Kathryn:     Hi there everybody and welcome to the ISC podcast – well, webinar on the menopause which is something that we’re wanting to focus upon today.  I mentioned podcast, it’s also going to be going out on my podcast if you want to catch up on it at a later date and we’ll share it with anybody.

So the thing that we’re wanting to do today, as I say, is to really focus upon the menopause and we’ve got some expert speakers on the panel today and what we’re wanting to do is really kind of break the taboo when it comes to menopause because it’s one of those things that – I’ve not reached menopause yet but I do have – my Mum who is going through it.  She’s going through a late menopause at the age of 66 and I have my mother-in-law going through it who’s in her early 50s and it’s something that really before they’ve gone through it, I kind of – I know about it and I know that there’s those kind of situations where I think in my mind the first things I think about are the fact that – well one, I’ll stop having periods, that I’ll possibly put weight on, that I may need to take something known as HRT but I don’t really know what that means and from speaking to different people.  I know that there is a lot of things that I simply don’t know about which is really strange because it’s something that all women are going to go through but it just seems to be something that we don’t really discuss too much.

So what we’re wanting to do today is provide some insights into kind of the medical background side of things.  So to be clear, nobody on the call is a medical professional but we do have some people who do have some expertise and have been able to get some pointers in the right direction in terms of things that we would need to know.  And we’ve also got some lived experiences from people on the panel and they’re going to share what they’ve been through ‘cos as with anything, everybody is different.  Symptoms can be different, the way that we’re able to react to the changes will be different and it can come to things that are different in terms of what it’s been like with our employer, the way we experience it how we work can have quite a significant change on how we’re able to react to those changes.

We’re also going to be discussing things like how to approach these conversations with people if you are in financial services and you’re supporting a client and they happen to be going through the menopause, possibly some additional considerations that you need to have when you’re having those conversations and then kind of naturally how this would then potentially flow into other areas such as your own workspace, whether or not that’s for you or potentially supporting a colleague who is going through the menopause and then also in terms of family members and friends.  As I say, it is something that we’re all going to be facing at some stage. So the first thing I want to do is ask everybody on panel to introduce themselves, just give a little bit of background as to who they are and to why they’re joining us on the session today.  So Sian, if I can ask you first please to introduce yourself?

Sian:           Thank you very much, Kathryn and good afternoon everybody.  I’m Sian Fisher.  I happen to be the current CEO of the Chartered Insurance Institute.  I’m also a longstanding friend and colleague of the ISC and Barbara and also of Johnny Timpson so when I was asked to do this obviously I was very keen to see if I could help and in common with most women of my age, so I’m in my late 50s – I’m actually experiencing the menopause first-hand so it – as Kathryn said, it doesn’t seem to be something that people are comfortable to talk about but it is a fact so let’s get on and talk about it in my view.

Kathryn:     Fantastic.  Christine, can you please introduce yourself?

Christine:    Yeah.  Thanks Kathryn and good afternoon everybody.  I’m Christine Husbands.  I’m the Managing Director of Red Arc Nurses who you may or may not have heard of and we provide value add services to a wide range of organisations including many protection insurers.  Like Sian, I’m late 50s and I’m also going through the menopause so I’ve got a lived experience of it too.  I’m not clinically trained even though I do head up Red Arc but I have gained a lot of knowledge from the nurse teams that I work with that hopefully will be helpful insights during the course of the next 45 minutes to an hour.

Kathryn:     Thank you Christine, and Helen, can you please introduce yourself?

Helen:        Yes, thank you Kathryn and yes, good afternoon everybody.  My name’s Helen Dick.  I’m the Senior Manager of Underwriting and Claims Strategy at Scottish Widows and as my title suggests, I’ve been invited along today to give an underwriting view on the menopause and symptoms associated with it and also from a personal experience, having come through it, I’d be happy to share some of my experiences with you all as well.

Kathryn:     Thank you everybody, and just for everyone to know as well, so I’m Kathryn Knowles.  I’m the Managing Director at Cura Financial Services so we are a financial – well insurance broker firm within the protection space.  I’m an adviser there.  So one of the things I really wanted to start off with possibly in the conversation – we’re going to quickly go into the chat because I know that everybody on panel has a lot of experience and thoughts to be able to share with everybody and we do only have 45 minutes before we’re going to be going into the Q&A so please do send us in any questions that you have or any thoughts that you have that we can potentially discuss towards the end.

So as an example, when we’re sort of looking at things when it comes to the menopause, when we’re looking at the statistics, there’s about 13 million women in the UK that are currently experiencing some form of – some stage of the menopause and experiencing the menopause symptoms.  So that’s a really lot of people and for myself, when I think of that from an advice point of view when I’m speaking to people, that’s obviously – half of my clients are women in any case but that’s a lot of people that are going to be engaging with our services who are going through the menopause and there’s quite a few considerations that we maybe need to look at when it comes to the symptoms that might be being experienced.  As I say, everybody is individual so we just – we never know but when you look into things, about one in four women are going to be experiencing significant menopausal symptoms that are going to be impacting upon things like their ability to work, possibly their home relationships and maybe also their understanding of financial services and different decisions that they are making.

Something that I found really interesting as well when I was looking into it – well I say interesting but also quite sad, is in some of the research it shows that about 72% of women feel that they’ve been unsupported by their employer when they’ve been going through the menopause and for me as I’m sure everybody on the panel will say and for the majority of people who are listening, that’s just not okay to have almost three quarters of women feeling as if they’ve not had support when it is something, as I say, that all of us are going to face and it really shouldn’t be the case in sort of like modern times that we are not having an environment where people can feel that they can just go through a natural stage in life and be fully supported.

So one of the first things that I think would be really useful is to chat to you, Christine, and to get a bit of a background as to what the menopause is ‘cos I think, you know, bar the aspect of me knowing – okay, so it means that I’m not going to – so no more periods, no more children now, I don’t know much about it so can you please enlighten us a bit?

Christine:    Yeah of course.  So as you said, Kathryn, menopause is the point where a woman no longer has menstrual periods.  For most women, it’s between the ages of 45 to 55 and I was spot in the middle – I think I was aged 50 which is probably the only thing I’ve ever done on time in my life, but there you go!  But at this stage basically the ovaries have stopped releasing eggs and producing most of their oestrogen and actually menopause is actually diagnosed when a lady has gone without a period for 12 consecutive months.  Some of the common symptoms – and I have to say, you know, some people have very few or very minor symptoms and others have very extreme, you know, some of the common symptoms are of course hot flushes, night sweats, things like recurring UTIs – urinary tract infections, mood swings, fatigue, hair loss – certainly hair thinning, I’ve experienced that.  Sleep disorders, difficulty concentrating which is one of the ones that Kathryn alluded to in terms of understanding, memory lapses, dizziness, weight gain, incontinence, bloating, allergies, high heart beats, depression, anxiety and the list goes on.  But there are some quite unusual ones – things like itchy skin and a propensity to electric shocks and of course there’s also the very personal and intimate effects that ladies can experience which can have a significant effect on their relationships and therefore their wellbeing as a whole.

Some symptoms can be really difficult to manage, I’m sure you can appreciate that from some of the ones I’ve just listed and I haven’t listed them all.  Hot flushes are probably the most commonly recognised ones.  You’re going through the menopause, “Oh you’re having hot flushes,” and actually they can be really, really embarrassing and often the butt of very bad taste jokes.  As a lady working with men, not just men though to be fair, not just men but, you know, it can wear a bit thin and you can get a bit fed up of smiling and laughing when they’re actually having a go and making light or making fun of your predicament.  And some ladies – I mean I was quite fortunate, I just got very hot but some ladies can really excessively perspire – excessively and it can be really, really embarrassing and a little tale that a lady told me recently is a lady who worked in a personal capacity with people using both hands and she said, “You know, when a hot flush comes and I’ve got both hands working with my client and the perspiration is pouring down my brow,” she said, “It’s so embarrassing, you feel so bad about it.”  It really does knock on your self esteem and your professional capabilities so you can understand the difficulty but fortunately I wasn’t that bad and still am not but it can be really difficult and, as I say, if you are sweating excessively, not good at all.

On average, the menopause – the symptoms of the menopause last about four years but about 10% apparently last up to about 12 years and then the stage before the menopause, that’s known as peri-menopause and that can begin eight to 10 years before the actual menopause which is 12 months without a period.  So it’s as the body is winding down in terms of producing eggs and at that stage people can start – women can start to experience menopausal symptoms but they’re still having a menstrual cycle and they can still get pregnant so it’s kind of being careful to know that you’re actually in the menopause or not.  So that’s a bit of a snapshot of what the menopause is and what the key symptoms are and hopefully that –

Kathryn:     Yeah, that’s really useful thank you and I think it kind of – part of that hits home to me as well in the sense of my – as I say, my Mum is going through things and she had this very, very long time period that the doctors were kind of like, “You’re going through menopause,” and she was like, “Oh, thankfully,” and then she’d have another period.  She’d maybe gone nine or 10 months and then she’d suddenly have another one and it would be a case of, “Oh back to square one, when will this ever end?”  She just kind of – she was just really, really wanting it to happen after quite a while.

And another thing for me is that sometimes – imagine the hot flushes again are quite difficult, definitely from what you were saying Christine, but on the basis that – I know with my Mum with her being in her 60s, she doesn’t feel like she can wear a strappy top, you know, she just doesn’t feel as if strappy tops are her kind of wear and she probably wants to wear something with a bit of a longer arm and I’ll sometimes say to her, you know, “Well Mum, if you’re getting really hot, why don’t you put a strappy top on or something?”  And she’ll be like, “No, I can’t.”  And I think that also doesn’t help the situation that she doesn’t feel comfortable to necessarily be wearing the same kind of clothing that somebody maybe younger than her would be wearing and I know that that’s possibly happened to my mother-in-law too.

It would be quite interesting to now move over to your sort of like knowledge and experience, Helen.  I know obviously you’ve said you’re going through it yourself but coming from the underwriting side of things in the insurance space, you obviously have a lot of knowledge in terms of the medical aspects of what’s happening to people as their bodies are changing and how that can also have an influence in terms of the insurances that people can access?

Helen:        Yeah sure, thanks Kathryn and thanks Christine for that insight as well.  It’s really useful to hear it all and just people talking about it quite naturally and especially when it’s so personal and we’ve been through it ourselves.  I mean, if I can start off just by saying my own personal experience was probably very fortunate because I didn’t experience many of the symptoms – certainly none of the severe symptoms and I think the – certainly the hot flushes definitely.  I recall having to run out in the garden and just cool down in the cold air outside because I thought my whole body was on fire so it’s things like that that you think, you know, people think you’re mad.  “What are you doing standing outside in the freezing cold?”  But it is things like that that it makes you do to try and get some relief from it but apart from that, that was probably the main symptom that I experienced and it was very lucky that, you know, it didn’t last very long with me, maybe two or three years at the very most.  So by my mid-40s, I had come through it really and was probably one of the lucky ones I would say in that respect.

But putting it into a bit of an underwriting context, yeah, it’s one of these things that doesn’t really – I mean it’s good news really for people looking to take out protection insurance ‘cos it doesn’t really impact the underwriting terms that we can offer.  For example, our application forms don’t specifically ask about the menopause or any specific treatment in that respect.  What it can be disclosed by is if someone is having severe symptoms and they’re maybe undergoing some investigation or maybe they are taking treatments that they will disclose that under those questions on their application forms.  But to support that, our electronic underwriting rules do actually cater for those disclosures and around 95% will get standard rates without, you know, very many questions being asked.  It’s mainly that the 5% where there maybe is investigation or there’s been an early hysterectomy, you know, that’s causing concern or maybe something else a bit more sinister going on.  So it’s those types of cases that we would look at a bit more closely however I would say it’s still very rare to actually go out and ask for medical evidence for those types of cases.

I think probably one of the main risk factors that we’d look out for would be a connection with osteoporosis which is basically sort of brittle bones, you know, your back starts to give way.  I’ve got a cousin that’s suffered really badly from that, having come through the menopause – her osteoporosis got much worse and she’s had two fractures in her spine as a result.  So it’s those kind of severe types of conditions that we would look out for from an underwriting point of view, particularly from a life and critical illness point of view for sure.  Anxiety, depression can be a factor again as well but that tends to be, you know, less severe and types of conditions – more anxiety and maybe with a little bit of depression but even for mental health disclosures of that kind, you know, our own stats at Scottish Widows that I can refer to here, we certainly can still get offered terms to customers of – around 75 to 80% still get standard rates for those disclosures on their own.  So it’s a consideration but it’s not a big impact certainly for someone in the menopause in isolation.

So I suppose in summary what I’m saying is, you know, the good news is for protection insurance – it is good news, you know, you can apply for it, don’t be frightened to disclose the information.  If your application does ask questions that you feel you have to answer in the way that’s connected to the menopause, do it because it’s not going to impact, you know, be reassured that that’s something that we can certainly look at but, you know, as I’ve said, high percentages – 95 at least in our experience anyway from our own data would be given standard rates for both life and critical illness cover.

Kathryn:     I was going to say, especially when we’re talking maybe like about the anxiety and depression side of things when it comes to the insurance underwriting, I think there can sometimes be quite a misunderstanding a lot of the time as to what is going to be available and certainly from my experience as an adviser – essentially sort of like the milder anxiety and depression are probably not going to have a significant influence with most insurers when somebody is going for life and critical illness cover.  Just to clarify one little bit there though Helen, so with – if somebody was taking HRT, is that something that would be coming up in the questions set in like the, “Have you been prescribed something in the last four weeks?” kind of questions when we’re looking at these protection insurances?

Helen:        They can do.  If a customer did disclose that as a treatment that they were on, we do have our electronic rules to cater for that as well and again it’s one of those rules that we pretty much give standard rates every time so unless somebody’s on HRT at a very young age for a different reason then it would take it down a different route but if you’re on HRT because of the menopause then you’re going to go through at standard rates.

Kathryn:     Okay, thank you.  And Sian, I think we’re going to come to you now for you to give your experience of what it’s been like and what it is like at the moment to be going through the menopause.

Sian:           Sorry I always keep my thing on mute because sometimes you get a sort of feedback from when you’re doing these things don’t you?  So I suppose there’s two perspectives for me that have been interesting.  One is my own personal experience but the other has been the big program of work that the CII has kind of sponsored and which some of your companies have actually been involved in which is called Insuring Women’s Futures.  And if I just said, the thing that’s come out most starkly from that whole program for me is just this realisation that there just is a different life experience for men and women.  It’s not right or wrong, it’s not judgmental – it just is a fact.  Women do, you know, women are designed to have babies and men are not and that does actually make a difference to the lived experience of men and women and strangely we still seem reticent to just accept that, you know, gender in itself is actually an amazing biological fact and it applies to almost everything.

It’s, you know, if it’s atoms, if it’s birds, it’s everything.  There’s gender in everything.  There’s male and female and positive and negative, there’s yin and yang, whatever you want to call it so it’s an absolute natural phenomenon and somehow in our sort of human society we’ve managed to attach all kinds of negative connotations – whether they’re humorous or otherwise to the female lived experience and, you know, I think things are changing significantly and we’ve got the opportunity to talk more openly about all kinds of things.

I mean, mental health just generally within this category – I mean, my darling Mum is living with dementia.  I mean, nobody – I mean my grandmother probably died from dementia but we never talked about it.  At least with my mother it’s probably openly recognised and we can even talk with her about it.  I mean, that would never have happened in the past and I just get this feeling that a few things are left which are quite difficult still for people to talk about and if the Insuring Women’s Futures program showed up anything, it’s like, “Don’t feel like that.”  You know, the fact that there are two genders – we are two genders and there is a very good biological reason for why women are the way they are and that is not a negative thing.  You know, everyone wants to have babies – men want to have babies so there are two genders for that reason and we have to understand what those differences of lived experience are and adapt our worlds for that, not be hyperjudgmental about one set of lived experience and penalise for that set of lived experience.

So I think, you know, that just came out very strongly from that program and really how unnecessary that is because if everybody understands and everybody is open, what’s the problem?  You know, it’s a fact so we have to acknowledge it.  So from a personal perspective, you know, I’ve had an interesting family experience so my mother was very fortunate that she never had – ‘cos I don’t know whether the menopause is linked in any, sorry, I don’t know whether your experience of the menopause is linked at all to your earlier experience.  I’d actually be interested in Christine’s view on that.

So I suffered from PMT I suppose is what it was and again, because of my age, that was not something that was very easy to talk about and eventually I found a kind of way through it by taking the pill which helped me but nobody ever really explained that to me.  It was just something that kind of seemed to work better than other things and so I took the pill for 30 years like we all do and then actually I don’t know whether it’s connected to the pill, I suspect it is, a lot of women of my age who have taken the pill all their life now have fibroids.  The medical profession is not that comfortable with fibroids.  They don’t – I know they know what they are etcetera but they’re not comfortable with them and therefore the usual solutions, so that means a hysterectomy – there doesn’t seem to be a lot of other options that are liveable with so there’s an awful lot of women of my age who are also having hysterectomies which is another thing which is not openly acknowledged and is not talked about.

I think people would probably be quite shocked if they realised how many of their colleagues were actually going and having a hysterectomy as well.  But what that can do is also bring your menopause on kind of quite suddenly – I suppose is the right way to put it and again, you are told but there isn’t a lot of discussion about what that means and what might happen and so, you know, that is quite a shock when you’ve been, you know, just feeling in yourself, you know, fit and healthy and normal and then suddenly, you know, you have a hot flush because people talk about it as a hot flush but boy oh boy, it’s a very, very odd experience – extremely odd experience and as the ladies have said, you know, it can be better or worse.

But just picture this, you know, my job is quite a sort of public job and I spend an awful lot of my time doing stuff like this and the very first major speech I had to make as the CEO of the CII – and, you know, it’s quite a complicated topic I was talking about and I hadn’t long had my hysterectomy and suddenly I just had the most incredible hot flush experience.  Now, I got through it and I’ve learned some sort of techniques of, you know, to deal with it but it wasn’t something which I felt that I would be able to share or to think about how I could be helped to manage that or whatever ‘cos it’s, you know, again, it is something where everybody is just like, “Don’t talk about that, just get through it.” And I just feel it would be better for people coming – like yourself, Kathryn, younger people coming up behind if there was, you know, if there was a more open – even if humorous acceptance of it but – and something where women themselves felt able to help each other in terms of talking openly about it and it wasn’t something that was maybe such a taboo.  So I totally – I’m with Helen in terms of some of her friends that she’s saying it can be quite an extraordinary experience.

Anyway, I appear – I’m hoping, Christine, I’ve got my fingers firmly crossed that I think I’m about five years in and it’s certainly a lot – in the sense of the physical day-to-day symptoms it’s a lot better so – but then one of the really weird things – and Kathryn, I hate to share this with a younger lady as well is you start to grow hair on your face as well.  That’s a real horror show and my partner laughed – as a man because he says, “Well, men have to put up with the fact that their hair drops out of their head and starts growing out of their nose, so I suppose it’s only fair for women to have something similar that they have to put up with as well.”  But anyway, just on a slightly humorous note, I thought I would just share that with you.

Kathryn:     Oh absolutely and thank you for sharing that.  It’s something to plan for maybe, going forward [laughs]?

Sian:           I’m told electrolysis is very good for it [laughs].

Kathryn:     I think another thing – obviously that in itself potentially as we were saying about the anxiety and the depression side of things, you know, people would potentially find that quite anxiety-inducing, you know, to have sort of like hair starting to grow on the face and things but it was surprising what you were saying Sian, I mean it just filters into so many things – like we were saying, “I’m feeling a bit of a hot flush.”  I can imagine people going to maybe a colleague who’s a friend and maybe sort of doing that thing, you know, sometimes when we say something that we kind of think is taboo and we kind of say it in a really hushed voice?  You know, maybe just mouth it to someone or like say it in a really, really strange voice, you know, like, “Having a [whispers] hot flush,” or something.

And I can imagine it would be exactly the same – so like for myself, if I was having a period, it was my time of the month, I would maybe go in to a colleague and obviously one of my main colleagues is my husband so I probably wouldn’t be saying it hush-hush to him, I’d be asking for sympathy from him obviously but, you know, sort of like saying to somebody, “Oh I don’t feel well,” sort of mouthing the word ‘period’ or something and in all fairness I do think with the majority of my colleagues, they would probably just loudly say it and then all the fellas would just instinctively kind of recoil a little bit at the thought of having it mentioned.  But it is strange that we do have still that kind of thing where – even with something like that, again, something that we’re experiencing every month that we’re kind of doing a – it’s kind of like something we have to whisper to each other rather than just saying, “Do you know what?  The next two days aren’t going to be particularly nice for me, can I possibly stay at home on the sofa with my laptop and have a hot water bottle?”  You know, it’s strange that we don’t have that yet.

Sian:           I do find that, you know, when I say younger or older I mean nothing by it but it’s just, you know, there has been a bit of a generational shift.  I mean I know that, you know, ladies in the office will now bring in a hot water bottle or whatever if it’s a day when they’re not feeling particularly great and again it shouldn’t feel brave, do you know what I mean?  Because why should it be something that you’re worried about because it might have an implication?  I mean, the fact is people do suffer, you know, do have pain and there doesn’t appear to be enough sort of medical research about how you can help people with these things.  It’s like everyone shrugs their shoulders and say, “Oh women have always suffered from that from time immemorial so you’ve just got to get on with it,” you know, and I’m sure, you know, let’s get some more lady research scientists and let’s start looking at some of these things that really do affect women and affect women’s lives and see what we can do to improve the situation.  Because it doesn’t seem either constructive or fair that there are some very unpleasant sort of symptoms of life that women are just expected to put up with as opposed to fully understanding them and working out what we can do to make the effects better.  Christine, I was going to – do you mind me asking a question, Kathryn?  I meant to ask you the other day.  Is there any known connection between PMT and what effects menopause might have?

Christine:    I wish you’d asked me the other day ‘cos I could have found out for you!  I don’t know is the answer, I’m sorry.  I don’t –

Sian:           No that’s okay.

Christine:    I can totally find out.  No, I don’t know to be honest.  Sorry?

Sian:           I only think it’s, you know, because quite a lot of women do have, you know, a poor experience in their younger life as well from PMT but if you knew that, you know, it was something that you could then, you needed to think about ‘cos it was likely to have some impact but as I say, I’ve actually never looked into that myself.

Christine:    No, I don’t know but it certainly see whether there was any research or any evidence suggesting that.  I just don’t know myself.  But while I’ve got the floor, I would just like to sort of urge a word of caution because I think whilst I think it’s absolutely right that we should be airing this, hence why I’m here and everything, I think we’ve got to be mindful that whether this is socially conditioned or not, but it is where we are, but for a lot of women this is a very, very private thing and not everybody will be comfortable with saying, “Yes, I’m going through the menopause so therefore I’m not having periods,” or, “Yes I’m having a period.”  Some of them won’t want to talk like that and so I can, you know, just thinking about people I’ve worked with that would be, you know, they wouldn’t want – they might want some understanding that things aren’t the same or whatever but I think some people can be quite nervous about that and may not, you know, we’ve got to be careful that they’re going to be asked what they might perceive as being intrusive questions about something that’s quite personal to them.  And whether that’s social conditioned or whatever, if that’s how a lady feels that’s how a lady feels and when we build onto that the impacts of the menopause itself giving anxiety potentially and those sorts of things then it could make life a little bit worse as well.  So I think it’s one of those – it’s important to be aware of but we’ve got to be quite delicate with how we approach it.

Kathryn:     You’re absolutely right.

Helen:        I’d agree with that, Christine.  Sorry.

Kathryn:     No, no, you go on.

Helen:        I was just going to say, it’s finding out something that is – it’s not like the same for everybody.  I think we’ve kind of covered that side of it but it’s how people feel about talking about it and I suppose either as employers or as colleagues, it’s understanding what is the right thing for us to do to make that person feel better in their personal circumstance?  Particularly if they don’t – if they’re not somebody that would want to talk about it and I think doing a bit more research either as employers or managers or whatever to find out how we can help our colleagues or our friends for that matter as well that might not want to talk about it either.

So yeah, doing a bit more research on that front and I think it’s something I know within Lloyds Banking Group anyway, they’re doing more awareness about the menopause and how they can try and get, you know, more experts in that field as well to come and talk to our people and really come up with suggestions as well as ideas as to how to make that situation better and for people’s understanding to be improved I suppose about what they can do to help colleagues and friends.  It’s finding out a bit more about that and that’s what we’re trying to do as well to improve that situation for everybody, so there’s more we can do certainly I think from an employer point of view but also how we can then translate that into how we help our friends and family as well.

Kathryn:     Absolutely.  I’m conscious sort of like a little bit on time as I knew we’d do this when we were sort of like starting to chat quite a lot and I’m conscious that we’re so – I just wanted to sort of like make sure that we get some – sort of like go to the next stage so that we can make sure we can answer some of the questions that are coming in.  So I suppose the next thing to sort of like – I think would be quite interesting for people is that there is this thing all about HRT.  So I know that, you know, HRT, hormone replacement therapy – I’ve heard of it, I’ve also heard that some people are like, “I’m going for that, no one’s denying me HRT,” and other people say, “No, not for me.”  So Helen, I was just wondering, can you kind of explain what HRT is and kind of like the pros and the cons of it in some ways?

Helen:        Yeah, well again I’m not a medical expert by any means but certainly, you know, the HRT can just help to replace some of the hormones that are not getting naturally created in the body and that can just help to suppress some of the symptoms.  I know my sister for example has been on HRT for quite some time now and she’s tried several times to come off but every time she does she gets – her severe symptoms will come back and she just says, “No, I want to take the tablets again.” And, you know, a GP will give her, you know, advice around trying to cut them down, cut them back because, you know, it’s not – it’s something, I understand anyway, is not good for your body to have this unnatural creation if you like of hormones and it can have other implications, you know, from a medical point of view.  And I believe, you know, GPs in particular try not to have people on it for too long.  It can help symptoms but similarly can cause problems further down the line.  That’s probably as much as I know about the implications of taking the HRT and how it can help in some situations but it’s more on a short-term basis.

Kathryn:     Yeah.  I know my Mum – I think she was offered it in a sense when she started going through it and when she spoke to the GP, the GP – obviously again, this is kind of from my Mum’s mouth in a sense so I’m not saying it’s exactly what the GP would have said or my knowledge or anything but the GP had said to her, “Well you can take it but eventually you’re going to have to come off it and you’re – it sounds awful but you’re going to have to face the symptoms at some stage.”

Helen:        Yeah.

Kathryn:     So do you – it’s like, “Do you want to delay it?  Do you want to prolong it or do you want to address it now?”  So it is a really difficult one.  I know Christine, you chose not to go down the HRT route.  Do you mind just explaining what you decided in that sense?

Christine:    Yeah, I don’t mind at all.  Yeah, for me, I know it’s a solution and I know that other people seem to get a new lease of life and they say it’s the best thing they ever did etcetera and when some of the symptoms are going on you feel very tempted but in my family there is a history of breast cancer and I have a condition which is sort of pre-breast cancer so I was quite cautious about that and also bearing in mind the fact that you do – well potentially do need to face that, what’s the word?  Coming to – your body coming to terms with that change in chemical eventually that I decided no, I wouldn’t go onto HRT.

But my biggest problem with the menopause – yes, I had and still do to a certain extent have hot flushes but my biggest problem was anxiety.  I don’t think it would be called severe anxiety but for me it was a big problem.  It was quite a problem.  It really was affecting me and that was due to the menopause.  So I needed to do something.  I didn’t really want to go down the HRT route.  I think I maybe would have done if I really had to because I couldn’t have carried on as I was.  My doctor prescribed me antidepressants and said they would really help or we think they’ll help with the anxiety and they have and I’m still on them now.  Yeah, at some point I will have to reduce that but I think it’s a slightly different change to come to terms with than the adjustment to not producing the oestrogen – I think it mainly is, hormones.  So that was what I chose to do and quite successfully with my symptoms.  For others, maybe different solutions.

Kathryn:     Yeah, and I think that’s really interesting.  I know that you potentially had said that there’s some kind of insurance implications as well if you’re potentially going down that route?

Christine:    Yeah, I mean – and very interesting what Helen had said earlier and granted that this was a few years ago now and that wasn’t my experience so I was looking for some income protection insurance a few years ago and went through all the forms and I think I had a tele-interview but I can’t remember.  I’m pretty sure I did and obviously I disclosed that I was taking the drug I was taking – an antidepressant for menopausal anxiety and when the results came back, I was told that I’d be excluded for any form of mental health so I just kind of went, “Oh, forget it then,” you know, and I was probably quite upset, quite annoyed ‘cos I don’t feel like I’m mentally ill.

I’ve got a condition caused by – and as I understand it, and again I’m not a medic but I like to have an understanding, my understanding is, the reason that you get anxiety and particularly kind of like panic attacks, sudden pangs of anxiety is apparently adrenaline fights oestrogen and when you’ve not got the oestrogen, the adrenaline has got nowhere to go so it comes out in these panic anxiety attacks.  So for me it was a natural thing to happen, a chemical thing to happen, yet I was being penalised.  However, I was trying to do it probably through an aggregator or something like that.  I didn’t understand the value of financial advisers and now where I am in my career and knowing financial advisers, it really does demonstrate to me the value of good financial advice – who would probably have been able to sort that out for me in other terms.  But I wonder if a lot of people have fallen foul of something like that when they’re just trying to manage a natural condition.

Kathryn:     Absolutely.  I think, Helen, we’d probably be able to go onto a very long discussion – I think we could have an hour addressing that [laughs].  I don’t think we can try and address that quickly or we sort of say that would even be a follow-up kind of session that we would do at some point, talking about how, you know, with lots of different situations that potentially just natural things how that can potentially have some kind of an implication that we wouldn’t necessarily expect.  But I imagine that would be very, very difficult in the income protection space as the rules and the algorithms for everything are set up now, to actually be able to go, “Well hang on a minute, that is actually menopause-related so we can look at this slightly differently.”  I think it would be very difficult the way that underwriting is probably set up at the moment to address that.

Helen:        Yeah, I’ll just say very briefly Kathryn, I think it’s one of the things that would have been worth a challenge at the time, Christine, and I think that’s where the value of the adviser would definitely have helped.  It certainly would be extremely highly unusual – it would probably never happen.  We wouldn’t put exclusions on life cover probably ever so if it was, you know, an income protection-type policy it probably still feels a bit harsh but it would definitely have been worth a challenge at the time.

Kathryn:     Yeah, absolutely.

Helen:        I’ll just leave it at that.

Kathryn:     And Sian, just coming back to you then ‘cos obviously we’ve talked about all this.  I know we’ve talked about your experiences and obviously, as you say, you are the CEO of the CII.  What can people – what would be your recommendation?  Say like for somebody like me, I’m not going through the menopause yet but, you know, I’m going to be facing it at some point.  I’m at some point going to get this luxurious beard that you’ve promised me [laughs] and I’m going to maybe – obviously I’m slightly different as I own my own business but assuming I was working for somebody else, what would be your suggestion for me if I was starting to maybe experience some menopause symptoms as to how to approach my employer about that and maybe even – what would you suggest would be possibly some quite, you know, non-intrusive kind of support that I could potentially ask for?

I mean, there’s part of me that’s sort of thinking, just even saying, “Can I possibly have a fan on my desk, you know, just dedicated to me just in case?”  You know, that kind of like springs to my mind but I know that that’s my very, very minor kind of outsider view and it would be really good to hear your points of view as to what you think people should possibly be asking or even challenging their employers to offer.

Sian:           Yeah, I mean I think all these things are, you know, it’s a journey isn’t it?  I mean, if we’ve gone from the fact that, you know, you couldn’t – as you say, you couldn’t say any kind of words like this without using a hushed tone but – and as I say, we’ve been on that same journey, we’ve seen that with, you know, mental health conditions.  We’ve seen that, you know, with – physical disability probably came before that, you know, so it’s not surprising that there are things which people are still finding their way with how best to help their colleagues.

So, I mean, employers talk about inclusion, right?  Inclusion is a mindset.  As they say, diversity is a fact but inclusion is a choice.  So, you know, in any employee situation you’re going to have a very wide range of lived experience and I think if you look at the work that Johnny spent his whole life doing, you know, in all different spheres, that seems to be really – what the essence of what he is getting at is that we’re all individual.  None of us know when we’re born what kind of lived experience we’re going to have and none of us know what is going to go well and what’s not going to go so well but what we all know is that, you know, there’s a lot out there that can happen to us all in different ways and the essence of inclusion seems to be that, you know, you’re not set back by the idea that people’s lived experience is different to yours or that they might need help with certain things when they don’t need help with other things.

So I think employers, when they talk about inclusion, this is just what all employers are trying to really just think about.  I notice one of your – sorry, in the chat I noticed the comment about, you know, flexible working – sorry, and I don’t mean part-time working by that I mean flexible working and the ability to work from home so that you’re not having to be present all the time.  You know, I think that is a big plus actually of a lot of the new ways that employers are happy for people to work.  And going back to Christine’s point about people who may want to be quite private about it, it’s therefore the flexibility of how they’re working that actually could probably help the most with that.

But I mean I experience in my own workplace, you know, if somebody felt that a fan would help them, frankly they’re going to say that.  In my workplace, they are definitely going to say that.  You know, they might not spend five hours explaining to everybody exactly why but if they felt that would make their work better and would make them feel more comfortable then, you know, I think there is a comfort level with asking for what would really help you.  And I think these days, as everybody knows, there is still a lot of – prejudice is probably not quite the right word but there’s still quite a lot of discomfort around about different things, largely just because people haven’t experienced it before so I think if you’re experiencing that it’s a question of trying to explain, you know, how it would help.  Not dwell on the actual thing itself but, you know, “This is a fact, this is how it’s affecting me and this is how it could be better for me.”

And if you think about lots of other things that we now take for granted about people having stand-up desks or people being told they’ve got to go and walk around every 20 minutes or not eat so many biscuits, you know, it’s all the same isn’t it?  But there’s still just certain things which are not quite slotting in yet to that normal lifetime, day-to-day discussion that is just accepted in the workplace.

Kathryn:     Absolutely and I think from an employer’s point of view, I think that a lot of people would probably hope and my employer’s point of view, from employing people is the fact that I always just think I’d want to treat people how I would want to be treated and I think that’s the same with any of us, any colleague and it’s just that thing of – as I say, just being a nice person and just do everything that you can to support each other because we’ve all got our different things that we’re experiencing.  As with anything, we never experience anything exactly the same as someone else and I think listening and as an employer, I think a lot of people can get quite worried in some ways and think, “Oh is this going to cost me so much money?  It’s going to be so much of an inconvenience,” and actually when we stop and listen to what someone needs, a lot of the time it’s actually quite small things that people need and it isn’t something that’s going to be massively expensive.

And even if it does cost a little bit, the loyalty that you would then get in return from someone – the fact that you’ve listened to them and you’ve cared – it can go a great deal in terms of that person wanting to work with you and then wanting to maybe sometimes just sort of like think, “Actually yeah, this is somewhere I’m going to stay and I’m really sort of like put lots and lots of effort in.”  Not saying that people don’t put lots of effort in anyway but, you know, there is that kind of loyalty that we all get together.

Now we’ve got some questions coming through and I know there were certain things – I know you mentioned Sian the Insuring Women’s Futures and somebody has mentioned that they think that they’re possibly peri-menopausal and sometimes they think that they maybe experience a bit of a brain fog.  And I know one of the symptoms potentially – we discussed this I think a little bit in this session and possibly beforehand as well is that there can sometimes be a little bit of difficulty in processing and thinking about things in the same way as we would have done before the menopause and I think obviously we have come at this from an insurance point of view with Helen so obviously thank you for giving that point of view but I think it also – it goes across to a number of things.  So obviously insurance-wise it’s a thought of possibly facing all of those forms, you know, it could be that someone’s had a significant life event around the age that the menopause would typically start and they’re having to maybe suddenly start and go out a bit on their own and those forms can potentially feel quite daunting and they may actually even walk away sometimes. And that’s not to say the forms are bad, it’s just that there can be quite a lot to potentially go through and think about if somebody is experiencing brain fog.

Then also there’s the aspects as well of people understanding and what to do in terms of their pensions and their investments and everything else.  We’re at the prime age as well for somebody who’s going through the menopause to really be knowing exactly what’s going on with that pension.  I don’t do pensions so I’m not going to pretend that I know all the fancy words and terminology but in my mind I’m thinking of people doing early drawdowns.  I don’t exactly know what that means but I know that other people will do on the call [laughs] and will be able to understand as I’m sure Sian will be able to bring in some thoughts about that.

But there’s so many connotations as to where this can fit in and I know – so like my Mum as well sometimes, it can be even a simple thing of the energy company has contacted to say, “You’re coming towards the end of your fixed tariff, what shall we do now?”  The thought of using a comparison site just absolutely – she just can’t face it and then she has to have me step in and become involved.  And she’s gone from being this woman who would be – she was the absolute matriarch of the household, you know, every bill, everything was through her.  She would be like spreadsheets, she’d have forms here, there and everywhere, folders everywhere and now it genuinely reduces her to tears the thought of doing that.  So is the brain fog something that any of you have experienced at all?

Helen:        Not that I know – it might be something that maybe my husband might say that that was the case but I can’t honestly say that I could say that was something I had experienced but I will ask him [laughs].

Kathryn:     But it is something that can happen isn’t it though, that confusion about decisions?

Helen:        Yeah.  Sometimes it’s the make-up-your-mind question isn’t it?

Sian:           No, I’m just going to – all I was going to say is I think sometimes you wouldn’t – if you experience it extremely and maybe the lady who’s put the question in has, but I know that quite a number of my friends – one of the reasons why they said that they wanted to take HRT was that they had felt this reduction in their ability to sort of concentrate and their ability to – one of my friends said she felt like there was just a gap between her and reality a little bit and that was something she’d never experienced before.  I know – I think some women experience that with pregnancy as well, don’t they, or just after pregnancy people can sometimes experience that.  So, you know, there’s no doubt probably that high levels of hormonal activity can have a – sort of an effect which Christine would know more about than I would.

But I think what – all I’d say about what effect that might have is I think one of the reasons that the regulator is all over vulnerability, it’s a very difficult word because actually in many ways it ought to be lived experience rather than vulnerability because the truth is, you know, we’re all vulnerable to circumstances that we don’t fully understand or we haven’t experienced before or whatever.  So I think it’s slightly harmful in the sense it tends to want people to put things in buckets but there’s a very good reason why the regulator is saying, you know, “When your customers are coming to you, are you looking at that customer and are you thinking about that customer holistically?  You know, what situation are they in?  Why are they coming to you?  What are they asking you?”

So, you know, this is one of the things that is very difficult about comparison sites or quick ways of buying products, whatever, is of course you don’t then have that interaction for somebody to just say, “Do you mind me just asking, you know, are you going through a divorce?”  You know, obviously the machine isn’t going to ask you those kind of questions, it’s just going to sell you whatever the product is and so, you know, I would have said that for women making certain decisions, if they do feel that they might need help, then I don’t think that’s anything to be ashamed of and the practical side of it is probably to ensure that you are using an adviser.  Of course, then the issue is, is the adviser themselves going to be remotely attuned or interested?

But there are – I mean, you know, advice used to be a very, very skewed profession but it is improving rapidly and there are now a lot better balanced advisers and sizes of advice firm and types of advice firm so I would certainly advise to give that a go if you’re even remotely stressed about your own capabilities and capacity at a particular time in your life.

Kathryn:     Absolutely, and I think we’re getting really close to time now and there’s some people – and obviously thank you so much for putting in your questions, there’s been some questions in terms of is there any advice, in terms of trying to help with any kind of hair loss or hair thinning or potentially how to get comfortable on a night time or tossing and turning and I don’t know if we’ll have a chance to necessarily speak about them now but Christine, I know that you’ve got – you were going to talk about some resources –

Christine:    Yeah, I mean, I was going to say I’ve got a number of useful organisations which would be able to help with a lot of those things.  I don’t know how you want me to do that, whether you want me to send them to you and they can go out with the recording?

Kathryn:     Do you want to name them as well just so that people –

Christine:    So there’s – I’ve got them listed here and I’ll give you the links so you can put them – the British Menopause Society, the Daisy Network, Manage My Menopause, Women’s Health Concern and Menopause Matters are the ones that we have signposted ladies to quite often.  Yeah.

Kathryn:     So I’ve just put that into the chat as well and obviously I’m sure that we can put links to that as well on the ISC space where this is going to be stored.  So something else that I noticed somebody has put in as a question is in the terms of sort of how would the mental health side of things like a pre-existing mental health side of things affect possibly any income protection application?  Again, that’s something that’s a bit more than what we can discuss in the last few minutes but if you wanted to contact me directly, please do feel free to do so.  There’s quite a few different aspects to it in terms of what the mental health condition is, what kind of symptoms someone is experiencing, kind of the treatment that they have so it’s unfortunate – it’s not one of those ones where we can kind of make a generic statement as to how that can be seen in different situations.

I suppose a good thing to possibly end on is one last thing for us to focus on as maybe something for us all to consider and then we can all say possibly one last thing that we want everybody to – sort of like to leave everybody with.  Maybe a tip.  One tip that you would have wanted to know pre-menopause so that you could prepare for it.  But somebody has mentioned that, you know, maybe what should happen is that this should be talked about more robustly and possibly the fact that there’s even maybe a health and safety – possibly going into an Equality Act kind of area in terms of providing women with sufficient support within the workplace for something like this which is something that obviously women – we can’t control.  It is just something that is going to happen at some stage and they’ve said maybe this could help us to address the stigma that comes with the condition – not condition, it’s not a condition it’s just a thing that happens.  I don’t even know what to kind of call it actually [laughs] in a sense.  It’s just –

Christine:    Natural life change.

Kathryn:     Natural development of life but maybe that would be an interesting thing.  Maybe it should be something that at some point there should be some standards of practice in terms of HR departments giving a lot of guidance and training to all staff at some point in terms of how to support people.  But I think probably with the time that we have left I can ask each of you to do a sort of like a final statement so if I start how I went earlier, so Sian, can you give us all a tip that you would like to leave us if we are pre-menopause as to what to expect?

Sian:           Yeah, I wish I’d known Christine and all the very, very sensible places she’s got to signpost people to because knowledge is king with all of these things.  So, go to Christine and go to her website would be my tip.

Kathryn:     [Laughs] And Christine, what would be your tip?

Christine:    [Laughs] Cheers for that, Sian!  I think it’s everyone’s so different so keep an open mind.  You may not suffer in the same way that others do and keep an open mind but look for help, it’s out there and some will have been through it before and try different things.  Some people might find that holistic-type therapies help them.  Some people might find antidepressants, like I did, some people – be open minded and try different things and look for knowledge, again picking up on Sharon’s point there.  There’s lots of different ones there.  Someone will have been through it before and someone will be able to help I’m sure.

Kathryn:     Thank you, and Helen, what would be your tip?

Helen:        I think mine would be try not to worry about it.  It’s something that’s going to happen.  Try not to worry and if symptoms do start and they start to feel like they’re unmanageable there is help out there.  So don’t worry about it.

Kathryn:     Okay, thank you very much.  Thank you all so much for your time today.  We’ve had some lovely comments come through on the chat and in the question space.  I’m sorry that we can’t obviously answer all of them but maybe we’ll get some kind of a follow-up at some stage.  I hope, if you’ve been here, that you’ve found it useful, that you’ve maybe got some tips and I’m sure that obviously we can put those links out there for you to have those extra support services that we’ve been discussing.  So thank you everybody, I hope you have a lovely rest of evening and a lovely weekend.

Helen:        Okay, thank you, thank you Kathryn.

Kathryn:     Thank you, bye.