Dr Louise Newson: [00:00:01] So Izzy, it's great to have you on my podcast. You're a doctor over in Australia. I'm a doctor over in the UK and guess what? We see similar patients with similar problems, but also we've learned a lot on the way, like our own personal journey, professional journey. Every day we're learning new things and medicine is an art and a science. You know, you have to know the science and physiology when we're talking about hormones, but actually putting it into clinical practice, listening to our patients, understanding the nuances of prescribing. You know we learn so much and it's great talking to you because, you know, we have the similar challenges, similar problems and similar patients. So thank you for coming today.  [00:00:43][41.3]
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Dr Isabella Sillar: [00:00:43] My pleasure. I'm so excited to be here and just talking a little bit more about, you know, my own personal journey and where I think medicine is going to go for women's health over the coming years. It's a really exciting time. We're absolutely in the trenches of turning things around. And I think it's one of those ones where, you know, I've had the privilege of looking behind the curtain, being a medical practitioner. But for a number of years, I was really quite unwell during my early uni years and, you know, nearly was successful in taking my own life like it was an awful time. And now that I'm stable on treatment, I've come such a long way. And so, yeah, the whole concept around premenstrual dysphoric disorder, I'm excited to talk about my journey. I really wouldn't be surprised if there's probably going to be some tears with us chatting today, because it's, it's a, a hard story, but I think it's one that I really do need to share tht's hard for clinicians as well to be heard in this space. And I was gaslit, awfully, during my time and it really took me having to take control and I was just really fortunate that I had incredibly supportive parents. I wouldn't be here without them having helped get me through this journey. And I just think of all the women out there who may not have that support or they're juggling busy families and it breaks my heart, so whatever I can do to help now as a health practitioner who sees a lot of women, it's, yeah, a really exciting place. [00:02:03]

Dr Louise Newson: [00:02:04] It's so important, and actually I was talking to someone yesterday and it was probably about 10, 11 years ago now, I sat in someone's clinic, a professor of gynaecology, and he's sadly no longer alive, but I sat at his clinic and there was a young lady that came in who was 24, and it was the first follow-up appointment for her. And she said, oh, thank you so much, you've saved my life, like my whole life has been turned around. And she was saying how she had PMDD, which is something I hadn't really, even as a very established doctor, hadn't thought much about. And she said, the gels that you gave me, the tablets that you give me, you know, the treatment has been transformational. And it was a lovely, lovely story. And then when she left, I said, oh, John, I'm really confused because you've just given her hormones. I was taught to give antidepressants to these women for two out of four weeks when they weren't getting symptoms, he said Louise. Come on, think properly. In medicine, you treat the underlying cause and the cause is hormones and I've given her actually progesterone, testosterone and Oestrogel because she needed all three and you know, look at the results and I just sat there and thought, well, why didn't anyone teach me that before? Why have I been a doctor, then I'd been a doctor for 20 years, now I've been a Doctor for 30 years, well why? And I always was a bit scared of those patients because they change so quickly and mental health is very scary because you've got a huge responsibility as a doctor to decide whether this person is so mentally unwell that they need sectioning, what treatment they have, or who their support is at home. And you're sort of dealing with a crisis rather than thinking what's causing it often. And so I've reflected a lot over the last 20, 30 years and thought, gosh, how many women have had hormonal issues that I haven't understood. And so now in the clinic we see a lot of women with PMS, premenstrual syndrome and PMDD, premenstral dysphoric disorder and the stories are almost more horrific and I don't know whether it's because these women are younger or just because it's more severe and I think it's probably both. So if you don't mind tell me just a bit about what's what happened to you Izzy? [00:04:12][128.0]
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Dr Isabella Sillar: [00:04:12] Yeah. So I think I, so I have a diagnosis as well of ADHD and autism spectrum disorder, which we know there is a comorbidity with that. I got my diagnosis when I was in year 12 and I first started menstruating when I was in year eight. My periods initially weren't too bad. Like I was just, I felt an emotional teary teenager. I felt the ADHD symptoms were definitely a lot worse as with a lot of women, there was a traumatic episode in year 10. And I think after that event, that's when things really started to change for me. And it got to the point where, you know, at school, people would actually make a comment, they're like, oh, you're clearly on your period and this sort of stuff. And I felt it was said more to me than other people. Like I was very angry, very aggressive, wanted to like literally fight sort of thing. I just was out of control and I think part of the pressure cooker of year 12, that sort of thing. And then eventually went off to year 12, sorry, university. During this time, we had tried using different contraceptives to get on top of my symptoms. We knew pretty early on that there was something hormonally going wrong, but, you know, they put me on the usual Yaz, Diane. We tried the NuvaRing and it just, I had so many side effects from fatigue, nausea, weight gain, just feeling really depressed and flat that, you know, we switched me. I tried the copper coil for contraceptive means, and that was kind of first year of medicine, managing that bit. Still cycling and I was getting worse and so in my second year of medicine when I moved out of college I moved in with some really great housemates and I just could, like I just was barely getting to uni I was barely passing I was really struggling and it really felt like I'd have these awful weeks and then I'd have weeks of lucidity and you gas, I was gaslighting myself being like, oh, it must have just been stress at uni. Probably didn't have my diet right and it wasn't until third year medicine when I had to go to clinical practice where I couldn't squirrel myself away in my bedroom. And I had turn up to the hospital system and interact with patients and have a certain amount of energy and engage with my peers. That was when things got really hard. And I was on one antidepressant during first and second year and then very quickly within third year I was on, you know, sodium valproate, Brintellix, duloxetine, recommended for risperidone because I couldn't cope and the doses were then increasing during my menstrual cycle, during the luteal phase and just into my first day of the bleed. And I couldn't get out of bed because I was so over sedated.  [00:06:43][150.4]
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Dr Louise Newson: [00:06:44] These are heavy-duty drugs, you know, they're more than just an antidepressant, aren't they?  [00:06:49][4.7]
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Dr Isabella Sillar: [00:06:49] And it wasn't helping. And this was the most awful part was, I think this is where I really knew I had to get this sorted because we know that like one in three will attempt suicide. And I was already having quite bad intrusive thoughts and it became apparent to me that I needed to take a step back from med school and actually go home and move back in with my parents because we had to park, I had park my car 500 metres from the hospital. I couldn't afford, you know, private parking sort of things, so I had to park on the street. And there was a four-lane busy road in front of the hospital and in the times where things were really hard, I would walk along the side of the road and buses and trucks would go past and I would not only get this voice but a sensation to step in front of it and it was just constant, it was like step in from the bus, step in front of the bus, step in front of the bus and the hardest part was it was my own voice and it was my own body wanting it. And I had to intellectualise and be like, you've got a medical career, you've worked so hard to get here. Like don't do that sort of thing. And it got worse and worse and worse. And I couldn't not go to work because I had to pass attendance requirements. And I just, there was so many days where I, you know, I was really plagued with these thoughts and I eventually called mum and dad and just went we need to figure this out because I'm, I give this two years, like I put a date on I was like I actually can't do this if I can't do medicine I don't know what I'm going to do and I was losing three months of the year when you add it up if I'm losing a week every month that's three months of the year where I'm essentially having these thoughts to kill myself and harm myself and not only was it the mental health stuff but there was a functional decline, I couldn't cook for myself. I couldn't go out to get my groceries. I had to stay indoors and I would do a lot of painting and journaling and that sort of stuff, but it really wasn't a quality of life. And I was not pleasant to be around because I was, there was so much despair and despondence. And so I moved home and this is where it gets worse. So not only am I suffering with this and mum and dad are great, they're being really supportive, but I was referred first to an Obs gynae. I think this is partly where some of the problems are is, all hormone issues were sent to an Obs gynae first, so I was sent to an Obs gynae and we put a Mirena in and I didn't tolerate it. I vomited for seven days straight and I was just like get this thing out of me, you know, despite Mirena's not having systemic uptake. So I was really quite sick, they took it out and the next thing that she recommended was that I should have an endometrial ablation, as a 21 year old.  [00:09:26][157.1]
Dr Louise Newson: [00:09:27] And for what reason? So for those listening, endometrial ablation is basically where there's different techniques you can do with heat or microwave or light or even water sometimes, but it basically strips the lining of the womb. But I don't understand how that would help your hormone imbalance. [00:09:41][14.8]
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Dr Isabella Sillar: [00:09:42] So, her thing, and I remember this so clearly, her statement was that if the endometrial lining has hormonal receptors in it, and if we get rid of that, then it may help the imbalance. And both mum and I just went, oh, that doesn't seem quite right. And so that prompted us to get a second opinion from a different Obs gynae, and he just looked at us and went, I would never, ever allow that to happen. If you were my daughter, that is not an option. So that's when, you know, I can, I have access to the medical guidelines as a medical student. I went to like, you know, the next stage I've done the antidepressants. I've tried the contraceptive. I feel like we're at the point of looking at a GnRH agonist, which is something that turns off at the hypothalamus and stops me from having my ovaries being active and he agreed to do so, but he, his thing was, is that he has known that theoretically that hormones can cause psychosis. So he'll give me the GnRH agonist, but he will not give me add-back hormones.  [00:10:42][60.1]
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Dr Louise Newson: [00:10:43] So this is really like quite an extreme, I think it's an extreme treatment, because it's basically switching off your hormones. It's giving you a big chemical menopause. So, and we know people with PMDD, that it can be the fluctuation of hormones rather than the absolute level that can trigger symptoms. So it sort of makes sense if you're just sitting down reading a textbook, but actually we know, and a lot of you as listeners know, that If you don't have any hormones in your body, I mean, there's health risks of that, but there can be real negative effects, especially on the brain as well.  [00:11:17][34.3]
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Dr Isabella Sillar: [00:11:17] Yeah and that's exactly what happened. The first week things felt like they kind of stabilised a little bit and I think it was just everything quietened down and then in the second and third week of treatment without the add-back hormones I got into a really dark place and I'll actually read you one of the, so this is day 15 of Zoladex... [00:11:40][22.7]
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Dr Louise Newson: [00:11:41] This is your diary that you're reading.  [00:11:42][1.3]
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Dr Isabella Sillar: [00:11:43] ...this is my diary that I was chucking everything at the time and what I've written, I feel like I'm an articulate person but even reading this back, it's so basic. I just want to be dead. I should put myself in front of a bus. All I feel is that I'm a burden. Do I deserve to even be alive when I don't appreciate it. I keep getting all these self-loathing thoughts. They don't feel like mine but they're in my head. I want out.  [00:12:09][26.2]
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Dr Louise Newson: [00:12:10] It's really sad, isn't it? And, you know, it would be great if you were the only person in the world that had that and clearly you're better now. So we don't want to dwell on the negativity, but some of you might have listened to the podcast that I did with my daughter, Jess, and she's got PMDD and I've just done another recording with her actually, and, you know, she wouldn't be here. I'm pretty sure she had some really dark times and she has awful migraine as well, so the two together. The days before her periods, when her migraines were worse, everything was worse. There was just no point to her life. And, you know, it's so hard when you really love someone and you don't know what to do. Because I can give that person and like your parents, I'm sure all the love in the world. But when you have those thoughts, it is a chemical imbalance that's causing it. It's not because you're stressed. It is not because of past trauma. It's a chemical problem. And I think this is where it's not addressed because people think it's just hormones and hormones are to blame. So let's remove those hormones and let's go around and skip and think everything's fine. And then if women are feeling like this, there must be a psychological or a psychiatric condition that's causing it.  [00:13:26][76.6]
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Dr Isabella Sillar: [00:13:27] This is probably for the listeners probably the best way that I can describe the sensation is it's like just as you're thirsty or just as your hungry and that sensation lives within your body like that feeling of despair and despondence that's as palpable as it was and it was awful and you know it was four days after that that I took actually a massive overdose and ended up in hospital for four days and when I woke up, I had terrible double vision. I couldn't feed myself. And, you know, for the first 24, 48 hours, I thought I'd done some serious damage to myself, but, you now, fortunately things got out of the system. And it was actually the first time when the psychiatrist came to see me, he said, well, of course, like this has happened. No wonder you've had a psychotic break because you've got no hormones. The first thing you need to do when you leave this hospital is you need go and get hormones. He recommended livial, which is a synthetic type of hormone replacement. And I was discharged home. I started on the HRT and it was, I remember looking at the clock and it was two o'clock in the afternoon and I remember feeling better and I was like, no, like this, this, it can't be this simple. And then again, like I'm tracking my mood and I've got it here in front of me. In the mornings, I'd wake up with an anxiety that was about six to seven out of 10. And by the end of the afternoon, it was down to zero, obviously, when the medication kicked in and I never looked back from that point. As soon as I was restarted on HRT and everything was level. Yeah. I had some problems, you know, I had vaginal dryness and, you know, had a little bit of weight gain or, you know, lost a bit of muscle mass, but I've now, you know, addressed all of those sorts of things that, I can't see another way of living, but it, like I am, you know, as you mentioned, GnRH, it's a pretty significant treatment option. And now I'm staring down the barrel of, I have tried to come off it and stay just on the HRT, but for some reason I do decompensate and it has made relationships hard because a lot of men want children and that's something that I don't know if I can do with what I've got. And so now that I'm stable, there's a lot of other questions that I need to answer and no one's, none of the clinicians know how to handle this. It's a really interesting experience to go through as someone who is also a doctor, as someone is also seeing a lot of perimenopause and menopause patients. There's just a paucity of any understanding.  [00:15:54][147.5]
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Dr Louise Newson: [00:15:55] It's really awful because so many times, like you say, hormones, if there's a problem, then go to a gynaecologist. And I have nothing against gynaecologists, but their only training is in the womb and the ovaries and the reproductive tract. And psychiatrists often don't think about hormones, so it was amazing that your psychiatrist did that time. So no one's really connecting the dots. And then people get very scared of talking, to especially young women and especially when you start talking about fertility and changing hormones and you know, but we need to support and learn and, you know, in our clinic we've reactivated a lot of Katharina Dalton's work from the 1950s and 60s who I've mentioned on this podcast before but she was a very inspirational doctor and she spoke a lot about natural progesterone, not synthetic progestogens, but when she was working, especially in the 60s, all the synthetic contraceptives were coming to market. So there was a massive push for these and everyone called them hormones, but they're not they are chemicals. So when she was giving higher doses of progesterone, especially as a pessary, the medical establishment really tried to take her apart and take her down and they didn't like what she was doing and she was reported to the authorities. But she was right, actually. And, you know, especially when we give the right dose of natural hormones, especially progestorone actually for women with PMDD, it can make such a difference. You have to be quite bold to prescribe differently to other people. But I think when you take a step back and think, well, am I going to continue this patient on an antipsychotic and an antidepressant? Or am I going to try a natural hormone? We've got to weigh up all the time in medicine, we weigh up potential benefits, potential risks, potential side effects, interactions, and so forth. And it sort of just makes a bit more sense to give hormones often, doesn't it? [00:17:47][112.0]
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Dr Isabella Sillar: [00:17:47] Well, I mean, one of the antidepressants I was put on, lamotrigine, I developed like the initial stages of Stevens-Johnson syndrome, like I got the rash and had to come off, it was put in high doses of steroids, you know, my mum also had it as well when she tried the medication. So that's an awful condition that essentially renders you as a burns patient. And you know the advice I was given around that was, oh, you might get a rash, just keep an eye on it for between day 14, 21 sort of thing. And I was pretty on to it again, being within medicine, I gave a lot of credence to that. But 100%, it's the, we will reach first for something that modulates the symptoms as opposed to taking a step back and being like, as a young woman, what is probably the biggest thing that is changing within her life, apart from social circumstances, it's actually her hormones. We know that in the early stages of puberty, women are typically in an estrogen dominant state, progesterone does lag and it's not until those early 20s that progesterone should actually start to catch up. But from what I'm seeing within my practice, is there's all of the kind of traumas that are within our society from poor food, through literacy and choices to drugs where it comes from nicotine, vaping, alcohol, poor choices around sleeping. Like our lives are so much more chaotic now that I think a lot of young women are getting these physiophysical harms that are changing the physiology of their symptom. We're seeing a rise in, you know, endometriosis, PCOS, and we're seeing lot of women starting to struggle with fertility. And the question is is. Well, why are we losing our natural hormones? And I have seen a number of young women who have been put on, say, a contraception like Yaz, and they have complete suppression of their estrogen and progesterone. And I had a case from 2022 where I actually called up the path lab and went, I've never seen bloods where it's completely zero for estrogen and progestorone and testosterone. I have her sitting here with the clinical picture of can't fall asleep, can't stay asleep, has crippling anxiety, has weight gain, is really struggling. And what she needed then was natural add-back hormones to be able to rectify the situation. She's now off them, which is great, but needless to say she's also off the contraceptive pill. And so it does worry me how much we are playing around with a system that we really do not know much about.  [00:20:00][132.5]
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Dr Louise Newson: [00:20:00] Yeah, I totally agree. And, you know, we know that progesterone really balances and helps with cortisol and our stress hormone as well. So when we have high cortisol, we often have low progesterone and then there are lots of endocrine disruptors that we still don't know about. So, you, know, the number of products that people put on their skin, on their faces, you know, that are marketed through TikTok to teenagers, we don't know the effect this is having, you know, the toxins, like you're saying, in our diet, in our environment. There's all sorts of things that we can't change because it's, you know beyond our control often, but actually how is this having an effect on our hormones and especially our progesterone? You know, increasingly just giving back even a low dose of progesterone to younger people can make a difference, especially, like, you say, with PCOS as well. We said, and endometriosis, which is an inflammatory condition, you know, we have to, I think, be thinking differently and wider. Because we're trained in general medicine, we can prescribe any medication, and we're used to prescribing lots of medications, and sometimes we're used to prescribed two or three medications at the same time. And I feel this is why as a general practitioner, a general physician, we're better suited to looking at hormones in women because we can make two or three diagnoses at the same time. We often, especially in a crisis situation, we will start medication, but then we will also de-prescribe and remove the drugs that we think aren't helping as someone improves. But somehow, often in women with PMDD, I've seen them for years and years they've been on these other psychiatric medications that have long-term side effects as well, and still no one's thought about their hormones.  [00:21:52][111.7]
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Dr Isabella Sillar: [00:21:53] And unsurprisingly, as you can imagine, I'm not on any antidepressants now.  [00:21:56][3.3]
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Dr Louise Newson: [00:21:56] Amazing.  [00:21:56][0.0]
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Dr Isabella Sillar: [00:21:57] Like if you speak to my parents, I was always a glass half full kid. Like I was very bubbly and bright and then there was a really dark transition. And as literally as soon as the hormones started getting added back, I threw the antidepresants out, I was like, I am fine. I haven't had a panic attack since and I was riddled with them during that time. And on that thing of progesterone and its importance, it makes sense when we take a step back from an evolutionary point of view, cortisol is largely our fight and flight hormone, or it allows our system to regulate and mobilise glucose levels and this sort of stuff. We do want to suppress progesterone because we don't want to meander away from the tiger. We want to run and sprint. And so it makes sense that when we have a lot of, it's a death by a thousand paper cuts, lots of little things that are communicating to our body and all our body is trying to do is actually protect us. Our body is trying to take in that data and be like, this could be dangerous, I need you to be on alert for this. That's where we do see the cortisol start to increase. And we know that women have a, are more sensitive to a blunted cortisol curve. And it means that they're going to be more in that hypervigilant state. And they are going to more sensitive because as a woman back in caveman era We couldn't protect ourselves when we were nine months pregnant. We were actually dependent on the community and it's just evolutionarily, our body hasn't progressed as far as what society has. We've made massive changes in the last 100, 200 years and I don't think our bodies have been quite ready for that and we are starting to see those issues emerge within young women.  [00:23:25][88.2]
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Dr Louise Newson: [00:23:26] Yeah, and we have to be more aware of it. And the other thing is we can try things in medicine and if they don't work, we have to think again and if they do work we learn from that experiences. So, you know, for you as a practising clinician now and you know thank you for sharing your story but I'm sure it's made you look at things differently and ask different questions as well to patients.  [00:23:47][20.8]
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Dr Isabella Sillar: [00:23:48] Oh, God, yeah, the probably the, I've become an amazing listener. And I think that's one of the things that, it's this and all the nurses that I've been working with on, like the women's health programme that I'm building, it's the piece of feedback that so many patients have given is I feel heard. I feel validated. There's often a lot of tears. And it's because when they tell me that they've got, you know, all these joint aches and pains and hot flushes, I go, that's awful. Like, who would want to live with that? You know, you're juggling a busy family. You want to be thriving, not surviving. So let's do something about it. Also, the language I've used has definitely evolved instead of it being very clinical, you take this and come back and see me in three months. It's actually like, this is a journey you and I are going to go on together. I'm going to get you, allow you to have access to the tools and your body is going to tell us what works for you. And here is a spectrum of where you can, like what medications you can take and what dose, and this is gonna keep you safe. And you titrate yourself, you know, it might be two pumps of estrogen one day and. You know, it might be three pumps the next, and that's fine. But it's my job to keep you safe. It's your job to listen to your body. And patients really like that. And it's about harmonising that whole process. So yeah, definitely a better listener. And I feel putting myself more in the patient's shoes of they want to be well. They want to turn up for their family. And you know you see it in medical practice all the time and I've heard horror stories where. You know, the clinician turns to the woman and goes, oh, but you're a 50-year-old woman. Why do you want to have sex? Your dry vagina's just part of it, and it's just like...  [00:25:15][86.9]
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Dr Louise Newson: [00:25:15] It's just awful, isn't it? And I do think, you know, empowering our patients with knowledge is the most important thing we can do. And recently my daughter was having worse symptoms and it's always hard to know, is it something else going on or is it hormones. And then, you she also said, but mummy, I'm getting my palpitations are back. I've got cystitis again, my skin's really itchy. Right, well that's more likely your hormones. Yeah, and so changed her preparation, not her dose, because it was quite warm and the patches were just not sticking properly and so and that's made a difference but in the past I would have concentrated on her mental health issues if she was a patient you know 10 years ago and someone with similar symptoms I would just be asking about mental health but because I know more and she knows more she can recognise symptoms and it is empowering patients because you know when we have short consultations we rely on our patients actually a lot and I think this is where things are changing and going to change more in the future because, you know, women are going to, quite rightly, understand more and, quite rightly, ask maybe for a different trajectory and different treatments. And we need to learn as clinicians, we need to be kept up to date and our patients keep us on our toes and I love it, but some doctors find it a bit threatening, don't they?  [00:26:33][77.8]
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Dr Isabella Sillar: [00:26:33] Exactly, I was going to say that I think some find it, you know, they label the patient as a headache or you know overbearing it's like actually for the most part this is largely just a person who wants to live a better life and you know that's where your application, your app has been amazing is because part of the whole process, this is a qualitative diagnosis for PMDD, PMS for perimenopause and menopause. It isn't actually a blood test that we can reliably utilise so it comes from collecting data points and that was the same with my story like no-one put together that it was hormones until I took the initiative to go something's going on here and so it's just all those sorts of things I think is going to change where patients will come better armed with the information and a higher expectation of clinicians for like this is a condition that affects pretty much 100% of women by 55 for perimenopause and menopause, increasing rates for PMS and PMDD. I need you to support me, so it's a very exciting time, but still a lot of women are suffering.  [00:27:30][57.3]
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Dr Louise Newson: [00:27:31] So we've got a lot to do by joining forces and really make a difference from each side of the globe. So before you finish, three tips. So a lot of people will be listening to this thinking, I wonder if me or my friend or my daughter or whoever has PMS or PMDD. So what are the three things that they could do to try and help themselves make the diagnosis?  [00:27:50][18.9]
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Dr Isabella Sillar: [00:27:51] So I think most importantly is you have to build your case. And it might not be PMDD, and it's not to say that what you're feeling isn't hormonal related, it could actually be multiple things. So you need to build the case around, well, is there a hormonal component to it, or is there micronutrient deficiency? So get your data, obviously like download Louise's app and track your menstrual cycles, track your symptoms. That was what fundamentally allowed me to get my diagnosis. And then the blood tests were what confirmed that my iron levels were fine, that I wasn't zinc deficient, that everything, I didn't have an infection, things were fine. So, absolutely, you gotta arm yourself with those data points. The more detail you can have, the better. And about how your day-to-day life is being affected, what's the functional impairment that you're experiencing. I think, you know, for all of the parents or partners who are looking, you're hearing their daughter or their sister or their wife in this conversation. Probably, you know, really just sit down with them and have that open conversation of I can see you're suffering, what can I do to help you and for me it was mum attending all the appointments with me because in the times where obviously my brain wasn't functioning properly I needed to have a second set of ears there to help advocate for my case, so getting your community around you is an exceptionally important part of this process. It is a little bit of a long journey and there will be highs and lows. And then finally, your lifestyle choices. It's having ADHD and autism. I have to be really dialled in on my sleep and my diet and my exercise and who I surround myself with. And it's not to say that it's going to replace the impact of hormones, but those things will impact how my body responds to hormones. So, you know, making good lifestyle choices around that is really important and acknowledging that when you are in those dark times, accessing those good decisions is really difficult and it's necessarily your fault, But it's something that shouldn't be ashamed of but should be seen as a northern star. I look forward to one day knowing that I don't have to drink myself during you know, the the times where I'm really really dark. I don't have to have five beers at night or I don't have to sedate myself with three antidepressants. Like how exciting is that going to be. But yeah the the lifestyle choices do really impact I feel this condition trajectory.  [00:30:11][139.5]
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Dr Louise Newson: [00:30:12] Absolutely and that's where it's so important that we think very holistically but we can't just do lifestyle without hormones and hormones often enable us to have a better lifestyle so I'm so grateful Izzy for you to be so open and transparent and I'm pleased there's a happy ending as well of course.  [00:30:27][15.2]
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Dr Isabella Sillar: [00:30:28] I'm still here and we're running the gauntlet for women and I'll be the loudest person on the block shouting, you know that we we need to keep working on this so thank you so much for having me. I reallty appreciate it. [00:30:37][9.1]
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Dr Louise Newson: [00:30:37] Oh, thanks, Izzy, that's great.  [00:30:37][0.0]