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The One About Hormones - POI, PMDD, Endometoriosis + PME: Dr HANNAH SHORT
Episode 3116th March 2023 • BLUE MUMDAYS • Vikki Stephenson
00:00:00 01:01:51

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My guest this week is Dr Hannah Short, a GP Specialist in Menopause, P.O.I. (Premature Ovarian Insufficiency) and Premenstrual Disorders. In this fascinating episode, Hannah educates me on P.O.I., P.M.D.D. (Pre Menstrual Dysphoric Disorder), Endometriosis and P.M.E. (Premenstrual Exacerbation). She also talks about her own experience of premature surgical menopause at the age of 35.

*TRIGGER WARNING: *Very brief mention of some women feeling suicidal feelings*

IN THIS EPISODE WE DISCUSS:

[00:00] Teaser quote.

[02:15 ] Introduction to Dr Hannah Short.

[03:23] Premature Ovarian Insufficiency (P.O.I.) - early menopause below the age of 40.

[06:52] Treatments available for P.O.I.

[07:56] H.R.T. or Hormone Replacement Therapy.

[11:17] Hannah's interest in this area - personal experience of premature surgical menopause.

[16:11] The impact of not having children - the way society treats women without children.

[20:25] The symptoms of premature surgical menopause.

[22:41] Feeling a sense of loss at missing out on her youth due to illness.

[26:23] The power of podcasts and talking openly, especially as a G.P. (General Practitioner)

[27:37] Pre-menstrual disorders - P.M.D.D. (Pre-menstrual Dysphoric Disorder).

[38:48] Endometriosis - what it is and what help is available.

[43:22] Feelings of rage.

[46:33] The effects of calming the autonomic nervous system - exercise, anti-inflammatory diets and meditation.

[51:05] The lack of recognition for these issues - stigma and taboo.

[54:05] Advice for women badly affected by hormones - tracking your symptoms.

[56:01] Pre-Menstrual Exacerbation (P.M.E.)

[57:33] The importance of psychological support.


KEY TAKEAWAYS:

  1. Follow this link to access Dr Hannah Short's website – Hannah is a G.P. specialist in Menopause, P.O.I. and Premenstrual Disorders. 
  2. You can order Hannah’s book The Complete Guide to P.O.I. and Early Menopause via this link.
  3. Click this link for NHS information on Early Menopause and P.O.I. (Primary Ovarian Insufficiency). POI is classed as menopause before the age of 40. Latest statistics suggest 3-4% of women across the globe or affected.
  4. You can read NHS information on  HRT (Hormone Replacement Therapy) here.
  5. Click here to read a patient leaflet on Pre-Menstrual Syndrome (P.M.S.) from the Royal College of Obstetricians and Gynaecologists.
  6. P.M.D.D. or Pre-Menstrual Dysphoric Disorder is a hormone insensitivity affects around 5-8% of women as well as trans men, anyone who was born with ovaries. You can access Mind information on PMDD by clicking on this link.
  7. International Association for Premenstrual Disorders (IAPMD) follow this link for a lifeline of support, information and resources for women and AFAB individuals with P.M.D.D. and Pre-Menstrual Exacerbation (P.M.E.).
  8. Endometriosis is a condition where cells similar to the lining of the womb are found outside the womb or uterus. It's a condition that affects 1.5 million women in the UK. Support can be found here at Endemetriosis UK.
  9. Meditation has been found to be very effective in calming the autonomic nervous system. You can access a 15 minute 'Loving Kindness Meditation' from Season 1 of Blue MumDays on the link here, which has been created specially for us by Poonam Dhuffer of YSM8.
  10. You can access the Primary Care Women's Health Forum on this link.
  11. PME (Pre Menstrual Exacerbation) occurs when hormone changes during menstruation worsen the experience of a pre-existing disorder – like depressive disorder or generalised anxiety disorder. Click on the link to read a Women's Health article on the subject.
  12. Click this link to read more about Cognitive Behavioural Therapy (C.B.T.)
  13. NAPS Guidelines on P.M.S. from the National Association for Pre-Menstrual Syndrome.
  14. NICE guidelines for P.M.S.


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NEXT EPISODE:

For a Blue MumDays special celebrating Down Syndrome Awareness Day, I'm joined by the beautiful Jannah Hayah. Jannah talks to me about life with her gorgeous son Musa, who is 5. Musa has Down Syndrome, hearing loss and is fed via a feeding tube. Jannah is passionate about wanting the world to know that while a life living with disability can have its challenges, the struggle comes with incredible rewards. It's a wonderfully life-affirming conversation.


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Action on Postpartum Psychosis (APP)

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Transcripts

DR HANNAH SHORT: 00:00:00

One of the most debilitating things about

DR HANNAH SHORT:

it is that it's cyclical.

DR HANNAH SHORT:

So it comes around month in month out.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

kind of think, "Did it really happen?

DR HANNAH SHORT:

Was it really that bad?"

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

or, you know, things like that.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

whatever you do, you feel horrendous.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

you know this and it is exhausting.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

anxiety alongside those changes.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

But there's definitely help and advice out there.

VIKKI:

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

VIKKI:

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

VIKKI:

times the darkest of places.

VIKKI:

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

VIKKI:

struggling with parenting.

VIKKI:

All the stories shared here are from the heart.

VIKKI:

These are real conversations and may be triggering, so

VIKKI:

please listen with discretion.

VIKKI:

Today's episode covers feelings of suicide.

VIKKI:

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

VIKKI:

Thank you.

VIKKI:

Today's guest is Dr.

VIKKI:

Hannah Short.

VIKKI:

Hannah is a G.P.

VIKKI:

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

VIKKI:

and premenstrual disorders.

VIKKI:

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

VIKKI:

Premenstrual Disorders, and the National Association for Premenstrual Syndromes.

VIKKI:

Hannah has a particular interest in induced menopause, Premature

VIKKI:

Ovarian Insufficiency and hormone sensitivity disorders.

VIKKI:

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

VIKKI:

Clinical Advisory Board and the Surgical Menopause Advisory Committee,

VIKKI:

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

VIKKI:

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

VIKKI:

Hannah has personal experience of premature surgical menopause, which

VIKKI:

drives her passion and informs her work.

VIKKI:

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

VIKKI:

And Early Menopause'.

VIKKI:

Hi Hannah.

VIKKI:

Thank you so much for joining us today.

VIKKI:

Welcome to Blue MumDays.

DR HANNAH SHORT:

Thank you, Vikki.

DR HANNAH SHORT:

Nice to be here.

VIKKI:

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

VIKKI:

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

DR HANNAH SHORT:

So Premature Ovarian Insufficiency or P.O.I.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

But it's not quite as straightforward as that.

DR HANNAH SHORT:

So menopause normally indicates like a permanent state, whereas,

DR HANNAH SHORT:

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

DR HANNAH SHORT:

you're not capable of conceiving.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

reduced fertility in these girls and women who are affected.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

are much more likely to stop.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

ovaries removed below the age of 40.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

VIKKI:

Thank you.

VIKKI:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

3- 4% of women on a global level.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

would be in the 20-30 or under 20.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

VIKKI:

Oh my goodness.

VIKKI:

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

DR HANNAH SHORT:

Yeah.

VIKKI:

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

DR HANNAH SHORT:

It isn't at all.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

the treatment and the support they need.

DR HANNAH SHORT:

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

VIKKI:

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

VIKKI:

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

VIKKI:

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

VIKKI:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

10 years before your final period.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

support, but it's not unusual.

DR HANNAH SHORT:

And perimenopause is different to P.O.I.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

about doing things like blood tests.

DR HANNAH SHORT:

Um, we just treat them clinically.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

and certainly under the age of 40.

DR HANNAH SHORT:

So everyone should be taken seriously really.

VIKKI:

Thank you for that.

VIKKI:

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

VIKKI:

perimenopause and, and the menopause.

VIKKI:

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

VIKKI:

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

VIKKI:

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

VIKKI:

If we stay with P.O.I.

VIKKI:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

and also your general wellbeing.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

And there are guidelines for this.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

girl or woman has symptoms.

DR HANNAH SHORT:

So not everybody will struggle with oestrogen deficiency or menopausal

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

VIKKI:

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

VIKKI:

23 years ago.

VIKKI:

And obviously H.R.T.

VIKKI:

has changed a lot since then.

VIKKI:

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

VIKKI:

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

VIKKI:

If somebody was considering taking H.R.T.

VIKKI:

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

DR HANNAH SHORT:

Well, in terms of P.O.I.

DR HANNAH SHORT:

there's no increased risks.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

really important for health.

DR HANNAH SHORT:

In women of natural menopause age, the benefits usually

DR HANNAH SHORT:

outweigh the risks as well.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

causes breast cancer."

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

is more risky than taking H.R.T.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

A lot of women stopped H.R.T.

DR HANNAH SHORT:

overnight, doctors stopped prescribing it.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

and stuff went up hugely after that.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

category.

DR HANNAH SHORT:

You would normally prescribe it if there are symptoms and,

DR HANNAH SHORT:

and things like that as well.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

if, if it's needed for them.

VIKKI:

Thank you.

VIKKI:

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

VIKKI:

straight on the blower to my G.P.

VIKKI:

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

VIKKI:

Um, but thank you.

VIKKI:

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

VIKKI:

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

VIKKI:

about things like P.M.D.D.

VIKKI:

and P.M.E.

VIKKI:

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

VIKKI:

effect of hormones on feelings of, anger.

VIKKI:

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

VIKKI:

into this area, this specialism?

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

what I would end up doing.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

an impact in General Practice.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

what they were consulting me about.

DR HANNAH SHORT:

And I've also always had my own issues.

DR HANNAH SHORT:

So I've always struggled with periods.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

the rota makes it impossible.

DR HANNAH SHORT:

And I think that just made everything so much worse.

DR HANNAH SHORT:

But I used to have incredible anxiety and really crashing low

DR HANNAH SHORT:

mood before my period arrived.

DR HANNAH SHORT:

And everything felt quite unmanageable, especially

DR HANNAH SHORT:

because I had irregular periods.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

psychologically I struggled.

DR HANNAH SHORT:

And then when my period arrived, physically I struggled.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

I tried various treatments.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

And I only kind of got minimal relief at best.

DR HANNAH SHORT:

And ultimately it was recommended that I have my ovaries

DR HANNAH SHORT:

removed and a hysterectomy.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

And so that's what happened at 35.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

were removed and then plunged straight into surgical menopause.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

you know, mid forties or upwards.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

And it's just developed from there.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

disorder space and yeah, there we go!

VIKKI:

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

VIKKI:

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

VIKKI:

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

VIKKI:

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

VIKKI:

so extreme at such an early age?

DR HANNAH SHORT:

To be honest, I felt so ill before the surgery

DR HANNAH SHORT:

that I was pretty desperate.

DR HANNAH SHORT:

And I actually wrote a letter.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

surgery because I naively thought having the surgery would put me

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

pretty much disappeared with that.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

I struggled with absorbing H.R.T.

DR HANNAH SHORT:

for example.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

Eventually that was sorted.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

supportive and eventually found a regime.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

applies to whether you are somebody who considers themselves childless

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

and feeling quite isolated.

VIKKI:

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

VIKKI:

have chosen not to, to become mothers.

VIKKI:

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

VIKKI:

mean that they hate children.

VIKKI:

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

VIKKI:

on to, you know, to live their lives.

VIKKI:

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

VIKKI:

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

VIKKI:

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

VIKKI:

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

VIKKI:

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

VIKKI:

It's such a ballache!"

VIKKI:

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

VIKKI:

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

VIKKI:

Is that more extreme?

VIKKI:

That must have been a very difficult thing to go through

VIKKI:

when you are still so very young.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

clinician kind of guiding me through it.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

huge drop in your levels, right overnight.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

straight away.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

months, you might not need it."

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

become non-functional after menopause.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

do much more than that as well.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

knew that it was gonna be difficult.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

We shouldn't treat it the same.

DR HANNAH SHORT:

You'll always be in surgical menopause.

DR HANNAH SHORT:

You don't get through it.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

it's not a natural transition.

DR HANNAH SHORT:

And I think natural menopause takes several years for your

DR HANNAH SHORT:

hormones to kind of levels fall.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

So,

VIKKI:

Wow.

VIKKI:

Yeah.

VIKKI:

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

VIKKI:

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

VIKKI:

straight away, so it wasn't as extreme?

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

And I was only absorbing minimal amounts.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

so like night sweats and things.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

women who don't get those symptoms.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

to have those symptoms to be perimenopausal or menopausal.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

My skin also changed.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

don't have that hot flush at the end.

DR HANNAH SHORT:

Because hot flushes are generally associated with a surge

DR HANNAH SHORT:

in adrenaline and cortisol.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

on there with that as well.

DR HANNAH SHORT:

So yes, I, I would get those symptoms.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

Oh, headaches.

DR HANNAH SHORT:

Yeah.

DR HANNAH SHORT:

Quite severe migraines and headaches as well.

VIKKI:

It sounds like the whole jamboree of...

VIKKI:

who'd be a woman?!

DR HANNAH SHORT:

I know, I know It

DR HANNAH SHORT:

It wasn't fun.

VIKKI:

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

VIKKI:

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

VIKKI:

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

VIKKI:

because of what they're going through.

VIKKI:

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

VIKKI:

being able to be a biological mother?

VIKKI:

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

DR HANNAH SHORT:

I think.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

I planned with loads of friends.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

the pain with my endometriosis.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

slightly ambivalent about being a mum.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

felt a bit more grief around that.

DR HANNAH SHORT:

But it's sporadic.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

didn't really feel like I had a choice.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

is not upset by not having children.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

to have them around and, and things.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

life without children, but I think.

DR HANNAH SHORT:

I don't know.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

children or you don't have children.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

and disadvantages to both.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

You know, I am more flexible.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

to make if I hadn't had children.

DR HANNAH SHORT:

But occasionally it really hits me.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

But...

VIKKI:

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

VIKKI:

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

VIKKI:

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

VIKKI:

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

VIKKI:

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

VIKKI:

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

VIKKI:

versus the reality and how dark it was.

VIKKI:

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

VIKKI:

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

VIKKI:

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

VIKKI:

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

VIKKI:

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

VIKKI:

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

VIKKI:

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

VIKKI:

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

VIKKI:

out rather than bottle them up.

DR HANNAH SHORT:

It sounds like you had a very difficult

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

podcasts and social media...

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

and felt alone for so much longer.

DR HANNAH SHORT:

I think that's brilliant.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

We're not special because we trained as doctors.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

feelings and, and everything else.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

VIKKI:

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

VIKKI:

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

VIKKI:

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

VIKKI:

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

VIKKI:

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

DR HANNAH SHORT:

Definitely.

VIKKI:

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

VIKKI:

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

VIKKI:

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

VIKKI:

and P.M.E.

VIKKI:

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

VIKKI:

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

VIKKI:

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

VIKKI:

have a listen to this bit!"

VIKKI:

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

VIKKI:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

- which stands for Premenstrual Exacerbation- of anxiety

DR HANNAH SHORT:

and things like that.

DR HANNAH SHORT:

But I was told I had a severe premenstrual disorder.

DR HANNAH SHORT:

And essentially, P.M.D.D.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

menstruating age and also trans men.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

And it's a condition of hormone sensitivity.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

or P.M.T.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

although it's not particularly funny.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

and affects around 30-40% of women.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

necessarily be in a problematic way.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

They don't constitute a clinical disorder.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

But the women with P.M.S.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

or breast pain in the lead up.

DR HANNAH SHORT:

And they may go to their G.P.

DR HANNAH SHORT:

and ask for some advice.

DR HANNAH SHORT:

And sometimes things like diet and lifestyle changes

DR HANNAH SHORT:

can make a big difference.

DR HANNAH SHORT:

Sometimes the contraceptive pill, which evens out hormonal changes

DR HANNAH SHORT:

and things like that can help.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

and try and put on a brave face.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

one week before your period.

DR HANNAH SHORT:

And then they should get better when your period arrives.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

which seem to be more common.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

know, oestrogen and serotonin.

DR HANNAH SHORT:

And also the breakdown products of progesterone as well.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

at different points in the month.

VIKKI:

Wow.

VIKKI:

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

VIKKI:

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

VIKKI:

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

VIKKI:

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

VIKKI:

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

VIKKI:

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

VIKKI:

person" or "life is just terrifying".

VIKKI:

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

VIKKI:

resurfacing from being underwater.

VIKKI:

So yeah, this, wow.

VIKKI:

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

VIKKI:

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

VIKKI:

would be an incredible comfort to some.

DR HANNAH SHORT:

One of the most debilitating things about

DR HANNAH SHORT:

it is that it's cyclical.

DR HANNAH SHORT:

So it comes around month in month out.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

kind of think, "Did it really happen?

DR HANNAH SHORT:

Was it really that bad?"

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

or, you know, things like that.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

whatever you do, you feel horrendous.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

you know this and it is exhausting.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

anxiety alongside those changes.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

But there's definitely help and advice out there.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

and they do awareness raising campaigns.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

psychologists and scientists and things like that.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

do attempt to take their own life during a crisis.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

they'd be better off without them.

DR HANNAH SHORT:

And it's, yeah...

DR HANNAH SHORT:

Treatment is out there.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

or your reproductive endocrine organs.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

are other repercussions with that.

DR HANNAH SHORT:

Sometimes that's necessary.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

have a hormone sensitive brain.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

actually your ovaries are gone.

DR HANNAH SHORT:

So you should be fine.

DR HANNAH SHORT:

But actually the issue is in the brain.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

ovaries' hormonal production.

DR HANNAH SHORT:

And so women need to be told that.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

for example.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

used in the luteal phase at a low dose.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

and they're much more manageable.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

use.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

be particularly helpful because that suppresses the natural ovarian cycle

DR HANNAH SHORT:

and gives you add- back hormones.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

for example.

DR HANNAH SHORT:

But there is the help out there.

VIKKI:

This does sound extremely complex and I think when we spoke

VIKKI:

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

VIKKI:

have issues with their hormones?

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

But it depends.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

of women will have symptoms.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

reproductive lives and menstrual cycle.

VIKKI:

What was interesting in particular when you were

VIKKI:

talking earlier about P.M.S.

VIKKI:

and P.M.T.

VIKKI:

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

VIKKI:

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

VIKKI:

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

VIKKI:

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

VIKKI:

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

VIKKI:

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

VIKKI:

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

VIKKI:

I don't fully comprehend what's involved.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

response to hormonal changes as well.

DR HANNAH SHORT:

So you can get internal bleeding.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

had endometriosis in their lungs.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

bowel can get stuck to the uterus.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

of like scar tissue in your pelvis.

DR HANNAH SHORT:

And obviously it can lead to repercussions of things like fertility

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

the response to the physical symptoms.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

brain, which can trigger depression.

DR HANNAH SHORT:

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

VIKKI:

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

VIKKI:

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

VIKKI:

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

VIKKI:

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

VIKKI:

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

VIKKI:

a question of going to see the G.P.

VIKKI:

first and foremost?

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

you know, a surgical procedure.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

could be triggering severe symptoms.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

but that may not be bothering you.

DR HANNAH SHORT:

But for example, could be found during investigation for

DR HANNAH SHORT:

fertility treatment, for example.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

there are risks that come with surgery.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

Um, but it, it's hard.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

endometriosis, look at Endometriosis U.K.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

or ibuprofen, that's not normal.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

are conservative measures that can help.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

And if other things improve that your G.P.

DR HANNAH SHORT:

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

VIKKI:

That was incredibly helpful, thank you Hannah.

VIKKI:

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

VIKKI:

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

VIKKI:

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

VIKKI:

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

VIKKI:

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

VIKKI:

anger, in the postnatal period.

VIKKI:

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

VIKKI:

to be a 'thing', postnatal rage.

VIKKI:

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

VIKKI:

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

DR HANNAH SHORT:

Well, I don't have much experience personally

DR HANNAH SHORT:

with patients with postnatal rage.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

degrees of hormone sensitivity.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

react to them is gonna be different.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

something called allopregnanolone, which is a breakdown product.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

and things like that as well.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

it without kind of confusing as well!

DR HANNAH SHORT:

Hormone disorders like P.M.D.D.

DR HANNAH SHORT:

are often to do with steroid hormone withdrawals.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

symptoms because it affects the other neurotransmitters in the brain.

DR HANNAH SHORT:

And the same thing happens postnatally.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

bottom out when you deliver the baby.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

having periods until you stop often.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

to hormone sensitivity could trigger symptoms like rage.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

things like postnatal mood disorder.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

should all be doing this" essentially.

DR HANNAH SHORT:

But I think it's a real phenomenon.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

expert in hormone sensitivity.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

the kind of hormonal fluctuations.

DR HANNAH SHORT:

And that can be done in various ways.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

So anything we can do to calm the autonomic nervous

DR HANNAH SHORT:

system down can be helpful.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

feeling really, really low.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

the neurotransmitters again in the postnatal period, as it

DR HANNAH SHORT:

does in the premenstrual period.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

these things can kind of be supported.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

Things like meditation.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

significantly decreased after 16 week course of that.

DR HANNAH SHORT:

So all of these things can have a...

DR HANNAH SHORT:

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

DR HANNAH SHORT:

but they can have a profound effect.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

VIKKI:

Yeah.

VIKKI:

And with things like breathing exercises, would that be helpful

VIKKI:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

breathing exercises and it'll help!"

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

journal output kind of calms down.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

And then that has a knock on effect psychologically.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

it's not always explained why.

DR HANNAH SHORT:

Um...

VIKKI:

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

VIKKI:

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

VIKKI:

Or "Breathe!"

VIKKI:

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

VIKKI:

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

VIKKI:

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

VIKKI:

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

DR HANNAH SHORT:

I know.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

some fruits and veg, but do we know why?

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

associated with general better health in terms of wellbeing in

DR HANNAH SHORT:

the moment and long term health.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

So inflammation is often behind these unpleasant symptoms

DR HANNAH SHORT:

at what the cellular level.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

period or in the premenstrual period.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

VIKKI:

That statistic you were saying about the meditation,

VIKKI:

that's incredible to hear.

VIKKI:

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

VIKKI:

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

VIKKI:

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

VIKKI:

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

VIKKI:

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

VIKKI:

just close your eyes and listen.

VIKKI:

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

VIKKI:

with when I had my PND was insomnia.

VIKKI:

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

VIKKI:

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

VIKKI:

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

VIKKI:

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

VIKKI:

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

VIKKI:

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

VIKKI:

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

VIKKI:

There's no right or wrong to meditating.

VIKKI:

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

VIKKI:

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

VIKKI:

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

VIKKI:

But it's incredible how.

VIKKI:

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

VIKKI:

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

VIKKI:

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

VIKKI:

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

VIKKI:

go through these experiences.

DR HANNAH SHORT:

Yeah, no, I know.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

issues together with mental health.

DR HANNAH SHORT:

It's like a double whammy.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

the right kind of support.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

see the value in planning these services.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

You know, there are no real premenstrual clinics.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

really inadequate, particularly in the area where I am.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

just cannot get access elsewhere.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

I was doing an NHS menopause and premenstrual clinic, alongside

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

there's, there was a huge waiting list.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

for re referrals everywhere else.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

You know, really should be.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

as well.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

to, you know, muscular skeletal services.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

And actually we could manage this stuff better.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

Um, so yeah.

VIKKI:

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

VIKKI:

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

VIKKI:

What advice would you give to them?

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

professional or for patients.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

exacerbation, which is slightly different.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

gets worse in the luteal phase.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

But the key thing is tracking your symptoms.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

not familiar with it- can look it up.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

So if you have a G.P.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

point, I think stick with that G.P.

DR HANNAH SHORT:

because they will help their learning and then they

DR HANNAH SHORT:

can help support you as well.

VIKKI:

Brilliant.

VIKKI:

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

VIKKI:

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

VIKKI:

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

DR HANNAH SHORT:

Mm-hmm.

DR HANNAH SHORT:

Yeah.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

And then symptoms will start at some point after ovulation.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

month, you're debilitated by the symptoms.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

know, a bad depression or anxiety.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

exacerbation of an underlying disorder.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

treatment is optimised for that.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

pathway and look at that and things like suppressing the

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

psychological support, so C.B.T.

DR HANNAH SHORT:

and things are recommended in the guidelines.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

psychologists who specialise in this area.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

recovery and managing symptoms long term.

VIKKI:

Thank you.

VIKKI:

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

VIKKI:

that's been affected by these things.

VIKKI:

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

VIKKI:

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

VIKKI:

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

VIKKI:

that might have been to do with my cycle.

VIKKI:

Because you question yourself, don't you?

VIKKI:

And you think, "Am I going absolutely mad?

VIKKI:

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

VIKKI:

else seems to be able to cope?"

DR HANNAH SHORT:

Yeah.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

I mean, I struggled for so long.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

was the more premenstrual symptoms.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

brain's response to hormonal changes.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

but, but there is help out there.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

generally things can improve, so

VIKKI:

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

VIKKI:

find out what, what's going on.

VIKKI:

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

VIKKI:

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

VIKKI:

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

VIKKI:

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

VIKKI:

very, very hard thing to, to go through.

VIKKI:

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

VIKKI:

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

DR HANNAH SHORT:

No,

VIKKI:

Or anger, let alone when you are a parent.

VIKKI:

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

VIKKI:

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

VIKKI:

So you mustn't feel guilt about it.

VIKKI:

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

VIKKI:

But for now, thank you so much Hannah.

VIKKI:

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

VIKKI:

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

VIKKI:

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

VIKKI:

to get in, in touch with you direct.

VIKKI:

But,

DR HANNAH SHORT:

there are some links on there as well.

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

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

DR HANNAH SHORT:

And everything like that.

DR HANNAH SHORT:

could help a bit more.

VIKKI:

Thank you so much!

DR HANNAH SHORT:

You're welcome- thank

DR HANNAH SHORT:

you for having me,

VIKKI:

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

VIKKI:

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

VIKKI:

and that means helping more parents.

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