LET'S TALK MENOPAUSE with DR. CAMILLE A. NICHOLLS - 18th June 2026

[00:01:59]Mhm.

[00:02:26]>> everyone, women and men.

[00:02:30]Today, as we host this evening's session, understanding menopause.

[00:02:38]This session is hosted by our women's department, Women of Worth by Group Lydia.

[00:02:46]And we just want to thank you for coming out this evening despite the weather.

[00:02:53]Also, just want to acknowledge our senior pastor, Pastor Chad Graves, Sister Crystal Graves, Pastor Jack, our leaders, our sister churches. We have from Glenn, Oakley Hall, and we have invited guests, our friends and family, our community members. Welcome to today's session. And we also want to say special welcome to our guest speaker, who will be formally introduced further, Dr. Camille Nickols.

[00:03:33]Okay, I'm going to call Sister Ulisia Davis, who's going to do our opening prayer. Stand with us, please.

[00:03:48]>> Good night each and everyone. Let us lift this service in prayer.

[00:03:52]Dear Lord and heavenly Father, we just want to thank you, oh God. We want to thank you for the woman of worth whom you have placed this vision in their hearts, oh God, and especially group Lydia. Lord, even right now I pray that you will bless this session, oh God. We want to thank you for Dr. Camille Nichols who have made herself available, oh God, to share her professional knowledge with us. Lord, we pray that you will just use her and you will bless her. I pray Lord, oh God, even as we learn what is presented here this evening. Lord, we will not just take it for knowledge only, but Lord, oh God, we'll apply what needs to be applied, oh God. I pray even right now for every person who is here that we will learn something. Whether it's it's for support for the men, you know, for the women in their lives that they will support them, that they will be able to understand what they're going through. Lord, oh God, and even for the women who might be experiencing certain issues and don't understand why it is happening, oh God. I pray Lord, this session will be able to enlighten them.

[00:04:53]So, I just commit everything into your hands and I ask that your will be done this evening in Jesus' mighty name. I pray with thanksgiving. Amen.

[00:05:05]>> Thank you, Sister Alicia. You may have your seat.

[00:05:11]And my apologies again. I would like to acknowledge Sister Celena Jack, you know, Mesa. I acknowledge Pastor Jack and I'm seeing in the back Sister Claudia Windsor.

[00:05:23]Nice to have you with us.

[00:05:25]All right, so we are going to go right into our program this evening.

[00:05:33]We're going to have our first lady, Sister Crystal, to introduce our speaker and we'll go straight into our session.

[00:05:52]All right, so we welcome sister Crystal Grace as she does an introduction.

[00:06:02]>> All right, good night everyone.

[00:06:05]And welcome. Thank you guys for coming out despite the weather.

[00:06:09]Um I want to acknowledge again Reverend Conrad Jack, sister Jack, and her her guests, and all of of our guests. And we have um first lady of the all of the House of Praise, Lady Windom. Just acknowledge her presence and all of our leaders and our visitors.

[00:06:29]Thank you guys for coming out.

[00:06:31]Okay, so my task is simply to introduce our guest speaker.

[00:06:37]Dr. Camille Nichols is a proud Vincentian who has dedicated her life to service in the field of women's health.

[00:06:46]She graduated from St. George's University School of Medicine and returned to St. Vincent and the Grenadines, where she spent 2 years completing her internship program offered by the then Kingstown General Hospital.

[00:07:00]At the end of her internship, she worked in the Department of obstetrics and gynecology.

[00:07:07]Dr. Nichols did an 18-month stint as a district medical officer in the districts of North Leeward and Beckwith.

[00:07:17]After passing part one of her postgraduate exam in Jamaica, Dr. Nichols went to the United Kingdom to pursue postgraduate studies in obstetrics and gynecology.

[00:07:29]With 18 months training in the United Kingdom under her belt, she was accepted as a member of the Royal College of obstetrician and gynecologist in 1998.

[00:07:43]Armed with her membership, Dr. Nichols decided to gain some postgraduate experience before returning home.

[00:07:51]She was offered a 2-year training program in Scotland. She then returned to St. Vincent and was appointed consultant obstetrician gynecologist in 2001.

[00:08:04]On the 1st of June that same year, Dr. Nichols opened her own practice at Victoria Medical Center, which recently celebrated 25 years of quality service on June 1st, 2026.

[00:08:19]She is now head of department of the Obstetrics and Gynecology Unit at Milton Cato Memorial Hospital.

[00:08:28]In 2006, Dr. Nichols was inducted as a fellow of the American College of Obstetricians and Gynecologists, FACOG, and in 2011, she was admitted as a fellow of the Royal College of Obstetrician and Gynecologist.

[00:08:48]Dr. Nichols is an advocate on women's health issues and readily accepts requests to meet with institution, women organization, church group like ours, and school children empowering them with knowledge and information. So, I want you to stand, put your hands together, and help me welcome my doctor, the best gynecologist, Dr. Camille Nichols.

[00:09:19]>> Thanks, everybody. Good evening.

[00:09:24]Sit, please. Thanks.

[00:09:38]First of all, let me say thanks for inviting me.

[00:09:41]When Crystal reached out, I was very hesitant because in my twilight year years, I have given up doing things like this because I think the younger folks should actually take over.

[00:09:56]But I did give it some thought and I think the topic is very important and we women are still not the knowledge is not there. So, I agreed to do it. I want to thank Sister Graves for having the initiative to even consider having this topic so that the women in the church and the men will be able to benefit.

[00:10:19]Um So, I'm going to I'm going to try. I'm going to try and discuss menopause. Yes?

[00:10:29]All of us all women inside and I think maybe the youngest person is maybe 25, 30.

[00:10:37]And the oldest one maybe 70.

[00:10:40]Just looking around.

[00:10:43]Sorry?

[00:10:44]Okay, 80. Let me let me >> [laughter] >> You look very young for 75.

[00:10:51]>> [laughter] >> All of us women, we are walking along memo- menopause lane.

[00:11:00]Some like Crystal might just be starting.

[00:11:04]>> [laughter] >> Some of us are halfway there.

[00:11:09]And some of us are almost at the end of it.

[00:11:12]Yes?

[00:11:17]I'm on this side, right?

[00:11:21]And it's important that we know exactly what menopause is because it affects all of us.

[00:11:27]Um and even the men are affected because they um they have to support and understand their partners, their wives, what they are going through.

[00:11:39]So, what is menopause?

[00:11:42]Do you mind if I stand over there so that I could see? Yeah.

[00:11:50]All right. So, menopause basically Oh, sorry. I have You have to do everything over.

[00:11:59]So, menopause is a part of our life's journey when we have cessation of our periods.

[00:12:06]Um Our reproductive years start from menarche to menopause. Menarche is when a girl starts having a period.

[00:12:17]Yes?

[00:12:18]So, normally girls start having periods at the age of 12.

[00:12:24]But, I'm sure you have noticed or you have mommies who come in a panic because their 8-year-old daughter is starting to have breast buds, she's starting to have pubic hair, and she's having her period.

[00:12:39]And you wonder, "How is she going to manage with periods and pads?" But, the reason that the age has gone down from 11, 12 to 8 is because of the pandemic of obesity.

[00:12:52]There's a critical weight, which is 47 kg or 103 lbs, when the girl body starts changing.

[00:13:02]So, we are actually seeing younger girls having periods.

[00:13:06]And of course, menopause is when your periods actually stop. So, when we say a woman has gone through menopause, it means that she has gone 12 months.

[00:13:20]And this is important.

[00:13:22]12 months without periods.

[00:13:25]The average age is between 45 and 55.

[00:13:28]And we all start our journey from around the age of 35 where we have ovarian decline. And I'm sure if you think back you used to hear people say you used to hear people say um girl, why you ain't going to make your baby now you're you um your eggs are getting >> [laughter] >> Yeah, you're drying up. Yes. And that's because after the age of 35 your ovarian your ovaries start depleting. One of the things we need to to know is that unlike men who produce sperm every 3 months women are actually born girls are born with a finite number of of eggs. So, we have 2 million eggs and then they go to sleep and at at menopause they wake up and they start you start having eggs produced every month.

[00:14:29]All right, so the as the older you get your eggs become worse. And they're not as functioning as they were when they were when you were younger. Yes?

[00:14:42]So, in terms of menopause there are different types of menopause.

[00:14:47]You could have natural menopause which is what most of us would be going through.

[00:14:52]And this means where you would actually have symptoms starting gradually and then they become exacerbated.

[00:15:00]Medical menopause is those persons those women who may have had to have chemotherapy or radiation therapy. And surgical menopause is what we doctors would offer the patient. This is where we would do a hysterectomy and depending on the cause we may have to take out her ovaries.

[00:15:21]All right, if her tumor markers are high, um we would advise that the ovaries are taken out. If we're doing a hysterectomy on a patient who is less than 40, we tend to want to save her ovaries because the ovaries produce estrogen.

[00:15:37]But after that, 45, 48, 49, we know that the function of the ovaries are no longer there, and we don't want to leave the ovaries knowing that there's a potential of ovarian cancer. So, as you get older, ovarian cancer is um it creeps upon us. When we know we have ovarian cancer, it's already stage three.

[00:16:01]So, our advice to the mother to the woman is we're going to do major surgery for you.

[00:16:08]Your ovaries are already going through menopause. Let's take them out and not leave them because we can give you estrogen if you need it. Yeah?

[00:16:18]Premature menopause is when you get um menopause starting before the age of 40.

[00:16:24]And this tend to be chromosomal reasons, or could be surgical reasons because we have made a decision to remove a patient's ovaries. I remember a 13-year-old girl coming in with this massive mass in her tummy, and we had to take out her ovary. If we took out one, and then 6 months after we had to go back in and take out the other one because she had some form of cancer.

[00:16:50]And she is on the combined oral contraceptive pill. She's about 30 now.

[00:16:55]She's on the combined oral contraceptive pill, so she's actually getting estrogen, which would help her until she goes through menopause.

[00:17:02]And because of that, she's actually getting a period every month. Not because she has ovaries, but because we are giving her hormones to mimic.

[00:17:11]Yeah?

[00:17:16]Estrogen, and I can't read now, so have to go closer.

[00:17:20]Estrogen um is important and it affects it works on all the organs of the body.

[00:17:29]It helps the heart. It keeps our skin um super.

[00:17:35]It It causes the ovaries to um produce the eggs.

[00:17:41]The uterus, you have a period every month, it works on the lining and it keeps our bones strong, okay?

[00:17:49]Um breast is responsible for our breasts being firm and um trying to find the right word.

[00:17:59]Perky, that's the word. And then when our estrogen levels start fall- falling, then they start going down to our our knees.

[00:18:10]But but um thankfully we have these what these bras you have now, push-up bras and stuff to give us a little lift, yeah?

[00:18:23]Before we actually get to menopause, our body go through what's called the perimenopausal phase or the climacteric phase.

[00:18:32]Here the estrogen levels are falling.

[00:18:35]Remember I mentioned that you're going to start having a ovarian decline, so you start producing less estrogen and because of that our periods become erratic. And we start getting the biggest thing is Does this have a pointer?

[00:18:52]It's on?

[00:18:56]No?

[00:18:57]Um Ah, okay.

[00:19:04]All right, so the biggest thing is that we start getting night sweats or hot flashes or hot flashes. You see think the British people say hot flashes and the Americans say hot flashes. It's the same thing. And a hot flash is basically where you have this feeling, this heat that comes over on your upper body, around your neck, your face. You feel flushed and you start sweating. Okay?

[00:19:33]Um With the falling estrogen, our ovaries do not produce as much.

[00:19:47]Our pelvic floor The pelvic floor is the bottom part of your abdomen that keeps the organs in place. And because of the lack of estrogen, the pelvic floor starts getting saggy and sometimes women end up with what we call prolapse. So the uterus comes down, the vaginal walls come down because of the lack of estrogen. Estrogen is responsible for the um bladder. If you don't have estrogen, it can affect you in terms of giving stress incontinence and prolapse.

[00:20:25]Okay? It's also responsible for vaginal dryness, which we'll talk about soon.

[00:20:31]So these are some of the symptoms you get in the climacteric or perimenopausal phase of life.

[00:20:39]Um Sometimes your children and your husband are the ones who going to pick up that you getting cranky. Everything causes you to get angry and you get You might feel that you're a little bit depressed.

[00:20:53]Um You can't concentrate. You get um fatigue very easily and you have mood swings.

[00:21:02]The physical signs would include hot flashes, night sweats, reduced libido and this is important because, of course, if you don't feel like having sex, it affects your partner. Yeah?

[00:21:15]You put on some weight some weight.

[00:21:18]I I mentioned the urinary incontinence because the bladder has estrogen receptors, and if your estrogen levels are falling, then you're not going to be able to hold in the urine as you used to.

[00:21:30]Vaginal dryness and bloating.

[00:21:37]So, when your estrogen levels start falling, it affects your ovaries, and you start um stop producing eggs.

[00:21:46]Ovulation, which means when you ovulate, that is when you are you can get pregnant at the time. So, if you're not ovulating, obviously, you're not going to be able to get pregnant.

[00:21:58]Um progesterone is needed, but if you don't ovulate, you don't produce um progesterone. They're two important hormones for the female, estrogen and progesterone, and they work in synchrony, which is why you would have um a regular period. If they're not working, that's when you start having erratic bleeding, and you're not bleeding every month cyclically.

[00:22:27]I think this just says the same thing.

[00:22:29]These are the symptoms that you get. I don't think we have we have touched on each one of them.

[00:22:34]Brain fog. That's something we didn't touch on. This is when your brain begin it gets fuzzy, and you can't remember things.

[00:22:41]Headaches, um and um joint pain.

[00:22:47]Sorry, there's a question?

[00:22:50]No question? No? Not yet? Go ahead.

[00:22:55]With the lack of estrogen, your hair thins out, your bones get um you lose you lose bone, which increases your risk of fractures.

[00:23:04]Your skin gets dry. You have an increased risk of heart disease because estrogen gives us that protection.

[00:23:11]Um headaches. I talked about the incontinence and the vaginal dryness.

[00:23:20]Right. When you When we say a patient has reached menopause, it means that she has not had a period for 12 months.

[00:23:32]You must go through that 12-month period of amenorrhea to say that you have gone through menopause. And I want us to understand that because I've had to explain this to a lot of my patients.

[00:23:45]So, let us say your last period was September 2025.

[00:23:53]It means that we will say you've gone through menopause when September 2026 comes. You have to go a whole year without periods to say you have gone through menopause.

[00:24:06]Let us say, however, that in April of this year your period comes back, you have to start counting from April to next year April.

[00:24:19]All right?

[00:24:20]So, 12 months of amenorrhea, which means no periods.

[00:24:25]If that period or bleed comes before that 12 month, we start to count again.

[00:24:32]So, that means if it came April of this year, you have to wait until April of next year.

[00:24:37]Right? If May comes 2027 and you haven't had a period, you could confidently say, I have gone through menopause.

[00:24:48]Yes? Okay.

[00:24:51]So, once you've gone through menopause, all the symptoms get exacerbated.

[00:24:57]Hot flashes, night sweats, insomnia, hormones all over the place, and the mood changes. And that includes, of course, being irritable, tearful, loss of, um, self-esteem.

[00:25:17]And menopause affects every part of our body, if you think about it. Every part of the body is affected by the menopause. So, not everybody will experience all the symptoms, but some.

[00:25:34]All right? And there are women who have gone through menopause that didn't even realize that they've gone through menopause because they have no symptoms at all.

[00:25:42]Okay?

[00:25:48]I want to talk a little bit about the emotional characteristics of menopause because I think we have touched on some of the others.

[00:25:55]The loss of confidence, lack of self-esteem, um, nervousness and anxiety, reduced libido, and problems with memory and staying focused. Okay? And I think all of us could attest to that, that we have had some element of that at some point.

[00:26:23]And the list goes on.

[00:26:25]I like this slide. It says it's the four dwarfs of menopause.

[00:26:31]Itchy, sweaty, sleepy, bloated, forgetful, and all dried up.

[00:26:37]What?

[00:26:39]>> [laughter] >> Yeah?

[00:26:41]This one, I don't think we could read this one, but it just shows you some of the issues we have short-term.

[00:26:48]We have the irregularity of our menstrual cycle, hot flashes, weight gain and sweating, palpitations, decreasing libido.

[00:26:59]The medium-term symptoms include your skin getting thinner, dehydration and loss of elasticity, depression, dryness of the vagina, pain during sexual intercourse and infections.

[00:27:15]And this is important because even though you may not have had any symptoms, that does not mean that the estrogen is not affecting our bodies.

[00:27:25]So, the long-term would be your bones being fragile, and increased risk of fractures, vertebral crushing, so you start losing height, and you might start being a little bit stooped.

[00:27:39]You have an increase in heart heart heart problems, your cardiovascular system. So, you increase your risk of stroke, you increase your risk of heart attack.

[00:27:50]And of course, your blood pressure can go up.

[00:27:53]Estrogen also gives us some protective effects for keeping your cholesterol within the normal range. So, once you've gone through menopause, it's quite possible that your cholesterol may also increase, and you may have difficulty maintaining it. We try to maintain cholesterol within modification of lifestyle changes, but sometimes you may need to give the patient the woman some medication.

[00:28:21]And this basically tells us that everything is going haywire.

[00:28:26]We're all dried up. It's parched.

[00:28:29]And we're not sure where we're going, in which direction that we're actually going.

[00:28:35]But are we all dried up?

[00:28:39]When we talk about drying up, do we have any young people? No.

[00:28:44]Okay.

[00:28:45]So, when we talk about um drying up, we're really talking about the effects that lack of estrogen has on our vaginas.

[00:28:54]And the biggest one is that if you get thinning on the walls of the vagina, which causes painful sexual intercourse. The word we use is dyspareunia. And obviously, if it's painful, you're going to lose the drive. You don't want to have sex as much as you used to.

[00:29:12]And you um this can affect your partner. You also have discomfort during sexual intercourse. So, it's a vicious cycle that women go through, and it takes understanding from the men.

[00:29:27]>> [laughter] >> Why you laugh, Gary?

[00:29:35]>> [laughter] >> All right?

[00:29:40]The effect of lack of estrogen can actually cause us to have a discharge and urinary symptoms.

[00:29:49]And I've had so many patients come and say, "Doc, I think my husband's misbehaving because I have a vaginal infection."

[00:29:57]And I would say, "Well, let's find out before we come to that conclusion. Don't go home and tell him that yet. Let's find out."

[00:30:05]Because that So, we will do tests, make sure that everything is normal, and if it's normal, I could say to her, "I think it's just the menopause changes that you're going through. Let us give you some treatment and see how you feel about it."

[00:30:21]Um obviously, if it comes back with an STI, then we have to go home and have that conversation.

[00:30:27]All right?

[00:30:33]And vaginal dryness, you may get some bleeding during sexual intercourse, stinging, you pee often, and you have that pressure feeling down below.

[00:30:44]And of course, we are there several things we can use to make down there juicy again.

[00:30:51]>> [laughter] >> There is good old KY Jelly.

[00:30:56]Yes?

[00:30:57]And KY Jelly and we also have what's called the warming gel. I have to apologize because I had planned to call some of the pharmacies to see if we have any of these available. We I know we have KY Jelly, yeah?

[00:31:15]Um and we have personal lubricants.

[00:31:20]But um it was a busy day today for me and I didn't get around to doing that.

[00:31:24]The one that works, the warming gel, is actually very pleasurable, I understand, because it gives the men a warm sensation as they go in. Right, Gary?

[00:31:36]>> [laughter] >> And um >> [laughter] >> Okay, I won't I won't embarrass you anymore, Gary.

[00:32:01]But the one that really helps, that makes it even more pleasurable, is the KY Jelly His and Hers.

[00:32:10]No, I'm I know this is Carnival and a lot a lot of you will have relatives coming home. You could get it on Amazon.

[00:32:17]So, it is a lubricant.

[00:32:19]Some go on the man, some go on the woman, and according to a patient, it's orgasmic.

[00:32:25]So, we can try and check it out. This one here.

[00:32:31]Um it is it's it's two tubes, two bottles, and one is for the male, and one is for the female.

[00:32:40]Okay?

[00:32:43]Another thing that happens, not necessarily connected to menopause, but it comes around the same time, and this is called the emptiness syndrome.

[00:32:53]This is when your children leave.

[00:32:56]They leave home, and or even if they're home, they just don't have any time for us anymore.

[00:33:04]Yeah, they have their friends. They don't want to sit down and chat with you, and you find that you are left alone.

[00:33:13]And it's can affect you psychologically.

[00:33:17]Yes? And it happens around the time of menopause, because if you think about it, you have kids at 25, by 50 by by time you're 50, these are big children, and they're ready to leave home.

[00:33:30]And again, understanding from the partner is very important.

[00:33:36]But, it does affect men, too, you know.

[00:33:40]They go through what's called andropause.

[00:33:44]Yes?

[00:33:46]So, they have their own issues.

[00:33:51]And andropause is similar to menopause, and it happens around midlife, the same time.

[00:33:59]And this is when they try to get a younger partner to keep themselves young.

[00:34:07]So, instead of spending time appreciating the woman who has been by their their side for how many years, they tend to want another a younger they want a replacement, a younger person.

[00:34:22]And um of course, this is going to affect the woman even more, because her We already talked about lack of confidence, lack of self-esteem. She's putting on a bit of weight. Down there might not be as tight as it was when she was in her 20s.

[00:34:43]And he's going he's going outside.

[00:34:47]Yes?

[00:34:48]It tends to happen much slower for the men than for the women, but they also have changes in their sex drive.

[00:34:58]And it affects the kids.

[00:35:01]Yeah, the arguments.

[00:35:03]The tension.

[00:35:05]The you know.

[00:35:07]And this is something we have to be aware of that the children can get affected by it.

[00:35:14]We go different separate ways.

[00:35:18]We are not communicating as we used to and we need to try and bring back that energy and love that you had for the first time.

[00:35:28]So even though he may not be as rigid even though she may not be as tight there is intimacy and this is what we need. Yeah, to keep us together.

[00:35:43]Understanding, communication.

[00:35:50]We do put on weight and this comes not just in it affects each part of the body.

[00:35:57]We can't button our clothes. I think we all have um we can all identify with this.

[00:36:03]And our memory go.

[00:36:06]And estrogen is also responsible the lack of estrogen is also responsible for our brains not functioning as well as they used to.

[00:36:21]Is it natural changes that we are going through or are we getting dementia? Alzheimer's being one of them.

[00:36:30]And of course we have to start thinking about that and seeing somebody for that.

[00:36:35]The thing with normal aging is that we tend to forget some of the things but not all.

[00:36:41]We can follow instructions.

[00:36:43]We can use our notes to help us.

[00:36:47]And we're able to take care of ourselves. When you're going through dementia or Alzheimer's, we don't have those faculties.

[00:36:55]Depression.

[00:36:57]You wake up in the morning.

[00:37:00]You don't feel so good. You're overwhelmed with the amount of work that you have to do. You think that the the kids and your husband is no longer appreciating all you have done.

[00:37:11]And you get into a tailspin and you can get depressed.

[00:37:15]Tiredness, that goes without saying. As you get older, you don't have the energy that you had when you was small younger.

[00:37:22]I talked about um loss of self-esteem.

[00:37:26]Your hair starts dropping out. And it's not just the texture of your hair, even your skin is not the same. It's not as shiny. It's um loose.

[00:37:37]And then you can also have hair loss.

[00:37:41]So how What are some of the natural things we could actually do to help us when we're going through menopause?

[00:37:48]One of the um over-the-counter products that can be used is black cohosh.

[00:37:54]Soy is also another one.

[00:37:56]And flaxseed.

[00:37:58]They're two um over-the-counter um products. Menopause and Menosense.

[00:38:07]You don't need a prescription for those.

[00:38:09]They actually sell them um over-the-counter and they And I have patients who swear by Menopause.

[00:38:16]And they sometimes Some of them actually started before they went through the full menopause.

[00:38:21]Exercise is also important and it's weight-bearing exercises. So, walking, running, using weights, cycling.

[00:38:32]Swimming is good, but it's not a weight-bearing um exercise, but it certainly would keep your heart pumping.

[00:38:43]Of course, eating healthy, cutting out the sweets and um the junk food, that would help. And then the other thing, the pharmacological things would be hormone replacement therapy. And there's several of them on the market.

[00:38:57]Um hormone replacement therapy is useful, is good, especially if we're using it just for the symptoms. So, like for the first 5 years of menopause.

[00:39:10]There are different products. They are oral or tablets. They are creams and patches.

[00:39:18]They are vaginal um preparations.

[00:39:22]Um there is a risk of for hormone replacement therapy.

[00:39:29]Um breast it you could increase your risk of breast cancer and it can increase your risk of endometrial cancer.

[00:39:36]So, anybody who I'm going to put on hormone replacement, I want them to do a mammogram and an ultrasound scan to check for the lining, the thickness of the lining.

[00:39:47]If you've already had a hysterectomy, then we don't have to worry about endometrial cancer.

[00:39:53]I whenever I talk about menopause and talk about breast cancer, I vividly remember this patient that came to see me.

[00:40:04]She was the wife of a missionary, a white lady.

[00:40:09]Doctor Providence, the um current Providence, had sent her to the clinic because she was having depression, going through depression, and wanted HRT hormone replacement therapy.

[00:40:21]And I said to her, "Before I put you on hormone replacement therapy, let's do a mammogram."

[00:40:27]And she got She wanted me to give her the HRT.

[00:40:36]She came back with the mammogram, and it showed that she had cancer.

[00:40:42]And I got very cold because I knew if I had not followed my instincts and had given her HRT, she would have blamed me.

[00:40:52]Yes?

[00:40:54]But by doing the mammogram, we were able to avoid things.

[00:40:58]She was supposed to go back in August.

[00:41:02]And I This was March.

[00:41:05]And I said, "Listen, you need to go back to the States because I think this is a cancer, and we need You need to get it sorted out."

[00:41:14]3 years later, I totally forgot about it. 3 years later, somebody dropped off a three-page A4 letter for me.

[00:41:25]And it was this lady thanking me for for basically ensuring that she had had the mammogram.

[00:41:34]I've kept the letter, and I read it when we moved because I'm I'm no longer at hospital there.

[00:41:40]When I was cleaning out, I found the letter and read it again. And it's a reminder for me to always do what I think is best and don't make patients coerce you into doing other things.

[00:41:51]All right? So, anybody I'm going to put on hormone replacement needs to do a mammogram. And if she has a uterus, we're going to do an ultrasound to check for the lining of the womb.

[00:42:01]Because HRT can cause increased your risk of breast cancer and endometrial cancer, which is cancer of the uterus. Yeah?

[00:42:14]Um Let me see. Oh no, let me go back.

[00:42:21]I tend to use the gels, HRT gel, because it's not really absorbed into the system.

[00:42:29]And um it works well. The patients like it.

[00:42:34]The patches is another one that can be used, but the problem with the patches is that the men wake up with the patch on.

[00:42:43]You got that, Gary?

[00:42:49]So, um you know, when you're doing your little intimacy things and touching up and rubbing up and so on, the patch ends up on the man. Not only that, because of our climate, they tend to fall off because we sweat a lot in the in the Caribbean.

[00:43:07]It's important that we have somebody, a support system, a sister, and I'm not talking about a biological sister, talking about a sister who you could talk to and discuss any and everything.

[00:43:22]Yes? It's important that we have that support system.

[00:43:26]I think in the Caribbean we are just reaching the stage where we don't feel uncomfortable discussing things. I mean, if you think about um domestic violence, women are now talking about it. You hit me, I'm going to tell somebody. We don't cover it up anymore. We shouldn't be covering it up.

[00:43:45]Um you have incest going on in the household, we talk about it. It's getting more and more open. So, it's just the same, we still could talk about our menopausal symptoms, how we feel, how it's affecting us psychologically, how it's affecting us physically and emotionally. We need to have somebody we could sit down and chat with.

[00:44:06]Yeah, this is not the time to be Heidi Heidi. We need to talk.

[00:44:12]Um I think the other slide.

[00:44:18]Oh, wow, it didn't go on this one.

[00:44:20]Last night when I was going over the lecture, I realized that I needed to talk about postmenopausal bleeding.

[00:44:27]Now, I know this is not part of menopause, but remember I said to you that you go a whole year without periods, and then if you if you have bleeding after a year, it's not okay.

[00:44:43]Anybody who has bleeding after a year of no periods, that needs to be investigated.

[00:44:51]I saw a patient on Tuesday.

[00:44:54]She said to me her period stopped during COVID.

[00:44:59]So, that's like 2020, let's see.

[00:45:02]She's been having bleeding on and off, and the people have friends tell her that's normal.

[00:45:08]It is not normal. If you're bleeding after you've gone through menopause, that's considered postmenopausal bleeding, and it must be investigated.

[00:45:19]All right, there are benign reasons for it. It could be that you had sex, and because the walls are thin, you had some bleeding. But, the one thing we worry about always is endometrial or cancer cancer of the uterus.

[00:45:35]And cancer of the uterus is the one cancer that we could actually work on early if you come in.

[00:45:41]So, once you have bleeding, you need to come in so we could investigate and do tests and try and help you.

[00:45:48]Yes? So, you should not be having any bleeding once you have gone through 1 year of no periods.

[00:45:56]Okay? So, I Yes, it's not part of menopause, but I think it's important that you are aware of that. And that you tell your friends your the lady you met, you haven't seen her for a couple months, you run into tongue and you have a conversation, she say, "I got fine a place because of bleeding."

[00:46:15]She has gone to menopause. This is not a period.

[00:46:18]This is pathological and she needs to be investigated. So, you can say to her, "Mary, this ain't this ain't normally, you know, you're supposed to go and check your doctor."

[00:46:29]Yes?

[00:46:30]So, I just wanted to plug that in.

[00:46:33]And I think that's the end of my little chat. I I hope I wasn't too long. But we're going to have a very open discussion.

[00:46:46]And we could Maybe we should take off the stream for this cuz we want them to ask the questions.

[00:46:53]So, I think we should say somebody Somebody want to come and say goodbye?

[00:47:00]All right. So, I'll sit then. We're going to close off this live streaming now and we're going to take some questions, intimate questions which we don't need to publicize. Yeah.