Dr Caoimhe Hartley

And that in itself is probably quite reassuring.

HRT's impact on all of this is really unknown.

It's remarkable that you get to perimenopause, your oestrogen levels go all over the shop and so your dopamine levels are affected and so that affects ADHD.

But in addition to that, you've the cognitive changes that everybody else gets too.

I think cognition is definitely more common than anything else in menopause.

It's the one thing that's just almost universal.

And the perimenopausal women are my most challenging.

I mean, I love it because they're really interesting and it's kind of recent, like only in the last maybe 20 years that we've talked about perimenopause at all.

But they're really interesting for that reason, because their own hormonal environment is also evolving and changing.

So it's like pinning a wave on the shore.

Like every time you fix something, you're like, OK, I feel great.

We had a really good review.

She's feeling fantastic.

But there's no guarantee that in six months they don't come back going, you know, I'm back to square one.

I don't feel great at all.

Whereas the postmenopausal cohort are somewhat easier because the hormonal environment is relatively stable in the background.

So once they find a HRT that works and they're happy, touch wood, that tends to be it then.

I'm pretty sure I have osteoporosis.

Yeah, actually, I had a conversation with a patient about this today.

So the international guidance is that over the age of 65, everybody should have a DEXA just across the board.