Episode 9: Understanding Your Hormones: The Truth about HRT, Alcohol & Blood Panels
21 October 2026
Episode Description
Tired of being told your changing body is "just normal ageing"?
In Episode 9 of the Mind and Muscle Beyond 40 podcast, I sit down with NHS GP of over 20yrs and hormone specialist Dr. Katie Armstrong, (founder of Clinic 51), to cut through the midlife noise and give you absolute clarity over your biology.
We chat about the fact that you do not have to accept 'normal ageing' or feel like you have to figure your health out alone. Whether it's learning how to effectively advocate for yourself in your appointments, understanding what alcohol is quietly doing to your sleep and anxiety, cutting through the myths on HRT timing, or realising that small consistent habits beat massive overhauls. The goal of this episode is to show you that understanding your hormones, gives you your power right back!
In this episode, we cover:
- Effective Self-Advocacy: How to navigate your healthcare appointments, push past dismissive answers, and get the right data.
- The Alcohol Trap: Why that single glass of wine is quietly wrecking your sleep and turning up the dial on anxiety and hot flushes.
- HRT Demystified: A clear-eyed look at Hormone Replacement Therapy - when it's beneficial, how to time it right, and why it's a tool for symptom control, not a magic bullet.
- Cortisol & Daily Stress: Why modern life keeps us in a constant stress loop, and how small, consistent habits beat massive lifestyle overhauls.
- Data Over Guesswork: Why blood panels, curiosity, and personal self-experimentation are your ultimate midlife superpowers.
🎧 Links & Resources:
- Connect with Dr Katie Armstrong and Clinic 51
- Grab your copy of my book, Project 80, to build long-term physical strength
Episode 8 transcript
Anneli (00:00) Katie, welcome to the Mind and Muscle Beyond 40 podcast. It is an absolute honor to have you on the show. I'm so excited.
Katie Armstrong (00:07) Thank you for having me.
Anneli (00:08) my goodness, I'm so excited. Katie and I have been trying to coordinate our diaries and making everything happen. And here we are recording this episode. and I'm just really excited to get stuck into all things.
What bloods we need to test for going into perimenopause, menopause? Where, you know, there's so many things that women have questions about when it comes to this because there's so much conflicting advice. So we're
Katie Armstrong (00:30) Mm-hmm.
Anneli (00:30) gonna talk through all of that today. But I would love to start, Katie, with maybe if you can give us a little bit of background on yourself and how I mean, you're a GP, you're a hormone specialist, but you've been doing this for twenty years, I think.
Katie Armstrong (00:43) Yeah, so I am a GP by background. I have been qualified for 26 years, blimey,
Anneli (00:53) Wow.
Katie Armstrong (00:55) but I've done lots of different things. So I've done NHS management, I've done, but with a core of general practice running through.
think the other really important thing to say is that I am a woman in midlife. I am a woman going through her own hormonal transition, have a young son. And
Anneli (01:14) Okay. Right.
Katie Armstrong (01:16) so I think we, of course, view the world and who we are through
Anneli (01:19) Mm. Mm.
Katie Armstrong (01:21) the stage that we are of life that we're in. And that's where Clinic 51 came from. So for
Anneli (01:24) One hundred percent. Right.
Katie Armstrong (01:27) me, as a female GP,
You often are the person in the practice who other
Anneli (01:33) Mm-hmm.
Katie Armstrong (01:34) women will come to see. So I would say in my career, I've probably spent a disproportionate amount of time seeing women and seeing children
Anneli (01:40) Mm-hmm.
Katie Armstrong (01:43) and teenage girls. And that is joyous for me, because that's what I'm interested in.
Anneli (01:46) Wow. Yeah, I imagine so. Never a dull moment, I guess.
Katie Armstrong (01:50) No. But I think as I hit
my 40s,
Anneli (01:54) Mm.
Katie Armstrong (01:55) I began to really understand firsthand what hormones
the impact that hormones could have,
Anneli (02:01) Mm-hmm.
Katie Armstrong (02:02) I could see exactly the same with all of my friends. Most of my friends are doctors and
Anneli (02:04) Mm-hmm. Mm-hmm.
Katie Armstrong (02:07) all of us went, hang on a second, we've been GPs for a long time. How come
Anneli (02:13) Yeah.
Katie Armstrong (02:13) no one really ever told us about this? Now this was pre-Divina and it was pre kind
Anneli (02:18) Ha ha ha
Katie Armstrong (02:19) of everybody, you know, not being able to turn on a radio, listen to a podcast without people talking about menopause. But at the time, what I
Anneli (02:26) Yeah, yeah.
Katie Armstrong (02:27) realized is that I didn't understand things for myself.
And I clearly, the more I learned, the more I realized that I had been doing a disservice to women,
Anneli (02:34) Mm-hmm. Wow.
Katie Armstrong (02:37) my absolute, you know,
Anneli (02:38) Mm.
Katie Armstrong (02:38) doing, trying my hardest. But, you know, this is just not, this is a perimenopause, menopause is just not something that I was taught as a medical student
Anneli (02:48) Yeah, yeah.
Katie Armstrong (02:49) that was spent, you know, didn't really have any time as I went through my junior doctor training,
Anneli (02:55) Mm-hmm.
Katie Armstrong (02:56) concentrating on. So yeah, that's...
Anneli (02:59) Mm.
Katie Armstrong (02:59) That's where I come from. And so
Anneli (03:02) Mm-hmm.
Katie Armstrong (03:02) in educating myself for myself, I have
Anneli (03:05) Right.
Katie Armstrong (03:06) then learned such a lot that I put into practice for patients and realize what a tremendous difference it made. And I say that not, and this isn't about just prescribing HRT, although that can be part of it, but it is about recognizing and helping women to understand and to feel heard.
Anneli (03:27) Right.
Katie Armstrong (03:28) which I think is one of the most important
Anneli (03:30) Hm.
Katie Armstrong (03:31) things for all of us all the time but never as much as so as in midlife when we tend to be juggling a million and one different things so that's a kind of all over the place little bit about where
Anneli (03:37) My goodness. Yeah. I agree with you so much. That's incredible.
Katie Armstrong (03:43) I come from.
Anneli (03:44) Isn't it that's so incredible? And I my my my brother is a doctor, so I come from a family of you know medicine. And I do think it's interesting because your own life experiences do tend to frame how you look at things so much.
But
Katie Armstrong (03:57) of
Anneli (03:57) your own experience as a doctor and having spoken to so many women, and I was literally just saying before we started recording,
I went to a networking event this morning and a lot of the women, I was talking to them about my book, Project Eighty, and I mentioned the Well Woman Blood Panel and how I went through my own journey of discovering what that meant. And I started experiencing perimor perimenopause symptoms at thirty nine, which is which is quite young, but I guess it it's not
Katie Armstrong (04:21) Yeah. Yeah.
Anneli (04:23) because women can go into perimenopause in different you know, at different stages. But
I had to figure out what that meant and then having conversations with my GP. And some of those conversations weren't necessarily they were quite tough. And I I mean I'm South African, so we tend to, you know, we're a bit more forceful when it comes to what we feel we need, which I keep saying to women, in this phase of your life, you need to speak up. You need to, you know, have agency over your body and advocate for yourself. But it's finding and
working with doctors like you who understand the background, who've had your own experiences and are able to help us understand what is actually going on in this phase of our life because there's a lot of things happening at the same time. And one of the things I actually wanted to ask you straight off the bat, because this is a question I get quite a lot. How can a woman tell the difference between typical stress or aging and genuine perimenopausal shifts?
in whenever that starts happening, whether it's your early or late forties or late thirties, how do you know?
Katie Armstrong (05:23) And I think the honest answer is that anybody who tells you this is how you definitively know is lying to you,
Anneli (05:30) Mm-hmm. Okay.
Katie Armstrong (05:32) because that's not how we work as human beings. We are a complex
Anneli (05:34) Yeah. Yeah, exactly.
Katie Armstrong (05:37) mixture of all of the different things that come together in us and our bodies. what
Anneli (05:43) Mm, mm.
Katie Armstrong (05:44) I'm going to say to you is that hormones play a vital part.
but they are just one part of the complexity of our life. you know, one of the things that I've learned, the more menopause medicine I do, the more
Anneli (05:58) Mm-hmm.
Katie Armstrong (05:58) I always say to women, I know that I can optimize your hormones, but I don't know how that's going to make you feel. And
Anneli (06:04) Okay.
Katie Armstrong (06:05) actually, if I've optimized your hormones, and you feel brilliant, fantastic, if I've optimized
Anneli (06:10) Mm-hmm.
Katie Armstrong (06:11) your hormones, and you don't feel any different, then actually, that's just another piece of information.
because what
Anneli (06:16) Okay.
Katie Armstrong (06:16) that shows us is that hormones weren't the underlying cause, right? Let's be detectives
Anneli (06:19) Mm, mm.
Katie Armstrong (06:21) and look at the other things in life.
Anneli (06:24) Yes.
Katie Armstrong (06:25) So I think
Anneli (06:26) Mm.
Katie Armstrong (06:27) it's one, recognising that
Anneli (06:29) Yeah.
Katie Armstrong (06:29) we bring ourselves with us at whatever stage of life we're in. And so I often have a picture
Anneli (06:33) I love that. Yeah. Hmm.
Katie Armstrong (06:37) of a woman standing on a cliff edge and she is
Anneli (06:39) Mm-hmm.
Katie Armstrong (06:40) juggling all the plates and someone says to her,
are you all right there? You're really close to the edge. You're juggling plates. And she goes, no, nothing. To see, I'm absolutely fine. And then all it takes is one little gust of wind or a little finger on the back. And that can plunge you into free fall.
Anneli (07:00) Yeah.
Katie Armstrong (07:01) And sometimes hormones are that trigger. Other things can be that trigger. You know, something going,
Anneli (07:07) Mm-hmm.
Katie Armstrong (07:07) know, grief, a job change, problems
Anneli (07:10) Yes.
Katie Armstrong (07:11) with kids.
It doesn't necessarily have to be something big though. Sometimes it can be the straw that breaks the camel's back. But
Anneli (07:14) Mm. Right. Yes, yes.
Katie Armstrong (07:20) the other thing I say to women is that if it is hormones that have pushed you over,
Anneli (07:23) Mm-hmm.
Katie Armstrong (07:24) and sometimes hormones might be a great big shrug, you know, it is a massive thing.
Anneli (07:29) Yeah.
Katie Armstrong (07:30) But actually, if it's a little thing, then yes, I can put you back on a cliff edge. But what
Anneli (07:35) Yeah.
Katie Armstrong (07:35) I really want to help you to do is to take a great big step forward to
Anneli (07:39) Mm.
Katie Armstrong (07:40) actually, you know, one of the things that I think is
actually a gift of hormonal change in midlife,
Anneli (07:45) Mm-hmm.
Katie Armstrong (07:46) is that it kind of makes us realise that we can't do it all,
all the time. Our
Anneli (07:53) Yeah, yeah.
Katie Armstrong (07:54) body starts to really shout at us and it is shouting at us because
Anneli (07:57) Yeah. Hmm.
Katie Armstrong (07:59) it is going through a major physiological transition and from that point onwards our bodies function differently and we have to acknowledge that and I'm sure we'll get on and talk about those changes.
Anneli (08:06) Yes, mm mm mm.
Katie Armstrong (08:12) But you know, so our body's shouting at us and
Anneli (08:14) Mm.
Katie Armstrong (08:16) the answer is not just reaching for a pill or a patch. It might be part of the answer, but actually
Anneli (08:20) Yeah. Mm-hmm.
Katie Armstrong (08:23) it's about going, okay, right. I've now got a chance in midlife to have a bit of an audit and to both understand
Anneli (08:28) Yes.
Katie Armstrong (08:29) what I want today to look like
Anneli (08:32) Yeah.
Katie Armstrong (08:32) and what I want tomorrow and 80 to look like. You know, we have such an agency, so we can see
Anneli (08:36) Yes, exactly. Hmm.
Katie Armstrong (08:40) it as this frightening,
overwhelming time, that symptoms are just the worst thing and they are the worst thing,
Anneli (08:46) Mm. Mm-hmm.
Katie Armstrong (08:47) but we could also step back and go, okay, right. My body and the universe are telling me something.
Anneli (08:51) what is actually going on. Yes.
I love that. I love that. It's being open to understanding, you know, that there's something going on, not sticking your head in the sand, but also understanding that it is a journey. A lot of the women that I speak to tend to some women think that HRT is just going to be the solution. And from my own experience and from what I've heard from many, it that's not the case. It's a bit of trial and error. It's figuring out what works for your body. Maybe it works for a while and then it doesn't, but it's not necessarily the most
the biggest factor. And one of the things that I think is important, obviously, is lifestyle. And we talk about stress. And that's why I think it's such an interesting question because whether your hormones are shifting, I imagine you don't really have a choice in the matter as you get older, but whether that is the main reason why you are feeling the way you feel, it might not be. It might be the fact that you're not sleeping. It might be the fact that you're surviving on, you know, snacks and red wine. I don't know. But
There's a million different things going on, isn't there? But when you say optimizing
Katie Armstrong (09:50) And so.
Anneli (09:51) hormones, I'm I'm curious, when you say optimizing hormones, what exactly do you mean?
Katie Armstrong (09:56) So I guess I'm gonna say, like I'm with you, that I think all of the different bits of life, it's like an orchestra, isn't it? And we all
Anneli (10:03) Yeah, yeah.
Katie Armstrong (10:04) know that a beautifully tuned orchestra sounds fantastic.
Anneli (10:07) Mm-hmm.
Katie Armstrong (10:09) Going to a school concert can be a slightly different experience. It's that thing about everything needing to be in balance and understanding that
Anneli (10:16) Yeah, true.
Katie Armstrong (10:17) the way our bodies work is that other things throw other things off as well. So our
Anneli (10:22) Mm, mm.
Katie Armstrong (10:23) bodies are designed for...
like everything to be nice and stable together. So
Anneli (10:28) Yes.
Katie Armstrong (10:28) actually, if we're particularly stressed, the way we're going to experience perimenopause is likely to be more problematic because we've already
Anneli (10:38) Yes.
Katie Armstrong (10:39) got something going on in the background. Equally, if we're going through perimenopause and something stressful happens, we've lost a bit of resilience. So when I talk about optimizing
Anneli (10:51) Right. Yeah.
Katie Armstrong (10:53) hormones, I mean, I guess
As women, we are not designed to have stable hormones in
Anneli (11:00) Mm.
Katie Armstrong (11:00) the reproductive phase of our life. Our
Anneli (11:02) Yeah.
Katie Armstrong (11:03) hormones are designed to change and to rhythmically change throughout the month, but that is a predictable rhythmic change. So the
Anneli (11:10) Yes.
Katie Armstrong (11:11) first thing I'll always say to women is that idea that we're meant to show up exactly the same way in the world every day is actually not the way our bodies are designed to work. No.
Anneli (11:18) Right. It i i yeah. That can't be. Mm.
Yeah. Mm.
Katie Armstrong (11:24) And yet we live in a world that has,
you know, particularly in a working world where
Anneli (11:30) Hmm.
Katie Armstrong (11:30) the world has largely been designed by men. I love men. This is not anti men, but,
Anneli (11:34) Yeah. Yeah.
Katie Armstrong (11:36) you know, men don't have hormonal changes month to month. So they are,
Anneli (11:40) Yes.
Katie Armstrong (11:41) it is more predictable for them, but actually, yeah. And, and for
Anneli (11:43) It's more stable, I guess. Yeah. Yeah. What one one second.
My dog is trying to claw his way out the door. Come on then. Come here. Come lie down. This has never happened before in a recording,
so that's great. Come diesel. On He's
Katie Armstrong (11:54) Hehehehehe
Anneli (11:56) having a bit of a moment, you see. He wants to be in the limelight, but he's agreeing with what you're saying, so okay.
Katie Armstrong (12:01) Yes, come, come and come...
you're very handsome. I'm not dissing men.
Anneli (12:07) We
are not dissing men, this fine diesel, don't worry. Yeah, sorry, so let's carry on.
Katie Armstrong (12:11) So yes,
so what I would say is, yes, we live in a world that is largely set up and expects us to be the same every day. And that doesn't happen through our reproductive
Anneli (12:22) Exactly. Yeah.
Katie Armstrong (12:24) lives. And actually, I would love a world where we did kind of go, do you know what, there's going to be times in the month when we're really on it and times in the month where we actually just want to hide away a bit and working from home would be good or, you know, and
Anneli (12:36) Yeah, yeah, yeah. A
bit more sympathy, mm.
Katie Armstrong (12:39) And actually us
and some of it being workplaces and work colleagues, but some of it also being ourselves, the way we
Anneli (12:44) Hm. Yes.
Katie Armstrong (12:46) treat ourselves with kindness and understand that our hormones do make, yeah, make us feel different. And that's also very
Anneli (12:49) Yeah, I agree. A bit more compassion. Hmm. Hmm.
Katie Armstrong (12:54) individual. So again, I'm slightly wary about, you know, this, I think there's a lot, you listen to various...
with things on Instagram and this idea
Anneli (13:02) Mm-hmm.
Katie Armstrong (13:02) that we're all exactly the same and we experience things in the same
Anneli (13:05) Mm.
Katie Armstrong (13:06) way. So rigid programs that tell you how you train around your cycle. You were all very different, but we do have a cycle and our hormones do change.
Anneli (13:10) Yes, yes, yes, yeah.
Katie Armstrong (13:16) So then what happens as we come into perimenopause is that all of that kind of goes a bit awry. So that
Anneli (13:24) Right.
Katie Armstrong (13:24) rhythmic cycle that we had becomes much less predictable.
But this is
Anneli (13:30) Mm.
Katie Armstrong (13:31) not a overnight change.
Anneli (13:34) No.
Katie Armstrong (13:34) You know, in our late 30s, early 40s, we've, you know, the hormones are produced by eggs in our ovaries, we're born with a finite number of eggs, that's determined by our genetics.
Anneli (13:46) Okay.
Katie Armstrong (13:46) So, you know, some of us will be born with more eggs, some of us are born with less eggs, so we
Anneli (13:52) Mm-hmm.
Katie Armstrong (13:52) don't all have menopause on the same set day.
Anneli (13:55) Right. Yeah.
Katie Armstrong (13:57) But
But what tends to happen is once we've got to, I don't know, we've worked through about 80 % of our eggs,
Anneli (14:03) Yeah.
Katie Armstrong (14:04) those eggs have been around with us through our, you know, into our late thirties, early forties. So the eggs are not of as good quality because they've just, they're older.
Anneli (14:16) Yeah.
Katie Armstrong (14:17) And we begin to see some change in that very predictable rhythmic cycle. And that tends to show up for women as slightly shorter cycles.
Anneli (14:26) Mm-hmm.
Katie Armstrong (14:27) and symptoms before their periods. So that's that classic very early, still having a regular cycle, but maybe really noticing PMT that they haven't had before, insomnia
Anneli (14:37) Right.
Katie Armstrong (14:38) before their periods, or suddenly finding it really hard to hold on to wee. You know, those
Anneli (14:43) Yeah.
Katie Armstrong (14:44) kind of just a difference, but that might go away.
Anneli (14:46) Yeah.
Katie Armstrong (14:48) Then as we move through this journey, what happens is,
everything just gets much, much less predictable. So classically, we begin to, our periods become less regular, they might be more heavy. But throughout the month, our hormone signals are varying. And I, the best way I can
Anneli (15:06) Right. Mm.
Katie Armstrong (15:07) describe that is like being in a room with a flickering overhead, like, you know, an office with a flickering overhead bulb, and it's on and it's off and it's on and it's off. And trying to, I just think about trying to get some work done in that environment.
and knowing how hard it is to concentrate. And that's what our brains are functioning under.
Anneli (15:21) It's very stressful. Yeah. Yes.
Katie Armstrong (15:26) And actually our body is very good at adapting to things, but it needs
Anneli (15:29) Mm-hmm.
Katie Armstrong (15:30) things to be predictable or steady to be able to adapt. And this is a time that is not predictable or steady. But because
Anneli (15:34) Right. Yes. Yeah.
Katie Armstrong (15:38) it's to do with what eggs we've got, we may then hit a little run where actually there's a whole load of quite good eggs. So you've been really crap, then it's all right again. Then it's really bad again.
Anneli (15:48) Wow, yeah. Yeah.
Katie Armstrong (15:49) and it's all very unpredictable.
Anneli (15:51) Mm.
Katie Armstrong (15:52) And then as you come down and kind of further on, and all this time you're still having periods, so then you come to a point where you've got less eggs, but you've still got some, your periods might lengthen out. Probably the primary thing is gonna be low hormone levels, but they're still fluctuating
a bit.
Anneli (16:08) Yeah.
Katie Armstrong (16:08) And actually at this stage, sometimes we can get really high hormone levels, because you can have two kind of failed cycles on top of each other, so you get a bit of a stacking
Anneli (16:16) Wow.
Katie Armstrong (16:16) effect.
Anneli (16:17) Right.
Katie Armstrong (16:18) So all of this, so what you see is during this transition, this idea of like, well, what's actually happening to my hormones or can I have a blood test that tells me what's
Anneli (16:25) Hmm. Bright.
Katie Armstrong (16:28) going on? You can kind of see this is not predict, you know, like this is a journey and
Anneli (16:32) Yes.
Katie Armstrong (16:32) it's constantly changing. And then when we finally get to the stage when our ovaries are done, that's the point where we lose our female ovarian hormones. So we lose 90 % of our body's estrogen, but actually it's
Anneli (16:46) Mm-hmm. Mm-hmm.
Katie Armstrong (16:48) stable again.
Anneli (16:49) Right. Mm-hmm.
Katie Armstrong (16:49) And when it's stable again,
our bodies have more of a chance to adapt. So we tend to feel a bit better and it can take a while, it can take a few years,
Anneli (16:58) Yeah, yeah.
Katie Armstrong (16:59) but often things get better at that stage, although they might not because we have got low levels of estrogen then, we used to have high levels of estrogen. So a bit
Anneli (17:06) Right. Yeah.
Katie Armstrong (17:08) like coming out of the, going into the cinema in the afternoon and coming out and it's dark. That's the difference.
Anneli (17:13) Right. It's dark. All
your eachogen is left. Yeah. Yes.
Katie Armstrong (17:17) Your oestrogen's left. It's a different place. The body has
a chance of adapting to it, but it's a different place. So when I...
Anneli (17:23) But you're but you're not experiencing
the erratic or the chaotic up and down of perimetopause. So it's a bit more yeah.
Katie Armstrong (17:26) Exactly. So it's often,
it's often kind of a more stable place. But
Anneli (17:31) Mm-hmm.
Katie Armstrong (17:32) I don't want, you know, I still hear people say that their doctors have said to them, well, you're over all of that now. So it couldn't possibly be your hormones. You
Anneli (17:40) Right.
Katie Armstrong (17:40) know, we know that one in five women will have hot flushes for the rest of their lives. That idea
Anneli (17:45) Yeah.
Katie Armstrong (17:45) that I've heard doctors say, just give it, you know, to a 65 year old, give it another year. It will settle at some point. I would say if things haven't settled,
Anneli (17:52) Wow. Mm.
Katie Armstrong (17:56) within three or four years of your last period,
Anneli (17:58) Right.
Katie Armstrong (17:59) know, your body's had a good chance to adapt. It's likely
Anneli (18:01) Right, right.
Katie Armstrong (18:03) that this is now how your body is with low hormone levels. And often you're going, my grandmother had hot flushes in her eighties. okay. You share common genetics.
Anneli (18:09) Right. Yeah. Yeah.
Katie Armstrong (18:13) So I think, and I, I also see people who sail through the perimenopause
Anneli (18:17) Right.
Katie Armstrong (18:18) and only get symptoms a year or two after their periods have stopped. And that's because we still have eggs in our ovaries.
Anneli (18:25) Right.
Katie Armstrong (18:26) that continue to produce a bit of hormone for a year or two after our periods. So it's only then that they're faced with low hormone levels and for them, that's what their body doesn't like. So we're very, you we are all very individual.
Anneli (18:38) Yes.
Katie Armstrong (18:39) For some women it may be, you know, one or two massive symptoms.
Anneli (18:44) Right.
Katie Armstrong (18:45) For many women, it will be a little bit of lots. And actually that
Anneli (18:49) Right.
Katie Armstrong (18:49) is just as bad. Death by a thousand cuts
is what I call it.
Anneli (18:52) It is and it's and it's
trying to figure out how I think for in my own personal journey, it's trying to figure out how bad a certain symptom is symptom is in terms of what what you think needs attention, if that makes sense. So if your hair is thinning, one of the things that I noticed was my hair started thinning quite a bit. And like I had some hair loss, but just overall. But then I looked back and I thought my hair had been thinning for quite a few years before then. But because I was experiencing other symptoms, I then started noticing it more.
Katie Armstrong (19:20) you suddenly put it together.
Anneli (19:22) Exactly. So it was like piecing a puzzle together. Mm-hmm.
Katie Armstrong (19:26) And I think some of it's
piecing a puzzle, but also some of it's about recognising that things stack.
Anneli (19:32) Right.
Katie Armstrong (19:32) So, you know, using hair loss as an example.
Anneli (19:35) Mm-hmm.
Katie Armstrong (19:37) Actually, for many women, they may already have a background level of anxiety, and then they suddenly go, I'm losing hair. And then they're really maybe a bit hypervigilant, and they're noticing it in the
Anneli (19:44) Mm-hmm, huh. Yes.
Katie Armstrong (19:48) shower more, and then they get more anxious. And then because
Anneli (19:50) Yeah.
Katie Armstrong (19:50) they're more anxious, they feel more worried about their hair loss than they're thinking about it all the time.
Anneli (19:55) Yeah.
Katie Armstrong (19:55) But the
same with sleep. So it's very classic. Our sleep cycle is dependent on estrogen. And so the classic perimenopausal-menopausal pattern is being able to get to sleep, but then waking in the early hours of the morning,
Anneli (20:09) Mm-hmm. Waking in. Yeah.
Katie Armstrong (20:11) struggling to get back to sleep. And sometimes you may have been woken by a hot flush or the need to go to the loo, but often actually
Anneli (20:16) Mm-hmm. Mm-hmm.
Katie Armstrong (20:17) it's that it's an independent symptom. But you wake up and you suddenly go, I'm feeling hot. I need to go to the loo.
Anneli (20:24) Then yeah,
yeah. Yeah, yeah.
Katie Armstrong (20:24) or I'm really worried.
But then what happens the next day is that you're shattered and of course you're then going to be more foggy, of course you're going to be
Anneli (20:35) Of course.
Katie Armstrong (20:35) more irritable and that might be a symptom by itself but you suddenly realise that all of these things interact with each other which
Anneli (20:44) Yes.
Katie Armstrong (20:44) is why I'm going to say a little bit of lots I think can be just as problematic and each one we may kind of go what's wrong with me? I should be able
Anneli (20:52) Hm.
Katie Armstrong (20:53) to cope with this.
Anneli (20:54) Right, right.
Katie Armstrong (20:54) You know,
I think many of us will pride ourselves on the fact that we have just got on with life. And
Anneli (21:02) Yes, that's what we're trained to do, you know? Yeah.
Katie Armstrong (21:05) suddenly, you'll go, why am I falling apart? Why does this all feel so hard? And one of the things I find quite helpful
Anneli (21:08) Mm, mm, mm.
Katie Armstrong (21:13) is that there's something called the Green Climacteric Scale. It's a symptom checker.
Anneli (21:19) Mm-hmm.
Katie Armstrong (21:20) It's not perfect, but it can be quite helpful to kind of sit down.
Anneli (21:23) Yes. Mm-hmm.
Katie Armstrong (21:24) and go, right, am I ticking these boxes?
Anneli (21:27) Yes, yes.
Katie Armstrong (21:28) But whilst you're doing it, also go, but are there other things that might be impacting on this? So
Anneli (21:35) What is going on in my life right now?
Katie Armstrong (21:37) what I also like to think about alongside is almost what I'm gonna call my kind of little lifestyle audit. But
Anneli (21:44) Well
Katie Armstrong (21:45) you know, I think about five pillars of lifestyle.
Anneli (21:50) Mm-hmm.
Katie Armstrong (21:50) that need to be in balance otherwise we're going to be feeling crappy.
So that
Anneli (21:54) Mm-hmm.
Katie Armstrong (21:55) is the fuel we give our bodies, so both food
Anneli (21:58) Yes.
Katie Armstrong (21:59) and water, how we move our bodies, how
Anneli (22:02) Yep.
Katie Armstrong (22:03) much sleep we get, how much rest and how easy we are to how much we can cope with stress,
Anneli (22:11) Yeah.
Katie Armstrong (22:11) whether we've got a common purpose and a sense of
what we're here in life to achieve. We know that's important, our kind of
Anneli (22:20) Yes.
Katie Armstrong (22:21) role in our community. And then the last thing is, kind of what harmful substances are around us. And
Anneli (22:26) Mm-hmm.
Katie Armstrong (22:26) I think if you can kind of almost at a time when things might be really confusing, step back and kind of go,
Anneli (22:32) Mm, mm, mm.
Katie Armstrong (22:35) might I be really good on one of those? I'm really rubbish on the other, because actually that's still gonna make me out of balance. And
Anneli (22:42) Exactly.
Katie Armstrong (22:43) hormones are just, and hormones are like one part of that.
Anneli (22:46) Yes. Yes. Yeah. No, this is great.
Katie Armstrong (22:46) they're just one part of that. And forgive me because I've gone off on a tangent because you asked me what do
I mean about hormones being optimized?
Anneli (22:55) Yeah.
Katie Armstrong (22:56) I guess guess what I mean is that I can in terms of when you're in the hormone chaos, I know that I can put hormones in to give you a degree of stability
Anneli (23:05) Right.
Katie Armstrong (23:06) to stop the really big troughs. So I know that I can. So I know I can do that.
Anneli (23:08) So this is the hormone therapy, yeah. Mm-hmm. Mm-hmm.
Katie Armstrong (23:13) But that is one not
reproducing what your cycle would have done. And
Anneli (23:19) uh-huh.
Katie Armstrong (23:19) two, that is not taking into account all of the other things that are going on in life. yeah.
Anneli (23:25) Yeah, yeah.
It makes total sense. And I'm so glad that you've touched on those elements within that framework because firstly keeping actually c actually keeping track of what's going on with your symptoms, but looking at your life as a whole and going, Okay, maybe I am doing quite well in these areas, but I'm doing this one thing that's actually impacting me more than I might have realized. And the one thing I always talk to women about is alcohol. And not to say we shouldn't have a drink. It's not, you know, it's a it's a complete it's a personal choice. However
I know, for example, if I've had a couple of glasses of wine, I will not be sleeping well that night. Now, it's not going to ruin my life, but it will impact how I function the next day. The choices I make around food, whether I go and train, there's a whole smogers bought of things that happen, and then the symptoms that I might have noticed before then feel worse because I'm already tired. So it's like it's it is this this sort of like hamster wheel, isn't it? But I wouldn't know that unless I didn't
Katie Armstrong (24:22) And that's exactly.
Anneli (24:23) keep track of things.
Katie Armstrong (24:25) Exactly that. And I think many of us may have perhaps culturally learned that when you're not feeling great, one of the things that might make you feel better is to reach for a glass of wine in the evening.
Anneli (24:36) Yes. Yeah, yeah.
Katie Armstrong (24:38) And without realizing that, you know, wine is a powerful chemical, essentially, it has effects on our brain and on the
Anneli (24:44) Mm-hmm. Mm-hmm.
Katie Armstrong (24:46) rest of our physiology, that when we're in perimenopause, we are less able to cope with. And I think
you know, a lot of women will be in this really difficult position while they'll both recognize that they find
the effects of alcohol are different in perimenopause that particularly affects their sleep and
Anneli (25:03) Mm-hmm. Yeah.
Katie Armstrong (25:06) hot flushes, night sweats. And yet it's really hard to break that cycle.
Anneli (25:12) Of course, yeah.
Katie Armstrong (25:14) But, but you know, what I tend to say to them is exactly as you said, it's not necessarily about making an all or nothing decision, but
Anneli (25:20) Mm.
Katie Armstrong (25:21) it is about recognizing that
you are probably going to function better taking out of everyday life.
Anneli (25:29) Yes.
Katie Armstrong (25:29) And then if you do decide that you want to have a few glasses when you see your friends,
Anneli (25:35) Yeah.
Katie Armstrong (25:36) I also think, you know, sometimes we pretend that life is going to just be the same again every day, but actually recognizing
Anneli (25:42) Right.
Katie Armstrong (25:44) I'm probably going to feel a bit rubbish for a couple of days after that. So I'm going to be really
Anneli (25:47) Exactly.
Katie Armstrong (25:48) kind to myself. I'm not going to plan something really massive at work on the Monday after I've been out.
on a Friday night, because I'm going to be less able to deal with it. I'm going to be less able to deal with family stress. I'm going to,
Anneli (26:01) Yes, yes.
Katie Armstrong (26:02) you know, be kind and be realistic, because actually,
Anneli (26:05) Mm.
Katie Armstrong (26:06) that's just a biochemical reaction that is happening in your body. That
Anneli (26:11) Exactly.
Katie Armstrong (26:11) is actually entirely predictable. And you can't get away from it. These things are going to happen. No, you are going to feel you're not going to sleep as well. You are going to feel more anxious.
Anneli (26:16) That's it. So don't beat yourself up over it, you know. Enjoy enjoy your life but understand. Yes. Yeah.
Katie Armstrong (26:24) you are probably going to make bad food choices so
Anneli (26:26) Right.
Katie Armstrong (26:27) you know kind of go into it with insight that's alright but you're not gonna want to do it too often
Anneli (26:30) Yeah. Yeah, exactly. With common sense.
No, exactly. It's it's definitely and I I was listening to a podcast the other day and this woman was talking about how also just understanding how alcohol affects your sleep when you're going through these hormone shifts. Maybe, you know, if so deciding to maybe have a drink with lunch instead of having a drink right before bed because
Obviously your body isn't quite able to process it as well because, you know, your body's sh I mean, I'd love to hear your thoughts on this, but the the more time, the b the bigger the buffer you can build between having alcohol and bedtime, the better your body's able to process alcohol.
Katie Armstrong (27:09) So, I mean, I think again, this is just about the biochemistry of the way that our body clears things. So
Anneli (27:16) Mm-hmm.
Katie Armstrong (27:17) what happens with alcohol is that it is going to bind to receptors. So it binds
Anneli (27:23) Mm-hmm.
Katie Armstrong (27:24) to, so for example, let's pick GABA receptors in our brain. So GABA receptors are the receptors that help us to feel calm and good and fine. And alcohol binds to GABA receptors,
which is
Anneli (27:35) Okay.
Katie Armstrong (27:36) why when you first have a drink, you kind of go,
feel a bit better. You also get a dopamine release. But what's really interesting with
Anneli (27:44) Right.
Katie Armstrong (27:44) dopamine is the dopamine is a is one of those chemicals that we get really tolerant to. So you don't get the same hit. So like the first time you drink, you may feel really happy. But if you do it
Anneli (27:57) Mm-hmm.
Katie Armstrong (27:58) all the time, you're kind of chasing that dopamine release. And we're
Anneli (28:00) Mm, mm.
Katie Armstrong (28:02) but also understanding that that dopamine release
and is quite addictive to our brains. Our brains want more of it, which is why we'll then want to come back and have another drink. It's
Anneli (28:12) Right.
Katie Armstrong (28:12) why or why we might want to replace it with some sugar.
Anneli (28:15) Mm-hmm.
Katie Armstrong (28:16) So you've got all of that going on. And then one of the major issues with alcohol is that when it unbinds from the receptors, your body is always trying to maintain equilibrium, but having essentially been a kind of calm but sedated
in a calm but sedated place, it kind of goes, what's happened? That's
Anneli (28:38) huh.
Katie Armstrong (28:39) been removed. Right, I'm gonna swing right the other way. So then you get the 3 a.m. anxiety and also
Anneli (28:48) Okay.
Katie Armstrong (28:49) you get the heart racing and you get the slightly sweaty clammy because your body
Anneli (28:51) Of course. Mm-hmm.
Katie Armstrong (28:54) has just gone, what happened? And
Anneli (28:56) Ha ha ha
Katie Armstrong (28:58) so yes, I kind of get that maybe if you have a drink at lunchtime,
you may get that effect in the evening rather than in the middle of the night. That
Anneli (29:09) Right.
Katie Armstrong (29:10) might be more capable for you. I'm going to
Anneli (29:12) Right.
Katie Armstrong (29:13) say that probably either one is not lovely. and
Anneli (29:15) It's not great. Yeah.
Katie Armstrong (29:20) again, think probably just also recognising that if you do decide to drink, that it is very likely that you're going to have that 3am effect.
Anneli (29:32) Yes.
Katie Armstrong (29:32) Or
if it isn't the 3M effect, it's also very likely for you to have, because it binds to serotonin receptors as well, that you're likely to have the next day, and anxiety and depression the next day as it unbinds from those serotonin receptors,
Anneli (29:47) Wow.
Katie Armstrong (29:47) that just to remind yourself that this is just a chemical effect. So
Anneli (29:49) Mm mm Yes.
Katie Armstrong (29:52) actually, when you wake up in the night, rather than having that, and I shouldn't have drunk and...
Anneli (29:58) Right,
Katie Armstrong (29:59) all these things are happening and now I can't sleep and now what's going to happen
Anneli (29:59) the guilt. Hmm.
Katie Armstrong (30:02) tomorrow just to go okay I'm feeling like this because I've had a drink okay right I'm just going to read my book I'm just going to listen to a podcast
Anneli (30:10) I love that.
Katie Armstrong (30:11) I'm just gonna try and stop my brain going into a panic I'm just
Anneli (30:16) Panic. Mm.
Katie Armstrong (30:17) gonna try and and we don't have a great link between those subconscious responses and our conscious brain
Anneli (30:23) Mm-hmm. Mm-hmm.
Katie Armstrong (30:24) but there is some link
So you can,
Anneli (30:26) Yes.
Katie Armstrong (30:27) but that is why, you know, a breathing exercise or something that
Anneli (30:31) Mm.
Katie Armstrong (30:31) that breaks that cycle of despair can
Anneli (30:34) Of spinning out. That's it.
Katie Armstrong (30:36) be helpful.
Anneli (30:37) That's really that's so so interesting. And also understanding the science and what's happening biology wise inside your body and understanding that it's temporary, but it is a direct result of a
Katie Armstrong (30:47) Yeah.
Anneli (30:47) decision that you've made and you are not a failure because you've chose to have a few glasses of wine and and and your sleep is poor tonight. It i you know Yeah.
Katie Armstrong (30:55) And this is a very predictable pattern that whilst
you may, know, people may convince you that they don't have this pattern. It is the predictable pattern. This is how it affects us. And if you drink more, people get more tolerant to it, but that's not necessarily a good thing. have also,
Anneli (31:04) Right. Right. It is the pattern. This is what's going to happen. That's really yeah, that's really interesting. Yes. No
Katie Armstrong (31:17) like their bodies adapted to having a slightly dampened system, you know, so.
Anneli (31:19) Hmm. Mmm. Mm. Mm. Yeah.
No, that's really helpful.
Katie Armstrong (31:25) But this does happen to everybody.
Anneli (31:27) That's really helpful. And I do think one thing women are really good at, especially as we reach our forties and beyond, is beating ourselves up for things we think we shouldn't do. But then I always think to myself, you know, you have these wonderful moments in life where you just let your hair down and you enjoy life. And
why should you then?
Katie Armstrong (31:44) Just enjoy
Anneli (31:45) It you know,
Katie Armstrong (31:45) it! That's joy!
Anneli (31:47) yeah, exactly. And it's you know, but I love the fact that you've taken the sort of mystery out of it because this is this is what's going to happen, so it's fine. Go into it with the knowledge that this is what the result will be and it's fine, you know? But but handling it well, I think that's important.
Katie Armstrong (32:01) that's, guess, my approach a bit when I think about all kind of, you know, when we talk about how those pillars of lifestyles matter, it's again, it's really easy to convince ourselves that everybody else has got everything sorted.
Anneli (32:16) Mm.
Katie Armstrong (32:17) And, you know, particularly when we may be doom scrolling on Instagram and seeing all
Anneli (32:21) Yes.
Katie Armstrong (32:22) of these perfect things that everybody projects and,
Anneli (32:25) Right.
Katie Armstrong (32:25) and actually to realize, and I guess,
I'm lucky enough, and I'm sure you see it with your clients to to actually see inside real people's lives, and
Anneli (32:34) Mm.
Katie Armstrong (32:34) to see how very, very few of us have actually got everything sorted. And when we have got everything sorted,
Anneli (32:40) my goodness, yes.
Katie Armstrong (32:41) it may be for really quite a short period of time. So
Anneli (32:44) Exactly.
Katie Armstrong (32:46) I'm going to come back to what behavioral psychology tells us. And it tells us that, you know, it's very easy to think that we should live by a certain set of ideals.
It's very easy to set ourselves a goal. And most of us will be really good at sticking to that for about two weeks. Most
Anneli (33:05) Mm.
Katie Armstrong (33:05) of us will have that kind of willpower to go, no, this is the person I want to be. And then reality kicks in.
Anneli (33:10) Yeah. Mm.
Katie Armstrong (33:13) And actually, if instead of either thinking I've got to wait for a perfect time or I've got to be
Anneli (33:19) Yes.
Katie Armstrong (33:19) completely perfect, we say instead, okay, what am I gonna do on my worst day?
on the day when everything
Anneli (33:26) yeah.
Katie Armstrong (33:27) goes wrong, what are the basic things that I'm going to hold myself to just to look after myself? Or what am I going to do to not beat myself up and to start a cycle of negativity, which is actually going to make it even harder for me to stick to what I want to be doing. You know, is actually my motto on my bad day is it's just a day and look at it from that point
Anneli (33:50) I love that. Yeah.
Katie Armstrong (33:53) and then
If you can do a set of basic things on your worst day, the good days look after themselves. Like, so that's how, and I say all of this purely, I mean, this is
Anneli (33:58) Right. Yes. that's a great strategy.
Katie Armstrong (34:03) again through, this is behavioral science, but it's also like my lifestyle experience. that, golly, I'd love to be perfect, but you know, there's a real world. You know, we've got, we've got
Anneli (34:12) Right. Wouldn't we all, but Mm. And real and real stress and yeah.
Katie Armstrong (34:18) kids and work and husbands and houses and dogs and all the stuff that.
Anneli (34:21) Yeah. It's
a million
Katie Armstrong (34:24) goes wrong.
Anneli (34:24) miles. I mean, and it and it's never gonna be perfect. I I was so our gym is closed for the next two days. And firstly I drove to the gym this morning, forgetting that fact, so that was great. And then I turned around and came home and did a workout in the kitchen. And I haven't done a workout in the kitchen since lockdown. And I did the workout this morning and it wasn't optimal. I like I like having access to heavier weights so I can push myself more. However
It was a bit of fun and I ended up doing the workout
Katie Armstrong (34:51) Good.
Anneli (34:51) and then I ended up having a bit of dance afterwards and I thought to myself, well, you know, it's less than optimal, but it's not every day, it's just one workout, and but it's it's about consistency over perfection. And that's what I keep trying to say
Katie Armstrong (35:03) Exactly that.
Anneli (35:04) to women. If you can do ten minutes of workout, great, if you can just do a few squats while making while making coffee, that's what you can do on that day. So it's enough for where you're at. Hmm.
Katie Armstrong (35:13) And that's exactly with you. And it's that thing of meeting
yourself where you're actually at.
Anneli (35:18) yes, I love that. Hmm.
Katie Armstrong (35:19) And so, you know, one of the things, and I'm sure you say it to women all the time, is that, you know, we may, that yes, we want to be exercising and, but you know, even for people who exercising all the time, they may still be having very sedentary lives.
And
Anneli (35:35) Mm.
Katie Armstrong (35:36) sometimes we overcomplicate things, don't we? So as you were saying,
Anneli (35:39) We do.
Katie Armstrong (35:39) just actually saying.
you know what, every time I go to go to the loo or make a cup of coffee, I can do 10 squats. That's not hard. I can do that
Anneli (35:47) Yeah. Yeah.
Katie Armstrong (35:49) in a day. And actually just at the end of the day, even then going, I did that. I did that. Yeah. And then then you exactly then you build on it. And I think although we've
Anneli (35:54) A little pat on the back. Yeah. A little a little celebrating something small you did. I love that. Yeah. Mm.
Katie Armstrong (36:01) kind of in some ways got off the topic of perimenopause and menopause, it's the same. It is the same thing because,
Anneli (36:07) It is.
Katie Armstrong (36:07) you know, I think it is
You know, this is a big hormone transition.
Anneli (36:11) Mm.
Katie Armstrong (36:11) It does take up bandwidth. It is like having 20 tabs open on your computer at all time.
Anneli (36:16) Yes.
Katie Armstrong (36:17) It does make things more difficult. am, you know, we should not deny that.
Anneli (36:21) Mm.
Katie Armstrong (36:23) But you also still have agency to then go, okay, but have I got other tabs open that
Anneli (36:32) Yes.
Katie Armstrong (36:33) I might shut that will give
me a little bit more headroom to deal
Anneli (36:35) Mm. Mm.
Katie Armstrong (36:38) with.
Anneli (36:39) Yes. Yeah.
Katie Armstrong (36:39) the fact that my body is going through a change because
this change is not going to happen overnight. This is not about gritting your teeth through
Anneli (36:44) Mm, mm, mm.
Katie Armstrong (36:47) a few months or even a year. For
Anneli (36:49) Yes.
Katie Armstrong (36:50) most women, this hormonal journey from the very start to the very end is probably going to be about 10 years. I'm not saying there's going to be 10 years of awfulness, but you know, exactly. And there's a lot of life that's got to be lived in between that time.
Anneli (36:58) It's a long time to be gritting your teeth. Mm. Mmm. There is a lot of life.
I love that you said that because it is about the the conversation is about so much more than just hormones. And I think I'm glad that we've gone off topic because this is exactly the point, you know? we can't lie to ourselves and think, well, you know, it's just my hormones. What else is going on? And what can you actively take control of in your life to alleviate what you're experiencing?
But I am curious, what your opinion is on, you know, I mean you've you've you've treated so many women, you have so much experience and including your own you know, your own journey. But what do you think is the bigger pe biggest piece of absolute nonsense that women are being told about their hormones when they hit their forties, would you say?
Katie Armstrong (37:45) biggest piece of absolute nonsense. I think it is that there is one size that fits all. So I always most worry about both ends of the polarised opinion. So that idea
Anneli (38:01) Mm-hmm, mm-hmm.
Katie Armstrong (38:02) of you can't take HRT or you can't do this because it's awful and it's going to kill you and it's not natural.
But I also really worry about the other end of the spectrum, which is every woman must take this and particularly that mantra of, and women have three female hormones and they must replace all three of them. And unless all three are replaced, your hormones can't be optimized. know, both of those things are wrong.
Anneli (38:31) Right.
Katie Armstrong (38:31) what we have to do I think is find our own middle ground and we
Anneli (38:35) Yeah.
Katie Armstrong (38:36) have to look at ourselves and go okay how am I feeling? What might benefits be? What might risks be? For me
Anneli (38:44) Yeah.
Katie Armstrong (38:45) as an individual because that is very different we've all got different bodies.
Anneli (38:50) Mm.
Katie Armstrong (38:50) Okay so so our
benefit is going to outweigh the risk for me as an individual, not for Devena McCall, not for... and I love all these women who I think, thank God we've got women speaking loudly, but just
Anneli (38:58) Yeah. Mm. Yes, yeah.
Katie Armstrong (39:03) because something has worked for a celebrity does not mean that it's going to work for you. Often if people have had a miraculous something or something that's worked really well, they want to shout about it because they want other women
Anneli (39:15) Of course.
Katie Armstrong (39:15) to feel well, but it's a bit like diets. You know, that
Anneli (39:18) Mm.
Katie Armstrong (39:19) idea that we're all going to respond to the same thing.
Anneli (39:21) Hmm. Yeah.
Katie Armstrong (39:22) our bodies don't work like that. We
all present with different symptoms.
Anneli (39:26) Hmm.
Katie Armstrong (39:28) But that myth of you must or you should,
it
Anneli (39:32) Mm.
Katie Armstrong (39:33) just... You could. You might. It... You know, that's
Anneli (39:36) Mm. That's I like that. Mm.
Katie Armstrong (39:41) how... That's what I think and that's what I worry most about. You
Anneli (39:44) That's good. Yeah. Yeah.
Katie Armstrong (39:46) know, because I do also think that some of that can put us in direct...
opposition with our health givers.
Anneli (39:52) Mm-hmm.
Katie Armstrong (39:53) And, you know, I am lucky enough that I get to spend an hour with women with them having filled in a detailed questionnaire beforehand, so I've got all the background information. So actually, what I can do is listen and have a really good chat and understand the context of their lives and understand what's worrying them. And even then it can be really difficult to see the wood for the trees.
Anneli (40:14) Yeah. Yeah.
Katie Armstrong (40:16) You know, most
GPs are not going to have that. It is going to be a short amount of time.
Anneli (40:21) Yes.
Katie Armstrong (40:23) But I also think it can be really easy almost to kind of go in and expect you're going to have a battle. And if you expect you're going to have a battle, you probably will have a battle.
Anneli (40:31) You probably will. Yeah, yeah.
Katie Armstrong (40:33) So I think kind of, yes, we absolutely have to advocate for ourselves on so many different levels. mean, one of the issues why there's so many differing opinions about all of this is because
Women are under researched because for many of these things, it is
Anneli (40:47) Yeah.
Katie Armstrong (40:48) like we actually just don't know the answer. Therefore people fill the void. Well, actually the answer is we don't know. Let's not try and pretend we know, we don't know. We haven't done this research.
Anneli (40:50) Right. Yeah. We don't know. Yes. We're still figuring it out. It's incredible.
Yeah. And I suppose that's why it's even more important that you I'm a big fan of self experimentation and not in a negative way or a scary way or a or a dangerous way, but actually trying things and seeing for a while how it makes you feel and then understanding that it's not a failure if it doesn't work for you.
Just because it worked for Davina. Yeah.
Katie Armstrong (41:20) So that's what we're quite and
you know that that thing when you said to me, you know, so how can you tell the difference? You know, one of the things that you can do is like, so I say to my women like, so we're going to approach this as if it's a scientific hypothesis. And what we do, what a scientific hypothesis says is we've got, we've got a question, and we've got a potential answer. So the
Anneli (41:45) Mm-hmm.
Katie Armstrong (41:46) question is,
Could this be my hormones making me feel how they are? And the potential answer might be yes. And then we're gonna go, okay, so how do we test that? Right, we're gonna test it with a trial of something. Like one,
Anneli (41:59) Mm-hmm.
Katie Armstrong (42:00) does someone else have the answer for us? No. Okay, so what's our trial? Okay, well, so we're gonna try some hormones. What piece, extra piece of information does that give us to retest our hypothesis? So this isn't a...
you know, go off and expect all things in life to be sorted. This is
Anneli (42:18) Right.
Katie Armstrong (42:18) a coming back and going, has it worked? Has it not worked? Okay.
Anneli (42:21) Mm.
Katie Armstrong (42:21) If it's partially worked, does that mean we need to tweak it? If it hasn't, you know, if it's made you feel worse, okay, is that because you've got side effects? If it hasn't worked at all, is that because there's a problem with how you're taking it or absorbing it? Or is it because actually we were just on the wrong path and we need
Anneli (42:36) Right.
Katie Armstrong (42:36) to think again? So it's doing these things with curiosity. And I often think when you
Anneli (42:42) Yes.
Katie Armstrong (42:42) talk to your GP, it
know it feels much less scary to say you do you think I could just try for three months and let's see
Anneli (42:47) Mm, mm, mm, mm.
Katie Armstrong (42:52) and sometimes that's an easier thing for doctors to kind of to get on board with as well.
Anneli (42:58) Right, right.
Having that sort of mentality as well about, you know, being curious about it, which I think curiosity is a good thing. And maybe that's also a mindset going into the season of our lives, being curious about what's happening. Yes, it's not ideal and you might feel horrible, but being curious about what is happening and how you can deal with the season, because if it ends up being ten years of your life, you're right. There's a lot of living that needs to be done. And you might as well approach it with a positive mindset and go, Okay, this is this is where I'm at. How do I approach this? What can I try?
Katie Armstrong (43:30) And if
we do take it that our body is trying
to tell us that something major is changing,
Anneli (43:34) Mm.
Katie Armstrong (43:37) then actually what is it that we want the next half of our life to look like? And actually
Anneli (43:42) Mm, mm.
Katie Armstrong (43:45) one of the things that I think we're getting better at, but we have traditionally been really bad at, particularly in British societies,
Anneli (43:52) Mm.
Katie Armstrong (43:52) is not seeing this.
as a transition into a fantastic part of life. It has felt
Anneli (43:59) Yes.
Katie Armstrong (44:00) like this, you know, am I just going to turn into this old wrinkly quone?
Anneli (44:05) Mm, mm.
Katie Armstrong (44:07) We look at many cultures who really revere older women, who see them as the wise matriarchs, who see them as their powerhouse. And
Anneli (44:15) Yes. It's celebrated. Mm, mm.
Katie Armstrong (44:22) And actually we can blame our own culture as much as we want, but some of us, you know, think sometimes we just have to look and go, well, what is it that I want to see for myself? What is it that I
Anneli (44:29) Exactly. Yeah, yeah.
Katie Armstrong (44:32) see when I look in the mirror? And actually am I every day when I'm looking in the mirror, having a go at myself
Anneli (44:36) Mm. Mm.
Katie Armstrong (44:38) and feeling and you know, and being hypercritical and, kind
Anneli (44:42) Yes.
Katie Armstrong (44:42) of being that my, my worst enemy or could I go, do you know what?
Anneli (44:45) Yes. Yeah.
Katie Armstrong (44:51) I don't know you listen to Mel Robbins, but she talks
Anneli (44:54) Hm.
Katie Armstrong (44:54) about, she's slightly irritating in her Americanism, I think. But she talks about looking in the mirror and saying to that woman every day, I've got you. I'll be your friend today. I've got you.
Anneli (45:04) Yes. It i
it's so important, the negative self-talk. I went to an event on Saturday, Pause Live, actually. I don't know if you're familiar with it. and Nadia Sawala was on stage and she she joked and she said, you know, I'm really good. I don't need to go onto Instagram and worry about people trolling me because I troll myself really well. I'm such a good self troller and it made me laugh because I think unfortunately most women are like that.
And I have this wonderful exercise that I do and I talk about it in my book about visualizing your eighty year old self. And it's such a foreign concept because I think a lot of women, I mean, I'm forty four, so even to me, thinking about what am I gonna be like when I'm, I don't know, eighty four.
The fact of matter is, I want to be the kind of woman who can, you know, be strong, mobile, independent, but also just be excited about life and and embrace myself for who I am and celebrate the things that I love instead of focusing on the things that I think I lack. But it starts with the things you tell yourself every day, unfortunately. It's so important.
Katie Armstrong (46:05) I
completely agree, but I am so with you of that just stopping and going, what is it that you want that time to look like? And so for me, so I'm 52 and the biggest difference for me has been that shift about all of the things that I thought I should be doing because somebody else told me I should be doing them to be
Anneli (46:30) Yeah.
Katie Armstrong (46:31) nebulously healthy, to...
look good to for the you know what I was gonna look at the next like at the next event to actually
Anneli (46:41) Mm.
Katie Armstrong (46:41) now going like that's because when I'm 80 I
Anneli (46:46) Yes.
Katie Armstrong (46:47) still want to be walking the dog on the downs and having lunch with my friends but so I need to be able to get in out of my car to drive I I want to carry
Anneli (46:50) That's it. Yeah. Carry my own shopping.
Katie Armstrong (46:57) my own shopping I want to go on holiday so I want to be able to put something in the overhead locker thanks very much
Anneli (46:59) Yeah. Yes, that's it.
Katie Armstrong (47:04) And actually using that as my motivation makes me do the 10 squats when I'm making my cup
Anneli (47:07) Mm, it's much more important. Yes. That's it.
Katie Armstrong (47:12) of coffee. So it's, I think that that, you know, because again, that is our power as we reach midlife. I think one of the
Anneli (47:17) Mm. Yeah.
Katie Armstrong (47:19) things that most of the women I talk to actually do recognise is one of the brilliant things that happens to us is that we start to care a bit less about.
what others think, we
start
Anneli (47:34) Yes.
Katie Armstrong (47:34) to step a little bit more in to knowing ourselves to and actually we may still be have that very negative self voice. But I think
Anneli (47:44) Mm.
Katie Armstrong (47:45) most of us can kind of go, do you know what? I've
Anneli (47:48) Mm.
Katie Armstrong (47:49) spent too much time trying to be
Anneli (47:50) Yeah. Yeah.
Katie Armstrong (47:52) like everybody else. Actually, the only thing I can be is authentically me.
Anneli (47:57) Exactly.
Katie Armstrong (47:58) So again, as I think as you're as you're trying to navigate
this change, all these symptoms, the
Anneli (48:05) Mm.
Katie Armstrong (48:06) fact that it could really, it can really rock your ability to cope, how you feel about yourself, how you might feel about your relationships, not just with your partner, but with your friends as well. I think no one really tells you about
Anneli (48:16) Yeah, yeah. Mm.
Katie Armstrong (48:19) the fact that female friendships can really struggle at this time as well, because everybody's going through change together and copes with it in different ways. But
Anneli (48:21) Yeah, yeah, mm, mm.
Katie Armstrong (48:27) I think understanding that it's real, happens.
big neurophysiological changes happening in your brain and the rest of your body. But actually your body is giving you the opportunity to do
Anneli (48:40) Hmm.
Katie Armstrong (48:41) a stock take.
Anneli (48:42) It is. It's a stock take. It's a rebirth. It's a chance to find maybe a newer version of yourself that you maybe have been holding back for the long time because you thought you should be something. And it is exciting. I mean, it's at the same time, it's I guess it's working with people like yourself who have all this incredible experience to help us understand ourselves better. So one thing
Katie Armstrong (49:03) Mm.
Anneli (49:03) I wanted to quickly chat about was the Well Woman Blood Panel. So
Katie Armstrong (49:07) Yes.
Anneli (49:08) I so I obviously advocate quite a lot for my clients to get one done at least once a year to see what's going on. But can you can you jump into a little bit of detail on what specific markers women should ask their doctors to track for in terms of baseline data?
Katie Armstrong (49:24) So I think there are two different things here. So I think I get asked a lot about should I be having my hormone levels done regularly to understand where I'm at. Now in perimenopause, I'm gonna say it's a bit of a fool's game trying to track your female hormones because they are all over the place day to day. And so one-off
Anneli (49:42) Yeah.
Katie Armstrong (49:44) readings are not particularly helpful.
Anneli (49:46) Mm.
Katie Armstrong (49:46) That's not to say that in certain circumstances they might not be important. So for example, if your periods have stopped before the age of 40, it's really important that you have some blood tests done. If you're on HRT and it's not working at all, it could be really helpful to get some blood tests done. But for most of us tracking hormones, not that helpful in our
Anneli (50:09) Yeah.
Katie Armstrong (50:09) 40s. What is really helpful is to know the baseline of how our body is
functioning so that we can be ahead of the game because if we think about most of the things that are the diseases that are going to affect us as we get, sorry, I'll kick the table, affect us as we get older
Anneli (50:28) Yeah.
Katie Armstrong (50:30) and both in terms of how long we're going to live our lives but how well we're going to live our lives but actually
Anneli (50:36) Mm, mm.
Katie Armstrong (50:37) just day to day how well we're feeling now that our body will give us
telltale signs often in our blood tests. So we can tell a lot through
Anneli (50:46) Yes. Hmm.
Katie Armstrong (50:49) a blood panel when we put it together with the other information about ourselves. So what
Anneli (50:53) Right.
Katie Armstrong (50:53) do I think every woman should have done? I think that when you hit midlife, it's really useful to get a blood screen to know what your thyroid is doing, because our thyroid can become dysfunctional and it becomes more common from midlife onwards, particularly for women. I think you need to know what your iron level is. So it's ferritin is your iron stores.
And think you want to check that it's not just like normal as in no disease state, but optimal. So I
Anneli (51:19) Mm-hmm.
Katie Armstrong (51:20) think most women will need to have a ferritin above 50 to have good hair, skin, energy. But the bottom of the NHS range is 15. So your doctor telling you it's normal may not
Anneli (51:30) Hmm. Right.
Katie Armstrong (51:32) be normal. Particularly important if you don't have meat in your diet,
particularly
Anneli (51:37) Mm-hmm.
Katie Armstrong (51:37) important if you're having very frequent or very heavy periods.
Knowing what your B12 and your folate levels are. Again, these are what we call cofactors. So they're used to make hemoglobin, but they're also really important for most of the important cellular mechanisms in our body, particularly the Krebs cycle, the energy cycle. So again, we want
Anneli (51:58) Hi.
Katie Armstrong (51:58) to have optimum B12 and folate. And this is not me saying you necessarily need to go out and get a whole load of supplements. This may be about looking at your diet
Anneli (52:06) Yes.
Katie Armstrong (52:07) and how you
and how you optimize your diet. But sometimes it is about, okay, I do need to just take that one thing, not everything.
Anneli (52:15) Mm. Mm-hmm. Yes.
Katie Armstrong (52:18) I think it can be quite helpful to look at a marker called the CRP, which is a marker of inflammation.
Anneli (52:24) Mm-hmm.
Katie Armstrong (52:25) Because you want that to be nice and low, you don't want to have any kind of low lying bits of inflammation going on in your body that might be because you've got a bit of gum disease, or
Anneli (52:33) Yeah.
Katie Armstrong (52:34) might be something else going on in your body. So it's useful to have a high sensitivity CRP.
Anneli (52:40) Okay.
Katie Armstrong (52:40) And think it's really important to know. So kidney liver function for blood count are kind of the basics.
Anneli (52:45) Mm. Mm-hmm. Yeah.
Katie Armstrong (52:49) Most GPs would do those that they are sensible to know.
Anneli (52:53) Yeah.
Katie Armstrong (52:54) A cholesterol profile, your cholesterol is the thing that is going to clog up your arteries over time. So think of it a bit like Lime Scale in pipes.
Anneli (53:05) Yeah.
Katie Armstrong (53:07) And it happens slowly, slowly, slowly, slowly, slowly over time. So it's not just about your level, it's about the length of time your pipes, your blood vessels are going to be exposed to it. So understanding what your cholesterol is in your 40s gives you such a
Anneli (53:20) Mm, mm.
Katie Armstrong (53:21) massive opportunity to make change happen. Equally understanding
Anneli (53:25) Wow. Yeah.
Katie Armstrong (53:26) how your metabolism works. So looking at your HbA1c, which is your marker of blood sugar over three months. And for most of these things, I'm interested
not just in one off readings, but understanding what happens to them over the period of time. Because if you can see
Anneli (53:41) Okay.
Katie Armstrong (53:42) an HbA1c that's slowly rising,
Anneli (53:44) Creeping up. Yep.
Katie Armstrong (53:45) then I'm thinking, hang on a second,
Anneli (53:47) Mm.
Katie Armstrong (53:48) there is something happening that is meaning that insulin isn't working as well in this person's body. There
Anneli (53:53) Right.
Katie Armstrong (53:53) are other things that are not so available on the NHS. But I think from what an NHS panel can be, I think that that they are
good sensible
Anneli (54:04) Yeah.
Katie Armstrong (54:04) starting point and something to
Anneli (54:06) Mm.
Katie Armstrong (54:07) keep an eye on as you go on. And as I say, its patterns tell you as much as anything else.
Anneli (54:14) Yeah. Would you would you say
that it's enough to do it once a year?
Katie Armstrong (54:18) So I think some of it depends on what your results are. So I
Anneli (54:21) Right. Yeah. Mm.
Katie Armstrong (54:23) think if there's something that is high or abnormal, you're clearly going to likely going to want to do something sooner than that to check that, you know,
Anneli (54:30) Yeah. Yeah.
Katie Armstrong (54:31) your iron supplement has worked to check that,
Anneli (54:33) Right, right.
Katie Armstrong (54:35) you know, if there's a pattern with your thyroid hormone. But
Anneli (54:37) Mm.
Katie Armstrong (54:38) I think if everything is normal, then I think once a year is absolutely fine. And actually,
Anneli (54:44) Yeah.
Katie Armstrong (54:44) Probably
in your 40s, you might be able to get away with a slightly longer interval. If
Anneli (54:49) Mm.
Katie Armstrong (54:49) for example, cholesterol is really perfect, if your HbO1c is really perfect,
Anneli (54:52) Yeah. Yeah.
Katie Armstrong (54:54) then actually you might kind of go every two or three years is absolutely fine. The other
Anneli (54:58) Okay. Yeah.
Katie Armstrong (54:59) things I think that you don't want to miss is, it seems such a simple measurement, but actually, somehow we don't do it is your, what's your blood pressure? So your blood pressure tells you about how healthy your blood vessels are.
Anneli (55:09) yes, of course. Mm-hmm.
Katie Armstrong (55:13) So you want your blood vessels to be nice and elastic and to be able
Anneli (55:16) Mm.
Katie Armstrong (55:16) to withstand the variability of your heart pumping. As
Anneli (55:20) Mm-hmm.
Katie Armstrong (55:21) we get older, our blood vessels get stiffer and therefore our blood pressure naturally rises.
Anneli (55:26) Right.
Katie Armstrong (55:28) A system under pressure causes
damage
Anneli (55:30) Mm.
Katie Armstrong (55:31) to the blood vessels and it makes it much more likely for then for the cholesterol to stick to a damaged lining of the blood vessel.
blood pressure really matters.
Anneli (55:43) Right, right.
Katie Armstrong (55:44) And again, I think people wear lots of wearables, they may be really upset, obsessed with heart rate variation or all of that.
Anneli (55:49) Mm, mm.
Katie Armstrong (55:50) And I'm not saying that that's wrong. But I think sometimes we miss some of the very basic measurements like a blood pressure, like a waist measurement to understand if you
Anneli (55:57) Right. Yes.
Katie Armstrong (56:00) put waist weight on centrally. And
Anneli (56:02) Mm.
Katie Armstrong (56:04) I also think the other thing that I'm really keen on is that
people also listen to their bodies. So I think
Anneli (56:09) Yes.
Katie Armstrong (56:10) we can become very obsessed with our wearables and we can look to our watch to tell us how we slept. Or, you know, or get really panicked about heart
Anneli (56:13) yes. It's gone a bit crazy, isn't it? Yeah. Hmm.
Katie Armstrong (56:19) rate variability. And actually, I'd much rather somebody checked in with themselves like do I feel rested this morning? Actually, I feel okay. Yeah,
Anneli (56:30) Before asking your watch.
Katie Armstrong (56:32) you don't exactly that. So just
Anneli (56:35) I agree with that, definitely.
Mm.
Katie Armstrong (56:37) listening,
you know, our bodies. We have so long, as particularly as women, in that way that we're supposed to turn up the same every day. We have taught ourselves to ignore the signals that come from our body. And actually, one of the things I'm really keen on is that we actually stop and listen to our bodies a bit more, because normally
Anneli (56:57) Yeah.
Katie Armstrong (56:57) those physical symptoms are trying to tell us something.
Anneli (57:00) To tell you
something. Yeah. That's so that that's wonderful. I mean, that's really thorough as well, which which I'm really grateful for. That's amazing. I think when it comes to the hormone conversation as well, let's let's let's just touch on HRT. I know we've already said that, you know, there's no one size fits all approach. but if I can ask you, I mean, I know if I was gonna say a common misconception, I think the common misconception is probably that people think, you know, you need all three replaced.
Or that, you know, yeah, one one sort of delivery system might be the solution when it might not be. But ultimately, when when would you say, is the is there an ideal window to start? Because I certainly heard starting b essentially before the car falls off the cliff is probably a better idea than, you know. Is is there a a sort of a thinking behind it that there is an age that's maybe too young to start, or what is the ideal window? What would you say?
Katie Armstrong (57:57) So I think that we know from the evidence that we have, and again, I'm just gonna just reiterate again how we are under-researched as women and we are particularly under-researched for women in menopause taking HRT. After the Women's Health Initiative that was published 24 years ago,
Anneli (58:14) Yeah.
Katie Armstrong (58:16) like everybody stopped looking at menopausal women. the research is only just starting again. So,
Anneli (58:18) Right. So helpful. Okay.
Katie Armstrong (58:23) but what the research does really clearly tell us is that
there is a window of opportunity in terms of looking after long term health. So we
Anneli (58:32) Mm.
Katie Armstrong (58:32) know that if you take HRT in perimenopause or within 10 years of your last period, it will help to protect your bones and
Anneli (58:43) Mm-hmm.
Katie Armstrong (58:44) it will reduce your risk of heart disease. So we know that. In terms of symptom control, we know that actually at whatever stage, if your symptoms are hormonal,
then whatever stage you are, HRT has the potential to help, but HRT is not a panacea for all symptoms.
Anneli (59:03) Mm, mm.
Katie Armstrong (59:05) So when we again, we look at the data that says HRT works for symptoms, I've heard that said a lot. And actually, when you look at what the research actually says, for most research, they have looked purely at vasomotor symptoms. So they've looked at hot flushes and night sweats.
Anneli (59:21) So hot flushes. Okay.
Katie Armstrong (59:23) When I see women,
whilst they may be suffering from temperature regulation, many of them, not all of them, don't, again, one in five women don't have a temperature regulation issue. That often isn't the primary thing that is causing the issue in terms of their quality
of life. So I
Anneli (59:42) Mm-hmm.
Katie Armstrong (59:42) think HRT is incredibly effective at treating vasomotor symptoms. In terms of many of the other symptoms, again, it can be quite individual and it can help
but it's not necessarily going to be the cure. So for example, for muscle and joint pain or for brain fog or for sleep, it might, but
Anneli (1:00:03) Mm.
Katie Armstrong (1:00:03) it's quite individual and the data is not amazingly robust. so I'm going to say, if we're looking at, so I'm always going to weigh up for an individual benefits against risks. So the benefits are symptom control, it's pretty good, it's not brilliant.
you know, and also always remember, it's only going to make you feel as good as you did when your hormone when your ovaries were actually working. And many of us maybe didn't feel great. ovaries were actually working.
Anneli (1:00:27) Right. Right so
Katie Armstrong (1:00:32) So that's another big clue of is it my hormones or not?
Anneli (1:00:34) Yeah, yeah.
Katie Armstrong (1:00:36) You know, has is this a new thing for you? So symptoms? Yes. Long term health? Yes. But you need to take it in the right kind of window. And
Anneli (1:00:46) Mm.
Katie Armstrong (1:00:46) I think I'm also always going to say to you that, you know,
If we know that we're beginning to feel crap, do we have to wait until we are on our knees on the floor before we do anything about it?
Anneli (1:00:58) Mm.
Katie Armstrong (1:01:01) No. Do
Anneli (1:01:02) Mm.
Katie Armstrong (1:01:03) I think that we should completely preempt and go, well, I'm 42 and this is an inevitability
Anneli (1:01:09) Right.
Katie Armstrong (1:01:09) and I'm feeling absolutely fine, but maybe I should start HRT now? No, your body isn't giving you any signals.
Anneli (1:01:15) Is there is there a downside
to taking HRT when you're not experiencing symptoms?
Katie Armstrong (1:01:21) I mean, I think the thing is, is one, it's a bit of a pain having to take something every day,
Anneli (1:01:24) Hmm. Yes.
Katie Armstrong (1:01:26) two, you're potentially giving your body hormones that it doesn't necessarily need. So you might get side effects. You might get tender boobs.
Anneli (1:01:30) Mm. Right. Mm.
Katie Armstrong (1:01:34) You might stop bleeding all over the place because
the lining of the womb is very sensitive to hormones.
Anneli (1:01:39) Right.
Katie Armstrong (1:01:40) And we don't know enough about risk to know,
Anneli (1:01:42) Mm, mm, mm, mm.
Katie Armstrong (1:01:45) you know, is that, might it be?
more dangerous to take them just because you
Anneli (1:01:49) Right.
Katie Armstrong (1:01:50) kind of went off, this is what I meant to do. So
Anneli (1:01:52) Right.
Katie Armstrong (1:01:52) I would say, I would always err on the side of have a good reason to take HRT, be using it for something, don't just be using it because. And yeah, the licenses are always going
Anneli (1:01:59) Mm, mm, mm. Yeah. Yes. Because you think you should. Mm. Mm.
Katie Armstrong (1:02:07) to say that actually the reason you take it is for symptom control.
Anneli (1:02:11) Yeah.
Katie Armstrong (1:02:12) And
we do know that there are some risks. So we know that there is an increased risk of breast cancer in
Anneli (1:02:14) Mm, mm, mm-hmm.
Katie Armstrong (1:02:18) women who take HRT or contraception that
Anneli (1:02:21) Mm.
Katie Armstrong (1:02:22) contains both estrogen and progesterone. So we know that and we know that that risk is duration dependent. So the longer you're on it, the higher that risk is. We
Anneli (1:02:31) Mm-hmm.
Katie Armstrong (1:02:32) do also know that not all hormones are the same. And it appears
Anneli (1:02:35) Right.
Katie Armstrong (1:02:36) to be the progesterone part that is different. So the older fashion progesterones
appear to have a slightly higher risk than the more modern progesterones. For none of this risk is big. This risk is still small, but it is there. So again, I've heard
Anneli (1:02:47) Mm. Yes. It it exists.
Katie Armstrong (1:02:51) people say, well, you know, now it's been completely debunked that there's any breast cancer risk with HRT. I'm like, no, we can't say that. The evidence doesn't tell us that. The evidence does
Anneli (1:03:01) Mm, mm. Right.
Katie Armstrong (1:03:03) say that there are an additional four women.
per thousand every five years over 50 in women who take combined HRT. So we do know that there's an increased risk.
Anneli (1:03:13) Mm. Right.
Katie Armstrong (1:03:16) We do need to acknowledge that.
Anneli (1:03:18) Mm.
Katie Armstrong (1:03:18) But for most women, that risk might be lower than, well, certainly the risk of having a glass of wine every night is the same as HRT.
Anneli (1:03:26) Mm-hmm.
Katie Armstrong (1:03:28) If you've got a BMI of over 30, your risk is much, much, much
higher. If you
Anneli (1:03:34) Mm-hmm.
Katie Armstrong (1:03:34) smoke, your risk is higher.
if you exercise regularly, your breast cancer risk is lower. So I think we've got to take all of these things into
Anneli (1:03:39) Right. Yes.
Katie Armstrong (1:03:42) consideration when we're looking at the woman in front of us.
Anneli (1:03:45) Mm.
Katie Armstrong (1:03:45) So if she's feeling so grim, that she is sitting on the sofa eating chocolate, drinking wine, having a fag because she's feeling awful, then actually giving her some HRT might improve all of that actually might improve her breast cancer risk. But that's a very,
Anneli (1:04:00) Exactly. Right, right.
Katie Armstrong (1:04:03) that's a very individual thing. So
Anneli (1:04:05) Mm, mm,
mm, mm.
Katie Armstrong (1:04:06) I'm going to go it's really
hard to go is there is one age better than another age
Anneli (1:04:10) Yeah. Yes.
Katie Armstrong (1:04:12) is is one HRT better than another HRT.
Anneli (1:04:15) Mm.
Katie Armstrong (1:04:16) It's it's all very, very individual. So
Anneli (1:04:19) Yeah.
Katie Armstrong (1:04:19) for a woman who's got a higher risk of blood clots, it's going to be best for that woman to take estrogen through the skin because when you take it orally, there's a small increase risk that of blood clots increasing. But again, for many women,
Anneli (1:04:34) Right.
Katie Armstrong (1:04:35) who don't have an increased risk of blood clots, actually taking a tablet form of HRT may be incredibly convenient and easier and better. So this idea
Anneli (1:04:41) Would be fine. Right. Mm. Mm.
Katie Armstrong (1:04:44) of it always has to be through the skin, that the progesterone always has to be a natural progesterone, know, let no synthetic chemicals near my body. That's not always right. If
Anneli (1:04:52) Mm. Right.
Katie Armstrong (1:04:57) you bleed all over, women bleed a lot more on natural progesterones than they do on synthetic progesterones.
And so actually for some women, maybe better to have the
Anneli (1:05:05) Hmm. Right.
Katie Armstrong (1:05:07) symptom control and not be bleeding all over the place. So this is where it is very, very individual. So again, I'm like that idea that one size fits all doesn't exist. But as a good starting
Anneli (1:05:12) Right. Very individual. Mm. Yeah. It doesn't exist. Yeah. Mm.
Katie Armstrong (1:05:22) point, I would say that starting HRT because you've got symptoms,
Anneli (1:05:28) Mm.
Katie Armstrong (1:05:30) not waiting to be on the floor.
Anneli (1:05:32) Right.
Katie Armstrong (1:05:33) So, you know, getting in before you've collapsed, ideally, is ideal. And
Anneli (1:05:35) Yeah. Which makes complete sense. Yes. Yeah.
Katie Armstrong (1:05:40) normally you're going to want to take your estrogen through the skin, so a patch of spray or a gel, and you're going to want either a coil or micronized progesterone or this new progesterone that's on the market, which is very similar to micronized progesterone.
but is in fact synthetic, it's called Nalve, better at bleeding control. You're gonna want one
Anneli (1:06:00) Mm-hmm. Okay.
Katie Armstrong (1:06:03) of those to start with because that's the lowest risk.
Anneli (1:06:06) Right.
Katie Armstrong (1:06:07) But then depending on how you are with that HRT, that
Anneli (1:06:11) Right.
Katie Armstrong (1:06:11) might be changed as you go along. If you're much younger,
Anneli (1:06:14) Mm.
Katie Armstrong (1:06:16) sometimes one of the most effective things you can do is go on the pill.
Anneli (1:06:20) Right.
Katie Armstrong (1:06:20) So the pill contains estrogen. And
Anneli (1:06:23) Mm-hmm.
Katie Armstrong (1:06:24) actually what it does is...
calm your cycle down. So actually, if you still got regular periods, but you're getting lots of symptoms, and you're thinking, hang on, I'm 39, I think this is hormonal, but
Anneli (1:06:34) Uh-huh.
Katie Armstrong (1:06:35) I think I'm going to have to go into battle with my GP to
get HRT. Well, actually thinking about one of the newer pills that contains contraceptive pills that contains a natural estrogen.
Anneli (1:06:46) Mm-hmm.
Katie Armstrong (1:06:47) So Zoli and Clara and Dravalis are
Anneli (1:06:49) Mm-hmm.
Katie Armstrong (1:06:50) the ones that contain natural estrogens.
actually can be a really effective way of managing symptoms, of managing your cycle, of controlling heavy periods and often GPs are much more comfortable with prescribing that. So that was my other top tip. Or
Anneli (1:07:02) That's interesting. Yeah. Yeah.
Katie Armstrong (1:07:05) the progesterone only pill, slend, because that also
Anneli (1:07:07) Yeah.
Katie Armstrong (1:07:07) calms your cycle down and can in the early stages be quite a good way of controlling things.
Anneli (1:07:14) Right.
That's amazing. Wow, that's really good to know. no, I I appreciate that. I think it is again being open to the options that are in front of you and having these conversations with your GP and and being honest with them about what you're experiencing. I I feel one of the big things I just wanted to touch on before we wrap this up. It's been such a great episode and I feel like we could probably chat for hours, but I no, it's great. No,
Katie Armstrong (1:07:38) I know, sorry, I've suddenly gone into massive long form, haven't I?
Anneli (1:07:41) this is this is fantastic. This is what I love.
But in terms of, you know, stress, cortisol, and our cortisol is kind of trending, isn't it? Cortisol is having its time.
Katie Armstrong (1:07:50) Yes.
Anneli (1:07:52) but if we talk about cortisol in in, you know, I find it difficult with a lot of women I work with where you look at the stress in their life and the cortisol and how that then how in your opinion does that link in with what we might be experiencing in terms of symptoms that we think is hormonal, but it could just be cortisol.
And then I'm not gonna talk about blood sugar because we could talk about that for hours. But all of these things are linked and how
Katie Armstrong (1:08:17) Yeah. Yeah.
Anneli (1:08:20) how do you help women navigate that and educate them around cortisol and the role that it plays in everyday function?
Katie Armstrong (1:08:27) So I guess the first thing I'm going to say is that it's really, one, my goodness, there are fashions I am realising now that
Anneli (1:08:33) Mm, mm.
Katie Armstrong (1:08:35) we are doing medicine through the genre of social media.
Anneli (1:08:41) The genre of social media, yes.
I love that, yes.
Katie Armstrong (1:08:44) So,
but, so cortisol is not a bad hormone. Cortisol is a good hormone. We wouldn't wake up in the morning if we didn't have this diurnal rhythm of cortisol that actually
Anneli (1:08:57) Exactly. Yeah.
Katie Armstrong (1:09:00) gives us our get up and go.
Anneli (1:09:01) Well
Katie Armstrong (1:09:02) Cortisol's job in our body is essentially to be our preparation for an imminent threat. So adrenaline is our
fight, flight or freeze. So adrenaline is the one that you get when you're actually in the situation. And that puts you on completely high alert.
Anneli (1:09:19) Mm-hmm.
Katie Armstrong (1:09:20) And that's what's what happened if you have a panic attack where you've got a load of adrenaline
Anneli (1:09:23) Right.
Katie Armstrong (1:09:24) coursing through you without the stimulus of,
Anneli (1:09:27) Mm-hmm.
Katie Armstrong (1:09:28) you know, the actual thing. Cortisol is more of the kind of the the amber light, the kind of be prepared stress
Anneli (1:09:38) Okay.
Katie Armstrong (1:09:39) hormone.
So if we think about so much of how our bodies work is primed for what our ancestors would have needed to stay alive. And if we think about modern life in the kind of annals of the history of man, this bit of modern life that is highly, highly sort of refined and we've got times of plenty, but you know, it's so mechanized, know, all
Anneli (1:10:06) Mm.
Katie Armstrong (1:10:06) of that is a very, very, very tiny.
Anneli (1:10:10) Mm.
Katie Armstrong (1:10:10) bit of time compared to the rest of the kind of, as I say, the annals of human life. So if
Anneli (1:10:18) Yes.
Katie Armstrong (1:10:18) we think back to our ancestors, just to be easy, I'm going to go like hunter gatherers.
Anneli (1:10:25) Yes.
Katie Armstrong (1:10:26) Cortisol would have been released because there was something going on that our body needed to be prepared for. So there's a wolf in the woods outside and that wolf could
come and damage us might also not make it safe for us to go and be able to go out and get food and we need to be on alert. So then think about, well, what would your body need to be doing in that
Anneli (1:10:51) Mm-hmm.
Katie Armstrong (1:10:51) scenario? So your body is still gonna need to rest, but not for very long. So cortisol tends to allow you to sleep from a minimum amount of time, four hours, then it wakes you up. There's a wolf outside, be careful.
Anneli (1:11:05) Mm, mm-hmm.
Katie Armstrong (1:11:08) promotes you putting laying down central fat because you might not be able to get out and hunt and do your gathering and your hunting. So we could talk a lot about blood sugars, but that's what it does.
Anneli (1:11:17) Yeah. Mm-hmm.
Katie Armstrong (1:11:19) It completely makes you focus on the here and now in terms
Anneli (1:11:22) Mm-hmm.
Katie Armstrong (1:11:23) of the way your brain works. So it makes you very kind of present in the moment, but it makes it really hard to step back and see a bigger picture.
Anneli (1:11:31) Right.
Katie Armstrong (1:11:32) It makes you feel like brace brace. You know, I'm waiting and I'm ready and I'm braced.
Anneli (1:11:35) Right. Mm-hmm.
Katie Armstrong (1:11:38) all of those things incredibly helpful if there was a wolf outside.
Anneli (1:11:42) Yeah.
Katie Armstrong (1:11:43) But of course, in modern day life, we are getting that same response because our phone is constantly pinging at
Anneli (1:11:52) Yes.
Katie Armstrong (1:11:53) us. Our body does not know our amygdala, that kind of system in the brain is primitive. It does not know how to distinguish between a wolf and
Anneli (1:12:03) Right.
Katie Armstrong (1:12:04) a message coming in on our phone.
Of course, the thing that would have happened in our past is that the wolf would have gone away and things
Anneli (1:12:13) Yeah.
Katie Armstrong (1:12:14) would have returned to calm and normal. So a really helpful response in the short term would have then returned to normal and allowed our physiology to return to normal. We're now in a place where actually ping, ping, ping, ping, ping, ping, ping,
Anneli (1:12:27) Mm.
Katie Armstrong (1:12:28) that threat response is high all the time.
Anneli (1:12:30) Yeah.
Katie Armstrong (1:12:31) So here's what I see women really worrying about. So women may understand all of that, but they'll go,
But what do I do about it?
Anneli (1:12:38) Mm.
Katie Armstrong (1:12:39) And I also think that this idea of it's gonna be terribly dangerous for us unless we are living completely zen chilled out lives, again, it's actually not physiologically true. It's not
Anneli (1:12:51) That's not feasible. Yeah.
Katie Armstrong (1:12:53) feasible, it's not physiologically true. Again, we're living in that make believe, you
Anneli (1:12:56) Yeah. Mm.
Katie Armstrong (1:12:58) when everything is perfect and wonderful, I will do this, I will meditate every day
Anneli (1:13:00) Right. Yes. Mm.
Katie Armstrong (1:13:03) and I will never get cross with the kids.
and nothing is going to go wrong. And then here's our real world. So what we need to know is that what our system would have been used to is the ability to regulate cortisol. So for it to go up and then down and then up
Anneli (1:13:20) Mm-hmm.
Katie Armstrong (1:13:20) again. So I want to think that for most of us, we're in the fast lane of the motorway. What we do not want to do is push the handbrake on and do a handbrake turn on a motorway.
Anneli (1:13:32) No.
Katie Armstrong (1:13:33) doesn't tend to do us any good, we crash.
Anneli (1:13:35) Yeah.
Katie Armstrong (1:13:37) So think about what you want to do is apply the brakes gently sometimes and go into the middle lane. So what
Anneli (1:13:43) Yeah.
Katie Armstrong (1:13:44) I talk to women about is understanding how they can ground themselves. And
Anneli (1:13:49) Mm-hmm.
Katie Armstrong (1:13:50) so much of us, we try and do this in here. So we try
Anneli (1:13:53) Yeah.
Katie Armstrong (1:13:53) and do it in our conscious thought, like be calm, I am calm, I must think myself less stressed.
Anneli (1:13:57) Right. Tell yourself to calm down. Yeah.
Katie Armstrong (1:14:01) when actually that very primitive side of our brain, the amygdala actually responds much more to our bodies than it does to our brain. So
Anneli (1:14:07) Mm, mm.
Katie Armstrong (1:14:09) actually just that's why a couple of deep breaths, these things that we know, but we might not do a
Anneli (1:14:14) Yes, yeah.
Katie Armstrong (1:14:16) couple of deep breaths, being out in nature, doing some exercise, I always think about what are the things that I need to do? How do need to convince my amygdala
Anneli (1:14:26) Yeah.
Katie Armstrong (1:14:27) that there is no wolf outside? Like if I laugh,
Anneli (1:14:29) That you're safe, yeah. Mm
mm. Yes. Love that. Mm.
Katie Armstrong (1:14:31) I wouldn't be laughing if there was a wolf standing there. If I'm having fun with my friends, if I'm
dancing, if I'm doing all of those things I wouldn't do. And even just a smile, we
Anneli (1:14:40) Mm-hmm. Mm.
Katie Armstrong (1:14:42) know that that can send a message back to our brain going, there's no threat here. So
Anneli (1:14:47) Yeah, yeah.
Katie Armstrong (1:14:48) you can do that through your senses. You can do grounding exercises, literally just allowing yourself to observe because you don't do that when you're stressed
Anneli (1:14:57) Yeah.
Katie Armstrong (1:14:58) and in the moment.
Anneli (1:14:59) Yeah.
Katie Armstrong (1:14:59) But
just think about those things that
Anneli (1:15:01) Mm.
Katie Armstrong (1:15:02) are, that just signal to your body, you don't need to worry. That was just an answer. That was just a message. That was just an email. Actually, there's not a wolf.
Anneli (1:15:08) Right. Hmm. Yeah.
Katie Armstrong (1:15:14) So that's how I think about it is
Anneli (1:15:16) Yeah.
Katie Armstrong (1:15:16) we are not trying to live no stress lives. We are trying to show our body that we can regulate. And actually doing
Anneli (1:15:20) y exactly. Exactly.
Katie Armstrong (1:15:23) small things a few times a day is probably just as helpful.
Anneli (1:15:25) Mm. Mm.
Katie Armstrong (1:15:28) as some big Zen life, which may be what some people decide to do, but not what
Anneli (1:15:31) That's it. Hmm.
Katie Armstrong (1:15:34) most of us can or want to do.
Anneli (1:15:37) I like that. It's it's also I think it's more sensible to think that if you break your day up with little mini stress relief pockets, it's probably more realistic than you going and doing a yoga session for an hour. Unless you can, which is great. But realistically you're more likely to stick to it if you just break it up during the day. And then it helps you get out of that hyper focused state of panic, maybe. So, yeah.
Katie Armstrong (1:15:58) recognizing that you can do
a yoga session in the morning and that might be wonderful and
Anneli (1:16:02) Yeah.
Katie Armstrong (1:16:03) you might feel wonderful for 10 minutes but actually by the evening you may
Anneli (1:16:07) Yes.
Katie Armstrong (1:16:08) still be doom scrolling and feeling full of cortisol again so actually kind
Anneli (1:16:10) Yes. Yeah, yeah.
Katie Armstrong (1:16:13) of signaling again to your body no hang on I need to remember to just remember how I breathed in that yoga lesson
Anneli (1:16:19) Mm.
Katie Armstrong (1:16:21) the other thing to remember is that often
those things that you do might not make you feel less stressed in the moment. So we tend to go, I'm doing this so I feel less stressed now. Actually, what you're trying to do is give your body a physical signal to signal that it can turn the cortisol down. And over
Anneli (1:16:35) Mm. Right.
Katie Armstrong (1:16:38) time, that will give you more tolerance to stress. But in the moment, these things
Anneli (1:16:41) Yes. Hmm.
Katie Armstrong (1:16:44) probably aren't going to give you more than two or three moments of feeling a bit calmer, then you will feel stressed again. But actually,
Anneli (1:16:49) Right. Right.
Katie Armstrong (1:16:51) they're still worth doing.
Anneli (1:16:52) So it's more of a long term strategy then, in terms of teaching your body how to regulate cortisol, and that cortisol is not bad. It's part of everyday life. I love that. That's really helpful. my goodness, I've had such a great time talking to you. and I'm so grateful for all your your wealth of knowledge and just sharing a really sensible, no nonsense approach.
to hormone health and HRT and stress management. is there one tiny last piece of advice that you want to give the listeners of the show in terms of how to just take better care of themselves or any kind of top tip you want to leave us with?
Katie Armstrong (1:17:27) So I think it's always gonna be what I find so hard to do for myself, but be kind to yourself. So my grandmother always told me to treat everybody as you would want to be treated yourself. I'm gonna change that slightly. And I'm gonna say, treat yourself as you would treat other people. That is my top tip.
Anneli (1:17:50) Love that. I love that. That is wonderful.
And what a note to end on as well. Such a positive note. Katie, thank you so much for coming on the show.
Katie Armstrong (1:17:58) My pleasure.
Anneli (1:17:59) I'm sure that we can do a whole different separate episode on episode on blood sugar as well, because I think that's a great topic. but thank you. Yeah,
Katie Armstrong (1:18:04) Yes, let's do that next time.
Anneli (1:18:07) exactly. Thank you so much. And yeah, any questions, I'm gonna drop Katie's details and all the details about Clinic 51 in the caption and where to find her.
do you tend to mostly see your patients in clinic or is that where people
Katie Armstrong (1:18:21) So,
Anneli (1:18:22) can yep.
Katie Armstrong (1:18:23) yeah, so I mean, people are very, very welcome to come to our lovely barn. This is my office.
Anneli (1:18:28) Yes, looks incredible.
Katie Armstrong (1:18:29) But equally, we do online, so.
Anneli (1:18:31) Okay, fantastic. So I will drop all the details in the caption or in the show notes. Thank you so much for joining us today. I will see you
Katie Armstrong (1:18:37) My pleasure!
Anneli (1:18:38) in the next episode and Katie, I will see you again soon, I'm sure.
Katie Armstrong (1:18:42) Bye everybody.
Anneli (1:18:43) Thank you.