Inside Health: Women’s Health

Hello, I'm Dr.Zoe Williams.

I'm your host for this event and this is the first virtual event of 2022 of the Bupa Inside Health Series.

We had such a great response from customers last year that we're back for more.

With more information, tips and guidelines around some of the topical health issues.

So today we're focusing on women's health and wellness and specifically, as we get older, there's going to be lots of advice around the symptoms we might experience as we get older, particularly around menopause and also how to reduce the health risks as we age and today we're joined by Dr.Petra Simic, who's Bupa's Medical Director of Clinics.

Dr.Samantha Wild, GP and is Bupa's Clinical Lead for Women's Health.

and later on, I'll be speaking to Emily Partridge, who's Bupa's MSK Clinical Lead.

I'm joined now by Sam Wild who's a qualified GP and the Clinical Lead on Women's Health at Bupa.

Sam is passionate about shifting the stigma when it comes to women's health and related issues.

And she hopes to empower women to get the correct information and feel confident to raise the topic when it comes to women's health issues.

Hi, Sam.

Hi Zoe.

So when we think about getting older, one of the things we often think about is menopause because it is inevitable that it will happen for all of us as women.

So let's have a chat about that.

And I'd love to ask you first of all, what does it mean to be perimenopausal?

And also, when does a woman become menopausal and what sort of things should we be looking out for?

So the perimenopause often starts around the age of 45 years, and it's when your hormones start to change but before your period stop for good.

So at this time, your periods can become irregular, they may happen more or less frequently than before, they can become heavier, or they can become lighter.

And you also start to experience some of the symptoms of the menopause that we talk about as well as psychological and physical symptoms.

This period of time can go on for on average about four years but for some it can be a decade or more.

And once you haven't had a period for 12 months, that's when you are said to have reached the menopause.

The average age of the menopause in the UK is 51 but we do know that a lot of women will experience this at a younger age.

So one in 100 women will experience under the age of 40 and one in 1000 under the age of 30.

So we say not to think of this as a disorder of older women, it does happen to younger women too.

And when thinking about perimenopause, as you said, you know that can start several years before menopause.

So in a minority one in 1000, that could even be happening in people's 20s.

Exactly.

Yes, it could be and so you know, it always must be on all people's radar.

You know, we want to encourage women to be very aware of the symptoms and also the doctors too, so that this can be diagnosed at younger ages.

Yeah.

So what sort of symptoms should we be looking out for?

What are the signs so that we, you know, we get to know our own bodies and we're all we're looking out for these signs it means we hopefully will go and seek help at the right time.

Yeah, so not everybody will get symptoms.

So just to start by saying that, but actually more than 75% of women will.

And for some women, the psychological and the physical symptoms can be very debilitating and affect their daily lives.

But everybody's experience will vary and symptoms may only last for a few months but they can go on for several years.

And different symptoms may also come and go.

Oestrogen protects a number of different systems in our body.

So when levels start to drop, that is when we experience symptoms and we can feel symptoms in our brain, our skin, our bones, our heart, our urinary functions and our genital area.

And they do say on average 34 symptoms of the menopause pause but I think without affecting all those different body parts.

There's probably many, many more.

So to start with, one that I think we all know about is the hot flashes and the night sweats.

And these do affect three out of every four women.

but there could be dizziness, palpitations or lightheadedness associated with these two.

And these can occur several times daily and also at night causing night sweats and some women will find that certain foods can trigger them as well as alcohol.

Obviously if you experience a hot first when you're at work, if you're out socially, this can be very embarrassing and it can affect women's confidence.

And if you wake up several times at night soaked through then again this is going to affect your sleep and make you feel very tired the next day and can affect your functioning.

And a lot of women will find that their sleep is disturbed.

Anyway, as part of menopause, even if they aren't waking up at night because of the night sweats, their sleep quality isn't as good as it once was.

I've touched on psychological symptoms as well.

So these include anxiety, mood swings, irritability, difficulties with memory and concentration.

And we often call this brain fog and women can find that it takes longer for them to complete sort of normal tasks.

And they feel that they have to keep checking things to see if they've done things properly.

And women often talk about feeling an imposter really at work, they feel that they're not up to doing their job anymore.

I also see women as I'm sure you do, thinking that they may be suffering without Alzheimer's or dementia, because the brain just isn't working as it once was.

I do reassure women that you know, having to go and check that they've done something or forgetting why they've gone into a room to get something or forgetting words mid sentence or people's names is all very normal.

and you know, it is part of the menopause, and it should improve.

And I think you've highlighted there some of the typical symptoms that most people do associate with menopause, you know, especially the hot flashes, insomnia, and brain fog and I know as a GP, those are the things that people are perhaps more likely to come and see me with.

But as you said, there are 34 recognised symptoms and probably more.

So what are some of the lesser well known symptoms that people might experience due to the perimenopause and menopause?

So lots of women don't realise that muscle and joint stiffness is very common with sort of aches and pains, and headaches and migraines may also worsen, Again affecting their sleep and concentration.

Their weight may redistribute.

So women may find that they gain weight, particularly around the middle area and I do reassure women that yes, middle age spread unfortunately does exist.

And this, again, is all due to the changing hormones and you can also find that your skin changes as well.

So you can get sort of sagging, fine lines and wrinkles, women may become more prone to acne, and also excess hair on the face.

Again, all these symptoms do affect their self confidence and how they feel about themselves.

And then really importantly, because of all these skin changes, you can also get vaginal dryness.

and this is one of the more taboo symptoms that women just don't talk about.

We know that up to 80% of women do suffer with these symptoms, and yet, only 8% of women go to their GP about it.

And this can result in urinary symptoms, such as more urinary tract infections, incontinence, urgency, when you feel you need to suddenly go to the toilet and again, obviously, it's all going to cause embarrassment and discomfort and you know, also will affect their sex drive along with other things that are also affecting them.

And there are other treatments to treat it as well.

So you know, it really is important, isn't it that people come forward and share those concerns with their doctor or with a healthcare professional because we can help?

I think just hearing that list, it can be really frightening, can't it?

It's not really something we look forward to the menopause but there is a lot of help out there.

There are a lot of treatments that are available.

Please tell it it's not all doom and gloom, is it?

No, it definitely isn't.

Which is why we encourage women to seek help and support.

It can be an incredibly positive time, it really enables women to sort of take the opportunity to take stock and reflect, look after themselves, really listen to what their to what their body needs and see this as a new chapter and transformative stage of life.

So now we want it to be positive please.

Let's go on and talk a little bit about HRT, because whilst you know it absolutely is the gold standard treatment for people who have disabling symptoms linked to the menopause, a lot of people are fearful about it, and particularly the links to cancer.

But we know that for most people, the benefits of HRT outweigh the risks.

So can you talk us through some of the benefits?

Of course, so HRT stands for hormone replacement therapy.

So obviously we're hoping that replacing the hormones that we once had, that will alleviate or reduce any symptoms that the woman's experiencing.

But there are also benefits for women's long term health as well.

So HRT is the best treatment for the prevention and also the treatment of osteoporosis, which is thinning of the bones.

So taking HRT has been shown in many, many studies now to improve bone density and also the risk of fractures occurring.

And there's also some evidence that suggests that HRT may help with muscle mass and strength as well.

Studies have also shown that women who start HRT within or under the age of 60, have no increased risk or even a trend towards a reduced risk of heart disease.

With some of these studies quoting up to 50% and so this is particularly important for women that suffer with a premature menopause and HRT can lower your cholesterol levels, which is beneficial for your heart as well.

Studies are ongoing but there's also evidence now that HRT reduces the risk of developing Osteoarthritis, Type 2 diabetes, dementia and bowel cancer.

So there's lots and lots of benefits to taking it.

So many benefits but despite that, I guess there will still be some people who choose not to take it or there are in minority people who can't take it safely.

So are there any sort of natural remedies or alternatives that those people can consider?

Yeah, so I'm going to start talking about bioidentical hormones or compounded hormones because a lot of women asked me about these, as they're marketed as being more natural and similar to our own hormones.

And they said that they're specifically tailored to an individual.

However, these are man made in the laboratory and the National Institute for Health and Care Excellence called NICE states not to use them as they are unregulated, so their safety and efficacy is unknown.

So the more modern HRT that most doctors now prescribe is derived from yams, which is a root vegetable.

And so those hormones are identical to those which we have and they're said to be body identical.

So to start, I always reassure women seeking a more natural approach that that's what we're offering anyway.

So that is that yeah, it's natural.

It's just coming from a plant.

Exactly.

And also, a lot of women ask about herbal preparations.

Now, there's no good evidence that these are beneficial.

However, that doesn't mean that they don't work is often just that there's been little research in this area.

So Agnus Castus, Black Cohosh, Red Cover, St. John's Wort, they're all preparations that are said to help.

But for all of them, there is uncertainty about the appropriate doses, actually how effective they are the safety profiles, and potential serious interactions with other medications.

So it's really important that women do discuss if they are going to take these with the doctor first, just so it can be sort of checked against any other medication that they may be taking.

I also would say that you've got to remember that even if these preparations are improving your symptoms, they're not going to have the long term benefits that HRT can have.

Cognitive behavioural therapy is something else that we can do.

that challenges the way that we think so it can help the psychological side of the menopause, but also has been shown to help with hot flashes and night sweats.

So again, I would encourage women to look into this, it can be very useful, and you can learn practical strategies that you can use for the future.

There's things like acupuncture and aromatherapy too, again, there might not be much evidence behind this, it may just be a placebo effect, which helps it to work.

But you know, anything that really is going to help a woman to focus on herself, I think is has got to be a good thing.

So you know, if it's working, if it's not paying a fortune for it, then absolutely great, I'd encourage you to do that.

Alongside all of that, then I must mention lifestyle is so important when we are going through the menopause more than any other time I think for women to make sure that we do have a healthy, balanced diet, that we are exercising regularly.

We're keeping our stress levels as low as we can.

We're not drinking too much alcohol.

We're not smoking and we are trying to get as much sleep as we can as well.

I know sometimes that's very difficult.

We go through the menopause, but at least allowing ourselves that time of bed and that time to relax.

And of course, all those lifestyle interventions that you mentioned, even alongside HRT are absolutely recommended because they will make make you feel much much better.

Thinking about HRT and limitations.

Are there any limitations?

So is there a upper age limit at which you can no longer take HRT or should you be lowering the dose as you get older, There must be an individualised approach that the guidelines support the notion that for the majority of women starting HRT when they are under 60 years, the benefits of taking HRT usually outweigh any risks.

And it's particularly important for those who have had an early menopause due to those long term health consequences that I talked about.

For older women who are otherwise fit and well, they will still get some benefit from taking HRT with regards to symptom relief, but they might not get some of those longer term health benefits.

They should however, get some help with those longer term consequences such as the genital urinary syndrome, so the vaginal dryness and the urinary consequences.

Also, the NICE guidelines are very clear that women can continue to take HRT for as long as the benefits outweigh the risks.

So for most happy women, this could be forever that is no reason why they have to stop it after five years, which is something that was happening a lot in practice in the past.

As long as they are assessed on an annual basis, it is absolutely fine to continue as long as the benefits continue to outweigh those risks.

There'll be a lot of people listening to that answer feeling a huge sense of relief.

So thank you so much.

People might just want to get through the menopause and be done with it.

but are you ever really postmenopausal?

Though as post menopause is a term to describe the time after someone has gone through the menopause, you're always going to be postmenopausal.

But that doesn't mean that you're going to suffer with symptoms forever.

The menopausal symptoms that you've experienced will hopefully lessen with time or go away completely.

But due to those lower oestrogen levels, you're always going to stay at an increased risk for a number of health conditions such as osteoporosis and heart disease.

So it's really important at this time that we do continue to look after ourselves the best that we can.

And what do you think about the over the counter HRT that's available.

So I think it's fantastic that the menopause has been talked about.

But unfortunately, the headlines and some of the articles that I have read have been a bit misleading.

What they are considering is launching a public consultation to make topical vaginal oestrogen tablets available over the counter.

And this is very different to the systemic HRT that we've been talking about today.

So topical oestrogen is very good for helping with any local oestrogen deficiency symptoms within the vagina.

And it's brilliant.

It works really, really well and it's a great proposal that brings us in line with some other countries.

But I think we just need to make it clear that this is this is different.

This isn't systemic HRT.

So whilst it's a step forward and can manage some symptoms, people shouldn't get their hopes up too much that it's the HRT tablets or patches that often we tend to think of.

Exactly, I mean, it's great.

We're increasing awareness.

It's, it's a first step.

But you'll still need to see your GP if you want to talk about HRT.

And you know, it's a time that really can be happy and healthy.

So it's so crucial that women aren't stuck at home suffering in silence that they do come forward, speak to their GP sooner rather than later and get the treatment that's going to keep them healthy and you know, not be suffering.

Exactly.

So research shows that 45% of women have never seen a GP to discuss their menopause.

Instead, they tend to ask their family and friends for advice and it's so important that women are educated and well informed and confident to speak to their GP about their symptoms, and to not give up if their medication doesn't suit them the first time there's plenty of other things that we can try.

Sam, and what support is available for people through Bupa?

If you're an insurance customer and you'd like some support around the menopause, you can call our menopause helpline and speak to a menopause trained nurse for advice.

It won't affect your policy or your premiums and you can call as many times as you like.

We also have our menopause plan product which is available for all women as a paid for product.

And this is specifically designed to support women through this life stage to consult with one of our experienced GPs to access HRT if appropriate.

And this consists of an initial 45 minute consultation, which can take place either remotely by telephone or video appointment or face to face with one of our GPs who has received additional menopause training.

We also have our Women's Health Hub, which is online and hosts a wealth of free information and support for many women's health issues.

Sam That's great.

Thank you so much.

Thanks Zoe.

Petra, thank you for joining me for some myth busting right let's bust some myths about common health issues that women face as they get older.

So the first one is, I no longer need to worry about gynaecological cancers once my reproductive days are over.

I mean, what a great myth and what I see often is women come and present quite late with gynaecological problems because they've thought well my periods have stopped therefore, I don't need to worry about what goes on downstairs.

It's one of those we wish was true, but it's not.

It's not unfortunately, like most other cancers, they're much more common as we get older and ovarian cancer, for example, is it peaks at the age of 75 to 79 So way after your last period.

So I think it's important that women understand that just because their periods have stopped and they may have gone through the menopausal symptoms and then are feeling much more stable.

They can't ignore worrying symptoms.

So the kind of symptoms they might want to look out for is bleeding after the menopause.

That's not what we expect, changes in the skin, so any new growths or anything that feels uncomfortable or abnormal even sudden new discharge, these can be signs that there's something untoward.

So any new symptoms that are gynaecological just because you've been through the menopause actually need more attention, rather than less attention So ovarian cancer gets more common as we get older, endometrial cancer the same is true and cervical cancer does get less common but it's still a rare.

Yeah, so cervical cancer kind of bucks that trend.

It's the only gynae cancer that is actually peaking in reproductive women.

So it peaks at about the age vanishingly rare actually, compared to other gynae cancers.

So with things like the amazing cervical screening programme and HPV vaccinations, it's becoming even rarer.

But anyone that has unexpected bleeding, bleeding after sex bleeding in between your periods or bleeding after the menopause definitely needs to get checked out Thank you.

The next one, I'm hoping you've got some good news for us on this one.

I can't have a healthy sex life as I get older after the menopause.

What a great question and it's really important that people feel free to talk about this and discuss it because having a healthy sex life is really important for lots of people.

Not everyone.

But for many people it is.

And interestingly, there's quite a lot of evidence to suggest plenty of people over 60 are having lots of sex.

And actually one of the areas where we saw a rise in sexually transmitted infections before the pandemic was was people aged around 60 to 65.

So that tells you that people are having healthy sex lives at that point.

There's bad news in that they're not thinking it but you know, really kind of reassuring.

People have been sexually active and with new partners as well, I guess as they come out of relationship, They're not thinking about sexually transmitted infection, actually, they're just as vulnerable as they might have been when the younger they may not need to worry about contraception but they do need to think about protecting themselves.

I think it's important, though, to recognise that having a healthy sex life as you get older takes a little bit more communication, perhaps a little bit more preparation.

And if you're finding that sex is painful or difficult for you and or your partner then it's important to communicate with each other, and perhaps talk to a healthcare professional because there may be simple things that might help such as using lubricants, possibly hormonal treatment, even just starting the communication can really help people to get to where they want to in their sex lives.

Great.

I'm glad we have good news on that one.

Do I have to just live with incontinence now and regular UTIs?

Well, you think so wouldn't new for the number of adverts there are about continence products and actually, there are lots of people with problems with continence.

But for many people that are treatments, it just seems that people are a bit too embarrassed to come forward and talk about it.

So the first thing to say there is lots of different types of incontinence, they're not all the same.

And because there are different types.

So whether it be stress incontinence so that you might wet yourself if you cough or sneeze or urge incontinence that you can't hold your bladder like usual, you need to rush to go to the toilet.

They actually have different causes and different treatments.

So again, really important that you go and talk to a healthcare Professional to try and work out what kind of incontinence you might be suffering from.

And it may be a case that exercises help or managing your fluid intake or the types of things that you drink.

Some people need medication.

I think one of the things that I notice a lot is there are women that seem to believe having regular urine infections are just a fact of life.

And that's just not the case.

So is it I mean, you shouldn't be having regular infections or regular episodes of cystitis.

If you are you need to go back to your healthcare professional, go back through the story and try and find out what's prompting that because you may benefit from treatments that can make them go away entirely.

It's not something you just need to put up with.

I think it's really good example of where, you know, women have sort of learnt to put up with just a little bit of wee or getting recurrent UTIs and in a men's world, you know, they wouldn't put up with it and neither which should we because there are things we there are things we can and we should do And just because you can buy products over the counter I like incontinence pads.

That doesn't mean that that's the way things have to be.

It may be that symptoms could get massively improved with the right kind of treatment.

So get over that embarrassment, speak to your doctor or the practice nurse, you'll be amazed what difference you might be able to get.

Brilliant.

Next one is I've been told I have arthritis.

How do I stay active and exercise?

Well, what a great question and you know, lots of people talk about arthritis as being wear and tear.

And if you had something at home, that was wearing out whether it be your boiler or your kettle, you'd think you'd stop using it.

But the human body is entirely different.

It's not wear and tear.

And we know that arthritis really benefits from staying strong, and active, the joints like moving for lubrication, the muscles need to be strong, good, strong muscles around the joint, reduce the pressure in the joints.

So if you have been told you have arthritis, then the solution part of the solution is to be more active to build up your muscles to get stronger, rather than resting the joint.

Resting often leads to muscle weakness, more pain, less range of movements.

So it's kind of counterintuitive, but staying strong.

Moving more, that's the key.

I'm nodding quite aggressively, because I'm really, really agree with what you're saying.

Absolutely, you know, arthritis, movement, although it seems like it might cause pain and it might be a little bit painful initially, when you get started.

You may need painkillers, it's the treatment, it's gonna help things in the long run completely Completly and listening to your body so getting things started not overdoing it but being consistent small amounts and building the strength.

You know?

Absolutely.

Yeah, it takes a long time to develop arthritis, well, it's going to take a while for it to get better too, be patient.

Heart disease is a man's issue.

I don't need to worry.

You know, If only that were true.

I think there's a lot of misconceptions around that not just in the general population but I think in medicine as well, for a long time, we felt that it was more common in men than women.

But actually, the evidence suggests we've just been not very good at picking it up in women and we pick them up later.

So I'm not sure why that's happened but women experienced the same levels of heart disease as men and the same symptoms, so they don't present in any different way Although we don't imagine women to have heart problems in the same way that we do with men.

I think we all have that image of a heart attack being probably a white man in a suit at a desk with a bit of a belly, who all of a sudden clutched his chest in absolute agony and collapses to the floor and that's not actually typically how heart attacks present in men or women.

No.

And when I come to think of it, I can't think of an example of seeing on the on the screen a woman having a heart attack, But it is, you know, the biggest killer of women as well as the biggest killer of man ischemic heart disease.

Absolutely.

I think there's a misconception that a heart attack is a big single episode like our heart diseases and that chest pain is a severe pain that you know, is really bad.

My experience is that for most people, it's a chest tightness a heaviness or discomfort comes on exertion normally can be associated with feeling six, sweaty, shorter breath pain up into your jaw or arm.

And that's no different whether you be a man or a woman.

And the symptoms people need to really be aware of shortness of breath, I think it's really important people don't link that with their heart they think about lungs or fitness and And I think a reduction all of a sudden exercise tolerance, you know, you used to be able to walk up a hill with no problem now you start to get symptoms, whether it be any of those things or dizziness, you know, something that that should alert you to that potential bit of problem with the heart as well.

Absolutely.

So any of these symptoms, if they've been going on for a while, you know, go and speak to your GP have a chat about it but should any of these things happen when you're at rest.

Should they all happen together.

It's one of those few cases where it's time to call an ambulance and get checked out.

It's better to be safe than sorry and they can do all the checks and paramedics can to make sure that you're safe and fine.

Brilliant.

Thank you so much.

Good mythbusting.

Bones and muscles don't necessarily spring to mind when we think about women's health issues.

But they're really important.

It's an important part of staying strong as we get older but also the hormone changes that happen later in life can affect our bones and muscles.

So now I'm joined by Emily Partridge who’s Bupa's Clinical Lead for musculoskeletal we'll call it MSK.

And we're here today we're going to talk about how we can really look after our bones and muscles.

So Emily, you Joined Bupa in 2009 as lead physiotherapist, and you're a strong advocate like I am promoting health and well being and providing a holistic approach to clients care.

And you're also a Pilates instructor.

I am.

Busy.

Yes.

Very busy.

Okay, so let's get into it.

Let's start with bone health.

So your bone mass, which is the density of your bones, naturally starts to decline from your 40s really onwards.

And this can accelerate actually, when we approach and reach menopause.

Is that true?

It is very.

So our bones are a living tissue that constantly regenerate.

So it's a mesh of proteins and minerals.

Some cells are building up the bone, some are breaking it down and then it's got a hard outer layer.

Our bones are at their strongest when we're in our late 20s, early 30s and then from about the age of about 35 to 40 they just start to degenerate a little bit quicker.

That's perfectly normal.

So what it means there is more cells are breaking down the bone than building it up.

Natural ageing process.

However, in menopause, when you have a significant drop in the oestrogen levels, that can actually rapidly speed up that process.

and what you end up with potentially is lower than normal bone density, which is something that's called osteopenia.

And then if osteopenia gets worse it goes beyond that, that's when we have the condition that people may have heard of osteoporosis.

Yes, Absolutely.

So Osteoporosis is a disease where your bone density is significantly lower than the normal from you know the age you'd expect it to be.

So what happens then is your bones become quite brittle and weak and potentially there's more risk of fracturing your bone.

Are there any signs then that we can look out for if this is something we're concerned about?

Yeah, it's an interesting one, because the early stages of bone density loss you don't necessarily get any symptoms.

The main one that I look out for, which would ring alarm bells to me if I had someone coming into my clinic, for example, would be if they had a fracture of their bone where the mechanism of injury didn't quite fit the severity of injury.

So it could be potentially got a minor fall, and they broken their wrist, for example.

So if someone came in with that, I'd be started to think, oh, do we need to have a look at their bone density.

So in osteoporotic fracture, is often one of the first signs of osteoporosis that someone will notice.

The main, you can fracture any bone in your body from an osteoporotic fracture.

However, the main ones are your hips, the vertebrae to the bones and your back or your wrist.

Your if you have a osteoporotic fracture of your hip, you'd you'd know about it it would be very painful.

You potentially couldn't put weight there through your leg, you couldn't move it.

At the other end of the spectrum, you can get osteoporotic fractures of your vertebrae that you wouldn't notice and actually, only one in three people with osteoporotic fracture, the vertebrae actually have signs and symptoms.

Wow, that's quite surprising.

Yeah, is so things to watch out for there are potentially pain in the area, a stooped posture that you can't sort of straighten back up from.

Okay, that sort of stooping forward.

Yes, exactly and then some people also notice it from a loss in heights, as well.

So your maybe family or friends might notice it or you might yourself notice that.

Now, none of those signs are absolute.

I've definitely got osteoporosis but they're certainly things that if I noticed one of them I might be saying potentially go and talk to your doctor about it or a physiotherapist.

And I think we can all sort of visualise a much older person, probably female, sort of perhaps with a stick slumped over like that who's got shorter and that's likely linked to osteoporosis?

and spinal fractures?

Exactly.

Really interesting.

Can you ask your doctor to check your bone density if you're worried?

Yes, you can.

So I mean, with anything, if you're worried about it, please go and talk to someone.

Doctors will sort of have a chat with you about your lifestyle because there may be some risk factors that could potentially put you at risk of osteoporosis.

They'll ask your family medical history because osteoporosis can be hereditary.

If they feel necessary they may order a DEXA scan, which is what measures your bone density.

So the potential results of that is that you've got normal bone density, potentially that lower bone density that osteopenia that we talked about, or it may show osteoporosis.

And I think if anybody has had one of those fractures that you spoke about particular of the wrist or of the hip, If that hasn't been arranged, a DEXA scan, then they definitely should be requesting that from the GPs.

Yes, I definitely go into the GP.

Emily let's talk about some of the things that we can do to protect our bones and strengthen our bones.

Yes, of course.

So the great news is there's lots of things we can do at any age as well.

So it's never too late to start, the things I'm about to go through.

So diet is important about promoting bone health.

Calcium, in particular is a really key component of healthy bone.

So when you're looking at your diet and what you're eating that calcium rich foods are really important and when I talk about that, I think about dairy products, milk, cheese, yoghurts, leafy green vegetables, so kale, broccoli, cabbage, tinned fish, particularly ones with bones in certain sardines is quite a good one.

You may want to talk to your GP as well about calcium supplements, that could be an option.

Talking about supplements vitamin D is really important.

So vitamin D is our sunshine vitamin, we get it from the sun and unfortunately, here in Britain, we don't get a lot, We don't get much.

Particularly in the autumn and winter and actually Public Health England now recommended that every adult every day has a 10 micrograms supplement of vitamin D.

The ones I take like gummy sweets, I take one every day, it's great.

I think you can get spray as well, and tablets.

So there's lots of options.

Have a look in your supermarket or your health health food shop there.

Vitamin D also is in oily fish and in eggs Vitamin D is really important because it helps to process and absorb that calcium.

So, you need calcium and you need vitamin D, one without the other, you're not going to have optimal bones strength.

Exactly.

It's that optimal we look for, if the vitamin D will help you absorb the calcium that you're adding into your diet.

I get asked a lot about supplements, as you've rightly said, you know, we should all be supplementing with vitamin D and I think calcium if you're eating a full varied diet that's full of dairy and you eat bit at this bit at that lots of leafy greens.

But actually, if people think that they're not consuming those things, it is worth taking that probably as a backup, as I'm approaching menopause and beyond.

Yes, absolutely.

So that's sort of your food habits.

Exercise is key to bone health, I'm going to say that I'm a I'm a physiotherapy, an advocate of activity.

But I completely agree with you.

Absolutely, there's no denying And weight bearing exercises in particular, to really try and lay down the extra layers of bone on that mesh that I was talking about earlier.

So when I talk about weight bearing exercises, I'm talking about things like lunges, squats, walking, jogging is one, I would just caveat that if you have been diagnosed with osteoporosis.

You likely want to avoid those high impact exercises where actually you're putting a lot of jolting through the bone.

So I err on the side of caution there and go more for walking but if this is more about preventing loss of bone, then definitely jogging a great one that you can do as well.

Because anything that puts that force through the bone that jolts the bone stimulates those cells that produce more bone that you spoke about earlier, doesn't it?

We're trying to get the more cells building up the bone rather than the cells that are breaking it back down.

Weight is important so that you know maintaining an ideal weight we don't want too much weight to being put through.

So you know talking to GP pharmacist, there's lots of support out there about maintaining a healthy weight, obviously, the healthy balanced diet that we talked about and the exercise will help to keep your weight at a healthy level too.

There are links with smoking and osteoporosis that can increase the risk of osteoporosis and the same with alcohol as well, so if you consume more than three units of alcohol a day that can increase your risk of osteoporosis too.

So again, things to get support on if you know, that might be something that you need to control a little bit more.

And then also talking to your GP about HRT, as well, if you are you think you're going through you're about start the menopause or going through it, then absolutely have those conversations try and replace those levels of oestrogen.

Absolutely.

And the other thing to mention is muscles, we've spoken about bones, anything that strengthens your muscles will also strengthen your bones and vice versa.

So let's talk a little bit now about muscle mass and core strength as well.

It might seem strange to talk about this and women's health, but it really is so important, isn't it?

Absolutely.

So just as important to keep our muscles nice and strong as our bones nice and strong.

again, at any age, our muscle mass actually starts to decline from about the age of 50.

So the more we can do before that age, the better but also, if you're starting exercise after 50, that's great, it's going to minimise that loss of muscle mass.

So many benefits to the exercising, as we've talked about, you know, the, the bone health is definitely a great thing, from an exercise perspective but also, muscles, if they're nice and strong, they're going to keep you mobile, they're going to keep you nice and stable and your balance good as well.

We talked before about osteoporotic fractures, we want to try and reduce that risk of falling.

So if you're nice and strong, and your balance is good, that's less likely to happen.

There's so many other benefits as well.

Things you may not think about straightaway with muscles.

So there are studies now that have shown a real link between good muscle mass and an effective immune system.

And you've got energy boosts, you know, improving your mood, which again, when we talked about menopause, you know, sometimes there can be low mood, there can be brain fog, as well.

So exercise actually helps you to focus the mind and really be present in that moment.

Other things, if you exercise well, your sleeping patterns tend to be good as well.

We all like a good night's sleep that has so many benefits to it.

So yeah, those more subtle benefits as well as keeping you moving.

And they're even more benefits to muscles, you know, they're metabolically active, they help our body combat stress and they're burning calories.

The more you have, the more calories you're burning without even trying even when you're sleeping.

Yes.

So lots of benefits there and it goes way beyond be in mobile, because muscle strength also supports you in lots of other ways like we've said and it's quite empowering.

I think it gets stronger, as we're getting older and a lot of these changes to our body, that are outside of our control, getting stronger and build a new muscle can just make us feel really good about ourselves.

Absolutely.

There's just so many benefits to exercise.

One thing I would say is exercise is meant to be fun.

Yeah.

And I think that's really important and it's one of the key messages I give to my patients is please try and find an exercise that you enjoy doing.

We're all very good at starting things, particularly New Year New Year's resolutions, and we start but if we don't enjoy it, then we're always going to little things are going to start creeping in like Oh, I am too busy, or I'm too tired and then it's just a downward spiral from there.

So it's so you want to pick an exercise that you look forward to doing.

Some people will think of the gym and for some that works really well.

There's a lot of facilities there.

There's a variety of the classes, there's professionals on hand to help there's the social side of it as well.

Other people will listen to this and think I can't think of anything worse then stepping into a gym, it might be quite intimidating for them.

There may not be a gym nearby, it may be quite expensive.

So it doesn't always have to be the gym.

I'd have a think about you know, do I enjoy exercising indoors?

Do I enjoy exercising outdoors?

Do I enjoy being on my own?

And actually, I want some just loan time because I'm around people all the time and this is my me time?

Or actually am I going to think about it as a way to get out there and spend some time and go for a walk with a friend for example.

Even things like do I want to learn a new skill, you could actually join it something like a dance class, where actually you are going there for another reason that actually the exercise and the benefits of that it's just an added bonus.

Also now at home, I think particularly since the pandemic, your online options are incredible now.

Yeah, amazing, so many different options and if you're a gadget person, then there's all sorts of gadgets that you can use at home that help track you track your progress or you know things that you can be holding on to and it turns it more into a game more fun, something you could do with the family.

The main thing I'd say from an exercise perspective is variety.

I think variety is the spice of life.

So I've mixed up a bit as well so you're not getting bored.

Ideally, I'd recommend a sort of mixture of cardiovascular something that gets your heart pumping something that's more weight bearing that strength side and then potentially something much more balanced stability, mindfulness side.

And then also just lastly, motivation if you what motivates you If so, if a reward motivates you then set yourself some goals and have a treat at the end.

It might be you know, if you do your it's recommended you do 150 minutes of moderate exercise per week as a minimum If after, you know, set yourself after eight weeks, for example, if I do that exercise, then we're going to go out for a nice meal or go to the theatre or in my case, it's normally by myself new pair of shoes.

With you on that.

I think the other thing is make it achievable as well, I think often we aim so high but yet the evidence tells us that even if you're doing a little bit more next week than you were this week and you're building gradually, every additional bit of movement gives you a health benefit.

And I think the important thing, it's not that mindset of transforming yourself or losing loads of weight, or you know, trying to change who you are, because that can be unachievable you set yourself out to fail is all the benefits that we've spoken about and while some people will love to get down the gym, throw some weights around or pound the pavement.

Actually doing simple things at home without any equipment can work really well.

Absolutely.

Yeah.

Yeah.

Don't always think it doesn't have to be that you're buying lots of equipment and you're, you've got to go to the gym.

There's plenty you can do at home.

Are there some that you could show me so that you can show me today Yeah, absolutely.

Okay.

Well, before we do that, can you just let us know what help and support is available through Bupa?

Yes, of course.

So our Bupa musculoskeletal team are made up of physiotherapists, we've got osteopaths we've got chiropractors and podiatrists as well and we've also got our musculoskeletal physician.

So a really nice team there that can provide really holistic care to support people in their more later stages of life and also in those postmenopausal stages too.

From a exercise perspective, also from strengthening up your muscles and bones if you think you may have osteoporosis and also pelvic health physios as well, because in menopause, our pelvic floor muscles can get weakened, we can provide expert advice on them.

Brilliant, fantastic right.

Exercises.

Let's go Okay, so we're going to go through four really simple exercises you can easily fit into your daily routine, minimal equipment required.

We've just got some cans of food here, I've got some small water bottles, potentially a chair and a wall as well.

I happen to be in my gym lycra outfit today, as you can see Zoe is in her normal clothes, that's absolutely fine.

Still even wearing my heels.

Exactly.

Okay, so the exercises are upper and lower body exercises.

So really nice overall workout, some weight bearing in there, as we talked about earlier about the benefits of having weight going through your bones and also some strength exercises too.

Okay, so number one is a squat.

So Zoe here is going for the harder version.

She's got weights in her hand, she's not supported at all and she's just bending her knees and then driving through heels as she comes back up and squeezing her buttock muscles together.

So it's strengthening up your quads, the front, your glutes, which your buttock muscles at the back.

If you've got any problems potentially with balance if you feel a bit nervous, you could do it with a chair in front of you, you could have your kitchen sink, kitchen worktop in front of you.

And what you're doing there is just again, going down, and then coming back up again.

So we want feet facing forwards, knees going in the same direction as your feet.

Pain free range.

So if you have any problems with the knees and anything sore as you go down then just don't go down as far.

Doing this range is absolutely fine.

The other way you can use a chair is if I just swivel it round, if I can just have it there as a bit of reassurance and come down, and then come back up so I'm not actually sitting down.

But it's there if I need it.

Okay, 8 to 12 repetitions and I do 2 to 3 sets of that one.

That's all right.

Already feel my body getting warmer so it's doing something.

Wonderful.

The next one is calf raises so I'm going to do that one.

So again, you can have something in front of you If you want to kitchen work surface, sink ,chair.

Okay, and then you're just going up onto your tiptoes back down again.

And you can use things that you do everyday already, to be reminded can't you?

So brushing your teeth, making a cup of tea, boiling some pasta, and just do it whilst you're waiting for those things to happen.

Yeah, really important to try and fit these into daily routine without making it too much of a hassle to do because otherwise you're not gonna you're not gonna do them.

That's working your calf muscles, strengthen up your calf muscles also working on your balance, you can make it harder, for example, by going onto one leg, if you want to, you could have weights in your hands.

You could also have a rucksack on it's weighted as well.

So different ways that you can make it harder if you want or easier, with some some support if you want.

Okay, bicep curls, you're ready when your weight.

Okay, so I just got water bottles.

Zoe just got tinned food.

So we've got our elbows in by our side, and we're going all the way upwards.

And then really importantly, all the way down as well.

So right to a straight elbow, and then come back up.

and as you feel your muscles getting stronger, you could add more heavy weights on here, if you wanted to, you could do this standing, you could also do it sitting in a chair, that's not a problem at all.

Okay, so again, And it's really important, I think, to be purposeful when you do these exercises to really think about those muscles as you're working them.

It's just a nice time to have some time out as well.

It just make you feel good, doesn't it, I can feel my heart rate is up a bit already.

Breathing slightly faster.

So although this is muscle strengthening and that's the aim my body's also getting some of those cardiovascular benefits because they feel those changes in my body.

Yeah, and those those mental health benefits as well it's just some time out some time out for you to look after yourself, which is super important.

Okay, that's bicep curls and then the last one to do is against a wall.

So I'll show you first of all, a bit of a gap there between yourself and the wall.

Arms out straight with your hands flat against the wall lovely, okay.

And then what you're going to do is bend your elbows and come forwards.

Keep your core so your tummy muscles nice and tight.

Squeeze your buttock cheeks together as well to really use those glute muscles and then push through those arms, a great overall one here.

So it's weight bearing through your your arms there, you're working your shoulders, your arms, your buttock, sort of glute muscles and also your core muscles as well.

If I step back a bit, does that make it a little bit more challenging?

Yeah and then you could progress it in due course into on the floor.

So with bent knees, doing a push up or then into full on push up but this is a really nice start.

and again, shouldn't take too long at all.

That was good.

I actually feel better I feel a bit more energised and a bit uplifted even though we just did a little bit so just make a difference a little bit makes a big difference.

Absolutely really good really nice way to start the day.

Yeah, it is.

We've had hundreds of questions submitted prior to this event by you, the customers.

So we're going to run through some of the top questions now with Petra.

So the first one is about perimenopause.

Really good question.

Do you need contraception at this stage and if you do what's most suitable?

Great question and I guess there's lots of answers, Witch is.

It depends.

So it really depends on your age and where you are in the process of your periods either being present or stopping.

So as a rule of thumb between if you've not had a period for a year, you can consider you you don't need contraception but if that's not the case, then you do for some women using something like the Mirena coil has great benefits because it provides contraception, but also an element that can be used for HRT as you can add oestrogen to that and you've got your HRT and contraception altogether.

For some women in that age bracket, using the combined contraceptive pills is a great way to manage their contraception and the oestrogen you get with that also provides a degree of HRT.

For other women who may be on HRT, they may need contraception, such as the mini pill or copper coil.

So there's lots of variables to consider.

Once you're 50, if you've not had a period for a year, you can be considered as not needing contraception and once you're 55, no contraception is considered to be necessary.

Okay, really quite complex answer, but really important because it is different for everybody.

Next question, is there treatment for vaginal prolapse?

Yes, so there certainly is but I think it's important to say there's a huge difference between people and how significant their vaginal prolapse is.

So some people can have a very mild prolapse, which is a weakness of the vaginal wall, that gives them no symptoms whatsoever and that doesn't require any treatment.

For other people, it may be much more significant and give them symptoms.

There are a variety of treatments and you know, best to discuss with your GP but they can be treated sometimes simply with pessaries.

There's little rings that can go inside the vagina to kind of lift the womb up and that can be really successful for some people.

For other people, surgical options may be appropriate but again, you know, having a chat with your GP going through the symptoms that you've got and the options available to you means you can make the right decision for you.

Next question is what do painful breasts mean?

Well, for most women, painful breasts are related to hormone changes.

So it could be the contraception that you're taking it could be where you are in your menstrual cycle.

For some women, when they start HRT they may get tender breasts.

For many women, when they're pregnant, they get tender beasts.

So actually, breast pain is commonly related to hormonal changes.

Often ill fitting bras don't help either.

So in my surgery, if I see someone with breast pain, one of the things I'll ask them to do is take their clothes off.

so I can see how well their bras supporting them because that can contribute to breast pain.

A lot of women are worried that breast pain means breast cancer and actually, it's not a common symptom of breast cancer But if you are having persistent breast pain and particularly if it's there throughout your cycle, then go and speak to your doctor, you may need an examination just to rule anything worrying out.

Brilliant.

Good question coming up.

What are the symptoms of under and over active thyroid and how are these conditions treated?

So the thyroid is a gland that sits in your neck, it's an essential part of your kind of metabolic pathways and kind of hormone or regulation and it can become overactive.

But more commonly, we find it to be underactive, so an underactive thyroid, typically we'd see symptoms such as unexpected weight gain, tiredness, dry skin hair that's breaking easily.

For some people even affects their mood and how they feel.

It's like your engine is under revving isn't Completely it's almost hard to get going and so if you're experiencing that it may be worth having a blood test to rule that out.

I would say those are common symptoms with just getting older, etc.

So most people with those symptoms don't have an underactive thyroid but it's very easy to treat, and it's just for taking a medication every day.

It's not something if you've got an underactive thyroid, there's nothing that will cure it, you just have to replace the hormones.

An overactive thyroid is much less common and it's normally picked up because people are losing weight without trying.

They may feel a bit jittery.

They may be having heart palpitations.

They're probably the most common symptoms that you might notice and that can be treated with medication and sometimes radioactive iodine to the thyroid but it's a much less common condition.

And again, the important thing is you know, they both can be treated.

So if you suspect something like that going on, don't hold back go and get it checked out.

And it's really easy to diagnose because it's just a blood test and GPs can get that sorted out for you.

Final question, and I think there'll be many viewers who will be interested to know the answer to this.

Hormonal issues can make it more difficult to lose weight or maintain a healthy weight.

And this person says that they've also got increased belly fat.

Is there anything specific that that person should be eating or doing?

You know, a great question and I think it's important to firstly say the scales are a really crude tool to measure body composition.

So we look at the scales as a reflection of how thin or fat we are, but actually, the scales measure everything from your bones to your muscles, to whether you've got a full bladder, what you ate in the last 24 hours will be reflected on the scales.

So the first thing to say is the scales is just one measurement and I think if you're monitoring your weight, it's important to do other things as well, such as measurements or even photos which can be quite challenging to get your head round.

As you get older, there is a tendency for you to lose muscle mass and muscles are great because they burn loads of energy even when you're sleeping.

So the smaller your muscles are, the less energy that you that you use up but most people don't reduce how much they eat as they get older or as their muscles get smaller.

So if you want to maintain a healthy weight, a really important thing is, firstly, make sure that you're keeping strong and keeping active but secondly, really keep an eye on what you're eating.

So, you know, managing healthy weight is probably 80% what you do in the kitchen or what you eat And 20% you're kind of activity.

I think also for women hormones and their menstrual cycle and the perimenopause can mean that you gain fluid unexpectedly.

So you may have a week where you've worked really hard on eating healthily and doing exercise, but the scales don't show a change but it may be that you're holding on to extra fluid because of hormonal changes.

So I think it's important to look at weight changes at this point in your life, over a longer period of time than one or two weeks, You know, thinking about well, how do I want to feel in six months time?

What do I need to do to change that and just being really conscious about things but to not get too disheartened if you can keep strong and keep those muscles working and, you know, try and eat things healthily, you know think about a really nice balanced diet.

It's probably the the best way to go forward, both psychologically and physically.

Actually, something really important about mindset isn't there in this period of your life, there's some things you can't control, it just is going to be more difficult to lose weight.

So having that positive mindset, gaining muscle, it'll make you feel strong, make you feel good, and it'll burn extra calories, nourishing eating to nourish your body and you know, having a positive mindset.

And not feeling too bad about yourself.

You know, if you do have a day where you don't think very consciously about what you eat, well, that's okay because one day isn't going to make any difference.

It's what you do the following day, and the day after that.

So really trying to be more positive about both your body and yourself and that positive mental attitude will really help you make good choices about exercise and food You know, our bodies are amazing.

And we need to be more proud of them.

Brilliant.

Thank you so much.

Like I say we did have hundreds of questions So we've just flown through some of the top questions right there.

Thank you, Petra.

Thank you.

Zoe Sadly, that is all we have time for today.

So thank you to Petra, Sam and Emily for all of their valuable advice on this really important topic.

I hope that you've learned something really useful to take away and please do head over to Bupa's Women's Health Hub.

For more advice and guidance.

The web address is bupa.co.uk/womens-health

Thanks