Women's Healthcare - Q3 2021 by Mediaplanet UK&IE

Q3 2021 | A promotional supplement distributed on behalf of Mediaplanet, which takes sole responsibility for its content

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We don’t know how many people are even living with secondary breast cancer. That data isn’t collected, even though it’s the biggest killer of women under 50.

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When it comes to breast cancer, not everyone has the same choices or access to care. We need to do more to support women of colour and those living with secondary breast cancer.

W INTERVIEW WITH Leanne Pero Founder, Black Women Rising

INTERVIEW WITH Jo Taylor Founder, METUPUK

WRITTEN BY Kate Sharma

omen living with secondary disease (also known as metastatic or advanced cancer) and women of colour can often feel excluded from conversations around breast cancer. This is despite Black women being nearly twice as likely to be diagnosed with late-stage breast cancer and life expectancy being as low as a little over one year for women diagnosed with secondary disease (when cancer cells spread to other parts of the body). Approximately 28% of women diagnosed with secondary breast cancer will be alive five years after diagnosis. Two women with first-hand experience who are working to change the conversation are Jo Taylor and Leanne Pero. “People think that secondary breast cancer is a chronic illness that you live with, like diabetes. They think there are lots of treatment options and clinical trials, but that’s not the case. The people affected by it are a hidden population,” explains Taylor, who lives with the disease and set up METUPUK, a patient advocacy group to champion issues relating to secondary breast cancer. Invisible barriers Feeling hidden is something that Pero, founder of Black Women Rising - a network for Black cancer patients and survivors - can relate to. Diagnosed with primary breast cancer at the age of 30, Pero received a hostile reception from many in her community. “I was told chemo doesn’t work for Black people and that it must be the white gene that caused me to get it,” she recalls. During her treatment, Pero was astounded by the number of women who’d encountered similar rejection – something healthcare professionals seemed unaware of. “I overheard nurses describing one patient as ‘difficult’, but if they understood her struggles and how scared she was, they may have treated her differently,” she says. Invisible barriers are everywhere. A survey from Black Women Rising found that 96% of respondents did not see women of colour in breast cancer-related media, and many women aren’t offered wigs that are appropriate for their ethnicity.

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Improving education A lack of education in healthcare professionals and the wider public is feeding the problem. As Taylor points out, “We don’t know how many people are even living with secondary breast cancer. That data isn’t collected, even though it’s the biggest cancer killer of women under 50.” Progress is being made, however. Earlier this year NHS England announced the first ever national secondary breast cancer audit, which will provide figures of how many people in England are living with secondary breast cancer. Taylor and charities including Breast Cancer Now were instrumental in securing the audit. Both Pero and Taylor are using their negative experiences to drive change. Taylor is setting up a database so that women can easily access information on clinical trials in secondary breast cancer as well as an infographic highlighting red flag signs and symptoms, which is being signposted by NHS England. Collaboration is key Likewise, Pero is collaborating with major organisations and charities. “They have the infrastructure and the programmes; however, they can’t get people of colour to use them,” she says. “I have a community who trust me. If we can come together, we can create inclusive pathways.” Next month, Black Women Rising is launching an awareness campaign involving UK-wide billboard advertising, events, and a photographic exhibition to highlight experiences of Black cancer survivors. METUPUK will launch a campaign specific to secondary breast cancer during Breast Cancer Awareness Month in October. A display featuring 31 individual female figures will reveal the bleak reality of living with secondary disease. It will travel around shopping centres UK-wide and feature online and via social media. There is no sugar coating a disease that kills 31 women every day. But if we want to change that stat, we need to include everyone in the conversation.

Paid for by Gilead

This content has been initiated, funded and reviewed by Gilead Sciences Ltd.

Find out more at gilead.co.uk Job code: UK-UNB-0823 Date of preparation: September 2021

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How menopause specialist nurses are helping women in the community

Putting the patient first –

how menopause treatment is improving

Specialist nurse practitioners can often help women through menopause and alleviate all their menopausal queries.

All women will experience menopausal symptoms in one way or another. Primary care is trying to ensure all get the help and support they need.

or nurse practitioner Teresa Davison, a British Menopause Society registered specialist and founder of Somerset Menopause Clinic, nurses provide the perfect gateway for menopause care. In general practice, a nurse can see women for a variety of reasons, such as contraception, sexual health worries and cervical screening. All of these are touch points for discussion about the menopause. Normalising the menopause She says, “Lately, we’ve seen that discussion around menopause in the media has been much more active and this has opened the conversation, allowing women to talk about their experiences more.” “While normalisation has been a long time coming, issues can often stem from patients not understanding what is happening to them. We often hear that 10-minute slots at a GP surgery aren’t always long enough to talk about personal issues, but in the appointments mentioned above, nurses may have more time and the perfect opportunity to signpost women to more information.” Training is the big issue that Davison feels nurses should embrace. Due to funding cuts, there is not always the possibility of specialist menopause clinics but having a member of staff trained in menopause – especially a nurse, would be an added benefit for any primary care facility. She says: “Nurses should seek training, and perhaps run group education sessions where women can come together. “As women, we have two or three hormonal journeys through life – the onset of periods, some will have pregnancy and all women will go through the menopause. We offer empathy and congratulations for the first two, but the last one is almost brushed under the carpet.” Menopause in the workplace Davison believes that another uphill battle for women is fighting menopause in the workplace, where not only is it embarrassing but support measures are not always routinely available. “Women make up a great percentage of the workforce and at this stage of life, possibly with symptoms such as brain fog, a lack of concentration and trouble sleeping, it’s no surprise more women are seeking help for anxiety and low mood,” she says. While recent press on the menopause has helped, it doesn’t always mean that women feel educated and empowered, which is why Davison is keen that nurses signpost women to correct and authoritative information. She adds, “Nurses are dedicated to helping people with all sorts of health journeys. Talking about menopause is sometimes one of the biggest ways we can support and help patients. By letting them know that help is available, patients learn that they shouldn’t be scared and that there is someone to talk to with lots of options available.”

INTERVIEW WITH Dr Anne Connolly GP SI in Gynaecology, Chair, Primary Care Women’s Health Forum SPREAD WRITTEN B Y Gina Clarke

r Anne Connolly from Bradford is a GP SI Gynaecology and Chair of the Primary Care Women’s Health Forum. She believes that supporting women through menopause is simply part of the holistic life-course approach. Not only is it about supporting women to keep fit and well during the menopause, but to enable them to continue working and to prevent the onset of future health conditions such as osteoporosis and cardiovascular issues. Dr Connolly explains, “Women are now spending nearly half of their lives post-menopausally, so staying healthy really is a benefit to all. Tailored treatment and support is available for many illnesses such as cardiovascular disease – health professionals now need to apply the same reasoning to menopause care.” Tailoring treatment and care plans Dr Connolly explains that GPs support and empower patients to make

personalised care plans, looking at the holistic needs including cultural, social and personal barriers created by the menopause which will point towards a more tailored treatment plan. She explains, “Concerns about women’s health and menopause have been constantly undervalued, but a one size fits all approach doesn’t fit with the wellbeing of a woman. Not only is better access to education needed, but also regular treatment reviews as lifestyle changes and other factors become apparent.” For Dr Connolly, it’s all about that initial consultation in primary care, she says, “Empowering women to make the call to their GP is the most important thing we can do. Often women feel that they are not important enough and they should simply tolerate their conditions but I know from experience that earlier interventions and chats about other aspects of mid-life are all great points to also discuss the menopause and potential treatments.”

As women, we have two or three hormonal journeys through life – the onset of periods, some will have pregnancy and all women will go through the menopause.

INTERVIEW WITH Teresa Davison Nurse Practitioner, Founder, Somerset Menopause Clinic and British Menopause Society registered specialist

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Are you worried about a loved one and their experience of the menopause? Watching your loved one going through the menopause is not easy, but your support and views on their experience can often encourage a woman to seek help.

N INTERVIEW WITH Dr Katie Barber GP Partner and Accredited Menopause Specialist, Oxfordshire, Clinical Lead for Community Gynaecology Service, Oxfordshire, Private Menopause Specialist, Oxford Menopause

Find out more at theramex.com/uk/

ot only is Dr Katie Barber a 90-year olds with menopausal issues. practising GP with a special Typically, there’s a false understanding interest in women’s health that once periods have stopped you’re and menopause, but she through the worst and don’t need also runs her own private menopause help anymore. But for many women, company. Speaking to menopausal symptoms continue to be intrusive for women on a daily basis, she often finds many years afterwards.” that the reason for a visit or phone There is good news in that many call has been prompted by someone treatments are available for common else. She says, “We menopausal forget that our loved symptoms such as ones love us and hot sweats, brain they want us to live fog, fatigue and the life we should. lack of sex drive. If your condition is having a So when someone Dr Barber adds, “If negative impact on your life, for else notices a mood your condition is change, or an increase whatever reason, then talk about having a negative the options you have with your in forgetfulness, it’s impact on your life, GP or menopause specialist. often the trigger we for whatever reason, need to seek help.” then talk about the Dr Barber explains that while the options you have with your GP or media and TV programmes have menopause specialist, especially if helped raise awareness among the complex factors are involved.” general population of common While a thorough medical menopausal symptoms, it often takes assessment is always recommended, someone else for a patient to realise Dr Barber points to good resources the severity of their condition. such as Menopause Matters, Rock My Menopause and Women’s Seeking help Health Concern as good sources of She says “It’s never too late to ask for information online. help, I see women from teenagers to

Why women’s health deserves more investment and innovation Despite the press and attention menopause is gaining, there is still so much work to be done.

ountry Manager for UK Women’s Health at Theramex, Tina Backhouse understands that everyone has a responsibility to improve the experience of menopausal women. From healthcare professionals and organisations to pharmaceutical companies, the Government and women themselves. She says, “We’re finally starting to see momentum in the menopause conversation, thanks to this huge collaborative effort. The challenge now is to continue to invest in education, for both women and healthcare professionals, to drive genuine improvement in the experience of menopausal women.” It’s why Backhouse and her team at Theramex have worked together with menopause experts to develop their own resources, both for GPs and members of the public to access and gain further information, while also working with leading specialists in women’s health to start a menopause mentorship programme for healthcare professionals later this year. She says, “We are investing in educational resources and partnerships to improve understanding of menopause because the pharmaceutical industry has to be committed to education, in whatever form that looks like, that is accessible to all.” Addressing disparities in access Still, Backhouse is aware that there are huge disparities in menopause funding and services, often dependent on geographical location. She says, “It’s a huge issue that where you live can determine whether or not you have the access to newer types of treatment, including HRT. There’s a distinct difference in terms of prescribing across the UK, which more politicians need to be prioritising. Public Health England and the NHS are working hard to address these inequalities, but we all need to move quicker.” THX_GB_PRESSR_005217 | Date of prep: Sep-21

INTERVIEW WITH Tina Backhouse Country Manager, UK Women’s Health, Theramex

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Menopause support at work: why the UK is a global leader Menopause symptoms don’t stop when you go to work. So, it’s great to see more and more UK employers putting the right support in place.

f we rewound five years, we’d be very unlikely to find many employers who readily encouraged discussion about menopause at work and even less likely to find any with policies, guidance and support in place. Thankfully, a lot has happened over recent years. Now, thousands of forwardthinking organisations realise their responsibilities in supporting menopause at work. They also understand much more about the benefits for their colleagues and the organisation. In fact, we’ve reached a point, a fantastic point, where organisations are actually achieving Menopause Friendly Accreditation. What does this mean? We’ve already seen the first cohort of accredited employers — HSBC UK, first direct, M&S Bank, ATOS and Aster Group. There are many others who have committed to being menopause friendly, working towards the standards set out for accreditation from an independent panel of the UK’s leading experts. Becoming menopause friendly These standards embrace all the key elements which, together, create a menopause friendly organisation. They include creating an environment where it’s easy to talk about menopause, putting policies and guidance documents in place, offering training to help everyone understand what can help at work and making reasonable adjustments available. Some employers are going even further, providing direct access to menopause experts, such as Peppy, through their employee rewards. Why wait to take action? We know that we’re an ageing population, living and working for longer. While menopause support at work isn’t yet law, thousands of employers are not prepared to wait until it is. It’s important for equality, diversity and inclusion. It’s also important for colleagues to know they’re supported. Employers are now taking action and they’re reaping the benefits.

WRITTEN BY

Deborah Garlick Director, Henpicked, Menopause in the Workplace

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Menopause facts and misinformation There is no one size fits all when it comes to menopause, it is important to dispel the common myths and misunderstandings around the condition.

yths about the menopause commonly arise from a misunderstanding that every menopause is the same. In fact, every woman will experience it differently. There is no ‘right’ age to start the menopause. Generally, the menopause happens later in a woman’s life, the average age in the UK is 51. However, whilst 51 is the average age, some women can experience menopause much earlier. Women should never feel embarrassed about going through the menopause, regardless of age, and should seek advice and information if they think they may be experiencing menopausal symptoms. The menopause means more than hot flushes. Yes, hot flushes are common, but this is not the only symptom. Some women experience various symptoms, including mood changes, joint stiffness, a reduced sex drive and difficulty sleeping. Others may experience very few, or mild symptoms. The menopause does not have a time frame. There is no specific amount of time in which a woman may experience symptoms, it varies from person to person. Some women can experience symptoms before the end of their periods. Symptoms may also continue for years after a woman’s last period. HRT and misinformation Misinformation about hormone replacement therapy (HRT), one of the most effective treatments in relieving many menopausal symptoms, can lead to women not accessing advice and treatments. Research shows that the risks of HRT are small and the benefits usually outweigh these risks. There is no evidence to suggest HRT will cause weight gain. You may gain some weight during the menopause, regardless of whether or not you take HRT.

How to manage the menopause is a personal choice, and the many different types of treatments available enable women to access what works for them. You do not need to stop taking HRT at 60. Treatment is tailored to the individual’s needs. Women should always have regular check-ups with their doctor or nurse, who will advise based on each woman’s personal circumstances. Even if you have had breast cancer or other serious illnesses, there are often ways your symptoms can be treated. Lifestyle changes can often help to manage symptoms. Exercise, a healthy diet and reduced alcohol intake can all help some women to manage the menopause. How to manage the menopause is a personal choice, and the many different types of treatments available enable women to access what works for them. The important thing is to discuss symptoms, treatments and concerns with healthcare professionals so that every choice is an evidence-backed, informed decision and is tailored to that individual.

WRITTEN BY Dr Edward Morris President, Royal College of Obstetricians and Gynaecologists

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Women should never feel embarrassed about going through the menopause, regardless of age, and should seek advice and information if they think they may be experiencing menopausal symptoms. Dr Edward Morris, President, Royal College of Obstetricians and Gynaecologists

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We need that lightbulb moment with secondary breast cancer Jacquie Beltrao, 56, was diagnosed with secondary breast cancer in 2020, at the start of lockdown. She explains how it feels to be told your cancer has returned.

INTERVIEW WITH Jacquie Beltrao Sky News Presenter and Ambassador of Future Dreams WRITTEN BY Louise Court

Jacquie talks about her secondary breast cancer diagnosis on an episode of the Future Dreams podcast ‘And Then Came Breast Cancer’ which can be found on the website or on popular podcast platforms. Contact Future Dreams at futuredreams. org.uk

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he news that Jacquie’s breast cancer had returned and was treatable but not curable came out of the blue and was quite frankly terrifying. “When you get diagnosed with secondary breast cancer you think, ‘That’s it, I am going to die.’ You want the breakthrough cure to happen now, but nobody is spending money on that in the same way people have been spending money on vaccines for COVID-19. Increasing commitment to cancer research “Unless people take that urgent attitude it won’t happen quickly enough for lots of people. It is an emergency for us. We have stage IV breast cancer and we want that lightbulb moment from the lab. There are so many different possibilities with cancer and leaps and strides are being made in treatments all the time, but it is frustrating when a COVID vaccination is developed in a matter of months. For someone like me, cancer trumps COVID every day of the week.” Jacquie has taken a relentlessly positive and pro-active attitude to her diagnosis. As a keen sportswoman and former Olympic athlete, she has always taken care of her body. Since being told she has secondary cancer, she has blended alternative treatments with the medical advice and drugs of her oncologist and breast cancer team. “I am bombarding it,” she says. She has changed her diet, going sugar-free, she has oxygen therapy and mistletoe treatment which is good for boosting the immune system and is used regularly in the treatment of cancer in Germany. Life living with cancer “Although I am on the latest cutting-edge drugs as well, I was told they won’t work forever so I am doing everything I can to try to weaken the cancer in other ways. She also has unflinching advice for the medical profession when talking to those with secondary breast cancer, who have an average life expectancy of three to five years. “My oncologist has been very upbeat and very problemsolving. What I think is terrible is when health care professionals say things like, ‘this is going to be your last Christmas.’ How do they know? Why would anyone say that? People get miracle remissions all the time so you mustn’t take that hope away from people. Be realistic but not pessimistic. I know people who have been living with this for 15 years.”

Why living a healthy lifestyle is important for your breast health It is important that women of all ages are aware that lifestyle factors play an important role in the prevention and recurrence of breast cancer.

n 2020, breast cancer surpassed lung cancer as the most diagnosed cancer worldwide and accounts for one in four cancer cases in the world1. Studies from the International Agency for Research on Cancer (IARC) have shown that a third of all breast cancer cases in Europe can be prevented by maintaining a healthy lifestyle. Looking at the available statistics, this means that each year 192,000 of the 576,300 new cases of breast cancer in the WHO European region could be prevented by choosing a healthy lifestyle1.

For many years, no one talked about prevention of cancer apart from attending screening programmes. Studies on cancer prevention For many years, no one talked about prevention of cancer apart from attending screening programmes. Now, a growing body of evidence shows the link between healthy choices and a lower risk of developing breast cancer.1 According to these studies, excess body weight and physical inactivity account for 25-33% of all breast cancer cases.2 In postmenopausal women, being overweight/obese is associated with an increased risk of breast cancer so limiting weight gain in adult life and maintaining a body mass index (BMI) of 18.5-24.9 is ideal. Alcohol intake has also proven to be a risk factor. In 2020, it was estimated that 13% of breast cancer cases globally and 21% in the WHO

Region Europe could be attributed to alcohol consumption3. Europe has the highest levels of alcohol consumption and alcohol-caused deaths in the world. There is no proven safe level of alcohol consumption, and this is why it is important to raise awareness and spread the message about the importance of limiting alcohol intake. Breast Health Day EUROPA DONNA - The European Breast Cancer Coalition established Breast Health Day on 15 October in 2008. It now runs a yearly campaign to inform women of all ages that lifestyle factors play an important role in the prevention and recurrence of breast cancer and that early detection of breast cancer through screening is crucial. Currently, EUROPA DONNA and its member countries are working with the European Commission towards the implementation of the Europe’s Beating Cancer Plan that was launched last year on World Cancer Day. The Plan has four key action areas: prevention, early detection, diagnosis and treatment and quality of life of cancer patients and survivors that will be supported by 10 flagship initiatives and multiple supporting actions. References 1.Ferlay J, Ervik M, Lam F, Colombet M, Mery L, Piñeros M, Znaor A, Soerjomataram I, Bray F (2020). Global Cancer Observatory: Cancer Today. Lyon, France: International Agency for Research on Cancer. Available http://gco.iarc.fr/today [accessed on 29 July 2021] 2. (IARC (2002). IARC Handbooks of Cancer Prevention, Volume 6, Weight control and physical activity. Lyon, France: International Agency for Research on Cancer. 3.Rumgay H, Lam F, Ervik M, Soerjomataram I (2021). Cancers attributable to alcohol. Lyon, France: International Agency for Research on Cancer. Available from: https://gco.iarc.fr/causes/alcohol, accessed [29 July 2021]

WRITTEN BY Barbara Klein Communications Officer, EUROPA DONNA - The European Breast Cancer Coalition

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How trials are making breast cancer radiotherapy smarter and kinder Researchers have developed and tested new radiotherapy treatment regimens, treating women with breast cancer with fewer daily doses of radiation, whilst minimising side effects and the burden on patients.

A WRITTEN BY Dr Navita Somaiah Research team leader, The Institute of Cancer Research, London and Oncologist at The Royal Marsden NHS Foundation Trust

round 63% of patients diagnosed with breast cancer in England receive radiotherapy as part of their primary curative cancer treatment. The total dose of radiotherapy given to patients is traditionally divided into small daily doses, called fractions, spread over a number of weeks. For decades the daily dose has remained small in order to keep side effects to a minimum. Shorter treatment courses However, various trials have shown over the last decade that for early breast cancer, a lower total dose is as effective when delivered in fewer, larger fractions, which can be given over a shorter period of time. These kinds of dosing schedules are known as ‘hypofractionated’ radiotherapy. These smarter treatments are kinder to patients too; keeping side effects low and reducing the number of times they have to travel to and from hospital. New clinical trials A number of clinical trials led by scientists at The Institute of Cancer Research in London and its hospital partner, The Royal Marsden NHS Foundation Trust, assessed the role of hypofractionated radiotherapy for treating women with early breast cancer. Historically, women received radiotherapy in 25 daily doses over five weeks. The UK START trials showed that 15 doses, or ‘fractions’, given over three weeks were as safe and effective

These smarter treatments are kinder to patients too; keeping side effects low and reducing the number of times they have to travel to and from hospital. as 25 fractions given over five weeks – reducing standard treatment to 15 daily doses in three weeks over ten years ago. Next step trials The next step was the FAST trial, which successfully showed that five larger fractions given as one fraction per week could be delivered safely, causing no more changes in the healthy tissues of the breast as 25 small fractions over five weeks. FAST laid the groundwork for the FAST-Forward trial, which tested an even shorter treatment course of five fractions of breast radiotherapy delivered in a single week. The FAST-Forward trial results confirming safety and efficacy were published just as the COVID-19 pandemic hit, enabling safe delivery of breast radiotherapy to thousands of women who may otherwise have faced delays or interruptions in their treatment. This 5-fraction regimen has now been adopted as the UK standard for patients with early breast cancer.

Knowing yourself and your body could save your life

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Although breast cancer is the most common cancer in females aged 25-49, a quarter of young people aren’t aware it could affect them.

A WRITTEN BY Harri Lowndes Marketing Manager, CoppaFeel

nyone can be affected by breast cancer, but through our research we’ve found that a quarter of young people don’t realise they are at risk. It’s why we’re asking you to know yourself as part of our new campaign. We want you to know your body, know it’s quirks, know how it changes and if you notice something unusual for you, speak to your GP. As well as being less likely to check regularly, this demographic is the most likely to delay seeking medical advice. Our research shows that one in five young people would delay visiting their doctor because of the COVID-19 pandemic. Early diagnosis saves lives and to support our ongoing mission to ensure young people are informed and proactive about breast health, we want to raise awareness and challenge the singular narrative about breast cancer. Get to know yourself We are celebrating self-discovery and exploration - an unfiltered and honest portrait of getting to know who you are. Young people are not routinely screened and often overlooked when it comes to breast cancer information. With the end-line, ‘Breast cancer can affect any body. Getting to know yours could save your life’, we hope you will take away the message that breast cancer is a relevant issue to young lives too.

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You know your body better than anyone, so if you are concerned about an unusual change, trust your instinct and book an appointment.

We know that the last year has been challenging and that the pandemic has put people off speaking with their GP, but we are here to tell you that your doctor still wants to hear from you. We all have breast tissue, young, old, guys, gals, non-binary pals – so we should all get to know our chests by checking regularly. You know your body better than anyone, so if you are concerned about an unusual change, trust your instinct and book an appointment. It might feel embarrassing or unnecessary but believe me: it could save your life.

CoppaFeel is launching the Know Yourself campaign. For more information about the campaign or how to check, visit coppafeel.org

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Taking an individualised approach to HRT All women should be able to access advice on how they can optimise their menopause transition and the years beyond.

here should be a holistic and individualised approach in assessing menopausal women, with particular reference to lifestyle advice, diet modification as well as discussion of the role of HRT. The decision whether to take HRT, the dose of HRT used and the duration of its use should be made on an individualised basis after discussing the benefits and risks with each individual. This should be considered in the context of the overall benefits obtained from using HRT including symptom control and improving quality of life as well as considering the bone and cardiovascular benefits associated with HRT use.

The HRT dosage, regimen and duration should be individualised, with annual evaluation of advantages and disadvantages. Finding the most suitable treatments The HRT dosage, regimen and duration should be individualised, with an annual evaluation of advantages and disadvantages. Arbitrary limits should not be placed on the duration of usage of HRT; if symptoms persist, the benefits of hormone therapy usually outweigh the risks. HRT prescribed before the age of 60 has a favourable benefit/risk profile. HRT initiated before the age of 60 or within 10 years of the menopause is likely to be associated with a reduction in coronary heart disease and cardiovascular mortality. If HRT is to be used in women over 60 years of age, lower doses should be started. Evidence from the Cochrane data-analysis as well as that from the long-term followup data of the WHI showed no increase in cardiovascular events, cardiovascular mortality or all-cause mortality in women who initiated HRT more than 10 years after the menopause. Women with POI and early menopause should be encouraged to use HRT at least until the average age of the menopause. HRT and the combined contraceptive pill would both be suitable options for hormone replacement in women with POI. However, HRT may result in a more favourable improvement in bone density and cardiovascular markers compared with the combined contraceptive pill.

WRITTEN BY

Mr Haitham Hamoda Chairman, British Menopause Society

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Top tips on how to manage menopause symptoms Everyone’s experience of the menopause is different. But there are lots of useful tips and advice on how to reduce the common symptoms of menopause. • Dress in easily removable layers so you can adjust your temperature if you need to. Wear natural fibres as much as possible, or mixtures containing some natural fibres. Avoid tight-fitting Lycra clothes. • Avoid synthetic bedding as this increases sweating. Use cotton sheets instead. Blankets are better than duvets. Try and sleep with the bedding loose. • Take warm showers instead of hot baths. • Women who are putting on weight are more likely to get hot flushes. • Cut out, or cut down on, coffee, tea, cola drinks, spicy foods and foods containing monosodium glutamate (MSG) as these can trigger hot flushes or make them worse. • Avoid hot soup, hot drinks and large meals in the evenings if they trigger night sweats or make them worse. • Carry a mini battery-operated fan. • Quit smoking. There’s evidence it speeds up the onset of the menopause by about two years. Menopausal women who smoke have worse hot flushes and than non-smokers. • Avoid drinking too much alcohol, as this can increase hot flushes. • Be more active. Aim for 150 minutes of moderateintensity activity (e.g. brisk walking) every week plus strengthening exercises on two or more days each week. If you’re new to exercise, have any medical conditions, are over 55 or haven’t exercised for three months, check with a doctor before trying a new routine. Be careful not to overdo it.

• Practise relaxation and paced breathing to reduce stress, help brain fog, help you concentrate and think more clearly. • Cognitive behavioural therapy (CBT) can help hot flushes, night sweats, low mood and anxiety as well as sleep and stress. You can use various techniques to help you relax, get into a healthy sleep routine and feel more positive about your symptoms and life in general. • With reference to anxiety, when you’re feeling overwhelmed, breathe in for a count of seven, then out for a count of 11 and repeat. After a few deep relaxing out-breaths, your body and mind slow down and your thoughts become clearer. • Mindfulness, meditation or prayer lowers your blood pressure and heart rate, reducing anxiety and stress. Focus on peaceful or positive images and develop calming sleep strategies, such as writing down anxious thoughts. Take time out and have plenty of ‘me-time’.

WRITTEN BY Norma Goldman, BPharm. MRPharmS. MSc. Founder and Director, The Menopause Exchange

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Finding the best treatment available for GSM A vaginal laser treatment is becoming a highly sought-after option for menopausal women suffering from vaginal dryness, pain, irritation and a deteriorated sexual life.

W WRITTEN BY Dr. Neza Koron Medical Research Specialist, Fotona d.o.o.

hile menopause is a natural and significant stage in a mature woman’s life, education and public discourse on the topic is unfortunately limited, especially concerning sexual health. A large majority of menopausal women are sexually active, yet almost half report problems in sexual intercourse. This is due to symptoms of genitourinary syndrome of menopause (GSM), which are experienced by 30–85% of menopausal women. GSM can negatively impact sexual activity and overall quality of life if not recognised and managed properly. Symptoms determine treatment options As symptoms of GSM vary between women, choosing an appropriate treatment requires an individualised approach, depending on symptom severity, patient preference and other possible health issues. Non-hormonal topicals and local or systemic hormone treatments are first-line options for otherwise healthy women. However, some women cannot have hormone therapy or prefer solutions that do not require regular application of topical creams, so there is a need for alternative first-line treatments that can safely and effectively fulfil the needs of these women. Laser treatments provide unique benefits Vaginal laser treatments have become a valuable, scientifically-proven addition to the spectrum of therapeutic options for women suffering from GSM. The

core of these treatments is known as Fotona SMOOTH® technology, which is based on infrared laser light delivered via a special patented thermal pulsing mode to the vaginal and vulvar mucosa. The application of gentle and controlled heat pulses to the tissue result in improved blood supply and regeneration of the vaginal and vulvar mucosa to their initial healthy state and function. As the symptoms of GSM are progressive, their management is continuous and lifelong. In contrast to daily administration of topicals, RenovaLase® is initially performed 2–3 times on a monthly basis, followed by additional annual or biannual top-up treatment sessions. Since there are many effective and safe treatment options, women no longer need to accept GSM and problems in sexual intercourse as inevitable consequences of aging. Raising the popular awareness on all aspects of menopause empowers us to find the best possible treatments to enable women to continue experiencing life to the fullest.

Paid for by Fotona

Fotona’s patented Fotona SMOOTH® Er:YAG pulse protocol was a key breakthrough that led to the development of an entirely new class of minimally invasive erbium-based gynaecological procedures. These newer “SMOOTH” treatments are widely used for treating genitourinary syndrome of menopause (RenovaLase®), stress urinary incontinence (IncontiLase®), vaginal relaxation syndrome or vaginal laxity (IntimaLase®) and pelvic organ prolapse (ProlapLase®). For more information visit www.fotona-smooth.com and www.fotona.com/en/gynecology

Thankfully, a lot has happened over recent years. Now, thousands of forward-thinking organisations realise their responsibilities in supporting menopause at work. They also understand much more about the benefits for their colleagues and the organisation. ~Deborah Garlick, Director, Henpicked, Menopause in the Workplace

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Menopause treatment the natural way Adele found a natural menopause treatment that worked for her, and now she and her two daughters are working to share it with other women.

A INTERVIEW WITH Monique Wragg Co-founder, Feminapause

INTERVIEW WITH Adele Wragg Co-founder, Feminapause

WRITTEN BY Linda Whitney

Find out more at feminapause.com

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s an investment portfolio manager in London’s finance sector, Adele regularly held presentations in a male-dominated environment. But then suddenly it made her uncomfortable. “Standing there I felt increasingly hot and anxious, but I couldn’t say anything about it to a room full of men,” says Adele. She was also experiencing other symptoms. “Night sweats were stopping me from sleeping, I was moody and irritable, and even though I’ve always been quite sporty and used to be a professional dancer, my physical and mental energy started falling. I was just not feeling like myself.” Mystified, Adele saw her GP and blood tests showed the changes were due to the menopause. “I thought it was stress!” says Adele. She considered HRT patches but was surprised to find it was unavailable at the time, so she looked for natural alternatives. “Like many former dancers, I have arthritis, so I tried CBD to ease my painful joints, but I found it helped my menopause symptoms too,” says Adele. She then discovered that vitamin B12 helped combat lack of energy, so she supplemented the CBD with vitamin B12. “The combination transformed my life,” she says. It didn’t take long for Adele to start feeling like herself again. She’s returned to the gym and hot sweats are a thing of the past. “I’m less shorttempered and the brain fog has lifted.” The birth of a business Adele and her two daughters recognise that every woman’s menopause journey is unique and many other women are looking for a more natural approach, so they created a natural herbal supplement called Feminapause. Adele’s daughter Monique says: “It combines British-manufactured, laboratory certified CBD oil and vitamin B12. A vitamin B12 deficiency, which occurs in many people over 50 is linked to insomnia, lack of energy, memory loss, fatigue, weakness and sleep deprivation. We also added vitamin B6 for its hormone balancing effect.” The supplement aims to relieve the symptoms of the menopause and peri-menopause and contains no artificial hormones. The feedback they have received is astounding with over 700 positive reviews to date.

Everyone’s experience of menopause is different, and symptoms can vary a lot, but as I am going through the menopause myself, I can really empathise with the ladies who contact us. By women, for women “We are a family business founded and run by women, and almost all of our customers are women,” says Adele. Marketing graduate Monique is in her 20s but uses the supplement for its anti-anxiety effects. The third partner in the business is Adele’s other daughter Juliette, who has a background in fitness and nutrition. Adele adds: “Everyone’s experience of menopause is different, and symptoms can vary a lot, but as I am going through the menopause myself, I can really empathise with the ladies who contact us. Many of them tell heartbreaking personal stories of the devastating effects the menopause has on their lives and those of their families.” Monique says: “Many women feel ashamed to admit they have symptoms because it was a taboo subject in the past. Some women feel confused and like they are not doing ‘the right thing’ which feeds anxiety and low self-esteem.” Surge of enquiries There has been a surge of enquiries as furlough ends. “Ladies are looking to natural products to help reduce the anxiety they feel about returning to work,” says Adele. “Husbands and even sons have contacted us looking for help for their wives and mums. It’s wonderful to see this compassion and shows a greater awareness of the issues that menopause presents.” Monique adds: “It’s also gratifying to see more acknowledgement of the problems women with menopause symptoms face in the workplace. From being something no-one talked about, it’s something that is gaining greater awareness – and we are delighted to be a part of that.”

Paid for by Feminapause

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