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Women's Health - What Your Mother Never Told You

Women's Health - What Your Mother Never Told You

Leslie-Ann and Dr. Earl Brewster discuss women’s health, with a special focus on menopause and overall reproductive health. They break down the term “menopause” and the issues surrounding this transitional phase all women go through when they get to a certain age, generally between 45 and 55.

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About the Episode 

Leslie-Ann and Dr. Earl Brewster discuss women’s health, with a special focus on menopause and overall reproductive health. They break down the term “menopause” and the issues surrounding this transitional phase all women go through when they get to a certain age, generally between 45 and 55. From understanding the different types of menopause and the unique role estrogen plays, treatment, and access to support services in the Caribbean; this episode captures the topic in a new light. Dr. Brewster takes time to dissect misconceptions and taboos about menopause and the benefits of treatments like hormonal replacement therapy. He also highlights symptoms of menopause that are not so widely known. 

Our audience will definitely learn about preparing the body for menopause, soothing measures through natural remedies, and just general “did you know” information. 


Key takeaways include Dr. Brewster defining menopause and the different types. Menopause is the end of a woman's menstrual cycle and fertility, usually occurring from ages 40 – 45; however, some women experience menopause before the age of 40 and this is called “peri-menopause.” Peri-menopause can be natural or induced, like in the case of surgically removing the womb and ovaries. 

Dr. Brewster highlights how the ceasing of reproduction and non-presence of estrogen in women is the cause of menopause and he explains how estrogen can be seen as the super hormone of the female anatomy as, in his words, it is “defining femininity.” This hormone also has a direct connection to maintaining bone density in women, and he advises that women eat foods rich in estrogen, such as dasheen, yams, and chickpeas because bone loss is a significant symptom of menopause, with the decrease of estrogen. 

The symptoms of menopause are far more than just hot flashes and night sweats, and can also include loss of sex drive, and the shrinking of vaginal walls and tissue, acute insomnia, incontinence, and in some cases, severe mental illness, such as depression. 

Dr. Brewster also touches on options for treatment like hormonal replacement therapy (HRT) and dismisses the misconception that this treatment leads to cancer of the breasts. He advised that women should visit a specialist and notes that not many medical practitioners are qualified to treat menopause this way, especially in the Caribbean, and that may be one of the reasons why there is so much grey areas over the use of HRT. 

In short, Dr. Brewster touches on how menopause is seen in the Caribbean and how many doctors dismiss it as something natural that can’t be treated. He notes that, slowly, the way menopause is viewed, is slowly changing, and soon, it will be accepted as a physiological transition that can be soothed and treated to enhance the lives of women at a certain age and stage.

Of course, general health and wellbeing should be the focus of all women: eating right, diet and exercise and annual or regular checks with our physicians.  

Episode Summary

As an episode on general women’s health focusing on menopause, Dr. Brewster breaks down the topic in a way that touches on all the aspects of menopause that women are concerned about—from what it is, what the symptoms are, what are some of the remedies or treatments to help address the symptoms. He breaks down the myths of certain treatments such as HRT, and discusses how beneficial it is. From defining menopause to the different ways it is viewed within the medical fraternity, and dissecting misconceptions, Dr. Brewster takes the issue right into the home and bedroom.

He also addresses rising trends in vaginal reconstructive surgery among women who want to enjoy sexual intercourse later in life, after giving birth and after menopause, so that they can keep living and enjoying one of life’s pleasures.  

About the Guest

Dr. Earl Brewster Snr. has provided excellent healthcare services to women in Trinidad and Tobago, his home country, the United States, and United Kingdom, for over 35 years. His expertise and interests lie in menopause, pregnancy, and gynecological reconstructive surgery. Today, he leads Brewster medical with his son and daughter, where they pride themselves on the optimal health, and well-being of each patient and regard their work as more than just a medical practice. 

His work and contribution in the field includes being the first menopausal clinic in the United Kingdom, and managing couples trying to get pregnant, diagnosing, and doing referrals locally and internationally, with high success rates. 

His core ideals stand on compassion, communication, and excellent care.

Transcript Season 3 - Episode 2


LESLIE-ANN SEON: Be bold. Take risks. Lead by example. Believe in your power. Say what you mean, mean what you say.

Hi, I'm Leslie Ann Seon, host of the new podcast series, Seon180. Join me at Seon180 on this journey of discovery and advancement.

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LESLIE-ANN SEON: Hello and welcome to Seon180. I am your host, Leslie and Seon. On our Caribbean podcast series, we feature Caribbean voices from around the world, who are making real differences in their sphere of influence.

I invite you to check out my website at, or visit your favorite podcast streaming sites for current, as well as past shows. You can also visit my Facebook and Instagram pages for weekly updates, tidbits, advice, and interactions with me, your host, and fellow listeners. 

On today's show, we are dissecting yet another taboo, The Taboo on Menopause, addressing what your mother never told you. And our guest with us is Dr. Earl Brewster Sr., from Trinidad and Tobago, a consultant by training and gynecologist who has been providing excellent healthcare services to women in Trinidad, the United States, and the United Kingdom for more than 35 years. His expertise and interests lie in menopause, infertility, pregnancy, and gynecological reconstructive surgery.

Today, he proudly leads Brewster Medical with his family, which includes his son, daughter, and niece, where they pride themselves on the optimal health and wellbeing of each patient, and regard their work as more than just a medical practice. Dr. Brewster's work and contribution in the field includes being involved in the first menopausal clinic in the United Kingdom, managing couples trying to get pregnant, diagnosing and doing referrals locally and internationally, with high success rates.

His core ideals as a medical practitioner are compassion, communication and excellent care. Dr. Brewster, welcome to Seon180. Thank you for joining us. 

DR BREWSTER: Thank you. It is nice to be here. 

LESLIE-ANN SEON: Excellent Doc. We want to break the taboo on this topic of menopause, which in the Caribbean is treated with a certain degree of hesitancy. There appears to be a stigma attached to it, and it's embarrassing, so to speak, about things that, as we would say, our mothers never told us. And so today, I wanted to engage you on some of the areas of menopause that you can enlighten and educate our audience. And while I know that there are different types of menopause, I'd like us to begin by telling our audience what is the most important thing women need to know about menopause.

DR BREWSTER: Well, I wouldn't say just one important thing. There's several factors that are important in menopause, but before we get into that, I think one has to be able to define menopause, and clearly state what it is, and the different aspects of menopause. So, let's begin first by defining what menopause is. Yes.

And we define menopause as the cessation of bleeding. Now, menopause occurs, normally, between the ages of 45 to 55. That's when the ovaries, uh, tend to cease its function, and as a result, there is the absence of egg production and, therefore, bleeding. Now, if there is no menstrual loss over one year, that is considered a Post menopausal and between the ages of 40 to 45, uh, that's the transition called peri-menopause and the peri means “around the menopause.”And that's the transition from reproductive function to when the cessation of bleeding occurs… And that's a very important aspect of, of menopause. Uh, uh, the, the not only transition, but the cessation of bleeding. And that's probably the defining moment for many women because of the symptoms.

And then you have pre-menopause or so-called primary, premature menopause, or primary ovarian failure, where the ovaries cease to function, either due to surgery or  other aspects, uh, women take, having, uh, chemotherapy or other conditions that subdue recent functioning and, and that occurs before age 40 years for age. So we have clearly defined menopause, peri-menopause, uh, early menopause, uh, is between age 40 to 45 and premature menopause. 

Now, why is this important? The importance of the menopause really revolves around the absence of, or the decrease or decline in production of estrogen, which is the super hormone in women.

And why we say it's a super hormone is because it defines femininity. It defines female development. You have breast buds being formed in adolescence, and then the development of the breasts. You have the hips. Women tend to have large hips described as knock or their knees become close, defining effect of the super hormone, estrogens.

Yes, of course there's also egg production and, and then the menstrual cycle that comes every month. There's also the effect of the estrogens in maintaining good bone health, as estrogens, and we talking about the primary estrogen, which is 17-beta estradiol, will increase the ability of bone cells with bone, and it's called the osteoblastic of the super hormone.

Then there's a function on sex drive, that give women that ability to feel sexy, to, they increase their libido, to have the desire for sexual intercourse. That's all part of estrogen acting on the brain and making women have that feeling. So there you go. With, with the, with the presence of estrogen, that defines what menopause is all, all about because with the absence of estrogen or the decreasing level of estrogens, it, it, it quantifies the effects and the symptoms of the menopause.

LESLIE-ANN SEON: Yes. I actually call it Queen E because of its dominion over the, the hormonal imbalance or balance of women. It's so important. And, and doc, you know, one of the important points that, uh, arises very often in, in these discussions are, of course, the symptoms, and everybody knows about, uh, hot flashes and night sweats and uh, brain fog and so on. but you've also spoken about the loss of bone density, um, cardiovascular problems, psychiatric problems. Some people, uh, have suicidal ideations, et cetera. Uh, tell us about these, uh, symptoms and, and perhaps the not so typical symptoms that are spoken about a lot. 

DR BREWSTER: Okay, so the most significant symptoms that send women really, um, becoming concerned, I would think is the Vasomotor symptoms. The hot flashes or hot flashes and night sweats and hot flashes are defined there. They're also called the vasomotor symptoms where there's a flashing and, and it starts from the face and it’s a warm sensation that emanates from the face going up to the anterior aspects of the chest. And women that, that's very uncomfortable because they could be in an air conditioned room with other women and flashing away, and that's embarrassing and it, it's something that, uh, makes them feel very uncomfortable. And, And they will seek medical help immediately, in many cases, yes. The other aspects of symptoms would be night sweats, where at nights, even air conditioned room, they could awaken with the underwear soaking wet and they have to change it, you know, underwear.

And that's also very significant aspect. And there are other aspects that are very important. Uh, the so-called uh, uh, is not widely accepted, but it's the so-called syndrome of the Vulvo-Vagina, or Urogenital syndrome of the menopause, where there's a trophy of the vagina. The, the uterus, the cervix, the ovaries, the vagina becomes very thin. The mucosal becomes very thin, and sexual intercourse is unpleasant. It also affects the bladder, where they tend to go more frequently, and, um, there's an urge to rush to the toilet and if they don't get there in time, sometimes they can wet themselves, become incontinent. That’s a very significant aspect, and of course, sleep disturbances. Many would be concerned and have difficulty, having insomnia to a great extent. Uh, now a symptom that seems to be very constant is one of palpitations. Again, it's due to the vasomotor symptoms, where the heart palpitates, and they think, oh my goodness, for one, one hour, the heart just pounds away and then it settles down. And that's a very important, important aspect that many women complain of that, but they don't realize that it is part of the menopausal symptoms. You have the, the other feeling of significant mood swings where women can move from aggression to suddenly crying or weeping openly, and feeling quite incompetent, feeling, uh, a lack of self esteem, and wanting to, to quit their jobs, wanting to feel that they're done now, and they can't continue anymore. And that's where it, it it progresses now to having severe mental issues and particularly depression. In fact, there's a significant number of women who are being treated for depression, who will benefit from hormone replacement therapy and walk away feeling fine when they get hormone replacement therapy. So that's a very important aspect of it as well.

LESLIE-ANN SEON: Yes. We'll get to, to the HRT in a bit, doc. Um, I know that one of the complaints, um, that women have had is in addressing these symptoms with their medical practitioner, their GP, uh, they tend not to get the kind of response necessary to either put them at ease, to arm them with the information to know that they, you know, this is a normal part of the process, but that it can be treated and somehow it seems to be dismissed um, because it is not an illness, it's more of a physiological condition. Uh, what can we do, Doc, as a medical practitioner consultant in your field, uh, to assist our GPs in treating women with these complaints differently and taking it seriously and, and understanding what is at work here.

DR BREWSTER: Well, well, this is the thing… a lot of doctors feel, and not only doctors, but caregivers and women in general feel that the attainment of the menopause is a transition. It's like aging. And, and that might be true, but then they, they will say, well, when you reach that stage, we are done. That's it. We have this feeling that we no longer interested in sexual activity. We may now want to take a backseat and, and, um, and, and, and do much less.

They, they don't want to be proactive, Engaging in active exercise and moving forward. And, and that's something that has to change now. We could only achieve that by, I think, getting on the airways and, and, um, making sure women understand that the menopause is an aspect of your life, but it doesn't, it is treatable, and it doesn't mean that it's the end of your life, and this is where we need more people to come forward and recognize that the menopause is something that needs to be treated seriously. It's like looking at diabetes. We know diabetes is the effect of decreased insulin, and then when you get insulin, it's treatable. You feel better. Menopause is a decrease in estrogen, and then you give hormone replacement, replacing the hormones that the ovaries no longer produce, then you feel better. And this is the concept that we have to parallel. We have to parallel menopause like a, a disease like, uh, like diabetes, to make people know that menopause can be viewed as a disorder or medical condition that requires treatment.

LESLIE-ANN SEON: So it's almost like it's a contemporaneous exercise. We have to arm our women with the information and the knowledge, and we also have to train our medical practitioners as to how to treat their patients when they describe to them menopausal. 

DR BREWSTER: Yes, but a lot of doctors are reluctant to prescribe treatment because of the fear and the concern that Estrogens or hormone replacement therapy, increases cancer of the breast and cancer in women. And this is a big thing, Now I agree the medical research bodies have not been able to clearly clarify and show where there is no evidence to support the view that hormone replacement therapy increases the risk of cancer. There's no evidence—unless of course, it's not given properly, because giving hormones in an, in an inappropriate way can increase risk of cancer. We know that. So, therefore, many doctors who are not qualified in the field are reluctant to take a step to treat them.

LESLIE-ANN SEON: Is that because of this historical, uh, research studies that indicated it might cause breast or uterus cancer? Um, how do we get over that? Because a lot of women are hesitant um, to accept that, uh, therapy because of this misconception perhaps, or, you know, myth, that there is cancer causing element to, to HRT.

DR BREWSTER: Quite rightly so, and, and again, as I said before, if given properly, there is no evidence to support the view that you will get cancer with hormonal replacement therapy for the menopause.

Yes, there's absolutely no evidence of it. 

LESLIE-ANN SEON: And has there been advancement in HRT, uh, therapy, Doc? 

DR BREWSTER: There has been a lot of advancements. There has been a lot of, um, supporting evidence that hormone replacement therapy would benefit women who have significant menopausal symptoms. Now, remember, only about maybe 10, 15% of women will go through menopause with no symptoms. And when you hear them speak, many women will say, Oh, well look, they have no problems. Why am I worrying? You know? But when you look at the significant effects, the complications of postmenopausal era, one can clearly see that hormonal replacement therapy is beneficial to women in the Post-menopausal period. 

LESLIE-ANN SEON: And is this…? Yes. No, I wanted to ask.  

DR BREWSTER: No, you go ahead. 

LESLIE-ANN SEON: Yes, Doc. With, with respect to the HRT, I've read that it comes now in patches, in creams, and tablets. Is there any better form of administering HRT as one, as opposed to the other? 

DR BREWSTER: Not really. It works and it depends on a patient's preference. Some people prefer a patch, some people may, um, uh, want injections because you know, a patch you putting on and you have to look after that patch twice a week, or you get an injection, um, like once, once a month. You get an implant. You have an implant where it goes into your sub pubic area every six months. It, it depends, and of course, it's a cost related factor to those things as well. But at the end of the day, any form of, because remember, hormone replacement therapy is a replacement of 17-beta oestradiol, which is what they will reproduce in a reproductive age group, right? You see? So it doesn't really matter which form, but what is important is whether the presence of the uterus is, is there or not. Because if you have the uterus and you give purely estrogens alone, then there is a possibility of having endometrial cancer because Progesterone must come in to oppose estrogens and then there will be no risk of endometrial cancer. So that's, that's where the concern is. And if given appropriately, there is no risk, you know, of, of, of cancer to the woman. The other concern is cancer of the breast. And again, Uh, we could look at all the data with, with, with men with less, you know, um, you know, who have been, um, wanting to convert to women or, you know, change sex and so forth.

They get massive doses and never any one of them could say they've gotten cancer, and they continue because you're getting to keep your abreast as big as those men who want to be seen as women. They take massive doses continuously, and there's no evidence of cancer, uh, of, of, of the breast in those men. So we have evidence to support the view that there's no direct evidence of cancer of the breast relating to hormone replacement therapy. Mind you, as you get older, uh, estrogens tend to be an important aspect of cancer the breast in women, and therefore, we have to be concerned and screening women for breast cancer is important.

So every year women should be screened, you know, to make sure there are no evidence of pre-cancerous conditions. Yeah. And that's very important. Yeah. 

LESLIE-ANN SEON: Yep. As a regular routine. Doc, there are two areas that, um, you've spoken about, uh, before that concern me, um, as a, as a, an effect of menopause and that has to deal with the loss of bone density and then the cardiovascular issues that can arise.

And I'm wondering, is there a way for women to prepare themselves for menopause, is there anything proactive that can be done? Because a lot of people don't realize how much an effect it has with respect to causing  osteoporosis, et cetera, and cardiovascular disease. Can you tell us about that? 

DR BREWSTER: Well, osteoporosis, remember, once you menopause, you will lose something like 1% of your bone mass per year.

Why that is so? As I said before, high levels of estrogen or normal levels of estrogen in the reproductive age group will cause the effect of significant osteoblastic activity, meaning that the bone cells are osteoblast and they build bone in decreasing levels of estrogens as women transition from from reproductive to menopause.

The level of osteoclastic activity, those are bone cells that tend to break down bone will be significantly increased and therefore, attaining like, uh, 15% of, of your, um, bone mass reduction will increase the risk of, what we call osteopenia bone pain, and then when they get a 20% osteoporosis where the bone becomes so brittle that it can fracture.

So, the main issue then would be to try to look at your diet and, and I'm, I'm, that's very important. And there are foods that will,  Phyto estrogen that will increase the estrogens in your diet. But, um, when you attain the, the menopause, you have to look at, uh, at monitoring your bone mineral density and, and if it's reached that point to look at taking steps to go on hormone replacement therapy because that's the only direct way that we know we could change things. Herbal preparations, especially the, the, the estrogens that, uh, in herbs that so-called phyto estrogens, their levels vary with, uh, the active ingredient, which will be the estrogens vary with the moon phase, and sometimes you're getting uh, levels that are considerably lower depending on the moon phase. So you can't rely totally, or, or, or solely on herbal preparations in preventing osteoporosis. 

LESLIE-ANN SEON: Yes, and, and with respect to cardiovascular disease, What, what preventative care can we apply

DR BREWSTER:  Again, Estrogen protects women, women in the reproductive age group, they don't tend to get, um, significant, um, cardiovascular problems like, you know, hypertension and, and heart problems. And after the menopause, that's when everything comes up. Uh, ensuring that transition where your diet will be important, diet and exercise, will have a significant effect in mitigating the effects of, uh, decrease estrogen levels good diet. Avoiding those, uh, smoking too, you know, and alcohol. Excessive alcohol. These have the effect of decreasing the amount of blood supply to the ovaries and, therefore, decreasing the effect of ovarian function. And, and minimize the effects of, of Estrogen in general, and so therefore, during that transition, it'd be a good idea to have dietary concerns and increase the exercise level…And strength training to build bones and, and you know…

LESLIE-ANN SEON: Right. So are there natural therapies? I mean, we always say that we have plants and herbs and grown vegetables and so on that, you know, is the master for, for any cure of, of ailment in the Caribbean. Do we have, can we draw on that resource? 

DR BREWSTER: We have, there’s been a concern and there are lots of studies that have shown that in the, uh, it's amazing that in the Amerindian community, they don't have menopausal symptoms, they don't have fractures, and they, live on things like yams and cassava and blue food like Dasheen and chickpeas, and that has the effect of…And they consume quantities at a significant extent. 


DR BREWSTER:  And, um, yes, yes, so you see that, that is, you know, you know Cassava, Yams, sweet potato in  significant amongst, Callaloo bush, as well…And that tends to have a high level of phyto estrogens. And that will, again, have an effect. Um, it depends on how much you consume, but the gold standard is really based on having 17-beta estradiol as part of the replacement for Hormone Replacement Therapy. 

LESLIE-ANN SEON: Yes. Doc, one of the complaints that I have really is when I look at how in the United Kingdom, they've devoted a whole body of studies now, um, to menopause, and specifically as a, as a woman's health issue. I don't get the impression that we have treatment of it in the Caribbean at all. And I'm speaking to you now as a consultant who has had tremendous experience in this area. Are medical practitioners, like yourself, at this high level, um, advocating for a change in how we treat, uh, with menopause, to clear up these misconceptions and also to even include why insurance coverage can't be available for menopause in the Caribbean. 

DR BREWSTER: Good. Well, again, we could answer the first one. The feeling is mixed. Some doctors believe, but um, menopause is not as important as it it should be. And they ignore it. I mean, I have colleagues, surgeons, and they, they surgeons and they say, No, no, stop it, because you get cancer of the breasts and, and patients come back to me very concerned. How could, how could he stop it? And I, and I, I call him, I say, What's the problem? He said, No, no, no. And then, you know, when patients again complain that they're feeling all the menopausal symptoms, they go back on it and I call them and say, give me the evidence that, that stopping my patients will benefit um, you know, your concerns. And, and you know, so we have frank discussions with that. So the medical body, to a certain extent is mixed in regard to that. Now, insurance companies in the Caribbean and, and many of the head offices in the United Kingdom of the States share different view, and I don't know why one insurance company would want to have a view that is different in the States and in the Caribbean, because many of them still look at the treatment of menopause as not necessarily taboo, but it isn't that significant, and I always bring the concern that like diabetes, you have to be concerned about the decrease in insulin, and, again, as for menopause, you have to look at decrease or the absence of estrogens, and to prescribe hormone replacement therapy is beneficial, and I try to explain to them that, uh, we view, um, menopause as a, as a medical disorder, as a disease, and gradually, many insurance companies now are beginning to understand and accepting this. You have to be constantly writing letters and saying that, you know, it's, it's, it's, you know, what is necessary. The fight is there, but I think they, we are winning in that regard, you know, we are winning in that regard.  

LESLIE-ANN SEON: I’m glad to hear that. So we, we are having some success, uh, in this area. Doc, I was curious when I read in your profile, um, about one of the specialties, uh, being, uh, Gynecological reconstructive surgery.  just wanted to get a sense of what is, what is that really, Doc? 

DR BREWSTER: Okay. So, as women get older, the vagina becomes very lax and, um, and women do not enjoy sex. Of course, often because it, it's, it's  lax. So, you know, and, um, so we could rebuild the vagina where it's, it's, it's a could vagina here and you do about two or three operations is until you pair where you tighten the vagina and the muscles around the vagina and sexual intercourse becomes more satisfying in that age group.

You know, it's, um, it's, hows I put it? It's, it's rebuilding. You have a lot of, of, um, redundant tissue that you have to remove. Yes. And you rebuild the vagina to the point where, um, and you have to use estrogens again to keep it, um, to keep the collagen content significantly increased, so that, women, um, enjoy sexual intercourse again, you know. Because if it is too lax and the penis goes in there, it doesn’t really make it satisfying. I mean, that's, that's how I, I would put it, you know?

But seriously, reconstructive surgeries, rebuilding the vagina, and giving women a sense that, um, vagina continues to be functional even at, at each 60, 70, some women at 71 want to enjoy sexual intercourse and, and, and 75, and we will rebuild the vagina for them.

LESLIE-ANN SEON: So there is a, there is a, a demand for, for this type of surgery in, in the Caribbean?

DR BREWSTER: Well, yes, there is a demand, providing also there’s a cost factor, but many women who can afford it, enjoy it, enjoy the fact that they can now enjoy sexual intercourse um, a lot better, because, you know, remember during birth, especially women who had, um, deliveries, The vagina tends to be more lax and, um, and, and doesn't have that, that tight feel, and, therefore, rebuilding constitutes a factor where we bring all the tissues together very tightly, and it makes a big difference in the sexual lives.

LESLIE-ANN SEON: The advancement of modern medicine, indeed. Doc, of course, as we close off our discussion, because 30 minutes, uh, tends to run away from us so quickly. Um, what general advice do you have for women, um, to help mitigate, uh, the onslaught of menopause and also just in taking care of their general reproductive health? I like our audience to go away with, with a message that resonates with them. Uh, that they can put into action. 

DR BREWSTER: Well, uh, in terms of reproductive health, I think, um, one has to remember that women move from menstrual cycles, puberty from menstrual cycles, pregnancy, or reproductive, then menopause. So, you have a transition from a puberty, where women have their menstrual cycles, Then comes pregnancy, and then comes the menopause. Each aspect of that stage is of concern to women. At puberty, they will tell the friends, I'm having my period  today, and next one say, next week is mine. And, and they bond that way. And then when pregnancy comes along, of course they have their babies. And then those who enter menopause, many of them at that point could prepare for menopause, knowing that it's a fact of the, you know, and it's coming and, and, and don't believe that when they obtain menopause, they should stop doing what they're doing. They could still continue to enjoy sex intercourse. Uh, if there's any episode of depression, they should seek medical help. If the vagina is dry and having difficult sexual activity, again, seek medical help because sometimes giving estrogens alone may not be beneficial and sometimes you have to add testosterone to increase the desire for sexual activity.

So, all these things are part of a woman understanding that where you need to look, uh, consult your doctor, let him know what's happening. Uh, you know, um, if there exchanges, I mean, one of the first things to, to happen in the, in the menopausal area is visomotor symptoms where women tend to have, wrinkled skin… All those things don't have to be persistent. They could be treated, and the skin could get better and, and, you know, still look as beautiful as you want to, you know, it's, it's just a question of, of seeking medical help as early as possible. You know what I mean?

LESLIE-ANN SEON:  Yes. And if you don't get it from your regular GP or doctor, you can go on for a second opinion. I think sometimes women just stop,  at that initial visit…

DR BREWSTER: Of course, but many GPSs wouldn't be able to handle this as well, because it's a very, very specialized area.So they're gonna be, you're gonna have to seek a specialist help in, in particularly with menopause, you know, because remember, before we put women on treatment, we have to do special tests, first of all to confirm menopause, and then to look at the endometrial thickness to make sure there's no precancerous conditions and look at the ovaries on a yearly basis to make sure there's no increase risk of ovarian cancer, and you have to maintain yearly investigations, uh, mammograms, in particular. So there's, there's a continuum of investigative work that must take place while you put women on hormone replaceable therapy. You see it? And that's very important. 

LESLIE-ANN SEON: Yes, doc, That's an important message. You have to confer with a consultant if you don't know it yourself, um, to get the correct information so you can make the right decisions.

DR BREWSTER: Yes, definitely. 

LESLIE-ANN SEON:  Well, thank you very much indeed, Dr. Brewster, for being with me this morning on Seon180 and for tackling this very important topic of menopause, what your mother didn't tell you. Now we're hearing it from you and I think we have sufficient information with which to arm ourselves for, uh, our treatment and how we get treatment from the right doctors. 

DR BREWSTER: Good. Thank you. Thank you. It was my pleasure. Thank you very much. My pleasure. 

LESLIE-ANN SEON: Thank you. Thank you. Take care.

And there we are friends, our engaging chat with Dr. Earl Brewster Sr. I want to thank him so much for his time in chatting with us. I must say I learned quite a lot today. I don't even think my own mother knew some of the things, uh, that we discussed here, this morning. I hope that my female listeners were able to gain some insight and are able to appreciate all of the information that has been imparted by Dr. Brewster today. 

So, folks, thank you for being with us once again on the podcast Seon180. This is season three, and we continue to learn from our Caribbean community of professionals who graced our Caribbean islands with their expertise, experience, and knowledge. 

Thank you very much. Be safe to everybody.

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