HOW DOES MENOPAUSE CAUSE OSTEOPOROSIS?
One of Australia's Most Popular Podcasts with Hundreds of 5 Star Reviews
Grab your FREE Ebook copy now!
Have you struggled to lose weight and keep it off?
Start your journey to boost metabolism and transform your body into a fat-burning powerhouse.
Episode 222:
Show Notes
In this episode of the Real Health and Weight Loss podcast Menopause Series, Dr Lucy returns with special guest Dr Sunita Chelva. They delve into the crucial topic of how menopause can lead to osteoporosis. Dr Chelva, a Women’s Health GP with extensive experience in menopause medicine, shares insights into how hormonal changes during menopause affect bone health. They explore practical advice on managing and preventing osteopenia and osteoporosis through diet, exercise, and lifestyle changes, and discuss the role of hormone replacement therapy (HRT) and other treatments.
Definitions:
- Osteoporosis: Decreased bone density and quality, leading to fragile bones and higher fracture risk.
- Osteopenia: Reduced bone density that is not as severe as osteoporosis but indicates an increased risk of developing osteoporosis.
- Osteoarthritis: Wear and tear of our joint surfaces. Degenerative joint disease affecting cartilage, leading to pain and reduced joint mobility.
Menopause and Bone Health:
- Menopause accelerates bone loss, potentially leading to osteopenia and osteoporosis.
- The decline in estrogen levels during menopause significantly impacts bone density.
Nutritional and Lifestyle Advice:
- Adequate nutrition, including calcium, vitamin D, and protein, is vital for maintaining bone health.
- Lifestyle changes, such as reducing alcohol and smoking, are important.
- Regular exercise, particularly strength training and high-impact activities, is crucial for stimulating bone growth.
- While vitamin D and calcium supplements can aid in bone maintenance, they are not sufficient alone for fracture prevention.
Exercise and Bone Stimulation:
- Engaging in resistance training and high-impact exercises can help prevent bone deterioration.
- Exercises like jumping and stepping can significantly enhance bone strength. Simple activities like small jumps or using steps can stimulate bone growth and are beneficial even if started later in life.
- The Lift More trials and similar studies show that specific exercise programs, including those with high-impact and resistance training, effectively improve bone health.
Role of HRT:
- HRT is highly effective for treating osteopenia and osteoporosis and is beneficial for overall well-being, which can improve adherence to lifestyle modifications.
- While HRT is a strong option for managing bone density, other medications like bisphosphonates and Prolia may be used, but they come with limitations and often are not as effective long-term compared to HRT.
Holistic Bone Health Approach:
- Even without HRT, maintaining a balanced diet, moderating alcohol and caffeine intake, and incorporating regular exercise are essential for bone health.
- Quality sleep and proper rest are crucial for bone regeneration and overall recovery.
- It’s important to start focusing on bone health early. Implementing small changes and incorporating weight-bearing exercises, like jumping, can have a significant positive impact on bone health, even if begun later in life.
Empowering Women in Their 60s and Beyond:
- Adopting a proactive approach to bone health is important, focusing on long-term health spans.
- Women who cannot or choose not to use HRT can still benefit from a balanced diet and regular exercise.
- Strengthening bones, improving muscle health, and establishing healthy lifestyle habits should start early but can still be effective if initiated later in life.
Connect with Dr Sunita:
IG : @heramenopause, @drsunitachelva
FB: @Hera Menopause and Women’s Health
LinkedIn: @DrSunitaChelva @Hera Menopause and Women’s Health
Download the Menopause checklist here: www.rlmedicine.com/checklist
Episode 222:
Transcript
Dr Mary Barson Barson (0:04) Hello, my lovely friends. I am Dr Mary Barson Barson.
Dr Lucy Burns (0:09) And I'm Dr Lucy Burns. We are doctors and weight management and metabolic health experts.
Both (0:16) And this is the Real Health and Weight Loss podcast!
Dr Lucy Burns (0:23) Hello, lovelies. We are super excited to be bringing you this series in Menopause, where we're interviewing guests on their expert subjects regarding perimenopause, menopause, and beyond. As always, any information in this podcast is just considered general advice and we would urge you to seek medical attention if you have any concerns about your health. If you're interested in exploring the symptoms of menopause or perimenopause, we have a checklist that you can download at our website, www.rlmedicine.com/checklist or as always, you can click the link in the show notes. Thanks, lovelies, enjoy this series!
Dr Lucy Burns (00:58) Hello, lovely friend. How are you this week? We're back. We're back with part two of a fabulous conversation I'm having with Dr Sunita Chalva, who, if you haven't listened to last week's episode, maybe run back and listen to that because this is part two of that conversation. Last week we talked about muscular health. around the perimenopause and menopause phase and beyond. And today we're really diving into bone health. Sunita, welcome back.
Dr Sunita Chelva (01:30) Oh, thank you for having me again.We had a lovely chat.
Dr Lucy Burns (01:34) I know it was such a good conversation and I know that initially we were going to fit and pack it all into one, but honestly, there was no way we could do that. So I'm so glad that you could come back for part two of the musculoskeletal syndrome of menopause. Last week, as we talked about, it was all around the muscles, but today we're talking all around the bones.
Dr Sunita Chelva (01:58) That's right. And you can't separate them all out necessarily. And a lot of the things that we talked about last week will apply to what we're talking about here in terms of bone health. But, bones are supremely important. I mean, we, again, we don't think about them. We don't think about it. Osteoporosis is one of the most important things as we age. So from menopause onwards, it's defined as the breakdown of the bony matrix of the internal scaffolding of our bone architecture. So it literally means porous bones and osteoporosis. It is a silent disease. and it has devastating consequences. Hip fractures result in 20% morbidity in the years after having one.
Dr Lucy Burns (02:55) So, can you just explain what that sentence means for our listeners?
Dr Sunita Chelva (02:59) Breaking your hip results in 20% of women having terrible impacts in their lives. That involves more time spent in the hospital than some cancers, even after having a heart attack. Wow. Yet we don't actually focus on preventing fractures, we don't screen for them. No. A lot of my patients get confused between osteoporosis and osteoarthritis. So osteoarthritis is wear and tear of our joint surfaces. Now, the loss of our joint surfaces in osteoarthritis is also under hormonal influence and genetic factors and is very common around menopause. But the terms are confusing. Today we're talking about osteoporosis.
Dr Lucy Burns (04:09) Did people use to call it thinning of the bones, which isn't quite the right term either, is it?
Dr Sunita Chelva (04:17) Not quite. But it sort of describes that sort of loss of the architecture and strength really of our bones.
Dr Lucy Burns (04:27) One of the visuals I like to use that is I think helpful is that thinking about, you know, when people build a house and they pour a slab of concrete. In that slab is the Rio, I think it's called that sort of wire. Yes. Reinforcement. I guess that's why it's called Rio. That's the reinforcement. Then you pour the concrete around it. So I kind of think that the bone matrix is a bit like the Rio.
Dr Sunita Chelva (04:28) It is, or it's a bit like a honeycomb. It's sort of a structure that, yeah, there's lots going on inside that bone. Our bones are living tissue, like muscles, as we say, they've got special cells, all of which have special processes and jobs, really. That's the word I was looking for. They all have special jobs. So there are cells known as osteoblasts, which build up, build up our bone. There's bones, there are bony cells known as osteoclasts, which break down bone. They're all modulated by osteocytes. And we build bone, Lucy, from early childhood, and to early adulthood and then it peaks our bone density peaks around the age of 30 and it declines steadily from there particularly precipitously in this perimenopausal era to menopause and all of the yes special cells are all under the influence of oestrogen, progesterone, testosterone and they all respond uniquely to each of these rights. So estrogen really is good at preventing bone breakdown and actually helps create bone formation and progesterone also helps to regulate skeletal growth. It's really interesting that women who are still having their periods, I learned this in my research for our talk that women still having periods in their luteal phase, so the second half of their menstrual cycle, when the progesterone's higher, actually tend to form more bone. They build more bone. Fascinating. But obviously, when you lose your cycle, you're not doing that anymore. Testosterone is another thing that we haven't really talked about, but that really is important for bone formation as well. But we haven't got a lot of studies on this, but it's in the pipeline, I believe.
Dr Lucy Burns (07:08) Yeah, which I mean, cause that's one of the interesting things is the difference in osteoporosis rates between men and women.
Dr Sunita Chelva (07:16) Very. Women, as we hit menopause, we lose around 10% of our body mass in five years. One in three women have had a fracture related to osteoporosis at the age of 50. And one in two, so that means you or me, Lucy, will have a fragility fracture. So that's like we talked about the hip fracture, the spinal fracture, just minimal trauma. That's alarming to me. That's terrifying to me. And that's quite young. I mean, given that our average age of living is 85.1 years or something, I think in Australia, you know, having a fragility fracture is no laughing matter.
Dr Lucy Burns (08:01) No, absolutely. And I think, you know we've coined this phrase recently called the Glory years, which is the bit, you know, the third, the last third of your life. So you've got your first third. I kind of look and go, well, during that first third, you're growing, you're, you know, establishing your identity, you're sorting yourself out, you might start a little bit of reproduction. Maybe second, third, you're still potentially reproducing if you're having children or not, but you're, you know, you're working, you know, you're the mom taxi, you're doing all the things. Juggling, doing the mom juggle. Then the last third is really when you kind of meant to be able to reap the rewards of all your hard work. Maybe you still might be working, but you potentially don't have to work quite as much. You've got, you know, maybe more time to holiday, more time to just spend, you know, maybe you've got grandchildren. Yeah. You're travelling, you're catching up with friends unless, of course, you're spending all your time in hospital, getting your hip fractures sorted.
Dr Sunita Chelva (09:05) That's right. And I mean, 20 to 30% of people who have a hip fracture And for those who actually do survive, die within a year. There's a lot of pain. There's a lot of disability. There's impact on mental health and not to mention, you know, DVT. So clots, urinary tract infections, urosepsis, and there's this cascade effect that we do see with people who have osteoporosis, osteoporotic fractures rather, who if you have one, you're more likely to have another one and so on and so forth. And that actually applies to women who have you know, even wrist fractures, so falling over, tripping on a pavement, from your height, falling over and breaking your wrist, you're more likely to have other more significant fractures going forward.
Dr Lucy Burns (09:57) Yeah. And I think it's interesting, isn't it, that we almost sort of tolerate wrist fractures as an, as being inevitable. Oh, well, you fell over, so of course you broke your wrist. Inconvenient. Yeah. Yeah. But people who are 20 fall over and don't break a wrist. They shouldn't. They shouldn't. No. So why then would somebody who's 50 break a wrist unless they've got osteoporosis or osteopenia? And in fact, that was one of my questions. If you could explain the difference between osteopenia and osteoporosis?
Dr Sunita Chelva (10:33) Yes. So osteopenia is just low bone density or weakened bones. And osteoporosis is actually I mean, by definition, having a minimal trauma fracture, but really these terminologies come about through bone density measurement. So we have this thing known as a DEXA scan. It's a very simple, low radiation scan, that looks at bone density in sample areas. So in our lumbar spine, in our hip, our femoral neck of our femur or our wrist. It gives a T score. which is a measurement of bone density compared to other aged-matched individuals. So zero to minus one is considered normal bone density. Minus one to minus 2. 5 is classed as osteopenia, low bone density, and greater than minus 2. 5 is classed as osteoporosis. We can't look at someone as a clinician and say, You know, I know what's going on. You've got a very, you know, you've got, I mean, sometimes we can. They're sort of hunched over. Yeah, yeah, yeah. It's often missed. You know, I have had quite a few women coming into HERA in their 40s with T scores of minus four. It's something that you would expect to see in an 80 or 90-year-old. You'd never guess by looking at them, they would be, you know, they'd look like the picture of health. And so this is why it's extremely important to consider asking for a DEXA scan from your GP for this reason. Perimenopause actually, you know, Medicare doesn't cover DEXA scans until a woman is over 70 or has a minimal trauma fracture. So that's those fractures we talked about. Coughing and breaking a rib, tripping over and breaking your wrist. It's too late by then, but in perimenopause, you know, it can last quite long from four months to 10 years. Studies have actually shown that there is escalated bone loss through that period as well. It's not just that one day of menopause that suddenly everything goes down. It's bubbling away probably as we said from our 30s. And so it makes a case for us to really start screening for this earlier, way earlier than 70 by the sounds of things. And it's not just hormonal. As we said, it's not always just about hormones. Some women we would classify like those women I talked about who've got T scores of minus four. They're very rapid losers of bone and that's a genetically determined thing. Obviously, aging, reduced physical activity, and changes in metabolic health, same as muscles, also impact poor nutrition, if you've been on steroids for a long period of time, if you have an autoimmune or thyroid disease, smoking, drinking, even drinking two units of alcohol regularly will impact your bones. A lot of women are on SSRI antidepressants and They're readily prescribed at this age. A lot of GPs are very reluctant post-WHI to actually prescribe HRT. SSRI antidepressants have been shown to have a significant impact on bone density, and it's not often considered, considered at all. Oh, I didn't know that. Yeah, which is. It's interesting to think about, you know, the Olympics are on at the moment, Lucy, and a lot of these supreme athletes, the gymnasts, will have quite suppressed hormonal profiles. So a lot of these women, by virtue of overexercising, perhaps have eating disorders. Some women actually have primary ovarian failure or early menopause, so that's losing all of your hormones younger than the age of 40. That can have a huge impact on where a woman reaches her peak bone density. And these women need to be screened early, particularly.
Dr Lucy Burns (15:01) Yeah. My daughter has celiac disease and she got screened. Excellent. As a 20-year-old, we have no idea how long she'd had it for. She was one of those asymptomatic. People who didn't have any gut symptoms just had prolonged iron deficiency. Yeah, her gastroenterologist is completely onto it. And yeah she'll have regular screens now. As a GP, I reflect back now on how poorly I understood it menopause health and probably the number of women that I dismissed, even though I considered myself pretty patient-centric. So many things I now think about where I'd go, Oh my God, around everything around, you know, health, metabolic health, now osteoporosis, how many people I didn't screen. So many things.
Dr Sunita Chelva (16:00) So true. And, by virtue of the fact that it wasn't taught. It wasn't talked about. I feel like we've missed out on 20 years of really being preemptive about women's health particularly. You know, it's good that we're talking about it now, but I agree, I shudder when I think about the number of women that I haven't actually looked at through this lens.
Dr Lucy Burns (16:27) Yeah, absolutely. So, what would your advice be to say, let's say you're a woman who maybe, let's say you're in your 60s, and you've just been told that you've got osteopenia. What would you advise them?
Dr Sunita Chelva (16:47) Well, it depends. I guess coming in to see me, whether they, um, have, I normally would look at the menopause side of things as well. But let's talk about first, what would we do in terms of diet, exercise and lifestyle modification. Because these are really, really important alongside that. So, diet, getting vitamin D, either from sun exposure or from supplementation. I mean, we, I don't like supplementation for no reason. It has to be guided by a blood test. Depends on the individual need. I mean, someone with darker skin like me, Lucy, is not going to absorb the sun as well as you are. Calcium from the diet is really important. You know, we always say from the diet as opposed to supplementing, but nuts and vegetables, dairy, of course. But if you really aren't having those things, then maybe supplementation carefully, vitamin D and calcium. I mean, a lot of my patients say, I've got osteopenia. It's okay. I'm on vitamin D and calcium. It's okay. But we know, I mean, even from that, bad old WHI study, they did show that vitamin D and calcium alone are really not good enough for fracture prevention. So they help with bone maintenance. They're important overall for lots of other reasons, but they're not going to prevent your fractures. Cutting down on alcohol and smoking is really important for bone health. And as we said before, eating protein, eating lots of green leafy veggies, and adding to our diets is really, really important. Exercise is superbly important. And once again, heavy resistance diet. and high-impact training has been shown to really make a difference. There've been some trials, the Lift More trials in Queensland, which you've probably heard about, which have very, which have shown that high impact, high resistance training is very effective in stimulating bone growth, particularly in women who've got osteoporosis and osteopenia. There's a special program called which You know, came out from this study and you can actually seek out specific exercise physiologists and physios who can help you deliver that, you know, into your everyday practice. As we said before, it's not about bulking up. It's about strengthening what we have and certainly, a specific targeted training regime starting small can really make a difference to our bones and can actually improve bone density. We can see that on the DEXA scan. So it's definitely worthwhile doing it. Even if you're jumping off a step 10 times, that's enough impact every day. So if you're playing tennis or playing netball, you're going to be doing it. And starting these practices early, teaching our daughters, teaching our young women, do it from your twenties, do it from even before. It's never too late to start changing and remodelling our bones and our muscles. They're all dynamic tissues. HRT is an extremely effective treatment for osteopenia and osteoporosis and it is actually You know, a preventative and a treatment for fractures as well. And it's better than any of the weapons-grade medication. One of my colleagues here in endocrinology loves to call all the other medications, weapons-grade medications. Yeah. They're pretty intense some of them, they're very intense. I mean, there's just, you know, quickly there's bisphosphonates. You may have heard about them. They prevent bone breakdown. There's an injection that you have every six months. Prolia, there are all sorts of medications that are out there that, you know, in certain cases will need to be used, but when you stop them, your bone density slides back down again.
Dr Lucy Burns (21:02) Uh, and prolia has, you know, that risk of vertebral fractures if you are late even. Redown fractures. Yeah, which is really scary and a lot of people are not aware of it.
Dr Sunita Chelva (21:16) Not aware of it at all. You know, if we're talking about women, so this woman is 60 with osteopenia, she, as we said, might live to 85. You don't really necessarily want to be on these big guns for 20 years. There is hormone replacement therapy. We've got other symptoms. As we said, and we'll say it again, if it means you sleep better, you feel better, you have more energy, you're more likely to go out and address your diet, pay attention to your exercise. optimise those things, the flow and effect on your bones will also come from there. But they themselves, HRT, will treat osteopenia and osteoporosis and prevent that slide further. So very, very useful. The benefits, and nowadays we know that they can be taken for as long as the benefits outweigh the risks. Even for women who have osteopenia, it's likely to be extremely, extremely useful.
Dr Lucy Burns (22:20) Yeah, absolutely. And I think, you know, we, again, getting back to the Glory Years, medicine is very good at keeping people alive for a long time now. We're pretty good at that, but there are not many of our medications that really improve the quality of your life or the health span of your life. So things like, you know, MHT again for bone muscle health as a quality of life component, not just for. The perimenopause phase, but beyond is really, really important.
Dr Sunita Chelva (22:55) Absolutely living. I mean, I think a lot of my patients and I have the conversation that you could be taken out by a bus tomorrow. You could, something could happen. You have to do the best you can with what you have, and you might as well live with quality. Some of my post-breast cancer patients will also have these discussions with me because we live longer, we are going to be having diseases, you know, experiencing cancers and living with quality and optimising everything that we can.
Dr Lucy Burns (23:30) Yeah. Yep. So, which I guess then brings me to the next point, which is the people that can't take HRT or don't want to take out HRT or for whatever reason, the things that they need to focus then come back to those basics by the sounds of things. Always. Yep.
Dr Sunita Chelva (23:50) So, I think whether you take HRT or not. Those basics have to be in place. It's only part of the picture. It's got to be all of it all of it.
Dr Lucy Burns (24:01) I think you mentioned just doing some jumping. This would be, I reckon the thing that people don't have any idea about, that jumping, a little jump.
Dr Sunita Chelva (24:11) Off a step.
Dr Lucy Burns (24:14) Yeah. And you can, even if that feels a bit scary, you can just start again in the kitchen, holding onto your bench and just do one little jump and see how you feel. That's right.
Dr Sunita Chelva (24:25) There's this fear of injury. I don't know why, but we've always been taught you know, pain is bad. Injury is dangerous. We need to wrap ourselves in cotton wool. Humans are amazing and we can do amazing things and we can recover from amazing things, but we don't have to be afraid of doing things and getting back to that inner child is actually quite enlightening, I think, to allow yourself to be able to do that. I think don't be afraid of the fact that you might pull up a bit sore, or you might feel a bit weak, but it will get better. Mind yourself, I think is a big message.
Dr Lucy Burns (25:11) I think, probably, you know, for lots of people, I know around that age, that 60 year old age, they've got osteoarthritis in their knees maybe they've had joint replacements even by now, and they are scared of impact. So, again, you don't need to fear impact, you just need to do it. Slowly.
Dr Sunita Chelva (25:35) Do it slowly and build on that.
Dr Lucy Burns (25:39) Yeah, yeah, yeah. Don't go out jumping, you know, don't buy skipping rope and jump 500 things if you haven't jumped once. That's right. Yeah, that's right. I agree. So some impact is going to be helpful. We're going to, you know, if anyone's smoking, hopefully you're not doing that by now, reducing alcohol. Any thoughts on coffee?
Dr Sunita Chelva (26:00) Well, coffee, poor old contentious coffee. is, you know, like for many reasons, I think it needs to be in moderation. The effect of caffeine has been shown to be beneficial for metabolism. I think that excessive amounts may have an effect on bone density. Similarly on kidney function and just needs to be kept in moderation, I think any of our practices, any of our little vices that we covet and we overdo needs to be pared back because it certainly can have an impact on bone health as far as I'm aware. What are your thoughts?
Dr Lucy Burns (26:50) Yeah, pretty much the same. I think that, you know, unlike say smoking where there is zero benefit of any amount. And honestly, I'd also say the alcohol industry have done a great job of convincing us that a small amount of alcohol is helpful to your health. I don't think it's helpful.
Dr Sunita Chelva (27:14) I think that's that notion has gone out the window.
Dr Lucy Burns (27:16) Yeah. It's still pretty entrenched in the community that, you know, drinking red wine daily is good for your health. It's not. I think though that some caffeine, as you mentioned, does have some health benefits in a measured amount, but like everything, like anything we do, too much of a good thing becomes harmful. You know, too much water can be harmful, too much oxygen. We know that is harmful. So too much caffeine makes sense then. So if you're drinking eight cups a day, you probably need to cut down. And I would say really try and aim for, you know, two, max three a day. And probably closer to two, I'm just looking at, I'd probably drink three some days, but yeah, but the thing that I also do, and I, and you know, this is a completely separate topic, but obviously keeping the majority of your caffeine before midday will help you sleep.
Dr Sunita Chelva (28:16) Sleep is so important and sleep is restorative for all of these amazing cells in our muscles and our bones as well and recovery from whatever we're doing.
Dr Lucy Burns (28:28) You're absolutely right. It's a great segue. I didn't even realise I'd done one, but you're right. Because part of this whole muscle development bone health is that the rest phase the bed, you know, the sleeping phase is just as important. Yeah. Yeah. Good point.
Dr Sunita Chelva (28:45) We talked about in our first episode that we have a basal metabolic rate. Well, that's important. We're doing things even though we aren't just sitting there as well. So. What you do in activity phase is also helping your restorative phase.
Dr Lucy Burns (29:00) So yeah, absolutely. We have coined another little phrase cause you know, lots of people don't like going to bed, particularly women who have been working and running around all day and it's like your sacred time and it's the only time when nobody's guilty of that. Yep. Yeah. So this is our little hack for that is we have changed them. It's not called your bed. It's called your rejuvenation palace. Yes. And you go and imagine, imagine how much you would pay to go to a rejuvenation palace where you just lie back and all these things, you know, your muscles are repaired, your bones are repaired, your memories are enhanced, your learning is, you know, catapulted 10x. All of these incredible things happen, you'd pay a fortune. And all you have to do is go the hell to bed.
Dr Sunita Chelva (29:54) That's right. And that's why I often say that conversely, sleep deprivation is torture. So we can just focus on that.
Dr Lucy Burns (30:07) Yes. Sleep deprivation is the equivalent of you know, if anybody who's still working, if you're like, you know, if you're working in public hospitals, you will know that concept where they've told you, you have to do more work with less resources. That's basically what the brain says. Every time you deprive it of sleep during that time, you're actually giving it more to do. That's right. And it's compounding. Indeed. As you said, it's just compounding. Excellent. Oh, I love this. So summary for our beautiful listeners to improve your bone health, obviously start early. The earlier you start, the better. But doing something is better than doing nothing. So start even with a tiny little jump, just one little jump by the kitchen bench will start you on that impact. For your bone strength, strengthening your muscles is part of bone health, part of that whole musculoskeletal system. Obviously, you know, food, alcohol is helpful and important and HRT will be helpful. It will be absolutely helpful. And so if you know, you're at all on the fence thinking, I don't know if I really want to use it, we'll look at all of the benefits in their entirety.
Dr Sunita Chelva (31:28) Absolutely. It's never too late to start either. I think that's, you know, you haven't missed the boat. You might have low bone density, or you might have the beginnings of psychopenia, but you can do something about it now and just consciously think about it in all your daily chores and you know, what you do, even in the car, there are things that you can do and be aware of.
Dr Lucy Burns (31:53) Absolutely. I love this, Sunita. If people want to follow you or connect with you, what, where can they go? Where can they go?
Dr Sunita Chelva (32:02) Well, they can certainly go to our website @heramenopause.com au. They can find us on Instagram at Hera Menopause. We're also on Facebook and LinkedIn. You're welcome to email us. Come and visit us at HERA. We'd love to meet you. And we love midlife medicine. We're passionate about preventative health and aging well, living life with quality because that's what's life. Life is a very precious entity and that's what we do. Life is about.
Dr Lucy Burns (32:40) Yes. And making those glory years glorious. Absolutely. I love that sentiment, Lucy. Absolutely. Well, we will have all of the links to Sunita in the show notes. And so if you're driving and you're thinking, Oh my God, I can't remember what she said. Just go to the show notes at the end and click on the links and you'll be taken to her website. Dr Sunita Chelva, thank you so much for joining us on the podcast. It has been an absolute pleasure and you have been a wealth of information.
Dr Sunita Chelva (33:0080) Thank you, Lucy. The pleasure has been all mine and I look forward to hearing some more podcasts from you. Excellent.
Dr Lucy Burns (33:14) Thank you.
Dr Sunita Chelva (33:15) Thank you.
Dr Lucy Burns (33:16) All right, listeners, I will be around next week and I'll chat with you then. Bye for now.
Dr Lucy Burns (33:24) The information shared on the Real Health and Weight Loss Podcast, including show notes and links, provides general information only. It is not a substitute, nor is it intended to provide individualised medical advice, diagnosis or treatment, nor can it be construed as such. Please consult your doctor for any medical concerns.
