app called um moody, and it's really good at talking about okay, in this phase of your menstrual cycle, and this is what's happening with your hormone levels and this is why you might be feeling x, y and z today, and what you can do to help is make sure that you basic self-care things that I know. Um.

Speaker 3: 37:39

I don't know about the rest of the panel, but when I say self-care, automatically my mind goes to a warm bath and some aromatherapy. But that's not what we're talking about. We're talking about making sure that your body is nourished and hydrated as a baseline. That's the baseline things. Making sure that you're getting enough sleep and sort of at least seven to eight hours a night. Making sure that you're off any of your electronic devices at least two hours before you go to sleep at night, because it will help your brain to shut down, and there's a lot of evidence to support that. Um, neurodivergent individuals have got a sort of different circadian rhythm, so when it comes to sleep, they have a delayed release of melatonin and so just working out how all of these things intersect, but they're going to give you a really strong foundation to work from.

Speaker 3: 38:27

Um, exercise at least half an hour sort of walking or semi-vigorous exercise every day to help sustain those dopamine levels. Um, cold water swimming is really good for your dopamine levels. If you spend 10-15 minutes submerged in cold water, like the British seaside or one of those you see them with the big tubs out the back door you can submerge yourself in the cold water. 10-15 minutes of that is enough to give you a good 4 hours of dopamine as if you've done loads of exercise. So it's really important to use that time wisely. Don't just come home and kind of pick out on the sofa. Use that time to um, get as organized as you can to prepare yourself in advance.

Speaker 3: 39:18

Um, I tend to now when I think about right, I've got my period on this date, so so I can sort of predict over the next four weeks when there's going to be good times to socialise.

Speaker 3: 39:35

So agree to going out for dinner with friends or organising parents' night, and I'll try to do that within those first three weeks. When it comes to that last week, I will try and reduce, you know, the amount of social commitment that I have, because I'm far more likely to feel anxious about those things. I'm going to be more tired, I'm going to be less motivated, and you know, my husband is very much aware of that now and knows to kind of pick up wherever I'm not feeling like it. Um, and actually I think a huge factor in all of this is how we talk to ourselves. We all have that inner dialogue, don't we? We have this little horrible person that lives inside our heads, um, and I can see a huge difference in myself from the the pre-diagnosis Laura that was. You know, I would beat myself internally with a stick if I've missed parents night or forgot that it was sports day.

Speaker 3: 40:39

I would oh my god, you're such a terrible mother. You're horrible. But now I think, well, look at why I've missed that, because actually I'm overspent on my wooden spoons. It's coming up to that time of the month. I know that my dopamine level is low. Go easy on yourself that you can't achieve everything, and just changing that narrative ever so slightly means that you can be a bit more compassionate to yourself and recognise what your needs are and therefore be able to communicate them a lot better to the people around about you that are going to support you. And it's not to say that you're never going to feel overwhelmed again because you are, but how to manage and having that information to know why that's happening, you can be so much more forgiving to yourself that's really interesting, actually, laura, because everything that you're saying now I'm like, oh my god, yeah, that's me, I'm resonating already so.

Speaker 2: 41:36

I'm learning as I'm going along, because you said something about your partner and your husband kind of understanding that, and I think that's really important in the whole scheme of that. That supportive network is, yes, you can, you can educate yourself and you can understand this, but it's really important for your household to understand that as well, because that those wooden spoon analogies is fantastic, because there is very, very a lot of times when my wooden spoons I've literally thrown them, all of them, out of the window at the same time get your shoes on.

Speaker 2: 42:17

Yes, that's it. But I feel the rage. I feel the rage and it's in the pit of my stomach as well, and I think a lot of people can resonate with that. Now, my husband understands that and he would actually say and when I come out of that window, we both reflect and I'll go and I physically say, I physically feel a different person. I am not myself and I cannot stop myself from being so aggressive and being so angry with the world. Now, my poor children all I wanted was an ice pole and I'm saying, no, dinner's ready and it didn't need that reaction, whereas any other time of the month it would have been, yeah, fine, fine, yeah, go ahead. It would have been, yeah, fine, fine, yeah, go ahead. And I physically feel that difference and my whole family actually notices that. So that self-identifying is really powerful, very, very powerful, and understanding who your support network is, so they can then adjust and pick up the slack if anything and to know that it's not personal to them.

Speaker 3: 43:27

Yes, yes, because sometimes that's what it feels like, and before my husband understood all of that information, there was very much like well, stop using your hormones as an excuse, like you're just being.

Speaker 1: 43:38

Isn't it? That's what I said. It's the hormones, it's hormonal. But these are very important points and I want to go to to julie with a slight um change or a different version of that same question, because a lot of your patients are professional women. They're working age women. There are women who are in various jobs, some very senior and so on and so forth, who come to you from time to time because they want a sick note, because they have to recover, for whatever. How do we empower these women to talk to their employees? How do we bring the employment side of the equation to this Right? How do we make sure that, as much as now, it is almost becoming a thing that you know, heavy payers and so on and so forth are starting to be something that is openly discussed in employment and so on and so forth. So women with painful payers can now be to a certain extent, exempt from work. How do we bring that to the whole more side of the discussion?

Speaker 4: 44:57

I think that's a bit more tricky because yes, that was my curveball.

Speaker 4: 45:03

Mainly due to the fact that it all depends on, I guess, your workplace environment. Again, I work with all sorts of women. I work with investment bankers, women I work with investment bankers. I work with teachers from all spectrums. So, depending on what setting you work in, depends on how probably how understanding they will be towards your concern. Perhaps if you're working in more of a corporate field and especially if you're working back in the stem industry, where you're one of a few women working there, again, it's still things that we need to broken down.

Speaker 4: 45:35

You don't want to show weakness. So, yes, you may be struggling with your menopausal symptoms, your period pains, just the fluctuations in your hormones, but you don't always want to be open about it. So one of the things I usually ask is I mean, when you come to me and they tell me, okay, this is my phone, I'm like okay, obviously I know this, I'm going to sign you off work, but what would you feel comfortable with me putting down? Because I'm very mindful that they may hopefully not. I don't want anything to ever come back against them. And then they're like oh, because the GP wrote this on my medical certificate. I wasn't quite comfortable with it, so I'll always just check, are you comfortable? I'm doing this. I think I think discussions like these are obviously what's needed. Um, again, just through my special on different months of the year, when companies are now actually employing people to actually come along and to talk about women's health issues especially, you know, women's Health History Month in March, there were lots of companies who were hiring women to come along and just to speak about the different issues and different things that we're going through and encountering. So there's more awareness, there's more openness to have these discussions.

Speaker 4: 46:36

I'm probably seeing more now than ever that someone will just be like you know what? I'm having medical symptoms right now. I'm absolutely fine with that. And I'm like, okay, go to you and I'm happy to like, write it down. I always say, you know, no, I have really happy periods that you write that down, so they know. And again, I'm I'm always happy to do it, but it's just. I'm always like, okay, yeah, even in the nhs, again, we should be at the forefront saying, okay, yes, you have all these symptoms, yeah, you need to have work, but sometimes we're so harsh on ourselves that, um, I think it almost reflects on the patients. I'm like oh, are you sure you want to do that, because I can always see how things proceed from my point of view where you know it's.

Speaker 4: 47:12

Again, it's all complicated but technically I won't go into that too much. But it all depends on the workplace environment. Yes, have more open discussions about it, but I understand that not every company is as flexible. Um, I'm happy to even write, you know, amended duty. So if there's a day where you feel like you know I actually can't make the journey, especially having severe periods, pains, you have adenomyosis, endometriosis you're like I can't go to the office today, I'll write you know, on these days of the month, if they can be considered to work from home because they have this issue, I'm more than happy to do that. But again, it's I know it's really challenging.

Speaker 3: 47:44

It all depends on your support system and it all depends on, like, the HR thing, if you have HR company as well, and the thing is my certainly my experience, in terms of if I've ever been off work with mental health, you feel a sense of people rolling their eyes little yeah, yeah, feeling a bit sad, and that you know that perpetuates that stigma, doesn't it? And I can imagine you know if, if you are having to be off because of, um, maybe menopause related symptoms, that that probably is worse perceived unless they've had that education within the workplace to understand actually, the the huge impact that it has on women. But historically, we're just supposed to take that on the chin, because that's just what it means to be a woman, so pull up your big girl pants and get on with it. But I think there seems to be a huge movement now of no, you're gonna, you're gonna validate exactly how I feel. Bringing this to the research.

Speaker 2: 48:48

I feel as if women are really taking back some of what we're owed now absolutely and and we need to, you know, we need to have these conversations to normalize these symptoms and to normalize the fact that actually I do change into a different person.

Speaker 2: 49:07

I am not, you know, on on it at this time of the month. So if you want me, as an employer, to give my all authentic self, to give my 100%, then you need to give me that room and to understand how my body works as well. So, having these conversations and sometimes really difficult conversations with HR or with your work, especially in the NHS as well, like Julie says, you know, and Laura, we are the worst enemy of ourselves. You know, we're a healthcare professional organisation that really doesn't care that much about our mental health and how women's health actually affects our ability to work and to care. So, yes, we have to definitely have some more of these conversations so then women feel more comfortable in getting signed off. I don't know where that comes from. If this is the start of it, then that's absolutely great, but it definitely needs to feel organic. It needs to feel like it's just another part of the conversation. So, yeah, where does that come from?

Speaker 1: 50:20

That leads me, then, to the next question, which is a tricky one, a difficult one as well. What would be the one piece of information that every woman, no matter whether or not, should know when it comes to hormones and menstrual health cycle?

Speaker 2: 50:41

that is one. For me it would be something that laura said and it really resonated with me is to be kind to yourself and to know that it's normal to not feel normal at certain parts of your cycle, and to understand how the peaks and the troughs work. Um. So if you don't learn anything from today, I want you to go away knowing what oestrogen is, and what does that do to your cycle and to your and to your psyche laura, um, I think for me it's um sleep.

Speaker 3: 51:20

Sleep is hugely important. Um, when we sleep, our brain processes lots of things and guarantee you will usually feel much better when you wake up in the morning after a good sleep than you did before you went to sleep in the first place. Or what if you've had a a really rubbish night's sleep? So if there's anything that you can do is try and sort your sleep out, Judy.

Speaker 4: 51:45

So I'll say main thing.

Speaker 4: 51:47

I think I can go on about my diary but again, even matching it with what Laura said, because I was like you know what I'm making.

Speaker 4: 51:53

My own notes are based on all the information laura's given me, all the gems she's given me, um, just in terms of just finding out how productive you are.

Speaker 4: 52:00

So, again, if you know during your menstrual cycle, you know your symptoms, you can actually plan, like laura said, your week or your month around when you're most productive and when you're least productive. So rather than, I guess, always feeling like a failure of you know I'm always procrastinating, I can't get these tasks done if you actually plan your tasks when you know you're most productive, then you're not going to constantly have that feeling where you always feel disappointed in yourself, which is something I struggle with all the time and I'm like I have all these things I want to do. But then again this listen to what just really echoed with me and resonated and I was like you know what? Actually I'm going to try and do that myself keep a diary, really understand exactly what's going on my productivity levels and actually understand when it's when it's best to like put certain tasks, because I know that by the end of the month I'm completely burnt out. I haven't got energy, and so I think that's so crucial yeah, yeah, that's fantastic.

Speaker 1: 52:52

Well, again, this is the first of many series of conversations and discussion we'll have, but most certainly take away when it comes to hormones and the knowledge you should acquire. You know what's your estrogen, what is that, what it is, read about it. Ok, there will be more information coming from from this panel around those specific uh subjects, but in the meantime, find out what, what, what are estrogens? What do they do? Sleep and then we'll have other meetings and other information, other courses and opportunities to talk about the uh, what sleep does to your body and your psyche and your mental health as a woman. Plan, have a diary Plan, and then we'll also touch on that in subsequent meetings what planning does, whether it's planning for becoming a mummy, giving birth, post-birth, what do you have to do and what you should do in terms of planning ahead and how that benefits your health and your mental health and your well-being.

Speaker 1: 53:57

But I don't want to stop here. I want to take you in a slightly different direction and again take a step back in the journey of womanhood, because that's what we are about. This is the school of womanhood, so there's a lot of um, so there's a lot of focus at the moment on PCOS, and many, many more brave women are coming out and challenging the Stitcher School.

Speaker 4: 54:29

Is there any link between hormones and PCOS? Julie, no, absolutely so. Again, we spoke about estrogen quite a bit. So first, one of the things that I will usually talk about managing PCOS, because the symptoms of PCOS can include having irregular periods. It can also include weight gain, excessive hair growth. You know it's more related to other conditions like diabetes, high cholesterol, etc. And again, I think we're always definitely advocating it's definitely related to things like neurodiversity as well. So we do know that your hormones can play a key part in it, particularly your estrogen level.

Speaker 4: 55:06

Usually women with PCOS, their estrogen level tends to run a little bit lower than what's expected and what I've usually found is that people with pts, they come in and they in particular the weight I think people are really aware of this that your adipose tissues, your fatty tissues, they release um estrogen as well, and people are always aware of this. And then sometimes people notice that when they have a certain optimal weight where the periods are of regular or regular enough for them, where if they put on too much weight or even lose too much weight, then the periods go completely out of sync. So, again, having regular periods that are already like one of the main things in terms of PCOS and how you have to manage it in terms of your weight. And again, we look at the hormone levels. For women with PCOS, you have a fixed phase of what we call your follicular phase. That's always, that always seems to be fixed between about 0 and 14 days. It's the utile phase, the phase between when you ovulate and to when you have your period. That's the phase that's prolonged, that we don't know the duration of. So that's the reason why we do hormone levels at certain days. So you're usually trying to.

Speaker 4: 56:12

If you're going to do hormone levels, we do it between day zero and day five and then we do a level at day 21 just to try and predict what's going on. But if you're having a prolonged luteal phase, where again that's the phase that we mentioned, that's the phase that we go oh, this feels great then that's the period you're stuck in for even longer than a normal woman. So you can only imagine how, what they're going through, that they're like. You know, I really feel crap.

Speaker 4: 56:35

I really I'm just feeling this way constantly and it's really because your hormone levels, your estrogen level, is low. Yes, your progesterone level is as high as one and there's a delicate balance between progesterone and estrogen, because even progesterone can actually add to some of the fluctuations your hormone, can actually add to you having the mood swings being a bit depressed and a bit anxious as well. So all these things, if you're stuck in that face for a long period of time, it can definitely impact your, your um, your mental health. It can impact your mental health as well. So I think that's something I really just want to be aware of and be kind to themselves.

Speaker 1: 57:07

Especially if they understand that they're stuck in that neutral place longer than an average woman, they can just really be a lot more gentle with what's going on in the body so, if I, if I understand correctly, so so that that sort of post ovulation career that you saw where described, julian and laura, is prolonged almost for those women who have bcos? Is that, yeah, all right, is that yeah?

Speaker 3: 57:32

yeah, that's how I, that's how I understand it, and actually you're therefore your um symptoms in terms of executive function, and however, your neurodivergent symptoms present can therefore go on longer than um what it might do for someone who's experiencing a typical menstrual cycle of 28 days and and I suppose the difficulty is knowing whether it's a bit of that chicken and egg analogy, isn't it? Because we know that, um, neurodivergent women and and I mean this might be a bit of a blanket term, so forgive me for this, but just to get a bit of a basic understanding women or people who are autistic may be more likely to experience an eating disorder. So disordered eating in terms of you know, whatever that looks like, but due to sensory sensitivities, they might not like the textures or the tastes or the look of the food. In terms of people with ADHD, they may be more likely to have disordered eating in the opposite sense that no impulse control, dopamine seeking and that's kind of comfort eating, but eating the wrong things, and things that are high in carbohydrates, are high in sugars, um, and so therefore, are maybe more likely to experience a raised bmi, therefore be more likely to then develop polycystic ovarian syndrome if they go on to then have a baby, they are more likely to experience gestational diabetes in the period of that pregnancy and therefore be more likely to have a child who is neurodivergent or who has adhd.

Speaker 3: 59:23

Um, the studies that I have read around in terms of pcos and gestational diabetes don't mitigate for the fact that we might have undiagnosed neurodivergent mothers, rather than it being. Do you know what I mean? It's like it's a bit of a, it's cyclical, isn't it? So we don't know which comes first, um and and so I guess it's down to more research to learn more about that. There are actually some clinics I'm aware of around the UK because of that statistic that women who have, or people who have, adhd because it doesn't just apply to women, this also can apply to men with overeating because of that impulse control, um, or even sometimes just a sense of boredom, sometimes just eat because we're bored, there's nothing else to do, so I'm going to walk to the fridge 15 times. Um that you're probably more likely then to seek bariatric surgery, so things like um drastic a gastric band.

Speaker 3: 1:00:38

There are some clinics now around the uk who are actually screening people for adhd prior to committing to the surgery and actually I have some friends who have had bariatric surgery and subsequently lost loads of weight but then put weight back on, and now that they've had their diagnosis of adhd, they've been medicated appropriately and actually gone on to a weight management plan, an exercise plan that's suited to their. The way that their brain works, as individualized for someone who's neurodivergent makes it more likely for them to stick to it means, then, that they've been able to sustain that weight loss now, and so I think there definitely is a place throughout other departments that are not necessarily sitting within psychological-based therapies and services, that, for instance, gynecologists who are diagnosing women with premenstrual dysphoria disorder. Why are we not screening these women? Oh yeah, women with endometriosis.

Speaker 3: 1:01:54

If you're receiving a diagnosis of those things I would then be starting to advocate for, well, I want to be screened for this, this and this, because you know there are other associated conditions that come along with neurodivergence, and actually we could be helping many more women to seek answers for themselves and why they feel the way they do, by broadening out and taking it away from purely psychological services. Um and I mean, that's true for things like you know, if you're neurodivergent, you're more likely to have um, you love dan. Loss syndrome, fibromyalgia, yeah, ibs, migraines all of these things are interlinked, um, and actually, if you are exploring investigations for those things, you should also be, in my opinion, be getting explored for neurodivergent conditions. But what happens with women? Because of that emotional aspect, because of the hormonal fluctuations, you're far more likely, as a woman, to be assigned a diagnosis of something like depression, anxiety, um personality, personality disorder precisely, rather than a neurodivergent condition, because what happened is the big diagnostic statistical manual that is used in mental health services.

Speaker 3: 1:03:19

It's like the bible. Um have removed the emotional elements for the diagnostic criteria, so therefore, why would they think that women fit within that? If it's, if they've removed the emotional components? They were taken out in the 1960s and never put back um. So it's really interesting because there's now a whole school of women who are trying to have their diagnosis redacted from their medical records of the mental health condition.

Speaker 3: 1:03:47

There are many people and I mean, I'm starting to get on my high horse here about it now, but there's a charity called autistica who do lots of research and they involve autistic adhd individuals in their research projects and so they're actually doing the research. They released a report and I'm I can't quite remember, so don't quote me in this. I don't know if it was over a two-year period or one-year period or what date it was from. It was recent. 48% of all suicides in the UK, across whatever time span that was, 48% were autistic individuals. Wow, they're only the ones that had the diagnosis. 52% would have benefited from a diagnosis, so that's another factor that plays into this. Across these um, you know these really important. The hormonal lifespan of a woman, um puberty, postnatally, menopause are the times that you know you're more at risk of these kind of impulsivities. You don't know what's happening in inside your head, with your emotions, your physical symptoms, and then what happens is that we have people who are starting to die by suicide. On that jeery note, it's not, it is.

Speaker 1: 1:05:10

It is incredible and and I was almost going to say what what a pity that we have to to come to to the end of today's webinar.

Speaker 1: 1:05:18

But it is not a pity because, as I said earlier, this is just the start and I I hope the last hour it's been an hour I hope the last hour has triggered the right kind of thoughts, has tickled your curiosity and has sorry, you have a way with what's it yes, and and, and I I do hope this is the start of a, an open conversation, because that's that's what what's going to be needed an open conversation, a non-prejudiced conversation about women's health and acceptance, which is actually the ultimate goal, the acceptance of the complexity of our being, rather than the masking of the different colours and shapes and presentations that we bring, the different colours and shapes and presentations that we bring. So I hope this was, as I said, an appetiser for things to come. We will be back in the late summer with our next series, where we are going to focus on postnatal health. So it's going to be centred around preeclampsia and fertility. So, of course, in prenatal health, but more importantly, I will be on launching our services during the summer.

Speaker 1: 1:06:40

So please stay tuned for our first use of courses touching on some of the subjects which we have discussed today. If there's any topic that you feel my, my God, I'd like to know more about and they didn't go into as much depth as I wanted Please feel free to reach out, but it's been a pleasure to have you today. Thank you so much, gemma, laura and Julie, and have a wonderful summer. I look forward to seeing you in September and reach out, reach out, reach out.

Speaker 3: 1:07:10

Thanks everybody for watching.

Speaker 1: 1:07:12

Thank you Bye, have a nice day.