Ep. 77 Navigating HRT Options and Shortages: Rene Schliebs’ Essential Advice

[00:00:00] Meegan Care: Welcome to the podcast Renee Schliebs. Tell us who you are and who you help.

[00:00:06] Rene Schliebs: Sure. Yeah. So I am a clinical nutritionist and medical herbalist, and I’ve been in clinical practice for over 20 years now, specifically in the women’s health space. Initially, like early on in my practicing career, I was helping fertility clients going through assisted reproductive technologies struggling with fertility and helping them to have their families.

So that was a very, very rewarding. Time of my life. And it was also very much mirroring what I was going through with my husband personally, because we were struggling to have a family and multiple miscarriages and did IVF as well. And, you know, I could have a lot of empathy for what Families were going through, you know, couples were going through trying to conceive at that time.

And then I’ve now naturally moved on to perimenopause and the menopause space because that’s where I’m at now. So, yeah, it’s kind of, in clinical practice, your practice kind of often just mirrors what you are going through yourself. And Yeah, so I’m incredibly passionate now about helping women in this space get the help that they deserve and you know to mitigate these often very disabling symptoms that they’re going through at this time of their lives.

[00:01:23] Meegan Care: Yes, so good to hear. So our topic of conversation today is about navigating medical treatment options so that women can be empowered to talk with their GP in a really, well, like a pro, right? In a really empowered way. So you’re a clinical nutritionist and medical herbalist. Why is this topic particularly important to you?

[00:01:47] Rene Schliebs: Well, in terms of where I’m at, I know what it’s like to suffer through these symptoms. And now that I know what I know, I can look back and, you know, say that early intervention and treatment for myself could have made life so much easier. And I was suffering unnecessarily through that time. Frame of my life.

And when I really made some concentrated changes by starting the, you know, HRT and really focusing in on, on my own diet and lifestyle choices, that’s when I noticed incredible changes, you know, with, with HRT, it was like a switch, you know, within three days. My symptoms had improved and I was coping with my life so much better.

So, you know, I mean, HRT might not be for everybody, but I’m very passionate about it because I know how it’s helped me. And I know how it’s helped a lot of people that I consult with and a lot of, you know, friends and family members as well. So it’s about educating women so that they can talk to their GP.

And get the right advice for them and make a decision that is meaningful to them to get the help that they need.

[00:02:58] Meegan Care: Yes, similar journeys actually. I struggled for many years sort of trying to put things together to help the symptoms. And because I went through menopause early, my friends weren’t going through the same thing.

So I was sort of a bit out of left field. And, and then. By the time I actually came to HRT, and then the shift it made for me, just to be able to feel like my life was I had enough energy to do my life again was massive and to drop the struggle. I and so I’m, I’m a real advocate for if it works for you and you’re okay with that, then absolutely have those conversations with your doctor.

So I’m glad we can talk about this today.

[00:03:41] Rene Schliebs: Yeah. Yeah, I agree. And you know, in the clinic, I consult a lot with corporate women and I do a lot of speaking in the corporate space and the most common thing that I hear from these women is I am so afraid of losing my memory. And that is, you know, that’s happening, you know, cognitive decline because of lowering estrogen levels.

It really affects the brain and it affects, it affects output. And when you start putting estrogen back into these women. It’s just calming everything down. Cognition improves, sleep improves, you know, it just improves their lifespan so dramatically and, you know, they can continue in their careers the way that they want to.

[00:04:21] Meegan Care: Oh, so, so good. Now, could you start by giving us an overview of the most common medical treatment? And options available for us if we’re in peri and or post menopause in New Zealand specifically.

[00:04:35] Rene Schliebs: Sure. Yeah. So the most common and the safest form of HRT is estradiol in the form of estrogen patches and micronized progesterone in the form of a capsule.

So these are 100 percent body identical. So they are the exact same hormones. That we are, you know, losing in rapid decline that we’re putting back into the body. Topical application has been shown to be very, very safe and effective. And the progesterone in the form of the micronized progesterone, you know, from plants is the most safe and effective treatment.

There are other options though, so some women prefer to take tablets of the estradiol. They do come with a slightly increased risk in terms of blood clotting if you’re taking it orally, because it does have to go through the liver to be processed by the body, whereas the patches don’t have to do that first pass, so they don’t have that increased clotting risk.

So yeah, the patches the tablets of estradiol and the progesterone is the most common forms. If you haven’t had a hysterectomy, so if you do have a uterus, you must take progesterone to protect the lining of the uterus from any unopposed estrogen. So that’s, you know, the uterus can thicken up if you’re not taking progesterone.

So we do need to do that if we have a uterus, if you’ve had a hysterectomy. and you don’t necessarily need to take the progesterone or you can take it for the benefits because it’s amazing for sleep, But you don’t have to have have it for those protective effects on the uterus. But then we also have, gels that are available, although not funded.

And, you know, they are also a very effective treatment for, for women going through this stage of their lives. But yeah, the most common treatment is the patches and the progesterone

[00:06:29] Meegan Care: together. That’s right. Yeah. And so do I, do I just go to my GP for this or do I like need to see a menopause specialist that can prescribe?

What’s your advice on that?

[00:06:40] Rene Schliebs: Your GP, any New Zealand GP can, can prescribe HRT, although what I’m finding with a lot of women is that their GPs aren’t listening to them, they’re not being heard properly, they’re being denied HRT, or they’re being told things like, I won’t prescribe this for you unless you have a, an IUD inserted.

So, you know, it’s about finding the right GP for you. If your GP isn’t listening, then I would highly suggest finding a new cheap GP, but yes, of course you can go to your GP and have this prescribed and you can also see a menopause specialist doctor. And there are a few out there that I absolutely love.

And, you know, if there’s more kind of complications going on with cysts or fibroids or concerns around, you know, endometriosis or other sort of reproductive disorders, you may be referred to a gynecologist or an endocrinologist for for further, you know, clarification and treatment.

[00:07:38] Meegan Care: And so how, how would I know if my GP is actually on the ball with menopause, like current menopause treatments?

Is it kind of hit and miss, I need to show up and just see what response I get, or are there ways to sort of navigate that?

[00:07:53] Rene Schliebs: Yeah, so, I mean, I would always speak to the practice manager and just find out who the best person in the practice is around menopause and perimenopause and specifically say that that’s what you’re coming in for.

Leave all other Concerns behind because you’ve got a 15 minute appointment basically. So you want to be specifically talking about the hormones and the perimenopause whatever you’re going through around that menopause space. So definitely calling in advance to find out who that person is. If they are advertising that they are menopause specialists, then usually they have a menopause certified, you know, qualification through the Australasian Menopause Society.

And they are the ones that I would highly recommend going to see because they’re up to date with their current research. They know what they’re talking about. It’s a 45 minute appointment usually, and you feel very validated and very, very heard in that space as well.

[00:08:55] Meegan Care: Right, so are those, are those GPs private though, the ones that are registered with the Australasian Menopause Society?

They are,

[00:09:02] Rene Schliebs: they are they’re not specifically private, but you do have to pay, you know, in, in, in some cases, you know, up to 300 an appointment. So it’s not easily accessible for for a lot of people, but there are clinics that are popping up that are trying to make this more available to women in the menopause space.

And There’s one that’s just recently started out called the Carla clinic. Oh, I saw

[00:09:27] Meegan Care: that. Yeah. This

[00:09:27] Rene Schliebs: way. Yeah. Yes. Yes. So that’s very exciting. And She is a, is a woman that went into menopause very young and never was able to find the right treatment for her and felt very unheard and unvalidated.

So it was her mission to start a clinic. that could validate women and was easily accessible. So I think the consultations are 89. And I imagine they will be booked out very quickly. So she might be finding,

[00:09:57] Meegan Care: I already saw they were like booked out at least a month in advance and that only sort of opened this way.

Yeah. So clearly there’s a massive of need. Isn’t there?

[00:10:04] Rene Schliebs: There absolutely is. Yeah. And I mean, I’ve just had a a client this morning and she very clearly, in my opinion, would benefit from being on HRT. She had been to see her doctor with her symptom score chart and the doctor dismissed the symptoms and said, I don’t think that you need this at this point.

You know, but we’re looking at mood changes, we’re looking at sleep problems, we’re looking at urinary issues. All of these things are happening because of the declining levels of estrogen in her body. So she’s now going to see a new GP and funnily enough, she told me that that GP is actually quitting the practice at the end of the year.

So we are also, you know, also looking at burnout, compassion fatigue, you know, doctors have been under a lot of pressure. In the last five years, and I mean that doesn’t, you know, dismiss, you know, not discussing concerns with women around HRT, but it’s telling you the state of the medical system, you know, it’s, it’s pretty bad.

[00:11:08] Meegan Care: Yeah. So we’re struggling as patients and consumers, but obviously there’s a massive load that they’re dealing with as well. So to bear that in mind, I think is, is helpful. And what is the checklist you briefly mentioned in there? Can you share a little bit

[00:11:25] Rene Schliebs: about that? Oh yeah, so there’s something called the Greenscale Adapted Symptom Questionnaire that you can find and easily download on the Australasian Menopause Society website.

So it basically is a symptom score chart that goes through every single system in the body that’s affected by menopause. Perimenopause and menopause, and you can grade your symptoms according to not having started on menopause hormone therapy three months later and then six months after starting. And it’s a fascinating score.

I think my first score was 46 and anything over and above 15 is very clinically significant.

[00:12:04] Meegan Care: So,

[00:12:05] Rene Schliebs: you know, I was really suffering. And then three months later and six months later, my score, I think after starting HRT To six and then three, so that’s how effective it was for me.

[00:12:17] Meegan Care: I love being able to visually see that for myself as well, because when I think back, you know, it’s been coming up to three years, I think, since I’ve been on HRT, and so much has changed.

But it becomes my life. And so then I can, it becomes more difficult to compare. So I know that so much has changed for me, but it’s hard for me to recall and remember and compare. And I think that that’s a, Helpful thing for us to do just for ourselves to check in with how we’re doing as women. Thank you for sharing that.

[00:12:49] Rene Schliebs: No, I agree. And also what’s very interesting about that score sheet is, you know, and you probably have found this in the perimenopausal phase, you’re swinging on those highs and lows very rapidly, very quickly, and things can change. So it’s also good to have that. Sheet on hand if you feel like things are changing a bit and your dose might need to be increased.

So it’s a really good measure for women on do they need to go up a level in their patches and their dosages and how are they going to do that and they can take that form to their doctor and say, you know, this is where my symptoms are at this point. Do I need a higher dose?

[00:13:27] Meegan Care: And so can you just clarify this for us? We don’t need to wait until we’re at menopause, you know, the 12 months since our last menstrual cycle, to actually begin HRT. Can you just speak to that briefly?

[00:13:40] Rene Schliebs: Oh, absolutely not. This is all based on symptoms. So if you ask, you know, perimenopause can start as young as natural, you know, sort of perimenopause around the age of 35 when our estrogen and progesterone levels are starting to decline, it’s faster after the age of 40.

So if you’re around that age and you’re noticing, you know, more severe swings you know, with mood. With sleep, any hot flushes. I mean, it’s not just about hot flushes. It’s about increased urinary, you know, frequency. The things for me were like debilitating anxiety, joint pain, muscle pain. and sleep disturbances, nothing to do with hot flushes.

So if you’re not kind of educated around that menopausal space, it’s very hard to know what’s going on. And you know, for a lot of women, they go to their GP with their symptoms and get put straight on antidepressants without even having had that conversation. So we need more awareness and more conversations out there with our doctors.

[00:14:48] Meegan Care: Absolutely. And so what is the limitation of, say, because I did go into perimenopause after my second child and so I was 37. I had no idea that was what was going on. I just thought I was crazy. Really fatigued, then irritable, and all the rest of it. Looking back now, I can see that that was what was happening.

Totally lost my train of thought. I was about to ask you something.

[00:15:12] Rene Schliebs: That’s menopause. That

[00:15:13] Meegan Care: is menopause. It

[00:15:14] Rene Schliebs: was the limitations. We

[00:15:16] Meegan Care: welcome, yes, that’s it, we welcome the memory lapses. We do, we do, we

[00:15:21] Rene Schliebs: do.

[00:15:22] Meegan Care: Oh, the limitations. So yes, if you get put on antidepressants, because I’ve heard that a lot from women.

What are the, can you speak to the limitations of that?

[00:15:31] Rene Schliebs: So, I mean, in terms of going on antidepressants, you know, there could be very valid reasons for that. However, if you’re looking at somebody in a perimenopausal phase, we are also looking at other kind of hormonal symptoms that might be coming into play there.

And what else do we need to treat? So, you know, we, we need to look at women holistically, not just as one kind of identified symptom. And I’ve just lost my train of thought there too. I was going to say, I know I was going to say about the antidepressants you know, there’s very clear data out there and it’s, it’s quite well hidden in the data sheets that antidepressants will cause osteoporosis.

So we’re already seeing a woman that’s got depleting estrogen levels, which is going to affect her bone health. Potentially being put, put on antidepressants for menopause rather than HRT for menopause further compounding that fracture risk and bone risk. So, you know, it’s yeah, there is a lot to be done in terms of actually, you know, just revisiting the space and educating GPs around it.

[00:16:41] Meegan Care: Yeah, absolutely. And so blood tests for hormones, right? I think maybe I’m in perimenopause. Can I just go to my doctor and get a blood test? What’s the picture around that?

[00:16:54] Rene Schliebs: Yep, you can absolutely go and have a blood test. However, as I said before, you know the hormones one week could be in the hundreds and then Below a hundred, you know, swinging in those highs and lows in terms of estrogen, follicle stimulating hormone, progesterone.

So those, those are the key bloods that you would test. And it, you know, it might be relevant in the beginning to just do kind of a baseline measure and see, you know, where a woman might be sitting, but it may not be clinically significant. What we really, really want to be doing is listening to her.

And believing her about where she’s at and what’s going on with her symptoms. And as I said before, that’s that green scale score chart is amazing for that.

But just on the blood tests one that is absolutely vital to check would be testosterone. Um, Especially if if the woman has hyperactive desire disorder, so you know, really low libido, no desire at all for intercourse, we want to be checking testosterone and there is help available for that.

So in New Zealand, we can prescribe a product called androfem and that is a game changer for a lot of women however, it’s once again not funded, but Pharmac are looking at funding that, so it’s expensive and not all women can afford to go on that. But in terms of bloods we must check that because we don’t want anything swinging into a male level of hormones in the body, we want to make sure that that’s maintained within the clinical norms.

[00:18:29] Meegan Care: Yeah so asking for a friend, not really, I’m asking for myself. Yeah. If someone’s using androfen, which I’ve found to be really helpful, what would you say is the time frame of testing? So they do a baseline test and then test again, when?

[00:18:43] Rene Schliebs: So when I spoke to Dr. Jenny Hill at Dr. Menopause, she said that You know, of course, there’s a mandatory first blood test and then again at a month and then at three months.

They’re going to be continuously checking that. They’re not going to leave you over a three month period and not check that. Because obviously they have to be very, very safe with their prescribing of it.

[00:19:05] Meegan Care: Yes, exactly. Yes. And so in New Zealand, and I believe currently worldwide as well, there is a shortage of HRT patches and it’s slowly been getting more and more significant to a stage now where it’s It’s pretty significant.

I’ve been talking to a lot of women who haven’t been able to fulfill their prescriptions and their repeats. What on earth are we going to do? I’m all right for a couple of months, but I’m like, what on earth am I going to do after that?

[00:19:38] Rene Schliebs: Yeah, it’s, it’s an unacceptable, absolutely dire situation for so many women worldwide.

So you know, initially it was blamed on COVID and now it’s because there’s been a massive uptick in the use of patches, but you know, come on, this is just women’s lives that we’re dealing with now. And you know, Yeah. Yeah. Suicide rates. I’ve heard of women actually wanting to commit suicide over this. So it’s, it’s dangerous.

It’s unacceptable. A lot of women are cutting their patches into thirds to stretch them out and make them last a bit longer. There is the option of the tablets. If women choose to go that way, but a lot of women don’t want that increased risk with the clotting and some women can’t take them because of that risk.

So You know, but that is an option and then of course, as I said before, there’s the gels, there’s the two gels available in New Zealand but they come at a cost as well. So, you know, a minimum of 40, sometimes up to 150 a month for that. So, I honestly don’t know how this is going to pan out Pharmac are apparently tendering for a new supply, a new contract, but I, I just, it blows my mind that this is taking so long.

You know, I don’t understand why it can’t just be done to support these women, including ourselves, you know?

[00:21:04] Meegan Care: Yeah. Yeah. You’re so right. It’s completely unacceptable. And yet we’re not really surprised by it, right? Because women’s health, in my experience, has always taken a back seat. And so it’s not surprising, although it’s outrageous.

Oh, I did hear from a woman this past week who said that her doctor, she went to the doctor to ask for HRT as a new user patient. And the doctor said to her, no, I’m not prescribing patches and progesterone because of the shortage. We’ve been told not to prescribe it. And that’s different to saying, yes, but there’s a shortage, let’s see what we can do.

[00:21:46] Rene Schliebs: Yeah, gosh. Because it’s still

[00:21:47] Meegan Care: coming in in dribs and drabs. Yeah. Outrageous.

[00:21:52] Rene Schliebs: It is. My pharmacist did tell me that there was a new shipment mid June and then another one in August, but she was also quite vague. She was like, you know, and they are suffering as well. They’ve got women coming in demanding these things and, and honestly they feel terrible about it.

You know, it’s not their fault and you know, the New Zealand government needs to do more in the space, but there are A lot of surveys going on at the moment. There’s petitions. So, you know, I encourage women to look at those and fill them out. And you know, have a voice in this space.

[00:22:28] Meegan Care: That, I mean, that’s, that’s what we can do when we can’t do anything, is to have that voice and to speak up about it.

Yeah, so it’s good to be seeing those petitions out there.

[00:22:39] Rene Schliebs: Yeah, absolutely.

[00:22:41] Meegan Care: So, in terms of If I’m going to my GP and I want to talk to them about HRT or the possibility of HRT for me, what sort of prep and what, what sort of steps do I need to take? What would you say to a client to help them prepare?

Because like you say, you’ve got that 15 minutes, it’s not a lot of time, it goes really fast and you want to get the best outcome for yourself from that.

[00:23:05] Rene Schliebs: So as I said before, ringing the practice ahead and finding the best consultant there for you and your condition, I would also book the very first appointment of the day.

So you’re not waiting around. You’re not flustered when you go in, you’re fresh and they’re fresh. So that’s, I always book the first appointment of the day. And then, you know, keep a symptom diary, write down how you’re feeling, what’s going on. Also be prepared to talk about your family health risks, any other risks that you think might be important in your own personal health care as well.

So going into those appointments as prepared as you possibly can be to get the best out of that situation. And then you’re going to be wanting to ask questions along the lines of. What HRT options are available for me. What’s, you know, perhaps the easiest, the safest route for me to, to get this and to have continuity of care.

I would also be asking, you know, at what point they would like to see you for a follow up, because I think it’s incredibly important for women to be followed up a month later. And then at the three month point, just to make sure that the dosage is right for her, because more often than not. It’s too low.

and they need a higher dose. And as I said before, you know, things are swinging very, very rapidly and they could need a higher dose quite quickly. So it’s about just really keeping in touch and building a good rapport and that good relationship with your GP so that you feel very, very cared for. I have actually a friend of mine messaged me last night and she said that her practice had emailed her about the shortage and to offer her the gel.

I haven’t had anything like that from my, from my practice at all but I thought that was, that was really reassuring and quite promising.

[00:24:58] Meegan Care: That’s very proactive. Yeah helpful. And if I’ve been talking to my doctor and I feel like they haven’t been taking me seriously They have just sort of told me to put up with it or whatever, you know, the case may be What what advice do you have for me?

And how can I sort of advocate for myself and my well being and health?

[00:25:20] Rene Schliebs: No woman should be denied HRT if that is her choice And we need to be giving this choice back to women. It’s her body. She is the only person that knows exactly what is going on for her and how badly her symptoms are affecting her quality of life.

So if she’s in front of a GP who is denying her that and not engaging in a conversation, Just get a new GP and the Australasian Menopause Society website has a fantastic list of GPs available in New Zealand who are menopause certified. And they can be, you know, those more specialist care ones like Dr.

Menopause or the menopause doctors or just general GPs. So if you’re not being heard, it’s time to get a new GP.

[00:26:11] Meegan Care: Great advice. And of course, there’s always telehealth now. Yes. So that makes us, you know, makes things a lot easier as well. Yeah.

[00:26:17] Rene Schliebs: Absolutely. That’s incredible. Yeah, for sure.

[00:26:20] Meegan Care: So you’re a clinical nutritionist and medical herbalist.

How do you see that integration of both natural and medical treatments? What’s your viewpoint on that?

[00:26:31] Rene Schliebs: Yeah. Well, I mean, as I said before, you know, it’s, it is my, you know, wish and desire that we all work together collectively to support women. And this is not just GPs. This is, you know, all sorts of integrative care, acupuncturists you know, counseling therapy.

And that’s an important one as well, because I see a lot with women that unresolved Childhood trauma really, and you probably see this in your practice, rears its ugly head around this timeframe when we’re having these massive, massive swings. So it’s about you know, extending that to all forms of healthcare for women.

You know, something that a woman can ask her GP in consultation is you know, do you work with any nutritionists? Do you work with any naturopaths? Any herbalists? You know, like who, who is your extended network of people that you could refer me to? And a lot of practices do have that now, which is really, really cool to see.

So I think the more that we can advocate for ourselves, be very firm with where we’re at, and Also, you know, just talking to your GP and educating them about what’s working for you. You know, I’m taking XYZ supplements and I’m following this anti inflammatory diet plan and it’s really working for me. How can we work together for the better, you know, for the better good of my health?

[00:27:54] Meegan Care: And so, for women who prefer not to use HRT or perhaps they can’t or they don’t respond to it very well, what alternative or complementary therapies, treatments are available and do you recommend?

[00:28:09] Rene Schliebs: So diet is amazing. A lot of women do very, very well from having a proper consultation with a nutritionist to get on top of their eating, really get an anti inflammatory diet plan in there for them.

Doing some sleep therapy as well, taking some nutrients that help with sleep are very, very good. So there’s things like, you know, magnesium and kava, 5 HTP, you know, speaking with a qualified practitioner about how those supplements could be prescribed for you for your condition. There are a lot of amazing herbs that help with the nervous system that have shown some clinical significance in reducing those vasomotor symptoms with hot flushes.

Although there needs to be a lot more research in that area, but there is help in terms of, you know, medical options. For not being on HRT steroids can be prescribed. Um, antidepressants can also be prescribed and have worked for a lot of women with hot flushes. But once again, we’re looking at these things don’t come without their risks, you know, so.

Everything medical can come with a risk and it’s about weighing up those risk benefit situations based on your personal medical profile with your GP and making the right decision for you.

[00:29:34] Meegan Care: Yeah. And as you say, everything medical comes with a risk. There’s still a lot of conversations that I hear.

That HRT is dangerous. You’re at risk of breast cancer. It’s a very high risk. I was talking to a friend a few weeks ago, and she was considering it. Then she talked to some other friends. She’s like, this is what they said. This is, and I was like, I wonder where that information comes from.

[00:30:00] Rene Schliebs: Yeah.

[00:30:01] Meegan Care: What do you see in that?

[00:30:03] Rene Schliebs: So that information came from the Women’s Health Initiative study in 2002, where they took a section of women, so they were mostly around 65 years old, they had been away from estrogen already for a good period of time, so 10 years almost. So it wasn’t a relevant study compared to, you know, when we do put women on HRT.

And the risk was, you know, You know, it wasn’t even clinically significant. So, that’s all being debunked now, and there’s so much that’s coming out around that, and how misinformed that study was. But, you know, there are, there are contraindications for use of HRT. You wouldn’t use it in an active blood clot.

So somebody with no and deep vein thrombosis, you wouldn’t use it in active breast cancer. And this is not to say that women post breast cancer treatment can’t have HRT. They absolutely can. And that is a conversation that needs to happen a qualified specialist and an oncologist and a doctor to make the best informed decision for that patient.

So yeah, liver disease um, active breast cancer, of course pregnancy you wouldn’t use it, and an active blood clot. But apart from that, it’s actually incredibly safe to use and we need to look at the benefits of HRT rather than talking about these supposed risks all the time. Do you want to have a long health span?

What does that look like in terms of cardio metabolic disease where your risk is decreased by 30 percent if not higher when taking HRT, your bone health, your risk for Alzheimer’s, dementia, you know, the list goes on and on and on. And we’re lucky at this time. And I think, you know, our daughters, our children going to come into the space, you know with a lot more education.

And, you know, power in this, in this situation. It’s a very, very interesting time in the menopause space at the moment.

[00:32:03] Meegan Care: It is an interesting time when we can really see you know, even in the last five years, how much things have swung and how much the demand from when I first started on HRT, which was probably three years ago to now the demand has increased, but It irritates me that that is being given as a reason, like we’re doing something wrong.

Oh, well, you’re running out because the demand’s increased. Like, there’s this inferred kind of, well, you’re all wanting far too much. This is like, this is supporting our health and well being over the long term. I don’t think it’s too much to ask. I,

[00:32:37] Rene Schliebs: I, yeah, I 100 percent agree with you. And, you know, when I look at all of this and I think of, you know, Other areas of medicine.

There is no other area of medicine where people are going to their doctors and asking for a treatment. You know, it’s, if you’ve got high cholesterol, you’re put on a statin, you know, willy nilly if, you know, drugs are, are handed out very, very, very readily. But in the HRT space, we’re having to go to our doctors To demand this it just makes no sense to me at all.

And if we look at, you know, for example, a thyroid disorder You’re given the hormone that’s going to support your thyroid. So why in menopause are we being denied hormones that are going to support these systems? It’s just crazy. It’s

[00:33:29] Meegan Care: wild, isn’t it? It would, it would take a good unpacking to understand the, the structures that have fed into this and the stage we’re at now with it.

Yeah.

[00:33:40] Rene Schliebs: Yeah, absolutely.

[00:33:42] Meegan Care: I did have a, a woman speak to me, and obviously, in no way am I any, you know, I’m not medically trained, but she was talking about she’d been on HRT and it really, really helped her, but she’d had, she didn’t know she had fibroids, and so that had become a problem, and they’d grown over the last year.

That kind of thing. What’s the, what’s the sort of general protocol around that? Because a lot of women do have fibroids, whether we know it or not, right?

[00:34:09] Rene Schliebs: Yeah, yeah, absolutely. So that’s a case where I would absolutely recommend a specialist, a gynecologist or an endocrinologist to look after the care of that woman.

And it may be that the dose is just titrated a little bit for her, you know, and she needs to be very, very clinically monitored. for that. And it’s not to say she can’t have HRT, but it’s about, you know, perhaps pulling back on the dosage under the guidance of a proper specialist for that person.

[00:34:36] Meegan Care: Yeah. So I think that’s the key, isn’t it?

It it’s when you have these added complications for your own health is to have that guidance from a specialist. It doesn’t mean that it’s necessarily a no go area, but you need that specialist help.

[00:34:51] Rene Schliebs: Yeah, absolutely. And you know, there’s amazing doctors out there. There are amazing specialists out there.

It’s just, you know, a group that we need to be kind of educating and bringing along on the ride with us.

[00:35:06] Meegan Care: Yeah, exactly. And I do love sharing resources, you know, like people like you, like Menno Doctor, we’ve got amazing integrative, a couple of amazing integrative GPs here and New Plymouth that are really up with the game with menopause.

And thank goodness, one of them was the woman that I went to see to talk to about HRT. And she just laid it all out for me. She said, you’ve got this option, this option and this option. Things were only partly funded then. And I went and went away and made an informed choice. She sent me all the information so I could have a look at it.

It was a very empowering experience. And. You know, I hope that more and more of us have that experience for ourselves as well.

[00:35:45] Rene Schliebs: Yeah, I agree. And I’m, I’m so glad that you got the help that you needed. And my experience is very, very similar with doctor Menopause as well. But yeah, as I said earlier, it’s really exciting to see these other little clinics popping up that are cheaper alternatives as well.

[00:36:00] Meegan Care: Yeah, so good. And so what resource, resource support systems are available in New Zealand for women who are navigating menopause? So, you know, that would be about accessing that to complement our GP’s advice to, to gain a better understanding of what’s happening. It’s taken me years to understand that and I’m at the other side now, but I finally understand perimenopause, menopause, postmenopause, and what was going on for me.

What, what are the resources available for us?

[00:36:28] Rene Schliebs: Yeah, so probably the, the only one that I would really endorse is the Australasian Menopause Society website. It’s an amazing directory of everything research based, so it’s clinically up to date. You can download articles there that you can take to your GP.

There’s information there on how to speak to your GP. There’s the quiz that you can do to take to your GP as well, and of course the link to All of the certified doctors who will be able to help you in this space. So that is, that’s pretty much the only resource that I really do recommend because it is, you know, certified and I know that the research is up to date.

 Te Whatu Ora, for example, if you go on there, so this is the New Zealand health If you go on there and type in menopause, you will get two articles and they are on cervical screening and HPV. That’s it. There is no information available, which is really sad. So, yeah, the Australasian Menopause Society website is where you’ll get all of the relevant and up to date information.

[00:37:34] Meegan Care: Okay, good to know. And yes that game needs to be picked up quite a bit. But, however, we have the Australasian Menopause Society. And so any, any final words of advice if someone was listening and they’re, they’re sort of thinking about HRT or they just started, but they’re pretty confused, they’re maybe struggling with their health, what advice would you leave them with?

[00:37:59] Rene Schliebs: I would say, you know, the first port of call as to find somebody who is going to hear you and to listen to your symptoms, because you want to feel validated. You don’t want to feel like you’re going crazy. And this is how a lot of women feel in this space. And I know for me, it was like, what the hell is happening to my brain, to my body you know, and finding somebody who is going to listen to you and validate what is going on for you as the most important thing.

So. My best piece of advice is if you’re wanting to navigate this space, if you’re wanting to talk about HRT, please find a GP that you feel very, very comfortable with, who you feel is listening to you.

[00:38:41] Meegan Care: Beautiful. And if people want to stay connected with you, perhaps they want to just learn more from you or even work with you, what’s the best way for them to do that?

[00:38:51] Rene Schliebs: So Instagram is the best way to find me and my handle there is reneeschliebs. menopause. expert.

[00:38:59] Meegan Care: Well, Renee, thank you so much. This has been really, really informative and I know it’s going to be one of those episodes that women come back to time and time again so that they can get that resourcing that we, that we all need.

[00:39:13] Rene Schliebs: Yeah. Thank you for having me. And also, you know, thank you for the work that you’re also doing in this space. I think the more that we can all band together and, you know, collaborate together as you know, women helping women, the better it’s going to be for the health outcomes of all of us.