Uncensored Money Season Five: Mel Talks Hormones and Menopause with Dr Ginni Mansberg

Melissa Browne: Ex-Accountant, Ex-Financial Advisor, Ex-Working Till I Drop, Now Serial Entrepreneur & Author, Financial Wellness Advocate, Living a Life by Design | 05/05/2024


Show Notes

Do you find that there is such a disconnect when it comes to women, hormones, and health?

In this episode of Uncensored Money, Mel digs into this disparity with her guest, Dr Ginni Mansberg. Dr Ginni is a GP who specialises in the management of menopause, a well known TV host, author of The M Word, and was voted the most trusted healthcare professional in Australia in 2022. 

Mel talks to Ginni about Menopause, the disparity in treatment, and the effect this has on women, and subsequently on their finances. A fascinating talk, this episode is discusses menopause, the lack of research there has been on it in the medical world, and why treatments often start to fail after 6-12 months.

Tune in for a discussion on women, hormones, and the relationship this can have on your finances.

Books and resources mentioned in this episode

If you're on insta, come play over at @MelBrowne.Money and make sure you’re signed up to Mel's Money Musings for more tips, tricks and ideas on how to best work with your money.

Finally, if you love this episode please make sure you subscribe and leave us a review.


Mel: Hey everyone. I'm Mel Browne. I'm an ex-accountant and ex-financial advisor, so I have the theory, but I also have the life experience. I'm now financially independent in my own right after coming back from less than nothing in my early thirties. I want this podcast to be like a chat with your girlfriends about money. My aim is to help you discover why you're behaving the way you are with money, to suggest new ways you might behave that are a better fit for you, and to increase your financial literacy and financial confidence. I hope it inspires challenges, educates and empowers you with how you do money. So let's get into it. Welcome to Uncensored Money.

Mel: I am so excited about today's conversation and that's because there is such a disconnect when it comes to women and hormones and health. And what I am seeing is that it is costing us, it's costing us with our health, but it's also costing us financially.

Mel: And I dig into that with my guest today, Dr. Ginni Mansberg. She's a GP who specialises in the management of menopause. She's a well-known TV host. She's a resident GP on Channel Seven Sunrise in the Morning Show. She's the author of a book that I love called the M Word. She was voted most trusted healthcare professional in Australia in 2022 and she's a member of the Australasian and International Menopause Societies and Co-founder of Don't Sweat It Menopause in the Workplace. It doesn't matter if you are 15, 25, 35, 55, 45, 65, 35 or 85. This is a conversation you need to listen to enjoy and make sure you check out the show notes for the links and then let me know what you think. Thank you so much for having this conversation with me. I've wanted to have a chat about hormones for such a long time. So before we dive in, can you tell me about yourself, Ginni, and the work that you do?

Dr Ginni Mansbe...: Oh wow.

Mel: I know. I guess why the particular interest in hormones and perimenopause and menopause, like why that particular niche?

Dr Ginni Mansbe...: I think to be honest, it's just being a woman in her mid fifties. That's where my patients are. That's where I'm at. I also am really fascinated by everything midlife women. I'm really interested in women in general, but I think midlife women, it's menopause is central to everything. It's like you're central to your physical health, your wellbeing, your spiritual, your emotional health. It's almost the glue that holds it all together. So yeah, that was where that interest came in. And also I find that because it's been relatively poorly handled by the medical profession for really interesting reasons. I mean there's some really good reasons why it's all happened like that. It's an area where you can make a massive difference and I always love to be able to make a difference. And I think that that's one area where there's been a lot of misinformation and a lot of failing to really validate and listen to women's concerns and address their needs. So yeah, that was probably all brought together with my interest in menopause, which started with writing the M word, which is version two is about to come out.

Mel: Oh stop! Oh good.

Dr Ginni Mansbe...: It's been a few years since the first version came out, so we just, I just rewrote it. Oh,

Mel: I have a copy of that book and I will be looking for the second version. That sounds awesome. And I will link it into the show notes as well.

Dr Ginni Mansbe...: Amazing.

Mel: For anyone that's listening, I am so looking forward to diving into all of these. 'cause What you just described was my experience. I was early on set menopause and I didn't have a clue what was happening to me. I'm pretty convinced. Perimenopause for me started in my thirties, my late thirties. And yeah, I felt like I really had to do all the heavy lifting when it came to it all, which was scary 'cause no one that was around me was talking about it.

Dr Ginni Mansbe...: Yeah. And I think the average age of menopause in Australia is 51. And we know that perimenopause starts like up to 10 years before you go into menopause proper. If you think about that, like the average woman is gonna be early forties when it all happens. It's not that much of a stretch that you'd be late thirties. Yeah. 14% of Australian women go into menopause before the age of 45, 4% before the age of 40. I mean, this is the heartbreaking thing. Wow. Before the age of 40, they're gonna go into menopause. Many of them have never even thought about having a family yet. It's one thing to go into menopause when you've had kids and then they annoy you and you're ready to sort of leave home. But another thing, if you never got the opportunity to have children and your ovaries just went, oh sorry, see-ya I'm outta here. Oh

Mel: Yeah, I didn't realize that. And again, because we're not talking about it. Yeah. Then we don't realize this sort of extra layer. Oh, I wanna rewind to periods. So when we actually have, so while we're in perimenopause or even pre perimenopause when it comes to sex hormones of women, certainly when I used to get my periods, I had raging PMT in the lead up to them. And I can see a difference now in how I reacted during that time, including how I would relate to money. Is that real? And do you think our behavior can change when we are going through PMT?

Dr Ginni Mansbe...: Oh look, we know that's the case for sure. I don't wanna traumatize anybody too much by taking them back to year nine. Science. Your hormonal cycle is designed to populate the planet and get you pregnant. So basically egg of the month gets released every month and she's meant to go off and meet the sperm of her dreams and then new little baby of a couple of cells. Big is meant to implant inside your uterus with a fresh bit of blood, waiting for it until it can grow its own placenta, which burries into your uterus and steals all your blood away. That's

Mel: What's sounds romantic need to happen. Yeah.

Dr Ginni Mansbe...: It's just so nice. And then of course, if that doesn't happen, your body goes, but wait, next month we could really get this baby happening. So out goes the old blood, in comes the new blood, and in order to shed that blood, your hormones fall to zero. That's what makes your uterus go, oh, there's no hormones there. Nothing happened. There was no pregnancy. Let's start this entire journey again. Let's give this another shot next month. And it expels the contents of the uterus, which by now we're a little bit old that blood's a little bit old, couldn't really house a new baby, incoming the oxygen's evaporated, that sort of thing. And when you've got your hormones now at zero, some people have brains that are very sensitive to those fluctuating hormone levels. So it is highly individual and highly genetic. And there are some people for whom that flat lining of hormones the few days before the hormones sets their brains off.

Dr Ginni Mansbe...: And then you can almost guarantee that when it comes to peri and your brain has previously not reacted well to those falling hormone levels, then the seesaw, the up and down hormone levels that you see during peri will have exactly the same response once again. 'cause Your brain loves hormones just to be at a steady level. Yeah. Which to a certain extent happens after menopause because you don't have much of anything. Yeah. And so while you don't have a lot of estrogen, and you might miss that in terms of not feeling as sharp and on your game as you were, you also don't have the seesawing levels. Mm. And so your brain often just coats that a whole lot better. But it's peri where you're just riding that wild roundabout of hormone levels that can really do your head in, particularly if you are one of those people who is very, very sensitive to fluctuating hormone levels. Oh,

Mel: That makes so much sense. And I feel like you've just described both my periods and my experience with peri. I guess if we think of, and I absolutely can see then how that would affect your finances because you are looking for that hit. You are in that rage. You're going for something. What can we do about it? Like how can we even that out if it's pre peri to start? So if that hasn't happened for us yet,

Dr Ginni Mansbe...: There are a couple of things that you could do. One of the options is, and I know a lot of people are like really anti it and there's too much stigma and shame about this, but antidepressant medications, if you do have terrible PMS, there's really good studies to say that it works. Now I understand that a lot of people go, whoa, that's really intense. Yeah. For something that I feel for just a few days a month and I get that. Yeah. But if your premenstrual syndrome is landing you in hot water, if it's meaning that you can't have proper relationships, if it's impairing your ability to go out, have proper friendships because you are flying off the handle and ruining friendships. If it's meaning that you are at risk at work or worse, like for your own mental health at worst, depression can be fatal.

Dr Ginni Mansbe...: If that is really having a significant impact on your health, I think you should be just open to doing whatever it takes. Now I'm gonna go really DNM here, but I have this conversation a hundred times a day with my patients. But <laugh>, I find like women are really terrible at self-compassion. Yes. So we have insane amounts of compassion for other women. Our girlfriends tell us something and we can be in tears hearing what's happening to our girlfriends and we wanna wrap them up. And we don't judge them. We don't judge 'em if they put on weight, we don't judge them if they go on a stupid date. We are kind to other people. Yeah. When it comes to ourselves, we are not kind and we judge ourselves so harshly, including if you have depression, you don't judge your friends who have depression.

Dr Ginni Mansbe...: You go, oh my God, you poor thing. Have you got an antidepressant? Do you need me to come to the doctor? Do you want me to do some shopping for you? But to yourself, there's judge, judge, judge, you're too weak, pathetic. Don't take an antidepressant medication. If you extend the same self-compassion that you have the compassion for other people, then you'll find it easier to accept help in whatever form that comes. One of which might be antidepressant medication. Yeah. There are some forms of the pill. And the idea behind the pill is that it flatlines your hormones. So again, we are really concerned about having that pill free break the sugar pills because again, you'll get your steady state for three weeks on your hormones and then boom, off a cliff it falls. But if we can take continuous hormones, we do that for women who have terrible hormonal migraines who get triggered into a migraine when they, when their estrogen levels fall.

Dr Ginni Mansbe...: We can do that as long as you're not having an aura. Aura with migraine is contraindication to build. But we can do that and we can do that for you if you're having PMS as well. Hmm. In perimenopause, the idea is actually to try and achieve steady state. But we don't do that on the whole with contraceptive pill unless you are under 50 years of age just because the clotting risk goes up. Yeah. The difference between the pill and hormone replacement therapy is that the pill is a much higher dose 'cause it's designed to stop you from ovulating. HRT does not do that. Yeah. So that's actually really quite important to know. You can still ovulate, you can still get pregnant. It's a much lower dose. But we also have body identical forms of the hormones that we use. Estradiol as it is made by your ovaries and body identical progesterone as it is made by your ovaries in the exact same levels. And they cross what we call the blood brain barrier, which is really important. 'cause They can actually get into the brain and do some beautiful magic easier within the whole space of hormone replacement therapy than with the pill that is tends to be more, we're still using the synthetic hormones with the pill.

Mel: I am so excited about this chat. I feel like the whole conversation about HRT and everything that you just said, I wish someone had had that conversation with me in my thirties. I wanna say that my experience with different doctors and HRT was, and I remember my very first doctor who was my longstanding doctor, that when I finally said, look, I think this is what's happening for me. She said, oh, well let's get your hormones tested. But of course you don't wanna get on HRT, do you? And I went, oh don't I? Okay. Sure. And it was only till a few years later that I went to another doctor and said, I think maybe this is something that I should be on. And she took one look at me and said with your bone structure, yeah, you probably should. 'cause It's more risky. Like the osteoporosis is more of a risk for you than other. And I just feel like the information I can see you shaking your head to go the misinformation around it all is so crazy. So talk to me about HRT seeing as you brought it up, like different treatments and why is there such a stigma with it?

Dr Ginni Mansbe...: Is it okay if I just go back into history please. Just for really quick to explain why doctors don't do this very well. Mm-Hmm. So back in the 1990s in America, there were very large numbers of what we call population cohort studies. So we take like everybody in the whole state of Iowa and follow them up for like 10, 20, 30 years or other really big cohort studies. And what they were noticing, and there was much more HRT use in like the eighties in America than there was, let's say in Australia. But what they found was that women who were on on HRT back in the eighties and we had some really old school forms of HRT back then, the synthetic hormones, much higher doses closer to the pill. But they did notice that those women who were taking HRT had lower levels of heart disease than the women who just never went on HRT. They decided let's run a massive trial. 116,000 women. Like a really big Oh

Mel: Wow. Yeah.

Dr Ginni Mansbe...: And we are gonna give half of them a placebo and half of them this old form of HR synthetic HRT. Yep. At an average age when they went into the trial of 63, 1 in four was over the age of 70. When they started the HRT for the purposes of preventing heart disease and possibly other chronic diseases. It was not about treating menopause symptoms at all. 'cause Most of them were over it by then. Yeah. And what they found after six years was that it did not help prevent heart disease at all. In fact, there was a group of women for whom having gone into menopause and then starting the HRT after having six or 10 years without menopause actually increased their risk of heart disease. So that was the first thing we learned, which we still, to this day, we would say, if you've gone into menopause more than 10 years ago, we can't give you HRT anymore because of that heart disease risk. Yeah. So that's a really good thing. Out of that study, the bad thing was this, for every 10,000 women who took a placebo, 30 of them developed a breast cancer for every 10,000 women who took that old school form of HRT 38 went on to develop a breast cancer. So eight additional breast cancers per 10,000 women. Yeah.

Mel: It seems like a really low percentage.

Dr Ginni Mansbe...: It really does. And if you took the group of women who started the HRT within that study, between the ages of 50 and 60, there was no increase in breast cancer. But eight additional breast cancers was enough for them to stop the trial plus futility. It didn't protect them against heart disease. But they went to the papers and went HRT causes breast cancer. Oh. Which you can see Yes. Kind of. Yeah. In older ladies who took it like 15 years after they'd gone into menopause, or 20 years after they'd gone into menopause in an old school form of HRT. Yeah. A little bit of an increase. But what we saw was 80% of women through their HRT in the bin and in America, litigation went bananas. Oh. Actual company that made the HRT that was used in that study went broke. Yeah. It got so many lawsuits and a lot of doctors were sued as well. As a result, there are now drug companies are so terrified they put black box warnings about breast cancer even though they know it doesn't cause breast cancer on every single HRT packet. And to this day, doctors stop getting taught anything about Yeah,

Mel: I can see that. Yep.

Dr Ginni Mansbe...: And drug companies went, oh, this is all too hard. We're not doing menopause anymore. We're not gonna do any research and development. We are gonna shut down our divisions of research. We're gonna stop doing education of doctors. And like it or not, drug companies pay for a lot of education for postgraduate doctors. Yep. There are possibly problems with that, but no one else is prepared to pay for it. So there you go. And it meant that we, we have now is a group of doctors who feel particularly ill-equipped to deal with this. It's not their fault. They weren't taught about it. Right. I wasn't taught anything about menopause at all. Ugh. As a result, if you have gone to your doctor over the last few years, they've got said things like, let's do a blood test. We know blood tests don't help because of the

Mel: Yeah. <Laugh>. Yeah.

Dr Ginni Mansbe...: Yeah. So because if I took your blood tests on Monday afternoon while you're in peri and do the same blood test on Tuesday afternoon, they're gonna look completely different. Which one's the true one? Yeah. I would probably need to do twice a day blood tests for the next three months to sort of get an adequate picture. Well no one's gonna do that. Oh god though. So, so we listen to you and you tell me my period have become a little bit irregular. I'm getting 'em every two weeks or I'm getting 'em every six weeks. I'm feeling really moody. I've got aches and pains everywhere. I can't sleep. I'm getting some hot flushes. My guts have gone awol. I'm feeling really tight all the time. Whatever it is, I listen to you and I go, that's peri, here it is. I don't need a blood test. We don't have a test for it. Yeah. But if we listen to our patients, we are more likely to hear what they're saying. And that is the test for peri. No blood test.

Mel: Ugh. And it's interesting 'cause I've got a girlfriend at the moment that has all the signs and she keeps coming back and going, I've had another blood test. I'm, I still don't have it. And I think that, I'm like, really? That's fascinating. I also didn't realize that there was that connection between drug companies and research. 'cause Of course if the drug companies aren't pushing that and the doctors aren't being informed, then there is a huge gap. Huge. Which yeah, there's a so many of us, A huge gap is an illness. Mm-Hmm.

Dr Ginni Mansbe...: And so many women feel dismissed by their doctors. But it's not, it would be like if you came to me for money advice, I would probably just go, oh, I don't know. Maybe go and ask someone else. I'm not trying to blow you off. It's just I don't really know anything about money. Go to Mel. It just is the way I think also doctors are really much better now at learning empathy skills, which is at least hearing and validating what people are saying to them and going, I hear you. That must be really tough for you. Instead of going, no, that does not compute with my algorithm of what happens to people at this age. So go away.

Mel: Yeah. Yeah. Off you go. Yeah. So I guess if we've said doctors aren't talking about the, or doctors just don't have the knowledge of this. Yeah. And it could start in your late thirties and you've listed a bunch of different things. They're from hot flashes to mood and so on. I know, certainly I didn't realize I was going through it. It was only that I looked back that I was like, I wanted to just, my husband sitting on the couch breathing was enough to make me wanna stab him. And I love him dearly. Hot flashes, just a tiredness when I'm really someone that worked around the clock and I just couldn't be bothered. Like there were so many things that I looked back and were so obvious and different irregular periods. I know it's different for everyone, but can you explain what perimenopause is and what we can expect from it?

Mel: If someone's listening going, maybe that's me.

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Dr Ginni Mansbe...: So the perimenopause is the period during which your ovaries are kind of planning their retirement, but they don't kind of go like at full speed and one day just go, I'm retiring. I mean some women do report that. They're like, they have a 28 day period, 28 day day period, 28 day period. No symptoms realized 12 months later they haven't had a period there in menopause. If that means you <laugh>. Yeah. I mean I haven't met her yet, but I mean they do exist. These women, I know that they, and particularly amongst like our parents generation who are like, oh, I don't remember going through anything like that. Lovely. You know, I think I've just blocked it out. For most women, their ovaries are like sputtering. They're just needing a few extra services here and there. It's like the car that you should have traded in, you know, years ago.

Dr Ginni Mansbe...: So that is what's happening to most women at this stage. And it can go on for up to 10 years. And hormonally, yes, your hormones are doing a somersault and a triple half a pike and they're going crazy and different levels seesawing all the time. And in terms of the symptoms, this is what I do for a living. And I'm telling you, I have never met two women with the same journey. Oh, no worries. It's so difficult. It doesn't make it difficult. It makes it fascinating. But what we know is that your personal history, your brain's chemistry, the chemistry of your joints, we have joint pains and swelling is a really big symptom. But it doesn't impact everyone. Some people have guts that just go off at this time. Some women put on so much weight, they pack on the weight. Some women have a whole lot of sexual problems.

Dr Ginni Mansbe...: Some women have brain fog. Some women struggle to fall asleep. But then once they're asleep they're fine. Other women are like, I crash at eight o'clock every night by 11. I'm up and completely awake. Every woman is different. And I feel like my job is to listen to everyone and to validate their experiences. And when I first started on this menopause Merry-go-round, I think there were maybe seven symptoms. We're up to 53. And unless somebody is listening and going, well that's really interesting, let's do a study on that. We would not have known that 43% of women get palpitations. Now they turn out to be benign. But if you are getting palpitations, it might not be because you are anxious. It might be because you are having heart palpitations. If you are having itchy skin, it might not be because you need to have a bit more moisturizer.

Dr Ginni Mansbe...: It might be because you're having itchy skin and menopause. And it takes doctors to listen and then go, oh we're gonna validate this by doing a study. All of this, listening openly and getting people to share all of their symptoms is allowing us to say the most recent one was chronic cough. Wow. Women who are like going, I'm coughing all the time. And it's like, we need to be listening. Yeah. And just 'cause it's not in our current list of symptoms, it doesn't mean that it's not coming. It does not mean that. So I think what I'm trying to say is, anything can happen at this time because there are estrogen receptors on pretty much every single cell in your body. From your bladder to your brain, to your heart, to your arteries, to the ears, to the inner ears. You can get vertigo to your teeth. Everything has got estrogen receptors. And it's all going to be affected by the wildly swimming hormones that instead of doing their nice 28 day dance are doing your day-to-day, dance hour dance.

Mel: I had no idea. Nutrition receptors were on everything. That is insane. So it sounds like too though, if you've gone to your doctor and said, look, these are some things and the doctor hasn't listened. Maybe it is a case of going and speaking to someone else.

Dr Ginni Mansbe...: That's a very personal thing and I don't wanna preempt that relationship, but I feel like most women go into menopause at a time. Are having a good relationship with your doctor and finding your person in the healthcare space is really important. And also we have rural and regional sisters who let's be honest Yes. Don't have a lot of options. Yeah. So if you can bring them to the table Mm. With the person who knows you, who you trust, who has been with you on your health journey and is going to continue to be with you on your health journey, that's ideal. Right? Yeah. If you can do that, what I'd rather do first is maybe go to the web and download a perimenopause symptom checkup. Yep. And fill that in and take them with you. Yeah. Perfect. Particularly if it's a validated one. And I live in New South Wales and the New South Wales government put together a symptom checkup.

Dr Ginni Mansbe...: But there are a few Right. That you can go. And that would be, I guess let's try that. Because if that can work for you and they already know everything else that's happened to you, that would be great. And they might be really grateful and go, you know what, thank you so much for bringing this to my attention. I feel like I've got a lot of reading to do. And I say that to today, patients all the time doesn't mean you're a terrible doctor, it just means that you don't know everything. 'cause You're not God. And that's cool, right? Yeah.

Mel: Yep.

Dr Ginni Mansbe...: But some doctors are like, they're too busy. They've got so much on their plate, they're really into sports medicine. They're not interested in picking up a new skill in women's health, which I completely get whatever is going on for them. Yep. Or you might have gone, you know what, I don't really love that doctor anyway. Like that was just sort of

Mel: Yeah, now's the time. Yep.

Dr Ginni Mansbe...: Now's the time to find your person. Yeah. And there are different ways of doing that. The Australasian Menopause Society has a find a Dr. Page, I think it's menopause.org au. And there's a Find Dr. Page. Maybe we can link to that in the show notes.

Mel: I will definitely Yep. And

Dr Ginni Mansbe...: You type in your postcode or even by your state. But one of the things that a lot of people don't realize is that Medicare, you know how they won't give you a telehealth rebate unless you are attached to a practice And if you haven't been for 12 months, they cut it. Mm-Hmm. <affirmative> not for menopause.

Mel: Ah, interesting.

Dr Ginni Mansbe...: Yeah. So there's a particular item number that doctors in the know use. Yep. So you can, and rural and regional patients get higher rebates, higher Medicare rebates. So they're not gonna be that much out of pocket. I see a lot of women from Queensland, for example, Northern Territory because they haven't found their person yet. I do encourage them, like I've got my we call them the peri posse, but like all the doctors that I know across New Zealand and Australia and I'm like, like you're in Perth. I've got the girls for you. You can go see these ones. But like while they're trying to find their people, they can certainly start by coming to see someone like me. Or there are lots of doctors who do telehealth. There's a whole network of doctors called welfem and they just do telehealth in that perimenopause space. But then they won't look after you for everything. They're just gonna do your menopause, write a letter to your GP and send you off. Yeah. But I think that it's a good place if you think, oh my God, I can't go start again at the beginning with a new doctor. Yeah. Try another 10 doctors to find my person. Maybe just get yourself treated temporarily with somebody who knows what they're doing in perimenopause. Get 'em to write a letter, send it through to your doctor. That's

Mel: Such great advice. 'cause It is really difficult when you're trying to navigate it. And I feel like there's so much time and money that you spend trying to navigate it. So that's fantastic. And

Dr Ginni Mansbe...: Can I just touch on your bone thing? 'cause This is actually really important. Yeah. Two years before you go into menopause, you start to really lose bone density. And then after menopause the first two years your bone density really drops quite substantially. And yet Medicare does not provide a rebate for a bone density scan until you're 70. Or unless you have one of a number of particular conditions. Rheumatoid arthritis, celiac disease for example. Mm-Hmm. <affirmative>, a bone density scan is just over $50 and it takes about 10 minutes. You are fully clothed. You line a bed, they hold a camera over your back, one hip, two hips, that's it. It takes like 20 minutes maximum from checking in at reception to being out the door. And I don't believe having been in this game for a long time and I order bone densities on absolutely 100% of my patients, even if I think they're towards the end of perimenopause as well, just to see whether they're at, because to see whether that can really inform your decision around whether you're gonna go into hormone replacement therapy or not.

Dr Ginni Mansbe...: 'Cause It's a really good treatment for low bone density. And we don't have a lot of other treatments unless you've had a fracture or are over 70. The PBS does not fund treatments for full blown osteoporosis unless you've either had a fracture or you're over 70, but HRT it will fund. So it's a really good thing to sort of think about in your decision tree about how you're gonna live your life. I'm telling you, Mel, I can't spot someone from the end of the bed and tell 'em that you've got osteoporosis or you don't. Yeah. I had a meeting with three women yesterday that I had sent off for bone density scans. There's like a stereotype that little birdie women that are really skinny have got osteoporosis. I had two women with quite major obesity who had osteoporosis and nasty osteoporosis. Like they had lost a lot of bone density. And another woman who was fit and muscly and is a dance teacher.

Mel: Oh wow.

Dr Ginni Mansbe...: So she's very active and she had osteoporosis, like full blown osteoporosis. And then there are women who look like you and are tiny and their bones are fine. My bones are amazing. And I have a condition called hyper parathyroidism where my parathyroid overactive. I can't pick it by looking at someone from the end of the bed. And I don't want anyone who's listening to us to go, oh, if I'm little and tiny, I'll go and get a bone density but otherwise I won't. Please go and do it because I can't pick it. I similarly can't pick it. Who's gonna have a cholesterol that just goes, jumps up to 7.9 the minute they go through through the other side of menopause and who stays at 4.5? I can't pick it. And we have to take everybody's health seriously and start at the beginning and screen you for everything. Because you are now in midlife. I do need to see your blood sugar. I do need to see your cholesterol. I do need to take your blood pressure. I do want a bone density scan because I'm not gonna be clouded by the person that I'm looking at in front of me with all of my biases in there. It doesn't work.

Mel: No. The words brain density scan have never been utter to me. I've just written down as a, I'm doing that in the next month. And my husband's a physio, he's been on me for years. You've gotta start lifting heavy weights. I know I'm on calcium, but no one has said, get a brain density scan.

Dr Ginni Mansbe...: You don't need to get on calcium. There's, oh my gosh, it's the calcium supplements. So there's a really good evidence that if you go into a nursing home, so if you're an institutionalized person over the age of 65 Yeah. That you are very likely to have an osteoporosis related fall. And that calcium supplements reduce the risk of those osteoporosis related fractures. There's no evidence for you and I, ideally, we'd like all of us to have a balanced diet and ideally we'd like to get our calcium from calcium rich foods, which part to the dash diet, which reduces your risk of heart disease, dementia, and high blood pressure. So we want you having calcium rich foods. If you are the sort of person who is dairy intolerant, doesn't like any dairy foods or any substitute foods for dairy and who doesn't like any seafood for example, or almonds or tofu. If you are a total fuss pot, I would go and see a dietician and if they think, oh my God, I just cannot work with you, then they'll put you on supplements. But most of us, the supplements are not required. But in terms of what exercise to do, I am going to support a particular exercise plan Please. And it's developed by Belinda Beck out of Griffith University. And it's been validated in randomized controlled trials. And it's called Onero. O-N-E-R-O.

Mel: Yep. Link that one up as well

Dr Ginni Mansbe...: There are quite a few accredited physios who do the O program. Yep. And it's what we call high intensity strength training. There's a lot of jumping, there's a lot of kettlebells, there's a lot of high intensity strength training. There is an online program which they have not validated with clinical trials. Only the in person physios can get accredited. And that one not only reduces osteoporosis fractures, which is the first time a non-drug intervention ever has reduced osteoporosis fractures. Wow. But it also improves mood, it improves hot flush frequency. It helps you with weight, it helps with cholesterol and heart disease. Like it is a validated exercise tool that is so incredible that I send every one of my women who go into menopause to go and do a course of onero because my local physio charges $10 a class.

Mel: Wow. That's so good. Yeah,

Dr Ginni Mansbe...: It's amazing. And also you're going and it's all other menopausal women Yeah. Have lost density. So it's just like, it's a group of like-minded chicks. Yeah. A lot of my patients end up going out for dinner afterwards or going out for wine afterwards. So it's a really, good way to go

Mel: I love that.

Dr Ginni Mansbe...: And if there are any other physios listening to us go and get accredited. Yeah, please. Everybody should be doing it.

Mel: It's really interesting because I feel like when it comes to money, there's so many myths and biases that I call BS two. And today when we've been chatting, I feel like you have been doing the same. It's like, oh yeah. Not that. Oh. Oh yeah. Not that when I was doing my research, the menopause market's been valued between $150 and $600 billion. Mm-Hmm. <Affirmative>. Which means it's big business to treat the symptoms of women who, like myself. I remember when I looked at the first blood test that my doctor did, which I look back now and after this conversation and go, it was a waste of time. But I burst into tears 'cause I was in my mid forties and I was so ashamed that I was suddenly middle aged. And I'd never occurred to me that I was Can you talk to me about that and the issues that you are maybe seeing with that and how we are being preyed on them, maybe what we should be listening to and what we shouldn't be listening to? 'cause I know I've overspent on things that like everything from yam creams to what <laugh> you where I go, what a waste of time.

Dr Ginni Mansbe...: I have a real problem with the meno-washing that's happening now, interestingly, in 2013, the North American Menopause Society did this massive meta-analysis of complimentary and alternative therapies for menopause specific symptoms. So we are not talking about insomnia or anxiety or things like this was a menopause specific meta-analysis. And actually did find a little bit of evidence for a couple of complimentary and alternative therapies. And then in 2023 they went back and did it again and went, there's not one for which there's evidence. Oh

Mel: Wow.

Dr Ginni Mansbe...: If you think about the size of the supplement market alone, it is huge. And my concern is that you put an M on it and put a pink label on it and you're charging a lot more.

Mel: Because people are desperate. Yep.

Dr Ginni Mansbe...: They are desperate. And that's on us as doctors. Yeah. Because I think we're not meeting their needs and they get into communities. But my concern with that is, remember how I just said before that if you delay your treatment for too long, you can't have it anymore because of the risk of heart disease. Yeah. Studies have found up to 75% placebo effect in a lot of different menopause supplements, which is really interesting. Mm-Hmm. And oh my god, if a placebo works for not a lot of downside, I'm there. I'm there for that. In my experience, the placebo will last between six and 12 months and my rooms are full of women for whom their supplements have stopped working. Yeah. And they've stopped working because the placebo effect ran out. Yeah, that's okay. As long as it hasn't pushed them to the point where now they can't have HRT or something that really works for both their bones for cardiovascular protection, for prevention of dementia, for prevention of osteoporosis fracture for prevention of bowel cancers.

Dr Ginni Mansbe...: Which it does. And not to mention all the symptom control for which it is the gold standard. There are many women who, for very valid reasons are gonna choose not to go down that path. And that's totally fine. They are gonna need to find other things. Mm-Hmm. But at this point, my concern around paying $80 a month for supplement X and then a hundred dollars a month for supplement y, often on a subscription basis. 'cause A lot of these things are run through communities that are on subscription basis. Mm-Hmm. <affirmative>. That is concerning to me. Yeah. The other area that's really close to my heart is skincare. So I've seen a plethora of menopause specific skincare brands come to market. And we know that after menopause you lose 30% of your collagen in the first five years and then you go on to lose a further 2% per year for the next like 10 years.

Dr Ginni Mansbe...: Okay. Yay. And 70% of women report that their skin becomes more sensitive. So there are things that you used to be able to handle that you can't anymore. But I just wanna ask the menopause skincare companies, what would happen if a premenopausal woman put that stuff on her face? Would a face fall off? Or if a man put that stuff on his face, would his face fall off? I suspect not because the things that build collagen build collagen. Mm-Hmm. <Affirmative>. There is evidence for them. And I've looked at the ingredients, a lot of these menopause specific menno washed skincare brands that have got nothing specific to menopause. In fact a lot of things that they're using are seventh rate, eighth rate collagen building ingredients for which there is not a lot of evidence, but they've just spied an opportunity to prey on vulnerable women who can see their collagen disappearing before their eyes.

Dr Ginni Mansbe...: Yeah. They can see their skin is like, ah, yep. That would be able getting fine. Yep. We're all on zoom going, oh my god, do I really look uhhuh that bad, urgent, urgent menopause skincare, type it into Google. Oh here comes something that I can use. Mm. They are absolutely ripping you off. And I get quite upset about women being ripped off because this is coming at a time where studies show us that, and these are UK based studies, but 10% of women will quit their job. Now of those women, 60% of them will go and find some other job, but often at a lower paying job or a less pressured job 'cause they feel like they can't cope. Yep. They feel like cognitively they're just not up to the task anymore. They're having fights. They hate everybody at their workplace 'cause one in three have a mood disorder and they get pissed off with absolutely everybody.

Dr Ginni Mansbe...: And now they're having big fights with their bosses and they storm off and they quit. There'll be 4% of women who just are now out of the workplace. There are an additional, apart from the 10% who quit, there's 14% additional who either go part-time or just drop their hours quite significantly. And that impacts their superannuation as well. Yep. And then you've got an additional 8% who either ask for a demotion or avoid a promotion. Again kneecapping themselves financially. Yep. And what we're seeing is that women are already retiring with a lot less super mm-Hmm. <Affirmative> than men. And not only that, they haven't got the savings 'cause they were not able to save while they were working. Forget the superannuation. Yeah. They were not in a position to say, I'm earning a hundred thousand, I need 50,000 to survive. I'm gonna go buy an investment property.

Dr Ginni Mansbe...: They're not doing that. They're earning 50,000. They need 53,000 to survive. So they're tapping into their savings all the time. Mm. And this is what's happening to women. They are the least capable of the ones with the worst menopause symptoms are the ones who are most likely to be tapped on the shoulder by these predatory companies and also the most likely to be affected financially. Yeah. By what's happening to their, to their bodies and minds and spirits and socially. And it's the peak time for divorce as well. So then they build dealt another blow because these women now they were living in a nice house, now they're paying rent on an astronomical apartment that they can't afford. Everything is culminating at this time in their lives where they can least afford to be ripped off. And it's most unical to rip off women at this time. And that's why I don't wanna sound like I'm standing on my high horse too much, but it's just unconscionable conduct really.

Mel: Oh no, I actually love your passion for it. 'cause I feel the same. I feel like there is a predatory behavior that's happening. And you're exactly right at a time when women can least afford it. We should be building at that age, especially when there we already have deficit and lack because we've got those super balances, et cetera that are lower and yet we are not, because we are overspending and we're dropping down dollars and time. It makes me so cranky.

Dr Ginni Mansbe...: And let me give you an alternate vision. Please. Instead of being off with everybody and dropping out of the workforce and getting divorced. And I'm not saying you don't get divorced 'cause he might be a real dick. But what if instead of that you've got great treatment for your perimenopause symptoms, you are now not anxious, you're not depressed, you don't have the aches and pains, you're actually getting some sleep. Your brain fog is evaporated. You are not having embarrassing hot flushes all the time. Now your career is soaring. 'cause You're just going to the top of the pops and now you're being offered a promotion and your superannuation balance is just going up and you're going, you know what? I've never earned this much in my life. I'm gonna go and look at some shares and I'm gonna go and be subscribing to Mel's podcast and by the end of this year I'm gonna have $50,000 saved.

Dr Ginni Mansbe...: Wow. What a different world that looks like. And you know what? You don't even need those supplements then because you are totally fine. My passion is to say, say, Hey girls, don't put up with this. Like, do not put up with your body letting you down at this time because the treatments that we have are amazing. And you can have everything that you had in your thirties only with the wisdom, with the sense of self, with the not take. You don't take prisoners anymore. Like you have got that corporate knowledge. You've got the experience, the wisdom, the connections, and you can really take on the world now as long as your body's not holding you back. So go and get treated. Oh,

Mel: I love that so much. Because exactly what you said, I listened to a podcast recently where they said it was a doctor, a GP that said she's seeing patients after they've gone through menopause, they've looked back and they've sold businesses, they've quit jobs, they've left marriages. And they're looking back going, I wouldn't have made those decisions if I felt like this today. So that call that you just did to go and get treatment, listen to your body and go and get treatment because you may not be making the decisions that are going to impact you so financially and so emotionally in the rest of your life.

Dr Ginni Mansbe...: And again, I'm gonna come back to that self-compassion. Mm-Hmm. That you deserve. Yeah. To have a great career, you deserve to have a great marriage or a great relationship. You deserve to have money in the bank and investments and to retire well off. You do deserve that. But you need to pull out the self-compassion. And if you think I'm talking BS self-compassion has actually been studied and it has better cardiovascular outcomes, less dementia for women who have self-compassion. So go and Google, Kristen Neff, NEF. She is one of the major researchers into self-compassion. She has YouTube videos. It can be taught, you can learn to turn the way you feel about others towards yourself. You can direct that compassion towards yourself so that you believe that you are worthy of going and getting this treatment and turning your life around. I'm the doctor, I'm telling you we can fix you now.

Dr Ginni Mansbe...: You need to believe that you deserve to be fixed. Because if you are so down on yourself and mean to yourself, you won't feel like you deserve to be fixed. And you're just gonna keep putting up with it and instead your wife's gonna cheat on you or your husband's gonna cheat on you with somebody else and you're gonna feel terrible about yourself. And you're gonna say, well I'm so ugly. I'm so horrible. I'm so dumb. I'm cranky with everyone all the time. I deserve it. And then you're gonna quit your job and it's irrevocable at this time. Get yourself fixed.

Mel: Thank you so much. I just feel like that is like a call to action for so many women that with everything that you've said today that we don't wanna just spend money willy nilly on something to put bandaids on. Actually go and and seek treatment for that. So I'll link menopause.org au. I'll link symptom checkers, onero Kristen Neff. Is there anything else or any other practical tips or places to go for more information for people that believe they're starting or going through.

Dr Ginni Mansbe...: The new version of The M Word,

Mel: Absolutely.

Dr Ginni Mansbe...: Which has just come out with lots of workplace stuff in there as well.

Mel: You've got a skincare brand as well that is particularly for menopause woman.

Dr Ginni Mansbe...: No, it's for everyone because there is no such thing as skincare for menopausal women. I love that. That I have put together a menopause kit, which is looking at the most how to build collagen in. That's the one I look at. Sensitive skin. Yeah. But you know what, if you're 30 and you've got sensitive skin and you wanna build collagen, you could use the same thing. It's totally fine. Nothing's gonna happen to your face. It's not gonna fall off because it's not menopause specific skincare is just evidence-based. So it's ESK care. So evidence skincare.com, that's again one of my passions and don't sweatit.com au, which is my Menopause in the Workplace company, our aim is to keep women connected to their workplace and empowered and with choices so that companies don't lose their best people and their mentors and their leaders. And so that women don't lose access to a, a good financial wellbeing as they move into the next phase of their life. It's a win-win.

Mel: Yeah. Perfect. Thank you so much Ginni for this conversation. I really appreciate your time. I will put all of those links and resources, et cetera in the show notes.

Dr Ginni Mansbe...: Thank you.

Mel: If you enjoyed this episode, we would love it if you subscribed and give us a review, then make sure you come and play with me on Insta. I'm at @melbrowne.money Remember there's an E on the end of Browne. I'm one of those fancy Browne's, and don't forget to check out the show notes for even more ways you can work with me to transform your finances.



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