Dr Anne Henderson: If you went to see a fully qualified herbalist like Anita, you would be prescribed a very personal tincture which she has blended herself using organically grown freeze-dried herbs that are her shop's like an emporium, it's stacked everywhere, the most amazing smell and there are these really potent herbs lining the walls. It's like stepping back into Charles Dickens.
Dr Rupy: Wow.
Dr Anne Henderson: So but that's the that's the other end of the spectrum and you would need a very experienced professional to prescribe those for you.
Dr Rupy: We've spoken about the menopause a couple of times on this podcast, but natural menopause remedies are things that I'm definitely asked about a lot, but I don't know too much about. And actually the whole concept and the whole area of natural remedies using herbal tinctures, tisanes, supplements, as you'll hear about on today's podcast, is something that I'm learning a lot about, particularly the research as well as anecdotal evidence of its efficacy. And today, I'm chatting with Dr Anne Henderson, a highly experienced consultant obstetrician and gynaecologist who has spent 17 years as a senior consultant at a major NHS trust following undergraduate studies at Cambridge University about this. Dr Anne is passionate about women's health issues, particularly menopause and HRT, which is now a key health agenda. And she has extensive experience in this area, having undertaken postgraduate research into the menopause, HRT, PMS and postnatal depression. She is also a British Menopause Society accredited specialist. Now that's a recognition currently held by fewer than 200 practitioners in the UK. And Anne also firmly believes in offering her patients the full spectrum of treatments, which includes complementary therapies such as herbal medicine. And in fact, she's worked closely with a medical herbalist in Kent for the last 20 years, and this collaboration has been highly successful and forms an integral part of Anne's clinical practice as well as educational seminars. And she believes that the role of complementary therapies, particularly herbal medicine, is greatly under-recognised by most healthcare practitioners. And I agree, because I'm probably one of them. And that's why we're going to be talking about it today. Our conversation will dive into the need to expand and improve the existing NHS service to ensure all women are able to access high quality menopause care, as well as the physical, emotional and psychological signs and symptoms of the menopause. But we also talk about tips for choosing herbal remedies, examples of integrative approaches to menopausal symptoms like brain fog, low energy, cognitive issues and weight gain. We also talk about how natural approaches can blend well with hormone replacement therapy, the difference between tisanes, tinctures and capsules, as well as a whole lot more. And I highly recommend checking out Anne's brilliant book called Natural Menopause. It's full of illustrations, tips and practical advice from a trusted professional who's really looked at this in great detail from both angles of both complementary medicine and traditional conventional medicine as well. Remember, you can download the Doctor's Kitchen app for free. This will give you a great grounding in the diet that aligns very well with what we want to do to support the menopause. We're also working on an extra health goal that considers all different areas of women's health. And you can check out my newsletter, Eat, Listen, Read, where I give you a recipe to cook for that week, something to read, something to listen to, and something to watch as well, as well as something to make you smile at the end of the email that a lot of people absolutely love. But for now, this is my conversation with Dr Anne Henderson from the Integrative and Personalised Medicine conference. I really do hope you enjoy this. Anne, thank you so much for taking the time. I know you're going to be speaking on stage soon. How's your conference been so far? I know we've literally just started, but.
Dr Anne Henderson: Yes, it's all run smoothly. The journey up was was better than I expected. You never know what to expect in London these days, but it's a great venue. I've had a quick look around just to get my bearings and it looks like it's going to be a great conference.
Dr Rupy: Yeah, yeah. I know it's a bit novel, isn't it? That you've got so much natural light in the exhibition area, which is awesome.
Dr Anne Henderson: Although it's a modern building, it's in contrast to the Houses of Parliament opposite. In fact, I was at the Palace of Westminster on Monday with the Menopause Mandate campaign. So it's the direct opposite of this. It's very dark and lots of ancient stonework and marble. So I was there with the menopause campaign led by Mariella Frostrup and Davina McCall. And it was great. It was it was a short session, it was only an hour and a half, but it was very well attended and there were a few members of Parliament there, including Carolyn Harris, who leads the all party women's health group. So it was great. It was just to get across the message about menopause, about all aspects, HRT shortages. So it was really good.
Dr Rupy: Yeah, tell us a bit more about the the menopause mandate.
Dr Anne Henderson: So it's a relatively recent campaign, and I know some of your listeners are probably going to think, oh, we're campaigned out with menopause. You know, and I have moments myself, although I've been doing menopause for 30 years and I've seen everything. I've seen the good, the bad, the ugly, you know, it's pretty ugly at the moment, I would say. But I think there's a there is a huge sort of ground level campaign vibe at the moment, which has really built up, I would say during lockdown and as we came out of lockdown. And you know, there are lots of different groups, all grass level. And what I think is fascinating is the common denominator is very few of them are actually led by doctors as such, whether that's GPs or gynaecologists like myself. And I think that's a fascinating development that it's it's the grassroots, it's women themselves and celebrity activists who are actually leading the way now. Now that's, you know, I think that's great, but I think it is open to a backlash to some extent. And I've it's interesting, I've seen even since Monday when we were up in in Parliament, just in the last two or three days, there's been, I wouldn't call it a backlash, but I think there's been some negative reporting in the in the mainstream media that I've covered. Yeah, you know, words to the effect of, have we reached peak menopause campaigning? And I even heard on the news yesterday that there is now a move to have menopause disallowed as a medical condition, which I think will will be very difficult because it flies in the face of the, you know, the workforce campaigning that that has has gone on. And I've been heavily involved in that over the last few years, particularly with the police, fire and rescue services and so on. And they the work they have done over the last seven years, particularly the the police forces over the country is astonishing. I mean, they have led the way in sorting out menopause environment in the workplace, having a reasonable access passports to help menopausal, perimenopausal and menopausal women. And, you know, the private sector is now following suit, but it was the public sector who led the way. And I think if the backlash affects that, and you know, almost tries to offset some of the gains that we've had, both in the workplace, but also in terms of positive publicity, I think that will be a sad outcome. But I, you know, I'm I'm pro it. I know not all doctors are, and I understand that, you know, everybody has to fight the cause in their own way. But I think there will come a time where we need to just have a happy medium balance perhaps and accept that you know, there is a limit to publicity, otherwise people begin to tire and you know, you you lose that that positive slant, I think.
Dr Rupy: Yeah, yeah. No, I agree. I just think, I mean, listeners of the podcast would have heard a lot about just the basic economics of improving access to menopausal care and purely from like the sort of selfish point of view of reducing costs, improving overall health, reducing the risks, all the rest of it. You know, that it just makes sense to to to do this. So we'll talk a bit about that in a second. You touched on some of the difficulties you had in creating menopausal clinics yourself. What were some of the the barriers that that people might face at the moment?
Dr Anne Henderson: Well, I mean, menopause is a bit like a soap opera. And because I've been around for so long, I just smile benignly at the late comers, you know, the the junior relative, I probably getting killed for this, but the relatively junior doctors. So I mean, I did, after I qualified back in the glory days where everybody had the luxury of doing postgrad and research as part of your registrar training, which, and I have to say, I think the loss of that is is such a detriment to medicine. I mean, I had three and a half years doing postgraduate research into menopause, PMS and postnatal depression. And I the amount that I learned, the depth of training I had in that time, you can't replicate by doing 20 years of clinics. You know, if you're doing full on research, it is a luxury, I I I grant that, but it's it just gives you the most amazing grounding to start the rest of your career. And you know that you're moving forward on a solid scientific basis and then you gather your clinical skills. So you end up with this combination of absolute confidence in in what you're doing. And obviously, you know, the science changes as the decades go by, sometimes positively, sometimes not. But I I think that the loss of the ability to do that for the generation of doctors coming through is is is a very sad one. I was fortunate to work with Professor John Studd, who we used to call him the godfather of menopause, and that was probably quite, there were mafia like tendencies, I would say. Sadly, he passed away last year, and he was working right till literally, I think, months before he died almost. And we're having a get together at the Royal Society of Medicine in his honour in a couple of weeks. So I think that will be, there'll be several generations of of doctors who come along, which I think will be a great evening. But you know, the training that we got was, you know, unsurpassed. I mean, we did clinics every week. So we were getting the clinical training, but we were all churning out papers, we were doing presentations in the UK and abroad and always looking for the next the next new step and you know, the training that I got was was really focusing on postnatal depression, but of course, we ran huge menopause clinics and I was able to see how PND segued into PMS and then often into perimenopausal PMS and then menopausal depression and psychological problems. And that was a big, that was one of the big aspects of our research. You know, we we had five, six, sometimes 10 projects going on at the same time and we all co-collaborated. So it was a fantastic time. So I feel, you know, that was back in the 90s and we've seen everything. You know, shortly after I came out of research, we had the somewhat disastrous women's health initiative papers from America and that was the early 2000s and then we had the, you know, the the drama, the breast cancer drama. And there've been ups and downs over the decades since then. And, you know, I think I'm I'm I'm fortunate that I can look back fondly with slightly rose tinted glasses, if you like, but, you know, I think we're in a great position now. And, you know, part of me is sad that that Prof Studd passed away as we were coming to this sort of peak peak interest, because he would have, I'm sure he would have been thrilled for the for the specialty. He fought long and hard to get frontline publicity, frontline headlines, you know, to get the education and training out there. I mean, you know, it was his life's work. And I think it's a testament to him now that we are where we are.
Dr Rupy: Yeah, yeah. So you mentioned a couple of barriers there just to clarify. So one of the main barriers, I think, is that lack of the opportunity of education for professionals coming through. And then there's the awareness piece as well that I think is getting better, certainly with the public work that you're doing. What about the other areas where there is a need to expand the services within the NHS? You've worked in the NHS for many years, you work privately now. What things can you do in your practice that you wish other practitioners could do within the NHS today? What what are those barriers?
Dr Anne Henderson: Well, we're I mean, going back to the the issues that you you touched on, there there is definitely a lack of awareness, but I I see that as being a fundamentally a medical issue. And we go back to the comments that I made earlier that the campaign and the the advances we've made recently, I think are being driven by lay people, not by medics. And I that concerns me. I mean, as a as a senior doctor, I'm thinking, you know, where is my college? What has the Royal College, the RCOG been doing? I know they've got many things on their plate, but has menopause been a focus? What about the Royal College of General Practitioners, the RCGPs? Where has their focus been? The GMC, you know, they're our overarching regulatory body, Department of Health, you know, there's a huge huge number of national institutions that could have been working together more effectively. And I think we've got to where we've got to because there's been a complete lack of compulsory training for all doctors. When I trained, as I've already outlined, I had the, you know, the the great pleasure and privilege to work in post-menopausal research, but the average doctor coming through, even now, has negligible menopause training. It's only very recently that I understand the RCGP has actually introduced a menopause module. So you could go through six years of medical training and postgraduate training and be presented with a menopause patient in general practice or in a gynaecology clinic and that could be the first menopause patient you've ever met. That is unacceptable. And it I don't think it should ever have been allowed to happen given that, you know, if women live long enough, they will all go through perimenopause and menopause. That's 50% of the population, 13 and a half million women estimated, probably more. It's astonishing that doctors don't have compulsory training. And that has led us to where we are now. We've now got a situation where the demand is swamping. I mean, swamping is probably even an underestimate. It's completely overwhelming the supply. And, you know, medics, the institutions that I've talked about should have seen that coming, made plans because we could have foreseen the demand would increase. And we have this constant disconnect between the demand, the expertise needed to supply that demand, and that's that's where we are now. We've got, I think, less than 200 BMS, that's British Menopause Society accredited specialists like myself in the country. So you can do the maths. Not everyone has a clinic. And I think, um, we've got around 140, that's a that's a a ball park figure. So I may not be completely accurate, but 140 menopause clinics in the whole UK trying to meet the needs of literally millions of women. So and and I I think about medicine and I think I can't think of any other specialty within medicine that has that huge imbalance. And you have to question how on earth did we get to this state and why was it not dealt with earlier? It seems like everybody's firefighting now, you know, we're introducing menopause modules because we've had to, um, instead of because it's the right thing to do. And it's it's all been done on the back foot. And and I mean, you know yourself, it will take, you can't train a doctor overnight. It doesn't matter whether it's menopause or not. The next generation of doctors are a decade away by the time they've done their house job, their medical training, their clinical training, their house jobs. So, um, I I it that's that's where we've got to. Um, and I, you know, as you as you pointed out, I ran a an NHS menopause clinic for many, many years, 20, 20, 25 years. And we had all those problems. We were fighting for funding, we were fighting to even get a room sometimes to run a clinic. It was it was very basic, despite the fact that, you know, our reviews were overwhelmingly positive and we we ran a great service on a very, basically a shoe string budget. So it's it it it, you know, I'm probably painting a very negative picture, but I think, you know, you want your listeners to know the reality and how did we get to this place? Because people will say, well, why is it such a mess? You know, um, and that's that's the bottom line. I think several of the institutions dropped the ball bad, you know, big time. Um, and I think this could all have been avoided.
Dr Rupy: Absolutely, yeah. And I think it's a very accurate picture. And it and a a headline I've heard many, many times actually from different practitioners about the struggles to get funding, the struggles to get a room, the very basic accommodation for what is going to affect 50% of women. I um, I want to talk a bit more about the nutrition element of it as well. But just to touch on herbalism, this is very new to me as well. I think I definitely need to educate myself. We've had a few herbalists on the podcast before talking about herbs in specific instances, even Alex Lidd, who has an NHS clinic working alongside a dermatologist where she prescribes herbs as well, which I think is fascinating in East London. Um, the different symptoms that women will experience with menopause are vast. So we've talked about vasomotor, you mentioned sleep issues. What are the other instances where you find that specific herbs, whether they be tisanes, whether they be supplements at the higher level of potency, have have a role?
Dr Anne Henderson: Well, if you if you just if you divide menopausal symptoms into three categories, you've got the physical cluster, you've got the emotional cluster and the psychological cluster. Um, unfortunately, some women have elements in all three, but some are just in one group. So the physical ones would be the ones we've touched on, vasomotor symptoms, musculoskeletal symptoms, headaches, tiredness, disrupted sleep, bladder symptoms. The emotional ones are the sometimes unrecognised ones, um, anxiety, which, you know, can become overwhelming, low mood, labile mood, sometimes clinical depression, but not always, hence the misdiagnosis. Um, and this wonderful syndrome that I just describe as the the red fog or the black mist. And it it sometimes, you know, a little description like that says it all. We don't need fancy, you know, diagnoses, you know, if somebody says, oh, the red mist came down today, you know exactly what they mean. Um, and that it seems to be something very peculiar to perimenopause and menopause, even in women who have the calmest, most placid personalities. So, and then we've got the, um, psychological ones, which, um, are are really problematic. And that includes the brain fog, cognition, loss of the ability to multitask, short-term memory, focus, concentration, and then this wonderful, um, thing which is actually correctly described as loss of nouns. So loss of nouns is what women try to describe when they're talking about it, but they don't that's the technical term. It is literally loss of nouns in speech. So it's very different to a dementia speech pattern where you lose verbs, adverbs, adjectives. In menopause, it's the nouns. So women will be trying to, you know, speak, they might forget a the description of something, a the name. I mean, a classical example is I was doing a video consultation the other week and someone was sitting in her kitchen with a huge stainless steel fridge freezer behind her. It was massive. So it was like a backdrop. Um, and we got on to her symptom profile and she said, um, yes, she said, now this is a case in point. And she pointed behind her and she said, I know what this is, but I can't tell you what the word is. So she started saying, it's huge, it's eight foot tall, it's got ice in it, it's stainless steel, it's got handles, we keep food in it. Couldn't get the word. And then we carried on. I said, well, let's move on. And then five minutes later, she said, it's a fridge. And it was literally, and we we'd moved way on. We were talking about something else. And she suddenly said, it's a fridge, you know. And and it was very funny. And of course, I knew exactly what, you know, somebody might have thought she was quite mad, but I said, okay, it's a fridge. And she said, this is what happens all the time. So this is the the classical loss of nouns. So you've got those clusters of symptoms. And I think the first thing to do when you're personalising your menopause journey is work out your, I would say, work out your five key symptoms. I mean, you may have many more, but there's always three, four or five which are the really important ones which are affecting personal and work life. And then focus on a program to deal with these. And that's where the the pillars of nutrition, fitness, mental well-being, complementary medicine and HRT come in. And then you start to build a program to to try and tackle those particular symptoms. And if you were looking at herbs, then you would drill down and think, well, we need to look at a particular cocktail that will address those symptoms. You know, if somebody didn't have vasomotor symptoms, we might not look at sage. We might look at say Siberian ginseng or ginkgo biloba if there's a libido issue. You know, there there's a huge range. Agnes Castus, of course, St John's Wort is, um, St John's Wort rather is renowned for the mood boosting properties. Agnes Castus or ladies mantle actually, there are randomized controlled trials looking at the role in premenstrual exacerbation. Um, so it works better than the pill, it works better than placebo. So you need to know what you're trying to deal with rather than have a scattergun approach because if if somebody is down and has the red mist, sage is probably not going to be an appropriate choice. Um, you would look at um other other um neurotropic type responses.
Dr Rupy: Yeah, that's fascinating. So I think uh separating out the different uh constellation and clusters of symptoms like you've done, emotional, physical, etc. and then looking at uh different types of uh supplements that could help with those. Are there particular categories of supplements or herbs that would apply to those individual areas or is it very personalized?
Dr Anne Henderson: There are and you know, there are herbs that generally have um properties that help regulate vasomotor issues, there are there are herbs and supplements that might have joint properties, um, I mean chondroitin and glucosamine are obviously the supplements that come to mind. And again, they they don't work for everybody, but but they certainly can be life-changing for some for some women. Um, you know, there's a huge, there's such a huge range and some herbs cross the boundary. So you might have a herb that has a calming property, but also lifts mood as well. So it's um, you know, there's just a huge range out there and it it's it's for a woman to decide individually if that's the route she wants to go down or if she wants to go down the conventional route and perhaps add some herbs in as well if there are gaps in her in her treatment portfolio.
Dr Rupy: One of the commonest questions that we get from our newsletter community, and we get questions every single week, as well as across social media and in relationship with the podcast, is about brain fog and energy, particularly. Now, a lot of people have heard various things about supplements and it's all sort of like scattered, you know, Ashwagandha, Lion's Mane, different types of mushroom teas, uh, ginseng, like you said, green tea. What are the the the uh the supplements or the tinctures that you think have the most robust evidence in that field when it comes to improving one's?
Dr Anne Henderson: Well, I mean, you mentioned some of them. I mean, Ashwagandha is often a a key part of a tincture for someone with cognition issues. Um, and you must also take into account the fact that part of the reason that women may have cognition issues is a sleep deficit as well. So you've got to tackle the direct impact of estrogen on the on the estrogen receptors in the in the key functioning parts of the brain, but also the element of sleep deprivation. So if someone's not sleeping, they may well have cognitive deficit because of that. You know, sleep deficit is uh as as has been said, it's a form of torture. So, um, you know, you have to deal with that. So that's when uh valerian, chamomile, um, the calming herbs would come in. So you might take that at bedtime. In the morning, you might have a tincture with uh Ashwagandha and other other relevant herbs to to fit that fit that mold. Again, going back to the the overall group of symptoms. Um, with with cognition as well, I'm always on looking, you know, I think women have got to look at their nutrition, look at nutrients as well. Commonly find that women in this group are borderline or frankly deficient with vitamin D and folate and sometimes B12 surprisingly, um, you know, um, particularly in the vegetarian vegan community, even though they're taking supplements. So in, you know, it complements the the overall picture if you look at nutrition and obviously the ideal is that you get everything from food. I mean, that that's obviously the ideal goal, but that's sometimes not possible. And I'm constantly astonished if we ever measure nutrient levels in the blood, how many women are borderline for these key ones, ferritin, folate, B12, um, and vitamin D. And they're all key, you know, they all have a an intrinsic role in the neural system, mood, mental health, well-being. We know that borderline vitamin D or low vitamin D levels are probably a major cause of subclinical depression. Um, one could argue that everybody should be on several thousand units of vitamin D before they even think about an SSRI. So
Dr Rupy: Yeah, yeah, absolutely. I know I would agree with that. And it doesn't shock me anymore when I look at a blood panel and I see vitamin D crashing low, B12. Um, to to I know we're running out of time here. I have so much stuff I want to ask you about. Um, do you have thoughts on uh two things, omega-3 supplementation, the long chain EPA and DHA, and protein supplementation? I get asked a lot of questions about whether women uh during the the menopause, perimenopause and menopausal stages should be supplementing with things like a protein rich powder, a collagen, that kind of stuff. What what are your thoughts on those two?
Dr Anne Henderson: Well, the uh amegas definitely. I mean, they're they're great for so many parts of the body, the skin, uh the breast tissue, for example, can be great for helping um mastalgia, breast pain and tenderness, joints, you know, absolutely. So they're kind of multitaskers. And of course, there's cardiovascular health as well. Protein is is uh fascinating. Um, one of the, I would say one of the commonest problems that uh perimenopausal and menopausal women experience is is weight gain. Um, it's it's not a menopausal symptom as such, but it's a very common complaint. And it happens even in women who um have a great nutritional input, they're fit, they're active, they're ticking all the boxes. They don't smoke, they don't drink to excess, many don't drink at all because it produces vasomotor symptoms. Um, but they're still struggling. And the key is that they're fighting a battle against losing muscle, muscle tone and muscle percentage. And if you're sedentary, it's a disaster zone. I mean, you're losing as much as 4 to 5% of muscle mass a year from perimenopause onwards. So you could hit menopause and you could have lost 15% of your overall muscle mass. So there is no way you will um be fit and active, um, and maintain your weight because you're essentially replacing muscle with fat, which is disastrous for your basal metabolic rate. Um, and that's where I think a diet that is is focused on proteins and ensuring that you maintain your protein intake, either just through healthy eating or with supplements is absolutely vital because you many women I see end up on these, so their focus is trying to maintain their weight, but because they don't know why they've put on weight, they just think I need to eat less. And of course, they calorie restrict, um, and often the things they restrict are the things you'd be eating. So they calorie restrict and they're not getting in enough protein for daily maintenance, let alone trying to build back the muscle they've lost. So this is I think where that understanding comes in. Um, and many women think, well, if you want me to eat protein, that's high fat. That's I'm having big Macs, you know, and of course it's not and steaks, of course it's not because we all know that you can have really healthy protein intake that's, you know, that that doesn't have other consequences. And I think this is such a it's such an important thing to get across to women that middle-aged weight gain, middle-aged spread, whatever you want to call it, is a consequence by and large of declining BMR and that's a consequence of loss of muscle tone and mass. And if you want to get to the core of the problem, that's what you need to address. Now, HRT works brilliantly, particularly if you get the right balance of estrogen and testosterone. Estrogen does help maintain muscle tone in contrast to the view is it has to be testosterone. It absolutely does not. But there's no doubt that a a properly judged low but adequate dose of testosterone in someone who is ticking all the other boxes, who also eats well and is doing strength training will work wonders. And I've I've seen patients transform their, you know, their body percentages, their physique, their, you know, just their whole lives really just by adjusting, um, recognizing what the problem is and adjusting what they eat and whether that's with intermittent fasting or time restricted eating or, you know, what works for them. But, um, I'm very much of the view that, you know, if you have a diet that's high in protein, adequate fats, low in carbs and you follow a TRE or a, you know, a sensible flexible eating pattern, it will work.
Dr Rupy: Yeah, fantastic. And we have to stop there. I'm I'm remiss because I want to ask you so many more questions. I've got so many more that I've just conjured up in my head as we've been talking, but thank you so much. You're a fantastic advocate for.
Dr Anne Henderson: We'll have to come back for round two.
Dr Rupy: I would love to do that. I would love to do that and we can talk a bit more about the topics in your book as well. But for now, I hope you have a great time on stage and I'm sure I'll see you at the around the conference during the next couple of days.
Dr Anne Henderson: That's great. Thank you very much for asking me. It's very enjoyable.
Dr Rupy: Brilliant, brilliant. Thank you so much. Thank you so much for listening to my conversation with Dr Anne. Remember, you can find her fantastic book called Natural Menopause with all those incredible practical tips and advice about how you can use herbal remedy alongside all the other treatments available to women. And I highly recommend you check out my newsletter as well, Eat, Listen, Read. You can sign up for free at thedoctorskitchen.com. I will see you here next time.
