How to track your menopause symptoms

Most women will recognize one or two symptoms of menopause. The infamous hot flashes or weight gain. But there are also brittle nails, tingling in your hands, and changes to your taste buds. In fact, there are more than 50 symptoms of menopause. 

Today’s guest, Tamsen Fadal, found out she was in menopause while she was on live TV. Tamsen is an Emmy-award-winning journalist and executive producer of the documentary “The M Factor: Shredding the Silence on Menopause.” She’s also got a new book titled “How to Menopause.”

Tamsen is joined by Prof. Sarah Berry. Sarah runs the world’s largest study on nutrition and menopause here at ZOE. She developed a free tool called the MenoScale calculator that helps you track your symptoms so you can find relief. Sarah is a world leader in large-scale human nutritional studies, associate professor in nutrition at King’s College London, and Chief Scientist at ZOE. 

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Transcript

Most women will recognize one or two symptoms of menopause. The infamous hot flashes or weight gain. But there’s also brittle nails, tingling in your hands, changes to your taste buds. In fact, there are more than 50 symptoms of menopause and just one of these symptoms alone could be menopause, knocking at your door. 

Today’s guest found out she was in menopause while she was live on TV. Her symptoms then tried to derail her health, her personal life, and her career. But she didn’t let them. And through ZOE’s latest research, published just this year, we’ve identified simple interventions that alleviate symptoms to help you feel like yourself again.

Today’s guest, Tamsen Fadal, has learned a lot since that day on the bathroom floor. Tamsen is an Emmy award-winning journalist. She’s got a new book titled “How to Menopause” and she’s executive producer of the documentary “The M Factor: Shredding the Silence on Menopause”. 

Tamsen is joined by Dr. Sarah Berry. Sarah runs the world’s largest study on nutrition and menopause here at ZOE. She developed a free tool called the MenoScale calculator that helps you track your symptoms so you can find relief. And today, she’s sharing a brand new breakthrough about how gut health impacts severity of symptoms. Sarah is a world leader in large-scale human nutritional studies, associate professor in nutrition at King’s College London, and Chief Scientist at ZOE.

Today’s episode will help you track and treat your menopause symptoms so you can embrace the power of midlife. 

Jonathan Wolf: Tamsen and Sarah, thank you so much for joining me today. 

Tamsen Fadal: Thank you. 

Prof. Sarah Berry: Great to be here. 

Jonathan Wolf: So Tamsen, we have a tradition here at ZOE, where we always start with a quickfire round of questions. 

Tamsen Fadal: Oh boy. 

Jonathan Wolf: And we have some very strict rules. You can say yes or no, or a one-sentence answer if you absolutely have to.

Tamsen Fadal: Okay. 

Jonathan Wolf: You're willing to give it a go?

Tamsen Fadal: I'm willing to give it a go.

Jonathan Wolf: Once your menopause symptoms began, did you feel prepared? 

Tamsen Fadal: Not at all.

Jonathan Wolf: Are workplaces supporting women who are going through menopause? 

Tamsen Fadal: Not enough.

Jonathan Wolf: Sarah, is there a simple medical test that diagnoses perimenopause? 

Prof. Sarah Berry: No. 

Jonathan Wolf: Have you developed a new tool for women to be able to make sense of their symptoms?

Prof. Sarah Berry: Yes. 

Jonathan Wolf: Can the right changes in nutrition help with symptoms of menopause? 

Prof. Sarah Berry: Yes. 

Jonathan Wolf: Tamsen, what is it that you wish you knew earlier about menopause? 

Tamsen Fadal: I wish that I knew that there was support out there and there were some answers and that I wasn't alone.  

Jonathan Wolf: I think that's really powerful and actually this idea of being alone, I mean, it's very strong.

I'm really excited you're here and for listeners around the globe who may not know you so well, you're one of America's most beloved news anchors. You covered Hurricane Sandy, the war in Afghanistan, and recently you've been covering this topic that we're going to talk about today, which is menopause.

And your new book, How to Menopause, based on interviews with dozens of experts, really aims to break the taboo about this topic. And you've also found fame globally with your viral video about 34 symptoms of menopause. A number that is staggeringly high, and yet I think today that Sarah is going to say she's found even more.

So Tamsen, I'd like to start with your own experience. Could you tell us about the moment that you suspected you were entering menopause? 

Tamsen Fadal: Yeah, I had been, if I look back, dealing with a lot of symptoms of it, though I wasn't aware of it. 

I was a news anchor for about 30 years. In the last year or so before I realized what was going on, I would have a hard time, I'd look at a word on the teleprompter, not be able to say the word, not know exactly what was happening. And I just thought, stress, I'm tired, I don't know what's happening. 

One night, it was November of 2019, and I was on the news desk, and we did live newscasts every night in New York City. And we were on a commercial break, and we were all talking, and everything was fine.And all of a sudden I felt this eruption from inside. 

My whole, everything broke down into a sweat. And my heart was just beating, beating, beating fast, I could hear it in my ears. And I thought, I don't know what is happening, but I'm not going to make it through this next round of news. And I said kind of jokingly, because I was in a studio of all men if I fall over, somebody catch me.

And I was a little uncertain. You want to feel like you're in control on live television and I knew I wasn't going to be shortly. So one of my coworkers walked me off and I walked into the bathroom with him and dropped to the bathroom floor just to cool my body down and calm myself down.

I got up fifteen minutes later, not something anybody in their right mind would do, is get on the bathroom floor in a newsroom, and left the studio and that following week proceeded to go to my doctor's to see what was happening. I went to one doctor after another because I didn't know it was menopause at that time. I just knew I wasn't right. Something was happening. 

Jonathan Wolf: Wow. I mean, that's a really good point. Really intense and shocking story. I always feel whenever I hear any of these stories, I think, particularly as a man, it's amazing because this is not something that anyone ever talked about with me until really the last few years. It sounds pretty terrible. 

Tamsen Fadal: You know what's interesting is that the guy that walked me in to the bathroom, he said I thought you were having some kind of heart episode. I didn't know what was going on, but I just knew that something wasn't right. And since then, we've talked quite a bit, and now I hear men asking these questions to talk about it. 

But yeah, it was terrifying because I wasn't in control anymore and I didn't know what was going on. When you lack answers and you can't go forward with knowing what you're dealing with, try to find a solution, I think that's the terrifying part.

Jonathan Wolf: And were you prepared for the fact that there was going to be an onset of symptoms and it's just that you were surprised that this happened now? 

Tamsen Fadal: I'll be honest, not too long later I got a message in my patient portal from my doctor. I'd gone to my OBGYN, I did blood tests, endocrinologist, I found a functional medicine doctor, and the message in the patient portal from the doctor said, in menopause, any questions?

And I was in the airport at the time with my now husband and I looked and I was like, My doctor says I'm in menopause, I'm too young for menopause. I was 49, beyond the average age of menopause. 

And so I had no idea because all I had ever seen were kind of media ha has about hot flashes and joking about it and women sweating and I didn't know very much else about it. So I was stunned to find those symptoms that I think some are very uncommon to women. They just don't know about it. And then there's the common ones that you don't realize how debilitating they are. 

Jonathan Wolf: And do you think your story is unusual? Or are most women not prepared for this? 

Tamsen Fadal: Well, that's what I thought was so strange. I was like, I have this unique story. 

And then I started talking to one woman after another and I went, this is not unique at all. This is common and all of us are in the same boat. And I think that's really what moved me forward with this purpose because I realized that there was such information lacking.

I tell stories my whole life and I never talked about this. I never said the word perimenopause on television. We talked about diets. We talked about exercise. We talked about the latest fads and drinking, you know, green tea. We never talked about this. 

Jonathan Wolf: Why is that? 

Tamsen Fadal: I ask myself that question a lot. I think there's a shame in a lot of ways, of feeling not as productive anymore after your reproductive years have come to an end. 

I think maybe there's the shame that's wrapped up in aging and feeling not as useful once you hit this time in life. And I think that a lot of women feel like my life is kind of over when I hit menopause and that's a really sad thing because that's just not true. 

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First I'm going to say thank you for sharing the story. It's very raw and powerful. I'd love Sarah, if maybe you could try and explain a little bit what might have been happening, what's going on in the body leading up to menopause. How could you have such a terrible experience? 

Prof. Sarah Berry: Well, I think firstly, before we even talk about biology, I think it's because we don't talk about it. We are of the same generation, Tamsen and I, where our parents didn't talk about it, the generation before that didn't talk about it. So we are unprepared.

And that's what I think is fantastic about the kind of things we're doing at ZOE and that you're doing, that I hope my daughter's generation will be ready for it. Because I think if you're ready for it, there's lots that you can do to prepare yourself for it. 

So what happens is that as you enter the menopause transition, which is what we call perimenopause, you start to have a decrease in the hormone estrogen. Now, you don't go to bed one day where you're premenopausal and you wake up the next day and, hey, I'm postmenopausal, that's it, the menopause is done. 

We know that on average, people become postmenopausal at the age of 51 and basically all that means is that it's one year post their last menstrual cycle, so post their last period. But there's this whole transition period. 

There's this transition period that can last for some women up to 10 years, although typically it's between two to four to five years. And during this transition period, you don't again have this nice, slow, lovely decline in estrogen that your body adjusts to. You have this rollercoaster. It's like this state of just craziness in your hormones. So it's like hormonal chaos I often think of it, where your estrogen is going up and down from day to day, from hour to hour. 

So you're dealing with firstly a reduction in estrogen. But you're also dealing with this roller coaster in estrogen. The reason that it has such wide-reaching effects, so you talked about 34 symptoms and we know it's even greater than that, it can be 50 and beyond in terms of number of symptoms.

The reason it has such a big impact on so many different areas is because we have estrogen receptors all over our body. Our brain is full of estrogen receptors. Everywhere in our body has estrogen receptors. Nearly every cell has an estrogen receptor. 

So if your estrogen is declining, it's going to impact everything from our brain to our cardiovascular health, to our bone health, to our muscle health, and it's going to cause therefore all of these really unpleasant symptoms that we talk about often to do with menopause.

Now it will differ from woman to woman what symptoms they have, it will differ from woman to woman how impactful they are on their quality of life, and it will also differ day to day and I think this is really, really key. 

With the research that we're doing, yes, we know on average 99.8% of women in our ZOE cohort say that they have experienced at least one symptom. 66% of women in our ZOE cohort say that they've had 12 or more symptoms. 

Jonathan Wolf: Twelve or more symptoms. 

Prof. Sarah Berry: On average, perimenopausal women in our ZOE cohort say that they have 13 and a half symptoms out of 20 that we're measuring. For postmenopausal, it's a little bit lower, it's 10, but that's still huge. 

But they vary day to day and I think what's most interesting, and it's interesting listening to your story about what suddenly kind of made you wake up and all this, and wow, what's going on. Was that hot flash that you had? Actually, that's what typically women think, Okay, I must be in the menopause because I've had a hot flash. That's actually one of the least common symptoms. 

So, from our ZOE Predict data, we know about 45% of women will experience hot flashes. 

Jonathan Wolf: So Sarah, you could go through menopause and never have hot flashes? That's possible? 

Prof. Sarah Berry: That's possible. And some women, and what I hear a lot, is what you've said, Tamzah, and this is what I experienced. I had one overwhelming hot flash. I remember when it happened. It was just before Christmas. 

I was on the floor in the lounge wrapping my kids’ presents and it was like, Oh my God, what on earth is going on? I thought maybe I'm going to faint. Am I going to collapse? What's, what is it? 

I've never had them since, but what I've had is all of these other symptoms, and these other symptoms that we know from our own data are so common. 

Jonathan Wolf: So Tamsen, I bet it would have been really great to have had this little medical explainer from Sarah before you ended up on the bathroom floor of the studio.

Tamsen Fadal: Yes, where have you been all my life? You know, it's interesting because we talk about this and you look back, and I thought to myself, wow, 12 months without a period, and I did go through, up, down, a lot of, a heavy period, crazy heavy period, none for four months.

But I had endometrium polyps, which is another thing to add on top of this, which didn't give me that defined marker of, Oh, I haven't had what seemed like a period for 12 months. So I didn't even know that was a thing either. I didn't know that you go 12 months without a period and that's menopause.

But if I look back at those transitional years now, I was gaining weight, I'd gone to see a doctor because I was having anxiety, I was put on antidepressants, I had dealt with a lot of these other symptoms, the brain fog, the irritation with the brain fog, the lack of word retention. So I just didn't know that that's what it was.

I attributed it to everything else. It's stress, it's difficult at work, I'm not sleeping well, weight looks different on my body now. So I just didn't know what I didn't know and that would have been really helpful to have just some indication. 

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Jonathan Wolf: You're describing these symptoms before you actually hit the point where you'd have no periods and you're on the floor.

Tamsen Fadal: I played whack-a-mole with them. No sleep, feeling anxiety, gotta work out harder, gotta eat better. And I just didn't know, looking back, that that was what is perimenopause. I didn't even have the word. 

Jonathan Wolf: And how did your symptoms progress after that day on the bathroom floor? 

Tamsen Fadal: You know, they were still bad for about a year plus.

I lost my mom to breast cancer when she was young and I was young. And that was always something that I was paying attention to. I wasn't thinking about anything else, certainly not menopause. 

So when I did finally go to a doctor and say, I've got to do something because I'm not functioning, I wasn't myself. And I was having more anxiety issues, a lot of anxiety and physical in terms of weight. And so my doctor said, well, you can do hormone therapy. I think that you're good. I'm not eligible for it, I'm not quite sure because you had a mom with breast cancer, we don't know.

So I went to a doctor who wasn't so sure, then I found another doctor who felt very confident and cleared up a lot of misinformation there is about hormone therapy. So I was given hormones and when I went on that It was about six months and I started to see the light again. The fog had kind of cleared.

But I had a rough go of those symptoms for a bit after that happened in the studio. 

Jonathan Wolf: Again, whenever I hear these stories, I'm always struck that there's these two parts to it, Sarah, with all these symptoms that start and you really have no idea where they're coming from because there's no test perimenopause in the way that I feel like we're used to a blood test for everything. And then there are these symptoms also in menopause. 

Sarah, could you tell us about this new research you’ve been doing about menopause symptoms? How many there are and in particular, you just mentioned that it's not just night sweats and hot flashes. What are the other symptoms that actually you are seeing are frequent?

Prof. Sarah Berry: Yeah, Jonathan. So we've been researching menopause symptoms, but also how menopause impacts our health. And this is really important to specify because often we think about menopause and we think because there's a lot more voices out there talking about symptoms, we forget that it also impacts our health, impacts our blood cholesterol, impacts our blood lipids, it impacts our blood pressure and so much more.

So we've actually been doing is looking at menopause across two areas. We've been looking firstly how it impacts our health in terms of disease risk and then how it impacts our symptoms. So these very kind of burdensome symptoms impact our quality of life. 

The research that we've been doing, looking at the relationship between symptoms, diet, and lifestyle and many other exposures, we've had over 70,000 individuals who were taking part in our ZOE Predict study, which is part of this huge program of work that we're doing at ZOE. It's the world's largest nutrition research program. 

We have studied 70,000 females, half of who are perimenopausal and half of who are postmenopausal. And this is really important because there is some growing research in the area of postmenopause, but actually, generally, you're either asked, are you pre- or are you post-?

So what we're really proud about is the work we're doing in the perimenopausal group. And this makes up about 35,000 of those individuals. And we've been asking these individuals lots of questions about their symptoms, how many symptoms they have, how impactful their symptoms are on their quality of life, because that's really important. As Tamsen said, 10% of women leave their job because of their symptoms. 

And then we've also been following these individuals up after they might make,diet or lifestyle changes. But in this first body of research, where in these 70,000 individuals, we asked them about their number of symptoms and the impact that they have on their quality of life. It was amazing just how many people reported having symptoms. 

We know that there's loads more than 20 symptoms, there's up to 50 and beyond, but we've asked individuals about what we know from our own research, are the 20 most common symptoms. And what we found really surprisingly is that actually the ones that we typically think of when we think of menopause, so the hot flushes, the night sweats, were the least common.

Only about 45% of the women reported having these hot flushes, these night sweats. And yet symptoms that the more we talk to individuals, we realize they talk about, don't know are a part of menopause. These are the ones that are most common. 

Sleep disturbances, more than 80% of individuals have these. Memory loss, brain fog, irritability, anxiety, depression, low libido, weight gain, slowed metabolism. More than 80% of individuals reported having each of those different symptoms in perimenopause. 

Postmenopausally, it was lower, but there was still a high proportion of women who had those symptoms. You're still talking in the range of 50 to 60%. And I think this is important because I think often we think, Oh, it's just during that transition period. You have these bothersome symptoms, suck it up, get on with it. After the menopause is over, it's fine. They reduce. 

Yes, we do see for every year post menopause your symptoms go down and this is really exciting research actually that we haven't published yet, Jonathan, but we've looked at the number of symptoms and how they go down per year past the menopause. They reduce, but even 10 years post menopause, so post that last period. you still have a big burden for menopause symptoms. 

So this is why it's so important not to just think about it as the perimenopausal phase, but also realize this is something that's going to impact you for quite a number of years.

Jonathan Wolf: Why is it that the symptoms reduce over time in menopause? What's going on that it's not just sort of constants from the point of menopause. 

Prof. Sarah Berry: So I don't think we fully understand that yet. What we do know is during the perimenopausal phase, the reason that they're so impactful on your quality of life is because of this roller coaster like you've just explained.

Also, our body hasn't adapted yet. Our bodies are really, really clever. Sometimes they're too clever, sometimes there's things during the perimenopause they're not quite clever enough at adapting. But we do adapt. We adapt to changes in the nutrients we're exposed to, the environment outside, we adapt to our internal environment as well.

So our body over time adapts to this reduction in estrogen, but also postmenopause it becomes more stable. So you're not having this kind of rollercoaster as well. 

We know at ZOE, because this is what we spend all of our time studying, that there's no one size fits all, that we all respond so differently to every kind of exposure that is put upon us. So we do know that there are some women that will sail through it. There are some women that will say they sail through it, because, particularly I think our parents' generation, it's the generation you had grit, you sucked it up. 

Of course you didn't moan about it. you don't moan about having menstrual cramps. You don't moan about, you know, having your periods, any of that. But I hope that my daughter, well, she's 14 and so she's self-absorbed at the moment, but when I am having my brain fog, et cetera, you know, I hope that when it's her time as well to go through the menopause that she has a very different experience.

I believe she will because of the kind of research we're doing, but because of the kind of voice that people like Tamsen have as well.

Jonathan Wolf: It's sort of clear from the research that Sarah says just this is a really big deal and so to not talk about it at all seems mad. And I find it very hard to believe that if we men had all been going through this that we never would have talked about it. So I think it's fantastic that it's starting to be talked about.

It's also amazing how little study there's been, right? It's amazing, Sarah, that this is the first data that's actually understanding this at any scale. 

Prof. Sarah Berry: And I think, Jonathan, it's really important as well, to talk about the increased disease risk that happens with menopause, because this isn't talked about much, and I think it's great we're getting a bigger voice in terms of the symptoms. But actually, when you enter the perimenopausal phase, and when you become postmenopausal, suddenly your risk of disease increases.

Women need to be aware of this because what is good about that is there's a lot you can do related to diet and related to lifestyle to reduce this. We published some research in a couple of years ago in eBiomedicine on the first large-scale study looking at how peri- and postmenopause impacts many intermediary risk factors related to disease.

So by this I mean things like blood pressure, blood lipids, insulin sensitivity, glucose, inflammation, body fat, and so much more. 

What we found was that for all of these kind of health risk factors, shall we call them, up until the menopause, women are doing really well. It's the one time, we're beating men at this, we've got lower blood pressure, we've got on average, we've got lower blood cholesterol, we've got lower visceral fat, so the fat around the tummy. We have better insulin sensitivity. We have lower inflammation. 

We reach the perimenopausal phase and suddenly this nice little, imagine a figure and you see you're going up kind of year by year, but way below men. Suddenly, wham, it goes up. And in some instances, for example, with blood pressure, you actually even overtake men. So your blood pressure becomes even worse than men of that age. 

For the other factors, then you become more at the same risk of man. So your blood pressure is increasing your glucose, your insulin, your inflammation and we see huge increases in inflammation. We know this is really related as well or we believe there's evidence emerging it might be related to some of the symptoms and the neurological symptoms

So it's a real point in time where I think women as well as thinking how they can handle their symptoms need to be really mindful about okay I'm now at increased risk of cardiovascular disease of type 2 diabetes. Of obesity-related illnesses, which then link in with cancer as well. And this is where I think diet and lifestyle becomes so, so important as well. 

Tamsen Fadal: I do too. And I went to the doctor and I had increased cholesterol. I had low cholesterol my whole life. I was shocked. I said, look, what did I'm not running around eating cheese and drinking like I wasn't doing something that would cause that. And so then I learned, after all these years of paying attention to this, I learned that as well. 

So, it's really shocking. But I do think people want to know what to do so they can kind of have some type of control, and I think eating is the one place that you, you actually can try to take some of your control back and do something about it early, early on, so.

Prof. Sarah Berry: Yeah, and I think this is where we can use diet, we can use lifestyle to reduce risk. But at the same time, something I think we also need to be mindful of is about being kind to ourselves.

So, what we know is that with the change in estrogen levels, where you deposit the fat on your body changes. So, in simple terms, estrogen kind of directs the fat to your hips. So, you think of pear-shaped women. Once you become perimenopause or women with the reduction in estrogen, then the fat is directed around your tummy, which is where it typically is directed with men. 

Jonathan Wolf: So, it's a scientific fact, is what you're saying, as you go into perimenopause, suddenly your weight is going to change where it gets put, and you are going to put weight on around your stomach in a way that you just didn't before that, and that's not because you suddenly changed, it's because your body has changed on you.

Prof. Sarah Berry: Absolutely, and this is why I think we need to be kind, because it's biologically what's happening. It's because estrogen, in simple terms, is directing the fat, or the lack of estrogen, to be around your tummy. 

Fat around your tummy is what we call visceral fat. We know this is very metabolically active. It's not healthy for us. That's why you have this increase in cholesterol, in inflammation, in blood pressure, for example, peri and postmenopause because of that increased fat there.

But the reason I'm saying it in the respect of we need to be kind to ourselves. I might be slim elsewhere, but I'm not comfortable wearing a bikini. Now I recognize that it's just a natural part of menopause and yes, I'm going to work hard to be healthy. 

But I think it's recognizing that, look, we can't have that six-pack necessarily. I mean, maybe some women can, but I don't want to live such a virtuous life that I have no pleasures to get anymore. But it's recognizing that there's some things we can do with diet, with lifestyle, with hormone therapy, if that's our choice. 

But there's also some things, let's just accept it, as part of aging. You know, aging can be a beautiful part of how we change as well. 

Jonathan Wolf: Thank you, Sarah. I'd like to ask the question that you teased to me before the show starts about gut health and menopause. Because I think like, oh, well, I know that my gut health is really important for my health in general, but surely it has got nothing to do with menopause because that's all to do with estrogen, that's something completely different. It's sort of what I was thinking until five minutes ago. So tell me, Sarah. 

Prof. Sarah Berry: So I will remind you of some data we've already published, and then I shall tell you about some new data that Tamsen, I have whispered to her already. So I'm sorry, Jonathan, that you're hearing with a second hand.

Jonathan Wolf:  I feel like you've cheated on me, Sarah.

Prof. Sarah Berry: I know, I do feel a bit like that. So we know from some research that we published a couple of years ago where in our ZOE Predict cohort of a thousand individuals who we really deeply phenotyped. So we studied loads and loads of different aspects related to menopause and health. 

We know that peri- and postmenopausal women have a different microbiome composition to premenopausal women. Which I think was really fascinating and this is even after we adjust for different confounders like is it to do with their diet or what else is going on. 

We also looked in that data set to see is the microbiome, why we're seeing some of these changes that I talked about related to health, the increased inflammation, the increased belly fat, etc. And really interestingly, we found that there were some species that were particularly elevated in the peri- and postmenopausal women. And these were species that we had previously identified through a huge body of research that we'd done a few years before that, so we're looking at the relationship between the microbiome and health.

These were species that we identified to be associated with inflammation, with higher blood pressure, higher blood cholesterol, and all of these kind of disease risk factors. And we found that there was one species in particular that was quite elevated in peri- and postmenopausal women which is associated with an increase in inflammation. 

We saw a huge increase in inflammation and also what we call postprandial inflammation, i.e. when you have a high carb, a high-fat meal, you do have an increase in inflammation. It's a normal part of having a meal, but if it's excessive and repeated, we know that it increases our risk of chronic disease. So we saw that particular species was increased. 

Jonathan Wolf: Sarah, can I just check? I've got that because we often talk about the latest research from ZOE has identified these sort of 50 bad bugs that can be in your gut, Tamsen, and also these 50 good bugs. And are you saying that basically that one of those particular bad bugs suddenly you're getting lots more of as you're going through perimenopause? 

Prof. Sarah Berry: Yeah, so we saw that on average there was a greater number of what you call bad bugs. Any microbiologists would hate that term but I think it's a good term to summarize it simply.

We see that there's an increase in these bad bugs, postmenopause versus premenopause and in particular the bug that's associated with increased inflammation. This is research we've already published. We published this a few years ago. 

Some hot off the press research, and I even had a latest update yesterday afternoon on this research, is that we have found that the microbiome, so the composition of the microbiome is related to menopause symptoms. This hasn't been looked at in humans before. 

We have data now on this 70,000 cohort. This is phenomenal. 70,000 peri- and post-menopausal women that we also have microbiome analysis from their poop. And we can look at how is the microbiome composition related to the number of symptoms, the severity of symptoms and different types of symptoms.

What's really interesting is we see a really strong relationship to the makeup of the microbiome and how many symptoms you have. We can do a particular kind of analysis that our genius team at Tamsen at Trento University, who are world leaders in this area, they do this analysis. It kind of blows my mind. I don't quite understand what they do. So Jonathan, don't ask me in depth.

But they can work out how predictive is your microbiome composition to a particular outcome. So they do this analysis to say, can we predict the number of symptoms that you have based on the bugs, the species, the microbiome that you have. And they can predict with reasonable accuracy, using the microbiome how many symptoms you will have, so how burdensome the menopause is.

Now it is important to say that we also know that your microbiome composition is so strongly related to diet, so is it that diet is impacting the symptoms independent to the microbiome, or is it that diet is impacting the microbiome that's impacting the symptoms? 

My feeling based on the results that I've seen, because they've done some more other complex stuff that again goes a little bit over my head, is that there's a little bit of both going on. That diet is directly impacting symptoms through various mechanisms but that there might also be this mediating effect of the microbiome. 

And then the new results that I saw yesterday when we tried to look at different types of symptoms was that the symptoms that the microbiome had the strongest relationship with was the psychological symptoms.

And I think that's really fascinating because this is what we're starting to see when we think about food as well and psychological symptoms. So by this, I mean things like depression, anxiety, low mood, irritability, memory loss, brain fog, and they have a strong association. 

So I think this just really hammers home the importance of eating to feed our microbiome, but also eating based on our understanding that certain foods or a whole diet pattern can improve the symptom burden that we experience.

Jonathan Wolf: This latest research shows there is actually a relationship between all those trillions of bacteria in your gut, this gut microbiome, and your menopause symptoms is that right, Sarah? 

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Prof. Sarah Berry: That's correct. And what we need to go on to do, which we can do with our data, so in a few months hopefully we'll have those results, we need to see is it causal.

And what I mean by that is if we use diet to change the microbiome, does changing the microbiome change some of these symptoms? And we have this goldmine of data that I'm always talking about, I know, that will enable us to look at this. 

As ZOE's Chief Scientist, I want to talk about something that's just not talked about enough. Menopause symptoms. As a perimenopausal woman experiencing menopause symptoms, I'm really excited that at ZOE we've just launched the MenoScale Calculator. This allows you to measure the number of symptoms that you have, but also the impact that they have on your quality of life. And this is a real game changer, I think.

As a perimenopausal woman myself, we're all discussing amongst my friends the kind of symptoms we have, how they impact our life. But it's really difficult to actually quantify this and now for the first time ever there's a calculator out there that I'll be sharing with my friends that allows us to quantify just how big an impact our menopause symptoms are having on us.

For the first time we can measure it in this free-to-use resource so that we can start thinking about what we can implement in order to change it. The MenoScale Calculator puts our science in your hands. Go to zoe.com/menoscale to get your score. The calculator is free and only takes a couple of minutes.

As we scientists say, if you can't measure it, you can't change it. All right, back to the show. 

Jonathan Wolf: I want to start talking just a minute about actionable advice about what women can do. 

But just before that, Tamsen, I really wanted to pick up on a thread that you talked about earlier. I don't want to bounce over it, because it sounds like your symptoms really impacted your career. You know, you were lying on the bathroom floor instead of actually being reading the news. That's pretty dramatic. How unique is your story? 

Tamsen Fadal: It's interesting. When I started going into all this research, I was like, I don't know where, because there was no place to find information. You can go online, you can find whatever you want in a lot of different areas. And I think that that's what a lot of women do. And it becomes very scary. 

But I realized that my situation is not unique at all. I have a community of people that I talk to online constantly and I hear one story after another way worse than what I went through. Trying to do all sorts of things to remedy symptoms, understand symptoms, figure out where they are. Understand what perimenopause means versus menopause versus postmenopause. 

So I don't think unique, it did impact my career. It wasn't the reason that I stepped away, but it was the reason I stepped away. The reason is because I just feel like there's a much larger story here to tell because we don't continue talking about this and we don't continue helping. We don't help that younger generation coming up and we're going to just keep repeating this cycle.

I think in some ways I do get sad that I wasn't here for my mother doing it, and I want to make sure that somebody else that comes up behind me does never have that feeling again.

Jonathan Wolf: As a result of this not being in play, are there a lot of women whose careers are being impacted right now? 

Tamsen Fadal: Yeah, I think we're seeing a lot of that. We're seeing a lot of women, there's statistics that have come out and there's a lot of different surveys that are being done saying that a number of women are leaving the workplace or not looking to be promoted within the workplace because they're not feeling like they can balance or juggle some of those symptoms. 

And that bothers me too because we're staying in the workplace is longer now, right?  women are at the prime of many of their careers. They deserve to be where they have worked so hard to get.

And I think we owe it to ourselves to try to help them be able to stay and maintain and go for promotions and not walk away from a job or career they've been working so hard for because of symptoms that we that we're learning more about. 

Jonathan Wolf: It's a pretty critical point, isn't it? I mean, it's basically my age and you're late 40s like you’ve got very good at whatever you're doing at this point, and that's just the point that you're saying, instead of, you're sort of having to potentially having to pull back because you're not being able to keep this under control.

I think it's just another aspect, right, along with the personal symptoms that you've been describing, Sarah, and the health impact. 

Prof. Sarah Berry: Yeah, I think, I always refer to the statistic that we have in the U.K. that 10% of women have left their job, they say, due to menopause. But I've never actually thought about the point that you just made that actually, as well as people leaving, what about the people that stay that aren't going for promotion, that aren't progressing their career?

I actually see that when I think of a lot of my friends. I'm 47, so lots of my friends as well are going through the menopause. And for a lot of them, it's their most insecure point of time in their life.  And so they wouldn't be going either for that promotion. They've worked so hard and they're so capable.

And so, yeah, it's interesting you say that because it's just something that hadn't occurred to me. 

Tamsen Fadal: Yeah, it's real disturbing, right, though, because you know how hard they've worked to get to where they are. 

I think that when you asked about the symptoms earlier and what I really saw after I had that incident, I think it was a real lack of confidence that I had. I was a newsreader, but then also you are talking all the time and to not feel like I could complete a sentence or retain a word or I would get lost in a string of thought didn't give me that confidence. 

I've talked to so many women who say, whether they lost their train of thought in the middle of a presentation or they felt like they had that massive hot flash in a room full of men or in a boardroom. It can be really, really difficult. It can really just knock your confidence. And so those stories are not unique ones. 

Jonathan Wolf: I want to say again, thank you both for sharing. I think that just the sharing is very powerful in terms of, I think not just women hearing about this who maybe haven't gone through this, but I also think that for men to even be aware, this is really a thing.

So as I said, I literally didn't know it was a thing a couple of years ago, and I don't think I'm the only man in that situation.

I'd love to transition now into actionable advice that women can take to alleviate their symptoms. And actually, Tamsen, can I start with you? Because in your book, How to Menopause, you pull together a lot of stories and strategies to help women going through menopause and I'd love to hear about one or two. 

I think one of the things you talk about, for example, is the best sleep of your life. And I know that sleep is one of the things, Sarah, that you mentioned is a very common symptom that's a problem. Can you share? 

Tamsen Fadal: Yeah. So when I was writing this book, I said, I don't even know how to get all my thoughts into this, but I think what was really important for me as a journalist is to find the best of the best out there to interview and to make sure women had something actionable. Because if they're going through brain fog and they're not feeling good, they just want to know what to do. What do I do to get to feel better? 

So sleep was a big one. And for a long time, I used to consider sleep a luxury, I'll sleep when I can, but I'm going to brag about the fact that I've gotten by on four hours of sleep tonight and I can do all this stuff. But I've realized really how important it is. I've realized what it takes for me to get good sleep because it doesn't just happen. I don't just jump into bed and it happens.

I've realized it's a lot of preparation and a lot of focus on it and working my schedule as much as I can. Because I know it's not possible to do all the time and we have a lot of things going on at this part of life, but I think it's important to focus on, and that's really what I did in that chapter of the book.

Prof. Sarah Berry: Sleep is something that impacts 85% of the cohort that we studied. And we know that sleep is so important in terms of all sorts of factors related to our health. We consider it to be one of the four key pillars of health. So we've got diet, we've got physical activity, we've got stress, we've got sleep.

We also know that sleep impacts the dietary choices that we make. If you have a poor night's sleep, the reward centers in your brain are on kind of fire and saying, Hey, Tamsen you’ve had a bad night's sleep. Go and eat that sugary breakfast, that refined carbohydrate. 

We also know if you've had a poor night's sleep, your response to any meal is also worse. And we've published research on this that shows that if you have a poor night's sleep, your blood sugar response the next day to a meal is a lot worse. So it's a lot higher compared to if you've had a good night's sleep. So you kind of set yourself up on this rollercoaster. 

We also know from the ZOE Menopause study as well, if you have a better sleep, that also offsets some of the other symptoms. Meaning that those people who have better sleep, which we know is a symptom, but they have less symptoms and less impactful symptoms.

And so I think it's really great that actually you talk about that first, because we use, can use that as the cornerstone, maybe from which we can start to improve other symptoms. 

Jonathan Wolf: So Tamsen, what are the tips? Somebody's listening, they're like, great, what can I do? 

Tamsen Fadal: My sleep. Let's, let's jump into sleep. Drinking is a thing that I think that I have just moved off the table as much as possible. But if someone's having a glass of wine, having it anytime four hours close to bedtime is going to knock your sleep off completely. 

Trying to be really cognizant of devices. I'm not good enough or virtuous enough to take my device out of the bedroom. But I do try to make sure it's on that blue light mode and I try to make sure that I'm not dealing with problems closer to bedtime at all.

I do make sure that I'm trying to go to bed at the same time and get up at the same time every day, which is not anything I had ever done before. I was the kind that was up till 2 o'clock in the morning, I'd get up at 6, I'd go work out, and I do feel like that consistency has played a huge role for me in feeling better the next day.

When I get up in the morning now, no matter if it's raining or sunny out, the first thing I do is get outside. It's fantastic. It's made a huge difference in my life. I started it about a year and a half ago when I was writing the book. I talked to a doctor who had really just focused on light and understanding how light impacted the body.

And so I wanted to make sure that I was doing that and putting that practice into play. So those are some of the the bigger things I do. My bedroom goes completely black. I have tape over any of those lights that are on every device that you have. I have a TV in the bedroom. That's my husband's fault, but I make sure that stays off a few hours before bed.

And I used to be the person that went, I don't know, does that really make a difference? It makes a huge difference. It really does. 

Prof. Sarah Berry: We've done some work looking at the importance of sleep consistency on different health outcomes and also on the dietary choices that you make. So we published some research at ZOE looking at what we call social jet lag.

And 10 years ago, you would have been a prime target for this study. So this is where people have different sleep patterns. So it might be that you're very consistent in the week, but you're going wild at the weekend. Or it might be, if you're hardworking like I am at ZOE, that you're going a bit wild in the week because you're too excited by your research and you stay up far too late working on it, and then you catch up at the weekend.

But either way, you're inconsistent, your pattern is inconsistent. And we've shown from our research on social jet lag that it does have an association with health. And those people who have the social jet lag or the inconsistency also make poorer dietary choices. So have higher sugar, higher refined carbohydrates, for example, in their diet.

Tamsen Fadal: I mean, I did that a long time in news business. I never had a 9 to 5 job in news. It was get up at 2 o'clock in the morning and be at the station by 4 a.m. But I would reward myself and think, I can eat some junk food now because I'm so tired. I just got to wake up a little bit.

That was for about 10-plus years. And then I'll flip side about 15 years. I did the night shift. So I wouldn't get off of the air until 11 o'clock at night. So I'd get home by midnight, I'd wind down a little bit, I'd have a snack, you know, I did all of those things. So those hours were so off. So I've definitely seen a difference in no longer saying I can just survive on three hours. Might come with age too. 

Prof. Sarah Berry: Do you know what, the World Health Organization have shift work listed with a health warning because they know that it has such a bad impact on our health. 

Jonathan Wolf: It's amazing. So Sarah's going to be really interested about this, I think, because Tamsen, you talk about some recipes that some people believe can actually help with alleviate these symptoms?

Tamsen Fadal: Yeah, in the book I talk a lot about a Mediterranean diet. I'm Lebanese and it was what I grew up on and it was a diet of whole foods. It was a diet of lots of olive oil and lots of all kind of plant-based, vegetables and then you'd throw in fish.

So I decided in the book because I felt like a lot of these things were game-changers for me. They were the basics that I went back to. I took some old recipes from my family, old family recipes. 

The one in particular was one that my dad, we did growing up. We had grape leaves growing up. So I changed out the rice for quinoa. We had the grape leaves rolled, drizzled with olive oil, all of these really super healthy for your diet. We did a salmon instead of a chicken and then we made sure we had some Mediterranean vegetables with all sorts of spices and a tabbouleh salad. 

So those are the kind of recipes that I put in the book because one, that's what I grew up eating. Two, a lot of them go back to the whole foods that I think are really, really important for this diet. And I think they're easy to do. They're not these difficult, I can't do recipes with 20 ingredients and them. I need it simple, and I need to know that I'm going to be consistent about it. So that's what I did in the book. 

Jonathan Wolf: Sounds delicious. I wanna be invited around to your house. 

Tamsen Fadal: I would love it. 

Jonathan Wolf: I’ll be there. 

Prof. Sarah Berry: He's quite cheeky inviting himself, isn't he? 

Tamsen Fadal: You're welcome to. We've already broken bread together. It often manifests like, I don't know if this is true or not, but the next day is when I just feel awful. If I've eaten poorly one day or made choices that just didn't make sense because I didn't have time, I just feel differently the next day. So that's been another kind of consistency I've tried to have. 

Prof. Sarah Berry: Yeah, we know that food impacts how you feel that day, but we also know how you eat, so the timing that you eat and what you eat actually can impact how you metabolize food the next day and also how you feel the next day.

And it's interesting you mentioned the Mediterranean diet. There's been very little research on how diet can impact menopause symptoms. Apart from the work we've been doing, there is one study that's looked at the Mediterranean diet and people were randomly allocated to either follow a typical U.K./U.S. style diet or the Mediterranean diet.

Those people following the Mediterranean diet had a 30% reduction in some symptoms. They only measured a few symptoms because until recently, people weren't talking about all the other symptoms. And so this is why the work that we've been doing, looking at all the other symptoms, I think in relationship with diets, are really, really interesting.

Tamsen Fadal: Yeah, I do too. I'd love to hear that too, because I feel like women are constantly asking, what can I do? And to be able to have an answer that is really important. 

Jonathan Wolf: Well, I'd love to ask that because when we set up ZOE seven or eight years ago now, I never thought at all that food could have any impact on menopause symptoms. If you'd asked me, I'd have said that sounds completely crazy. Is it completely crazy, Sarah? 

Prof. Sarah Berry: It's crazy that it does, because I thought exactly the same. 

So we've done this really exciting study where we have followed up just over 4,000 women who are peri- and postmenopausal who are following the ZOE program. So the ZOE membership is this program of personalized nutrition and at the heart of it is eating according to the personalized guidance that we give a very plant-based, diverse, fiber-rich kind of diet. We also encourage other healthy lifestyle changes, but it's predominantly focusing on diet. 

So the ZOE members following the personalized nutrition program had a 35% reduction after an average of 18 weeks in their symptoms. And we also saw differences in the level of reduction depending on the kind of symptoms. So where we saw the biggest reduction was in these psychological symptoms. 

Jonathan Wolf: When you say psychological symptoms, what does that mean? 

Prof. Sarah Berry: So these are symptoms such as the brain fog, the memory loss, the irritability, the low mood, the anxiety, the depression.

Jonathan Wolf: They don't sound really, to me, I don't know about what you think, Tamsen, they sound pretty real, brain fog doesn't sound, that sounds pretty real…

Tamsen Fadal: It's very real. Rage is another one, there are some real symptoms, mood swings, up, down, up, down. I mean, you think we went through puberty, those are, you know, those are the up downs and they're real, they're real symptoms.

And I think that's what we're talking about when we say, you don't feel like myself anymore. I can't tell you how many times I've said that over the course of this whole transition. 

Jonathan Wolf: And Sarah, can you explain for a minute, obviously there'll be quite a, probably the majority of long-term listeners are ZOE members, but a lot of people listening who don't know what that is. What are the key parts of that membership that people are going through that was achieving that change? Because I think a lot of people listening are like, well, what does that involve? 

Prof. Sarah Berry: Okay. So the ZOE membership involves getting this lovely yellow box that has various tests that allows us to test people's individual responses to food through their microbiome, through wearing a glucose monitor and lots of other ways as well.

We then deliver about personalized dietary advice that enables people to follow the best diet for their biology with support from coaches, lots of fun things like recipe cards. We have links to grocery deliveries, that sort of stuff. 

And then you can opt at the end of a certain period, so let's say 12 weeks to actually have certain things retested, your microbiome retested, and also answer again lots more questions about your health. 

It's this data that we've been using for our menopause research to look at those who are ZOE members and following the ZOE personalized nutrition program, how their change in diet is linked to their change in menopause symptoms. 

And what we see is that on average, people following the ZOE program and therefore making these dietary changes, reduce their symptoms on average by 35%, but that there's big differences in the different symptoms.

There's psychological symptoms, for example, some of those can reduce as much as 40%. And I think that's really interesting because there's now a huge body of work coming out from Lisa Moschini's group, looking at how the brain is regulated in menopause. 

People are putting forward this idea now that actually, menopause is a state of neurological disruption, which explains why the most common symptoms are these neurological, psychological symptoms. And the fact that on the ZOE program, we're seeing these ones reduce the most, I think is really encouraging. 

I think that's because we also know from our own work where we've conducted a randomized control trial where we compared the ZOE program versus the U.S. average diet, we actually saw that some of the psychological symptoms that we asked people about, so mood for example, had the biggest improvement on the ZOE program as well.

So it all kind of ties in quite nicely. We've got all these different pieces of the puzzle now fitting together. 

Tamsen Fadal: I think that it's so important for us to feel two things; we're not alone and we're not going crazy. And I think that those are the two things I kept overwhelmingly hear women say, which kept pushing me into this area of like, wow, what is, what is going on that everybody is going through this and then everybody feels so alone.

Jonathan Wolf: I can't wrap up without talking about this amazing brand new free tool, which I'm amazed Sarah, you haven't already plugged three times in this podcast. It’s a sign you must be a little jet-lagged. You've done something on the back of all of this research. Would you explain what it is? 

Prof. Sarah Berry: I would. so we have developed a new tool called the MenoScale and this is a tool that basically allows women very easily, at no cost, to record the burden that menopause has on them.

So it allows them to look at how many symptoms they have and the impact that they have on people's quality of life. And the reason we've done this is because there's actually nothing out there that enables us to track our symptoms. And, as a scientist, we always say, if you can't measure it, you can't change it.

And, for me, that's what's at the heart of this MenoScale calculator. So people can go online, they can go to zoe/menoscale.com. It takes a couple of minutes to complete it. We ask you a few very basic questions about your age, whether you're on HRT for example, and then you tick whether you have 20 of what we now know, so it's informed by our research of the most common symptoms, and then you grade them in terms of how much impact they have on your quality of life.

You then get a score of 0 to 100. Now, then what you can do with this score is lots of things. Firstly, you can use it to track how anything that you might want to do to help your menopause can impact it, whether it's changing your diet, changing your physical activity, going on HRT, for example. It enables you to then see what works for you, which I think is really, really important.

When I started on HRT, I went to my GP, they said, well, can you track your symptoms? Well, how am I going to do that on some scrappy piece of paper that I know I'm going to lose somewhere? If I'd have had that a couple of years ago, that would have been fantastic. And that allows you to titrate your dose if you want to do that, or change your diet according to what works best for you.

The other thing as well, Jonathan, I think it allows us to talk about our symptoms, and going back to what you were saying, Tamsen, It means that I could talk to my friends and say, actually, this is how I'm scoring. And I don't mean it in a competitive way, but I mean it as in getting that reassurance that we're not alone.

So when you get your score back, you get also how this compares to a woman of a similar age, the average woman of a similar age on HRT or not on HRT. And it also tells you about your top symptoms and how that compares to other people. So it kind of enables you not to feel alone, but it also enables you to share and discuss it with people around you.

But I think that, and also, selfishly, if you take the consent that we can use it for research, I get to look at all of this data and also enable us to move forward even further on the menopause research that we're doing at ZOE. 

Tamsen Fadal: Also while you're getting the research and women are able to be a part of it, you get more data.

You're creating a community helping move this message forward and helping solve this. There's something to that that is so valuable for women to feel that they're taking part in helping, we're all in this together. And I think that that's what I've noticed more than anything with this conversation.

Prof. Sarah Berry: And I love that because at ZOE we talk about community science and that's at the heart of what we do. That everyone that becomes a ZOE member, if they consent to share their data with us as scientists, they are becoming community scientists because their data. They are pushing forward our understanding of research and it's the same with the MenoScale. They're becoming community menopause scientists. So everyone, please go fill it out. 

Jonathan Wolf: We'll put a link in the show notes for anybody. We're pretty much a time, but Tamsen, I really want to end on a message that I felt was really powerful from your book because you talked about how often there's this fear of almost becoming invisible, you know, when I think about this.

And you talk about a feeling of growing bolder through menopause, and I'd love you to maybe share that before we wrap. 

Tamsen Fadal: Oh, thank you for pulling that out. Yeah, I am. I was trying to figure out what I've learned through this whole experience of aging and of menopause and of being very vocal about the story because I don't know that I would have done it five years ago.

I would have said, Yeah. I'm not getting any older, but I said, I don't think we're going into these as golden years, I think these are our bolden years. I feel like I always have a little bit of fear, of course, but I feel like I'm a little more vocal. I'm advocating for myself. I want to do amazing things next, you know, and I'm not in that game of comparison and that game of competitiveness.

I'm in that wanting to feel good going forward and knowing that I'm living my someday today. Right. And so I want to get every part out of it, and that's really important to me. So I feel we're a little bolder, a little sexier, a little wiser these days than what commercials may indicate, that we're two older people sitting on a bench in a park petting a cat. That's not what I want to be. 

Jonathan Wolf: And if anyone's listening to this and saying, well, I would like to be growing bolder, Do you have any advice for other women to achieve the same? 

Tamsen Fadal: Yeah, absolutely. I mean, I think first and foremost I'm big about, you've got to take control of your health because if you don't feel good you can't do that next step of acting. It just, it doesn't work. And I think that that gives you control. It makes you feel like you're in the right place moving forward. 

I think, stop putting these old narratives into place that I'm too old, that my best years are behind me, that I should have done it back then. We have a long road ahead of us. It's very different, we're living longer, I think we're living healthier. I think we're living with more opportunity ahead of us. And so, that's my advice, is to really embrace that and not leave it for someday, because today is someday. 

Jonathan Wolf: That's beautiful. I'd like to wrap up, as always, with a little summary, and both of you keep me honest if I get it wrong.

We started with this incredibly powerful story, Tamsen, about how you could end up lying on the bathroom floor with the sudden impact of these symptoms, not even realizing really that you'd been having this series of symptoms maybe for years, it sounds like, potentially, and then suddenly it's bang, and your body's saying, no, you can't ignore this anymore, this is a big deal. 

And so it makes you realize this is a big deal and it's important to talk about it. It's important to understand whether it's affecting you or your loved ones as it is going to be in my case. 

That there are a huge number of symptoms associated. I think you said on average 13 symptoms in perimenopause, Sarah. And then you said 10 or something in menopause? So an enormous number of symptoms. It's just very different from most things where there's this one very clear symptom. And so it's obviously complicated. 

It's not just symptoms, this has a big impact on your health. And you were saying Sarah, women are on average much healthier than men until perimenopause and then there's this catching up or even getting worse at this point. So you've really got to see that change. 

You talked about your biology really changing. So that just one example of that that I think a lot of listeners will stuck on is suddenly the estrogen that was pushing any fat towards your legs, it's like, no, no, no, put it on your tummy. And that's real. It's not because suddenly you're eating worse, it's because your body has changed. And that's a reality you've got to, to deal with. 

You can take control of your health. This isn't something that is just genetics, there's nothing you can do, you're stuck with it. Which is something that comes up a lot on this podcast, but here I think it's particularly powerful. You can''t duck the fact that this is going to happen, but you can take control of its impact on your health. 

Sarah has just launched this amazing new free tool, and the first step to taking control of your health is just to understand actually the symptoms you have. It's called the MenoScale Calculator, it's based upon this huge study that you've done. You can find it at zoe.com/menopause. It'll be on the links as a way to sort of understand where you are. 

And then I think, you know, to wrap up, we talked about this really amazing new research that suggests that diet and your microbiome actually is interrelated with your menopause, despite the fact that Sarah and I both thought that sounded crazy.

That there's all this data, Sarah, you shared that menopause is changing your microbiome, that you can get more of particular bad microbes, which I'm going to say even if your microbiologist friends don't like it, because I don't have a lot of microbiologist friends, Tamsen, so it's okay. 

But interestingly, brand new research actually you can see this link between how bad your symptoms are and your microbiome. So you can see that this thing is sort of really deeply interlinked. And that's especially around things like brain fog and low mood, which are exactly the same things that you also said are most linked to the food you eat.

And just to wrap up, diet really can improve your menopause symptoms in a big way. And you shared the results of this study of ZOE membership, saying that on average it actually reduced these menopause symptoms as calculated through your calculator by 35%, which is a really big amount.

And I think that just fits into this incredibly positive story that you're not completely stuck. It's not like there's nothing you can do about it. And I think it is fascinating how much the lifestyle that we lead impacts this. It's not only a question of whether you're taking hormone replacement or not, which is.

I think we've touched on on a number of other podcasts if people are interested. Did I catch the key bits? 

Prof. Sarah Berry: You are a genius at summing up. Jonathan, I think one thing to emphasize is what Tamsen said about sleep. And although it's a symptom of menopause, I think it's often so overwhelming when you're in the menopause, the amount of things that are going on, the amount of changes that you might need to make if you are following an unhealthy diet.

So I think that actually maybe to start with a really good action is to focus on some of the things that Tamsen said about sleep and make that the first thing that anyone's listening to you to do today. 

Why don't you make sleep the priority this week? And then that might give you the strength to then make some of the other changes.

Jonathan Wolf: Brilliant. Thank you both so much. I always find this is incredibly powerful as a topic to talk about and I always feel both privileged