Angela Wright is a GP based in North Yorkshire who has a diverse background in palliative medicine and clinical sexology. Her training has included two years doing a psychosexual therapeutic diploma followed by attendance at the European Society for Sexual Medicine doing their advanced exams. She is now a Fellow of the European Committee of Sexual Medicine, meaning her knowledge spans both therapeutic and medical expertise.
As Angela has used her training with a number of women going through menopause in her clinic, she also did the British Menopause Society's Advanced Menopause Specialist training. She now works in a number of different settings working with menopause and sexology but retains her interest in cancer and oncology as a result of her background.
In this article she talks about how she helps women in menopause, to help them have the best, most empowered and healthy experience possible
Is HRT the only truly holistic solution to an unruly menopause?
How do you help women?
I try to give women as much of the information I have buzzing around in my brain as I can to help them make their decisions themselves. If it's a menopausal query or an issue with sex, I see my role as helping them to get the information they need to help make the best decision they can for themselves
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What are your top three tips for a healthy menopause?
- Information - getting hold of the science and the understanding that you need to make fully informed decisions.
- Look at menopause with a biopsychosocial lens. That means looking at what's happening in your body but also trying to look at what's happening in your mind and in your world because all those things will help you to feel better.
- Find your tribe - I think there's a lot of benefit in getting a team around you to help fill in the gaps in your knowledge. That means getting a good medical team around you but also a good team of women going through similar things to help give you support.
What three things should be avoided if one is to remain well throughout menopause?
- Feeling disempowered or like you haven't got information or access to things that will help you. That feeling of being isolated with a problem and not having a sense of what the solution might be.
- Not to put all your faith in one aspect of menopausal treatment. Don't just go for HRT or manage it all with nutrition. Try to have an open mind, try different things and see what works for you. Menopause is so individual.
- Don't sit still. Try to find movement you enjoy. It doesn't have to be 'exercise', it just needs to be something to get you outside and moving your body. I'm a big believer in movement to calm the nervous system.
What is naturally good for menopause?
Where can one go to find information?
I think there's a million sources at the moment and lots of useful information available on the Internet and social media, but you have to approach that with a critical lens and make sure what you're reading is of good quality. I think you can get good information from the right practitioner - you need someone who will inform you - who treats you as an equal and invites you to the discussion about what you're going to do about this transition you're going through. I think there's quite high quality information both written and on podcasts, so it's about casting your net really wide, looking for sources that speak the language you speak and going with that.
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How do you know when information has some weight behind it - who do you trust?
I think you have to be quite careful about the sources of information in the first place. If you're looking at medical approaches to menopause, check out the qualifications of that person. There are lots of people who brand themselves as specialists but if you look at their CV or who's employing it will give you an idea as to whether that's evidence based knowledge. I am also a big believer that nothing is an easy answer in medicine - everything is nuanced. So, if someone is giving you an 'always' or 'never' solution it's probably a very top level answer that's not particularly accurate.
I see a lot of people talking about things I know about - sexual function and libido - and they give answers that are shaming or create pressure, so I think checking your sources is really important. Lots of people have the ear of the celebrity but don't have the underpinning knowledge to say things.
How can menopause impact relationships?
What would you say about sexual function and libido, as the expert?
The message around libido for most of the women I see is that it's far more complicated than simply adding testosterone or using lube or a sex toy. That message really frustrates me because it puts pressure on women at this stage in their lives that if they just do these simple things they can keep going.
My advice would be, going back to biopsychosocial, is that yes there are things that change in your body in menopause but a lot changes in your mind and your identity as well. We also get a lot of societal messages that are not helpful in terms of what's sexy - there are lots of images telling us about what we should be sexually and how women's bodies should work that don't tally with how women's bodies do work. So, I think any situation around sexuality in menopause needs to centre around the woman and her needs as an individual and to look at the nuance rather than one-size-fits-all solutions.
I deal with women who've experienced trauma - the trauma of a cancer diagnosis for example - and you don't solve that with lube. Your body doesn't feel safe and that isn't a simple solution. The culture that's happening around menopause at the moment - those women don't look like the women in clinic. Most of us spend a lot of our lives thinking we would be happier if we were half a stone lighter and had a better wardrobe and drank more green smoothies - I think it’s exhausting that's carrying on at this stage and it needs to be a more inclusive conversation.
The women who don't look like those celebrities - who have been through cancer, have broken relationships, come from trauma - have other things going on in their lives. We've got to be really careful to speak to them with all of this as well. The flip side is that it's lovely to see vibrant women who are bossing at life but there's a gentleness we need to embrace.
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How does menopause impact your mood and wellbeing?
I think there are lots of different ways it can do that. Most women suffer a loss of sleep and low moods, but there is a subset of women who are sensitive to hormones. These are the women who have had PMS and premenstrual dysphoric disorder and sometimes experience postnatal depression - they have a biological change in their systems that makes their mood react very badly to changes in hormones. For those women, menopause can be significantly unsettling in terms of mood change. If they get the wrong sort of HRT it can exacerbate the problem, so it's really important to speak to someone who's used to dealing with those conditions, which is something we do. If you get the right HRT though it can be a game changer.
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How do you identify those individuals?
They usually have exactly the same story or a variation of it. It's been grouped as reproductive depression because it has this biological underpinning sensitivity to hormone fluctuations. Most of these women have previously reacted badly to the pill or hormonal contraception, they have often had issues after pregnancy - not always diagnosed as postnatal depression but they recognise it.
They also tend to have cyclical responses, so mood symptoms up to two weeks before they bleed or even three weeks in their cycle. They're often really frightened of hormones when you talk to them about it - whether it's a coil or hormonal therapy because they've had a bad experience in the past. It also runs in families so it's often present in daughters and aunts and mums.
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