Dr Rupy: I do these huge operations on these patients where we make a cut all the way from the pubic bone up to the rib cage almost. And then the next day I say, so now you're going to get out of bed, right? And we're going to take the catheter out and you're going to walk around.
Dr Anitra: And I think back to myself and I was there like, I just have this recollection of one of my colleagues coming to see me and I'm like clinging on to the edge of the bed. And she's like, oh my goodness, get her some more pain relief.
Dr Rupy: Dr Anitra is back on the podcast today. She is an NHS doctor working in obstetrics and gynaecology with experience in both clinical medicine and research. She actually completed her PhD on the vaginal microbiome in cervical precancer and the reproductive complications of treatment for cervical precancer. She's also author of the fantastic book, Gynae Geek, and her new book that I can highly recommend, Dealing with the Problem Periods, in which she details what normal and abnormal looks like and the various conditions that can cause problems. I highly, highly recommend this book. It is ideal for young women and women in their middle age and anyone that has women in their families. It's super important for us to understand what can go wrong. Today's discussion is about what normal means for periods and how to personalize them to your own cycle. We talk about what her current day job entails in her gynaecology cancer speciality, as well as the reasons why problem periods can arise and the investigations that she recommends. We also talk about why it's important to monitor periods and how to track them. And as a GP, that information is so, so useful. And if there was one thing that I would take away from today's podcast, it is everyone should understand how and why they should be tracking their periods. This information is perhaps the most telling out of any investigation that you can find online. Just simply tracking your periods is a phenomenal tool that everyone should be doing. You can find Dr Anitra on Instagram. Her book, Dealing with Problem Periods, is out in all good book stores and online. She has plenty of resources on her website, and I have a sneaky suspicion this probably won't be the last time we're chatting to Anitra because I would love to deep dive into specific topics with her like PMS, PMDD, PCOS. I think there's a lot to unpack there and explore, and I'd love to do that with her and perhaps one of our other guests as well. So watch this space. You can also watch this podcast on YouTube, of course, where you can find recipe videos and a ton more content that we're pumping out on YouTube. Subscribe whilst you're on YouTube, or you can also subscribe, hit the notification bell on Apple or Spotify, wherever you're listening to this podcast. It does help us out massively and it is no cost to you. On to the podcast.
Dr Anitra: The average woman has 400 periods in her lifetime, which is 10 times the number we had about 100 years ago. Why is that? Well, essentially, we have fewer babies and we don't tend to breastfeed for as long. And so that's why we have many, many more periods. And it's not surprising that periods are going to be problematic if you're having something 400 times in your lifestyle, in your lifetime. And that is also the reason why I think that we see so many people just really, really suffering because it has just happening every month continuously.
Dr Rupy: Okay. And so, you've written books before, you've talked about lots of different subjects, and you've chosen to write this book about problem periods today. Why is this particular book so important right now?
Dr Anitra: Well, I think that we are just hearing more and more about people who are having problems with their periods. And I think that it's probably because we're a bit more able to talk about it in society these days. It still is a huge taboo and it's a real problem. But I do think that we are a little bit more open. I don't know, I'm also probably in a little bit of an echo chamber. But I think that we are just starting to hear so much about people can't go to work, people can't look after their families, can't go and do sports, go to social occasions. And you know, there's so much data out there about how much is lost in terms of earnings per year, the cost of the to the economy of problems with periods, but there's so many costs to people's lives that you just can't put a figure on. And that to me is the most important thing.
Dr Rupy: This is really interesting, right? Because you're privy to this, not just because you are in the field, you're a women's health specialist, you see women every single day of your clinic, but you're also on social media. You've been on it for years now. You're literally getting DMs every single day about these issues. And actually you're collecting information using the medium of social media as well. Tell us a bit about the study that you did on the back of the surveys that you collected a couple of years ago.
Dr Anitra: So first of all, this is all your fault, because you are the one that said to me, Anitra, you need to get on social media. So, I mean, jokes aside, you've really, really supported me and I'm really appreciative about it because, you know, I think it is really important to have the voice of a doctor talking about women's health on social media. And there, yeah, it just the number of messages I get really gives us an insight into the fact that there is a huge problem when it comes to gynecological health and the fact that people aren't getting help. Because obviously, whilst I'm honored that people want to contact me and want my opinion, it just shows that they're not actually getting the help that they need from the healthcare system. They're not getting the answers that they need. And you know, there's staggering statistics from the, you know, the data that was collected by the government to show that, you know, the proportion of women that aren't listened to or don't feel listened to during a healthcare consultation. And so, you know, the fact that someone has to open their phone and find a person who they've never met before and ask them for advice really shows the sort of the scale of the problem. And you know, I think that it is important that we do put reliable information out there on social media because there is a lack, even now, you know, the problem years ago was much worse, but there is still a lack of really reliable, engaging, evidence-based information online because that's where people go for their their health information these days. And I actually see that day-to-day. Unfortunately, often related to the misinformation that people have gained through social media. And that's why I think it's really important that, you know, there are a really good number of healthcare professionals these days using social media to put out, you know, responsible content. But also, I think it's important to say that it doesn't replace having that one-to-one individual consultation with a doctor because, for example, you might find somebody on social media and, you know, I'm really grateful to all the patients and people who are, you know, experiencing problems out there who talk about it on social media because I think when it comes to gynecological health, because it is still, you know, a taboo, we often don't know somebody who's been through it ourselves. Well, we probably do actually, but they just haven't spoken openly to us about it. And so it can feel really isolating. So then when you go online and you find someone and you think, oh gosh, there's someone, you know, similar to me, she's going through it too. Okay, maybe there is hope. And I think that there is definitely a huge community spirit that you can feel on social media in the kind of patient group. And so that can be really helpful, but also sometimes what you see, you know, is applicable to that person who you're following, you're watching their journey. Okay, they had that medication or they had that operation. There are reasons why that might not actually be suitable to you as an individual. So that's why it's really important to to have that one-on-one consultation.
Dr Rupy: Yeah, you got to you got to individualize your own experience and what necessarily worked for one person doesn't mean that it's going to work for you. Like a lot of people have found benefits from lifestyle changes, dietary changes. That's why a lot of people sort of veer toward a certain influencer, whether that's medical or non-medical, but at the end of the day, you've got to be respectful of your own journey and actually what may or may not work for you. So I think you've always got to take that with a pinch of salt. It's not like a a panacea or universal treatment for every person.
Dr Anitra: Yeah, definitely.
Dr Rupy: And with that in mind, I guess a lot of women will be asking themselves, what is normal? So what is a normal period and how do you know whether you're stepping out of that arena of what is normal and and when to actually approach a health professional?
Dr Anitra: Yeah, so I think that's really important to understand because you have to understand what's normal before you can identify that something is abnormal. So very broadly speaking, a normal period should last less than a week. Okay. So the average is kind of three to five days, but less than seven days. And it shouldn't be too heavy. Okay. So there's no set amount. It's very individualized. It's what's heavy for you. And to give you a some context about that, I might see somebody who says, my period's not very heavy. And then I ask, okay, how many pads or tampons or, you know, times you change your menstrual cup per day? And they might say, oh, well, I use about 10 pads per day. And then on the other hand, I might have somebody who says, my period is really heavy, and maybe they're using pads and tampons, but changing maybe two or three times a day. So it's it's so variable and it's if you think your period is too heavy for you, then, you know, absolutely. And if you're becoming anemic because of the amount of bleeding, that's another sign that, you know, maybe this is too heavy. It shouldn't be too painful. So what's too painful? I think it's really, I find it really difficult because lots of patients say, I've got a really high pain threshold. And that always makes me feel a bit anxious because I think, gosh, are you sitting at home thinking like, you're tough, come on, tough it out. It always makes me feel really sad that someone's had to feel that, you know, maybe they have to justify it or that they are really tough, but you know, they're really like toughing it out essentially. So my kind of concept of what's too painful is if you're kind of clock watching to work out when you can take painkillers. So it's a bit like when my kids are sick. Me and my husband have this little like whiteboard on the fridge and we kind of like make a little medicine chart. I mean, we're both doctors. I mean, you know, that's just the way we do it. So we write like when they last had like whatever Calpol or ibuprofen or whatever. And then like when they could potentially have the next dose. So it's kind of if you're doing that, you know, I mean, we're basically doing that because we don't want to overdose our kids. But you know, it's our like communication system. But you know, if you're kind of thinking like, right, okay, I had paracetamol at 12 noon, therefore, I can have the next dose at like 4 p.m. at the earliest. That's to me a little bit sinister if it's always like that. It's quite normal that you might need to take some pain relief, particularly on the first, second, maybe third day. Because, you know, it is painful when you have a period because your uterus is actually contracting. So I'm not sure that everybody understands this, but you have a huge muscle that makes up the bulk of your uterus. And actually, when you are having your period, it's it's contracting like the same way that it does when you're in labor to push the blood out and to try and, you know, stop the bleeding ultimately. And that's why it happens and that's painful.
Dr Rupy: I don't think a lot, I don't think a lot of people realize that. You know, that it is a type of muscle and you have essentially contractions to sloth the excess blood that's built up over the course of your
Dr Anitra: Yeah, yeah. So your your inside of your uterus is the endometrium. So that's the lining that's coming away. And then so you've got some old cells and then you've got blood and then you've got, actually quite a lot of water in the blood as well. And then yeah, the muscle is the layer above that and is the bit that's kind of squeezing to get it out. And then you've got the serosa, which is kind of like, I always kind of explain it to patients as like, it's kind of like cling film that surrounds the the uterus. And then you've got kind of like a little bit of fluid inside, inside your tummy that kind of lets it slide over the other organs. And so that's how everything should be kind of like moving around inside because you've got loads of bowel that's kind of like moving over the pelvic organs and they should all be kind of like sliding over one another nicely. And then the final thing is that you should have some idea of when your period is going to come. And so, you know, textbook 28-day cycle, you know, only about 10% of people have a 28-day cycle.
Dr Rupy: That's really important to know. Like underline that, you know.
Dr Anitra: Exactly. And so lots of people, I say is your period regular? And they say, no, not really. Some months it's 27 days, then it's 29, then it's 28, then it's 30. But that actually still counts as a regular cycle because there is some kind of, you know, it's never going to be bang on 28 days unless you are, you know, that textbook person. But even somebody who has a 28-day cycle has that fluctuation. And so yeah, you've got to have some idea of when it's going to happen and and generally speaking, you should have a period every kind of like 21 to 35 days. When you are very young and you've just started your periods, then we have a little bit more leeway. So for the first couple of years, it's quite normal that you might have longer gaps or shorter gaps in between your periods because your hormones are still kind of like settling in, shall we say. And so it takes a bit of time and that's quite common. And I think the other thing to say is that it's really important that it shouldn't be having a significant impact on your quality of life. That's really important and and for me, in a way, that's the most important thing because you shouldn't be suffering. It's something, it's very important that we have periods, but they shouldn't be something that you you dread every single month.
Dr Rupy: Yeah. Okay. Timing, the amount of bleeding, the pain and the amount it impacts your quality of life. Have you ever come, I'm sure you have, have you come across patients where they've always had what you would class as abnormal periods, but they've deemed it normal for them and they've essentially suffered in silence?
Dr Anitra: Oh gosh, yeah. So the the first chapter of my first book is a pretty shocking story about somebody who used to sit on beach towels because her period was so heavy. And she came to A&E because she'd collapsed essentially because she'd become so anemic. And she said to me, I just thought this was normal. And then the sad thing was that when she realized that it wasn't normal, she didn't really know how to kind of bring it up with her doctor. And that's why it's so important that we empower people to have the language to be able to explain what's going on and also to feel that it's not something they've done to themselves. I think there's a lot of blame culture and I do see this a little bit online as well. Because I really, you know, one of the things that you and I bonded over so much is the the whole, you know, lifestyle impact on our health. But sometimes I think that that gets a bit oversold and becomes detrimental because it makes people think, well, is it because I ate this or because I didn't do that or, you know, it's it's not your fault. And and you know, sometimes I see people who have the healthiest, like the the most beautiful lifestyle. I think, gosh, I wish I could be like you, but they have dreadful periods. And then on the flip side, I might see somebody who does everything the way that we wouldn't really recommend and actually is like, yeah, okay, period came, period went.
Dr Rupy: Totally. Yeah. And this is what I I find the beauty of long form content because you can have a more nuanced discussion rather than the sound bites that you see on social media. Because I I completely agree, you know, it can spiral into a shame cycle whereby even if you lead the healthiest lifestyle, you eat your vegetables, you exercise, you're in sleep by, you know, a reasonable hour, you're getting your eight hours, etc. You meditate, you do all the mindfulness regimes, you can still suffer from a whole host of conditions. You know, everyone's had that experience of seeing a patient who's presented with cancer and they've had the, they've ticked all the boxes, you know, according to WHO guidelines and everything. They should not have had cancer for that reason. But there are just random mutations. There is just, you know, the fact of life unfortunately, where people suffer conditions undeservedly so if you look purely at their lifestyle. So whilst it's a really important factor, it's not the be all and end all.
Dr Anitra: Yeah, totally. And I think that's a really important because obviously I work in the field of gynecological cancers these days. And I see people who, you know, have done everything perfectly. They've never smoked, they've, you know, really looked after themselves and they found themselves with cancer. And maybe even people who don't even have a genetic mutation. But then also, I kind of look at it from my personal perspective and I know, for example, at the moment, my life is really hectic and I do really try and you know, do all the things that we're meant to do. But you know, there are times in your life where you're not actually going to do it all perfectly. So I know that I'm not, you know, my job is very active. I stand up all day for like 12 hours at a time. And I know that, you know, the operating we do is really physical. And I still, you know, I'm, I do 10 minutes of yoga every morning. I try and do a bit on the weekend. This weekend, my kids were like, what are you doing? And like climbing all over me, so that didn't really work. But, you know, I try and do all that kind of thing. I mean, realistically, I can't really remember the last time I slept for eight hours. And there is that kind of like guilt feeling that comes over you. Like, I'm really not looking after myself. But I think that we have to remember that someone explained it to me that we go through kind of seasons in life. And I'm just in a different season at the moment. And I know that, you know, the end is in sight. But you can feel really guilty sometimes that you're not doing all these things that you know that you're meant to. But I think, you know, you just have to do what you can. And I say this to patients all the time. I say, you know, I'll see them before surgery and I'll say, look, you know, now's the time, you know, it's only a couple of weeks till your surgery, you've just got to try and, you know, be the healthiest version of you. And you know, okay, you're not going to end up being in the most perfect health because, you know, you've got this, you know, awful situation where you've been told you've got cancer. But as long as you know that you did everything you could at that point in your life, I think that's the most important thing.
Dr Rupy: What, I've asked you this before, not on the podcast. What what made you go into oncology in the first place for for for women? What why did you go into gynecological cancer treatment?
Dr Anitra: Well, first of all, I find the surgery really interesting. And so, you know, when we talk about treatment for gynecological cancers, we work as a huge team, okay? And so, I read this really interesting statistic on social media recently. I can't quote the source, I'm afraid, but it was something like when you when you've had a diagnosis of a gynecological cancer, you'll have about 144 professionals involved in your care.
Dr Rupy: 144.
Dr Anitra: And that even astonished me.
Dr Rupy: Wow.
Dr Anitra: So, you know, when you when I see people, they either have suspected or confirmed gynecological cancer. So we work as a huge team. We have the people who look at the specialized team who look at the scans, so the specialized radiologists. We have the pathologists who look at the tissue samples. We have the oncologists who are involved in doing things like chemotherapy, radiotherapy, immunotherapy. We have all the team on the ward, the dietitians, physios, OTs, the nurses, we have the specialist cancer nurses. You know, so many different professionals. So surgery is actually a really tiny part of what goes into the care of these patients. But the surgery is still important and I I really enjoy that. But I just think I find the disease so fascinating. And I maybe fascinating isn't really the right word, but I just I just find it so interesting that we you know, you have this disease that can kind of take over your body. And we still don't really understand everything about it, but we're so devoted to trying to do the best thing for our patients. And I I just really we have really lovely patients and I really admire them and I there's so many patients who I think about every day. And I just think, gosh, I wonder how they're doing. You know, but I just I'm so humbled by what they go through because, you know, I had a cesarean section when my kids were born. So it's like a, I mean it's we always say it's like a 10 centimeter cut in the low abdomen. Mine's tiny because one of my colleagues did it for me and he was being very, very kind. Made a tiny cut. It's tiny. I have never felt pain like it. Okay. I have looked after, I've probably done a thousand cesarean sections. I've looked after over a thousand patients who've gone through this process. And I've seen people on the ward and you know, I've sat with one of my colleagues who had a cesarean section like maybe six hours before and she was just sat on the sofa with us in the in the doctor's office having pizza. I mean, not sure that's kind of like your your standard recovery, but I just thought, oh, it's going to be a breeze. And it's really interesting because people are like, oh, Anitra, you're like really fit and healthy, so you're like, you'll be fine. And it's just those little comments and you think, oh my gosh, am I really weak and really pathetic? Whereas then I I do these huge operations on these patients where we make a cut all the way from the pubic bone up to the rib cage almost. And then the next day I say, so now you're going to get out of bed, right? And we're going to take the catheter out and you're going to walk around. And I think back to myself and I was there like, I just have this recollection of one of my colleagues coming to see me and I'm like clinging on to the edge of the bed. And she's like, oh my goodness, get her some more pain relief. But you know, we're all different at the end of the day, but honestly, I'm so humbled by that. And I unfortunately, I do unfortunately still have to ask my patients to get out of bed the next day because, you know, we do it for a good reason. It reduces the risk of blood clots, it helps the bowels to start moving and working and, you know, helps the healing process. But I just think back to myself and I just think, gosh, if I if I was there, I'm not sure that I would, I don't know, I don't think I'd manage it, but they're just amazing. And I tell them every day. Honestly, I tell my patients, I think you're doing an amazing job and they look at me like, are you nuts? But I really do think they are and I just I just find the women so inspiring and I think actually that makes the job so much easier and so much more enjoyable.
Dr Rupy: Definitely, yeah. I mean it's amazing that you find so much joy in what is I think on the outside seen as quite a somber area of medicine to be in, you know, particularly with certain
Dr Anitra: We all have our, we all have the things that we like. So I remember when I, because I don't do obstetrics anymore really. I so, you know, looking after pregnant women, being involved in deliveries, I only go if there's a huge complication on labor ward or something where they need more kind of surgical input. And I remember telling, you know, it's like kind of the 3:00 a.m. conversations that you have on labor ward. It's a it's a really interesting environment. You know, you really it's a real team environment and I've had some great conversations in the middle of the night with colleagues and, you know, the midwives. And I just remember someone saying, well, because I said I don't like, I don't like obstetrics. It's such an honor to be there when someone's baby is born. Sure, yeah. And to be involved in a delivery, but I found working on labor quite traumatic. And someone said to me, how can you, how are you going to manage to work with people with cancer? And I don't know, it's just the way our brains are and the way our minds are. And for example, I could not watch this is going to hurt that series by Adam K. I found it, I I did watch it.
Dr Rupy: Oh, you did watch it?
Dr Anitra: I did watch it.
Dr Rupy: Okay.
Dr Anitra: It took me about six weeks to watch it, not because I was busy. I kind of, it's I can't even explain it. It was like, I I didn't want to watch it, but I made myself watch it and it was awful. I found it incredibly traumatic. Because I've just been through some horrible experiences on the labor ward and situations where I think I I feel awful that people have to go through this. And that gosh, now I'm probably making people scared of labor and it really doesn't have to be like that. But you know, I don't think that we really talk about the situations that we are kind of like second victims to, if so to speak, where you experience something that is really kind of unpleasant and it's not really spoken about as doctors, we kind of just like keep it hush and just get on with it. But I just really didn't enjoy it. And I had some, I also had some bad experiences working with some quite unpleasant colleagues, so that obviously contributed to it. And I actually ended up going to see a psychologist to talk about a lot of the things that I experienced at work because I just found it incredibly problematic. And what's really interesting is that I kind of mentioned this to some colleagues and they were like, oh, I wouldn't have thought that you would need to go to see a psychologist, you're really tough. And again, I thought, oh, that's really interesting because like, it's not a sign of weakness.
Dr Rupy: No, that's exactly what I was going to say. Like, because you go and see a psychologist, it's probably a sign of good self-awareness.
Dr Anitra: Yeah.
Dr Rupy: And and the strength to actually go and seek help, I would say, rather than as a something to be embarrassed about. I think that's a very sort of old school mentality in medicine, like stiff upper lip sort of thing.
Dr Anitra: But I I think it's something that all of us should do working in the medical profession because it it helped me deal with so many different situations that I found myself in and dealing with different personalities. You know, I think that it's so, so important and we're not really taught about how to kind of handle our emotions in difficult situations. You get taught kind of like, you know, like conflict resolution and that kind of thing, all those kind of like courses that you're supposed to go and do and things, but I don't think that it really prepares you for kind of like dealing with your feelings in that situation. It's just like your language maybe or like how you discuss it with somebody or, you know, it's totally different.
Dr Rupy: I remember reading the book and just thinking, gosh, this is basically Anitra's life. Um, and then also like resonating with so many of those stories, particularly when he was a junior and through his specialist training and all that kind of stuff. But the show was so triggering. And I think it was triggering for a lot of medics actually, regardless of whether you're in that specialty or not, because there were just so many truths in it. And like, I know you're, I know we're just talking about how, you know, you went and had therapy and everything else, but like, I bored my eyes out for most of that like the end of that show because it was just like, and you kind of knew what was going to happen. And when she turns to the camera and then she says that line, I just like, I I just lost. I I even now like just thinking about it gets me quite emotional.
Dr Anitra: It's like put the hairs on the back of my neck up.
Dr Rupy: I know. I know. It's just so, yeah, it's really, yeah.
Dr Anitra: Gosh, we need an emotional break.
Dr Rupy: Yeah. Yeah. And the stats around that as well. Like, I was on this, um, I was talking about it recently. I think I might have mentioned it to you. I went to, um, Well Medics. It's like a, uh, it's Well Medics with an X on the end. It's, um, uh, a an event that's held every three, every year, uh, in the mountains with, it was started by an orthopod and a surgeon.
Dr Anitra: Oh, you got me. I'm in the mountains. I'm sold.
Dr Rupy: I know. Yeah. Honestly, you would love it. You're definitely going to come next year. I'll introduce you to the people that started it. Um, and it's basically a a time where, you know, you can afford to be a bit selfish, you can, you know, uh, talk about vulnerability and there's loads of really empowering talks about everything from resilience to nutrition, to mindset, all that kind of stuff. Um, and it's a space to be vulnerable as well. And the number of people who have experienced burnout and actually talked about like their experiences there was phenomenal. But I heard this crazy stat, like, um, every two weeks a doctor takes their own life. And for me, like, I knew it was high, but I didn't realize it was that stark.
Dr Anitra: That's terrible.
Dr Rupy: It's terrible, yeah. And so it just like, you know, paints a picture that therapy is nothing to be ashamed of and actually it should be a requirement, not just a nice to have or something that we should do. Um, and something that I think other medical systems, particularly in Australia where they're a bit more privy to the the the impact on lifestyles and outside of work, um, where they're introducing a lot more, but yeah.
Dr Anitra: Wow. Get me to the mountains.
Dr Rupy: I'll get you to the mountain. I'll definitely, uh, I'll I'll I'll introduce you to them.
Dr Anitra: That was our last trip together before the world shut down.
Dr Rupy: It was, yeah, COVID.
Dr Anitra: Amazing, amazing ski trip.
Dr Rupy: Yeah. So, um, yeah, it's interesting that you, you know, you find that joy in in the work that you do. And I guess, um, cancer itself as a, as a, is very much an umbrella term. You know, most people have a warped understanding of what cancer is. Perhaps you could just give us an insight. I know we're very, very quite, quite far off the the topic of your book here, but, um, the the the topic of cancer, I think just gets the wrong sort of information around it. It's very much an umbrella term. There's so many different types of cancer. Maybe let's hone in on the different types of of of gynecological cancers.
Dr Anitra: Yeah. So, I mean, the most common cancers that we are treating, so, you know, I work in a very, very busy cancer center. So a cancer center, um, is basically a place where we can treat, um, more advanced cases of cancers. And this is the way that in the NHS, we make sure that the right people are getting the right specialized care. So as a gynecologist, we are trained in, uh, in in investigating and diagnosing cancers. And then we are trained in, you know, the very basics of treating early cancers, okay? And so by early, we generally mean kind of like what we call stage one. So when we talk about staging systems of cancers, we're talking about where in the body they are. So stage one basically means it's in the original organ, generally speaking. And then if you have anything that is beyond that, then usually you're referred to a cancer center. So that's where we have all these specialist, um, teams. We have to have more kind of advanced higher training to perform the surgeries that these people patients need. So, yeah, in the cancer center where I work, we are predominantly treating a lot of endometrial cancers. So cancers of the lining of the the uterus or the womb. So uterus, womb, same thing. It's all interchangeable. Um, fun fact, my surname is the Greek word for uterus. You already know that, but you know, just sharing it with the listeners. Um, and then ovarian cancer. That is the the so those two are the most common gynecological cancers. And then we also see people with cervical cancer, and then vulval cancer, and then vaginal cancer, which is incredibly rare. Um, we do see a little bit of. Uh, and so we are, you know, seeing people who some of them have confirmed cancer, some are suspected, and then we are, you know, involved in arranging their their treatment. And so for many people, it involves surgery with a combination of, you know, chemotherapy or radiotherapy or both, either before or after the surgery.
Dr Rupy: Gotcha. Can you put some numbers on the ovarian and endometrial cancer rates?
Dr Anitra: Yeah, so endometrial cancer is the most common. So it's about one in 40. So if you think of 40 people, one of those will probably get an endometrial cancer. And then ovarian cancer, so it's about one in 55. So also, you know, not uncommon. Um, cervical cancer about one in 135 in their life. And then vulval and vaginal are much more rare. Um, but so it's, you know, it's not an uncommon thing. There are some some different genetic mutations that are known to be associated with these types of cancers. So lots of people have probably heard of the BRCA mutation. Uh, some people call it the Angelina Jolie gene. It's a a gene mutation, well, there's two different, um, genes, there's BRCA1 and BRCA2 that can increase your lifetime risk of getting an ovarian cancer. So about 20% of ovarian cancers are related to mutations in the BRCA gene. There are some other, um, some genes that can increase your risk of ovarian cancers, they're much more rare. And then many people don't realize that endometrial cancer, so cancer of the the lining of the uterus can be associated with something called Lynch syndrome. And so this is a syndrome that actually tends to be more commonly heard of when we're talking about bowel cancer. So it's a mutation in genes that repair DNA damage. And so this is something that's been introduced when it comes to diagnosis of endometrial and bowel cancers in the UK. So if you're diagnosed with one of these cancers, then you'll be tested for the particular genes that can be mutated. And then if we find that those genes are mutated, then there's some other tests that need to be done to see if you have Lynch syndrome. And then if this is the case, then, you know, it has implications for family members. And so when we talk about, for example, BRCA mutation, people say, well, I don't have any daughters. But it's still relevant because actually, you can have a a son who then carries the mutation and then has a daughter, for example. So, you know, this is how it it is still important to find out. And also, particularly with BRCA mutations, it can have an impact on what kind of treatment you're offered afterwards. So it is important to find out about these things. But actually, the majority of gynecological cancers are not related to a specific mutation.
Dr Rupy: Okay. Okay. And so in terms of the advice to the general population, when it comes to finding out whether you do have any mutations, do you think it's worth most people getting that information?
Dr Anitra: Yeah, so it's down to your, it's down to your family history. Okay. So there are set criteria to have genetic testing on the NHS. And it depends on who in your family has been affected, you know, how closely related they are to you, what age they were. And so if you think that you have a possible risk of, you know, it's it's about the specific cancers because some people say, well, I have a risk of, I have a family history of cancer. But maybe they actually had somebody who had a lung cancer. Generally not related to gynae cancers, for example. So it matters what cancer people had. And if you think that you're at risk, there's actually a really good, um, calculator that you can use. It's very basic and it's not going to tell you, you know, whether you do have a gene or not, but it can give you an idea of whether you're eligible for screening. And it's on the ovarian cancer action website and it's a clinical risk calculator. And so what you can do is you can actually fill that in and then take it to your GP who can then look at the information that it's put out to say whether you may or may not be eligible for testing. And then you need to see a geneticist. So it's not about going to your GP and saying, this is what I've got, I think I'm eligible and the GP says, okay, I'll take a blood test. It's a lot more complex than that. So that's generally how people find out, either through having a family history, having a family member who's had a particular type of cancer and found out that they've got the BRCA mutation or that they've got Lynch syndrome, for example, they're the ones that I commonly see. But then we do see people who've had testing privately. So you can get it done.
Dr Rupy: Yeah, that was going to be my next question actually.
Dr Anitra: Interesting. So once a month, we run a clinic in the hospital where I work where we see people who have a genetic risk of cancer. So, you know, again, generally BRCA and um and Lynch. And every now and then we do see someone who has done some private testing and found out that they have a mutation, but no one in their family's ever had a cancer. Okay. And it's interesting because then you're you're when you get genetic information about yourself, you have to think about what you're going to do with it. Because then they're faced with this difficult decision of what do I do next? Because we can offer people what we call prophylactic surgery. So we can do risk reducing surgery to, so if you have a BRCA mutation, we can remove the tubes and the ovaries. And you might be thinking, well, why are they removing the tubes if removing, you know, for ovarian cancer? Well, let me tell you, about 70% of ovarian cancers actually begin in the fimbrial end of the fallopian tube.
Dr Rupy: I did not know that.
Dr Anitra: Okay. Well, there we go.
Dr Rupy: Oh my gosh. I had no idea.
Dr Anitra: So, you have, um, I always talk about like the fallopian tubes as being like arms, okay? Because they're kind of like flapping around and they're attached to the uterus, which is the body, which is where the baby grows. Fallopian tubes flapping around and then they they're not attached to the ovaries, you know?
Dr Rupy: Okay.
Dr Anitra: They have these little like finger-like projections and they kind of like move around. And you know, actually, your your right fallopian tube could actually get an egg from the right ovary because they move around.
Dr Rupy: What? I did not know this.
Dr Anitra: Have you not read my book, Rupy? Gosh.
Dr Rupy: No, I mean, it's a bit of a niche fact, isn't it? Not really.
Dr Anitra: Okay, yeah, yeah, yeah. But and the fimbrial ends are the little finger-like projections at the end that kind of like pick up the eggs. And so those the cells on the end are the ones that can sort of turn into to ovarian cancer. So that's why we recommend taking out the tubes as well as the ovaries.
Dr Rupy: Okay.
Dr Anitra: Um, because actually you don't need your tubes for anything. They transport the the eggs into the uterus. They are the site of fertilization usually. So eggs and sperm meet in the fallopian tubes usually and then get sort of flapped along into the uterus.
Dr Rupy: It's like the restaurant or bar of the fertilization situation.
Dr Anitra: Yeah. I like that analogy. It's very good.
Dr Rupy: You can use that.
Dr Anitra: Okay. It's not a Wetherspoons, though. The all bar one. Well, okay. I like that. I like it. And um, they don't they don't have any role in hormone production. They just transport eggs and can cause ovarian cancer.
Dr Rupy: Okay.
Dr Anitra: But if you're someone that's young, so say you're like maybe like in your early 30s, you, you know, most people in their early 30s haven't even thought about having their babies because we're having babies at, you know, older and older. And then someone says, well, you actually you've got this risk of ovarian cancer. The only thing I can do to prevent it is to take your tubes and ovaries out. Then you're like, oh my gosh, what do I do? And we don't generally need to take them out, you know, we recommend normally doing it kind of more in your 40s than in your 30s, but you've still got this information that then you have to make a decision about and actually can provide a lot of anxiety. So, you know, I think it's really important to not just kind of do a random test at some point. I think if you're worried, you need to go through your family history. And it's important to know what kind of cancers people had because this is the thing about gynecological cancers. Often people will come and say, well, my grandma died and she had some kind of cancer and we don't know, we think it was like something down there. And if it was cervical cancer, that's very different to it being like ovarian cancer, for example, because cervical cancer doesn't really have any known, you know, genetic predisposition. And that can make a huge difference to your risk and to whether you're eligible. So that's why it's really important that we do kind of like talk about family history and understand what's gone on. But yeah, I I definitely think that that risk calculator can be quite useful to work out if you're eligible because um, the criteria is quite set. Um, and it has changed recently. So there has been a change that if you have a Jewish grandparent, then you're actually eligible for testing because of the higher risk of the BRCA mutations in the in the Jewish population. So that's something that's changed recently. So yeah, I I would definitely advise people to to have a look if they are concerned or think that you know, there might be a um, a hereditary component in their family.
Dr Rupy: Gotcha. And so with regards to screening, I think everyone's aware of cervical screening, um, uh, the genetic screening if you're eligible, you can use that calculator. Are there any other screening tools that we have for the other gynecological cancers?
Dr Anitra: No, there aren't. And that's the problem is that we haven't really developed a way of of finding these cancers. You know, ideally with cancers, you want to find something before it turns into a cancer. So the the beauty of, beauty is not really the word for describing a cancer, but the beauty of cervical cancer that makes it um, suitable for screening is that it has a very clearly defined pre-cancerous form, which is called CIN or cervical intraepithelial neoplasia. And that is a window of opportunity that we have to both detect it and take it away to stop people from getting a cancer. So we can remove the abnormal cells from the cervix to stop people getting cancer. And that's been shown to be highly effective. And but we haven't found anything like that with with endometrial or ovarian cancer and that's the problem. And you know, particularly ovarian cancer, that's a real problem. And I think that, you know, I I remember going to a lecture by one of my colleagues and I think she said we need to be able to detect the the cancer before it's less than a centimeter. So can you imagine trying to make a test that you can do, it has to be something that's not too invasive that's going to find something super tiny in your body. And there's been so many different trials that have been looked at to do, you know, for example, annual ultrasounds, annual blood tests. There's a blood test called CA125 that we sometimes use as part of the diagnosis and also as part of the follow-up for people with ovarian cancer to monitor. But doing that, for example, hasn't been shown to be effective in reducing the the risk of death from ovarian cancers in a population, either in the general population or people who are at risk. So people with a BRCA mutation, for example. And that so that's what makes it really difficult. Now, actually, some of my colleagues have done some really interesting, uh, studies and and kind of tried to think outside the box. And there's some studies that have looked at what people Google in the lead up to getting a diagnosis.
Dr Rupy: Oh, that's so smart.
Dr Anitra: Yeah. So that was just published actually a few weeks ago.
Dr Rupy: So you can find from someone's search history of their symptoms that they're trying to figure out what what they are, like whether they're actually at risk of, oh, that's so smart.
Dr Anitra: Exactly. And then somebody also did something looking at people's loyalty cards and what they were buying. And found, for example, that people were purchasing lots of, um, you know, like anti-reflux medication in the lead up to getting a a diagnosis of ovarian cancer. So I think it's really important that kind of like looking outside the box and you know, there's so many, you know, amazing technologies and things, but actually those things haven't, you know, over the years found a solution so far.
Dr Rupy: Yeah.
Dr Anitra: But actually something really simple as what what are you Googling?
Dr Rupy: Yeah, that's so interesting. I think there's so much opportunity there, particularly as we like move into a world where LLMs or large language models are becoming so commonplace, that we're going to unveil like real simple ways in which to capture something as grave as, you know, cancer. Are there any technologies on the horizon that you've come across? Because I'm hearing a lot about, um, I think the company's called Grail where they do liquid, um, biopsies. Um, they look at certain blood levels as well for various other cancers, whether it be pancreatic or colon cancer. You know, like you said, it's all about trying to get and detect, uh, a cancerous cells way before it becomes a a solid mass. So sub one centimeter in the case of ovarian cancer. Are there any things that are on the horizon that we should be looking out for?
Dr Anitra: I think there's lots of things that are being developed, but I think, you know, there's not sort of one thing that's standing out at the moment. But there, you know, there are so many people who are devoting their careers to looking at this kind of thing. But I think the most important thing is that it has to be a test that isn't, you know, overly invasive that can be, it can be done on large scale. The idea of screening is always that it's administered in a well population. So people who don't have symptoms. Because when when it comes to diagnosing people who do have symptoms, we're very good at it. There's lots of, you know, very established pathways for for diagnosing symptomatic people. But you want to get someone who's well before, you know, ideally before they have a cancer or when it's in the very, very early stage because that's the main problem with, um, with ovarian cancer. So about 70% of cases are diagnosed in stage three or stage four. And that's quite, that's too late. Yeah. And so, yeah, it has to be something that's acceptable. It has to be something that doesn't put people in undue harm. Because you don't want to be doing something that's incredibly invasive, risk of complications from whatever investigation that is. And we need to be sure that it's going to be accurate because we also have to remember that having a positive screening test is incredibly anxiety provoking, particularly if you don't actually have the disease.
Dr Rupy: You know, I heard something on a podcast recently, and this is a glib example of, I think, data, um, that we kind of brush off. And so they were talking about this idea of smart toilets, right? So every day when we go to the bathroom, we're expel our urine and our feces, there's so much information in there that's just being lost and and flushed away. And the reason why, you know, screening tools and stuff are so, um, icky for people is because you don't want to collect that material and send it off and all the rest of it. But if there was a smart toilet, and this might not be appropriate for ovarian cancer, it could be appropriate for a number of other cancers, whether it be bowel cancer or, um, STIs and all the rest of it. But if there was a way to collect that material and have it tested at home and to monitor any changes in your biome or your feces, that would be pretty incredible. But no, I haven't come across anyone that's working on that.
Dr Anitra: It would be really, it would be really amazing and that would be really interesting. But then I think also we have to remember that sometimes you can get too much information. And so it's all about putting it in context. And so I think that's something that I can appreciate as someone who's an academic, so, you know, has very much a foot in the research world, but also sees people and what goes into kind of like their processing of having an abnormal result and also the kind of investigations and things that they have to go through. So people say, why don't you see a gynecologist every year in the UK? Um, you know, in lots of countries, people go and see their gynecologist, they, you know, they've probably known their gynecologist since they were teenagers and they end up having their first smear test with them, then they, um, have their babies, um, with their gynecologist and then their gynecologist ends up prescribing their HRT or whatever for their menopause. But actually, you know, we see lots of people who have been for a scan, for example, just just because. And if you do a scan just because, you'll find all sorts of things that maybe they don't mean anything. So if you look at a population of women in the street and you scan a hundred of them, about 70 will probably have some kind of fibroid.
Dr Rupy: Oh.
Dr Anitra: Okay. So a fibroid is a little overgrowth of the muscle layer of the uterus. And particularly now, I was just saying this to one of my colleagues in clinic this morning, like our scan machines are so good. Like the pictures you see, you're like, wow, this is amazing. It's so crystal clear. And I'm like, oh, it's actually not because I'm really good at scanning. It's just because the machine's really good.
Dr Rupy: The machine's amazing. I'm sure you're great at scanning.
Dr Anitra: But I mean, you can find little things and then someone hears a fibroid and then they go home and obviously they go to their search engine of choice, should we say. And look at what it says and, okay, fibroid, it means that you're going to have, you're not going to be able to get pregnant. When you have a baby, you need a cesarean section and then, oh, it might turn into a cancer. All these awful things. And sure, okay, in a very small proportion of people, that might be the case. But actually, if you don't have any problems, and then suddenly you've got this information that you've got this thing inside you, I can understand that's completely anxiety provoking. And the same with cysts. And it's so kind of like, you get in this situation where you have to think, actually, do I need an operation? Because every operation we do, first of all, has risks. Every time we take a cyst out of someone's ovary, we're going to damage a little bit of the healthy ovarian tissue, okay? If we remove a fibroid, then that potentially has risks. If you need these things doing, it's absolutely, you know, it's worthwhile because it's all about risks and benefits, isn't it? But if you are just having random scans here, there and everywhere and find these random things, it can potentially lead to problems. And that is why I think it is so important to really get to know what's normal for you. So kind of like bringing it back full circle. If you know what's normal for you, you you get to know your own health, okay? I really like apps for tracking periods, okay? And because I think that's really helpful for kind of like working out what's going on. And giving yourself some data to say, oh, actually, things have changed. I love it when people open their period tracking app in a consultation because it it does really give you tons of information. And actually, one of the things that we tend to do if somebody comes and says, I've got problems with my period, is, you know, we give this very old-fashioned, you know, these sheets that have been photocopied like 15 times and it's all grainy with like a menstrual cycle tracker. This is the information that we need.
Dr Rupy: Yeah, totally.
Dr Anitra: So if you've already got that, then brilliant. You've done half the job. Obviously, you can still go and see your doctor if you don't have, you know, a whole thesis about your menstrual cycle. That's absolutely fine. But those kind of things can be really helpful. And so, you know, that's why it's I I just think it's so important to educate people about what kind of symptoms might be a sign to to be alarmed. I think that's actually way more empowering and has much more impact on your health than going to see someone every year who charges you money, does a scan and says, wow, beautiful ovaries. Okay, great. Or, oh, okay, maybe something that probably doesn't mean anything, but now you know about it, you're a bit more worried about it and actually we're not going to do anything. So it's not that I have a problem. If people want to go and see a gynecologist every year, that's absolutely fine. But I think that it's about information in context.
Dr Rupy: Exactly. And I think from everything I'm hearing you say right now, it's about, uh, teaching women to be more intuitive about their own bodies is perhaps the first order problem, not the investigations underneath. First, it's about educating what is normal for you, understanding what is abnormal, what that might be. And actually that was going to be my question as you brought it full circle in terms of the abnormal symptoms. So increase length, uh, heaviness, pain, etc, outside the bounds of what's acceptable and it's having an impact on your quality of life. What are the common things that you see causing that in terms of conditions that you talked about so eloquently in your book and thereafter, who is the first point of call and what are the investigations would you imagine somebody having, uh, when assessing whether there is something wrong with periods in the first place?
Dr Anitra: Yeah. So, I mean, I kind of like to think that the book is a little bit of a, you know, uh, what's the word? Encyclopedia of period problems because I've really tried to encompass everything that can happen. And the things that we're hearing so much about these days, endometriosis, PCOS, uh, we're hearing more about adenomyosis, which is something that's really quite common, which is where the lining of the uterus, so the endometrium grows down into the muscle layer and can cause really painful, really heavy periods. Um, and then, you know, things like, you know, we don't really talk very much about something called PMDD, so that's premenstrual dysphoric disorder. It's a very severe form of of PMS. So it's not specifically related to bleeding, actually gets better when the bleeding starts. Um, but it's when people can often actually feel suicidal because their hormone fluctuations are so severe. And, you know, it's estimated actually about 5 to 8% of the population have it.
Dr Rupy: 5 to 8%?
Dr Anitra: Yeah. So it's not, it's not that uncommon.
Dr Rupy: That's one in 20.
Dr Anitra: Absolutely. And because, you know, it's not something that people have really heard of, people, honestly, I see people who say, I actually feel like I want to kill myself and I think that, you know, people can be misdiagnosed with things like psychosis and all sorts of mental health problems. And it is a form of mental health problem, but it's very clearly related to the hormones of the menstrual cycle. So it tends to be in those last few weeks, um, before your period. Uh, and so, you know, there's it's again, it's about lack of knowledge of the different conditions that are out there. So in the book, I really try and talk about all the conditions. So, you know, other things like fibroids. I do touch on cancers as well. Um, you know, things like endometrial hyperplasia, which is a type of pre-cancerous abnormality. And really what I wanted to do was explain exactly what they are, how we investigate them, how we treat them, in terms of medications, lifestyle, surgery as well. Uh, just to give like a very kind of a broad overview. And it's not meant to be used for self-diagnosis. And again, I just really want to reinforce, you don't need to know what the diagnosis is before you go and see a doctor. So your GP is your first point of contact. And then investigations, so usually, you know, again, it depends on what your symptoms are, but usually I'd want to see people having things like maybe a blood test to see if they're anemic, um, looking at, um, you know, hormone tests can be useful for some of the conditions, but not for everything. Um, an ultrasound scan potentially could be useful looking for things like cysts, looking at what the lining of the uterus looks like, looking for fibroids, so many things, but it all, you know, explained in the book about why we do particular investigations because I think that's the important thing is I've really wanted to explain why we do it, not this is what we do, but why. And why is something useful and why is something maybe not useful in that situation? Because I think that's often not very well explained. And I actually wrote it when I was on maternity leave. And I think I managed to get it done in about three or four months.
Dr Rupy: Three or four months?
Dr Anitra: Yeah. I started writing in February and I delivered it in June, just before I went back to work. But it was really, it was really easy to write because I literally sat down, well, to find time to sit down wasn't always easy. A lot of it I I actually wrote standing at my kitchen island while one of them was in a sling napping. But I I just would be like, okay, let's get into clinic mode. And I would sit there and I just type as if I was talking to my patient. And I hope that comes across that it's it's kind of not chatty, but you know, it's conversational. It shouldn't be a heavy read. It shouldn't feel like actually reading an encyclopedia. It should just feel like you're having a conversation with me.
Dr Rupy: Absolutely. No, it really does. It really does. And in terms of, you know, going back to the start of what we talked about, uh, the reason why we're seeing more problem periods. Are there other causes that you think are perhaps not as well known or as well addressed that could be leading to problems with with periods?
Dr Anitra: Well, I think that one of the things that I I'm going to take your question and segue it to something I want to talk about. So I'm seeing a lot of things written online about the pill causing problems with periods. Okay. So I want to kind of like debunk this, okay? So the pill can be used for many, many reasons. Okay. Most commonly for contraception, but it can help with the symptoms when it comes to periods related to, generally speaking, the pill makes your period a bit lighter, a bit less painful. You'll have a, particularly if you take the combined pill, you'll have a very reliable timing of your bleed because, you know, it's related to the hormones in the tablets. It doesn't mean that maybe your cycle, you know, you can't take the pill and reset your own hormones. It doesn't work like that. Um, but also some people might find that their mood is better on the pill. And so often what happens is you start taking the pill when you're maybe in your late teens, early 20s when, you know, realistically, you're not that interested in your periods because I have noticed that we tend to get more interested in our periods the older we get. Okay. Because we want to use them the older we get because you're kind of thinking like, okay, I want to get pregnant. Now, I know not everyone wants to, but you know, it it that's generally what I see. So you're not interested in what's going on with your periods. You're like, whatever, okay, it's just this inconvenience and that's that. And then you take the pill, maybe not realizing that actually maybe your period was a bit painful or was a bit irregular or, you know, was a bit heavy every now and then. And then you stop the pill because you probably want to get pregnant or because social media has told you, you know, you're causing yourself to get cancer, which I want to address in a second. Um, if I know, let's address it now. Taking the pill does increase your risk of cervical and breast cancer. And that lasts for about five years after you stop it. Okay. After that, your risk should go back kind of to the general population. But actually, if you take the pill, your risk of ovarian, endometrial, and bowel cancer is significantly reduced and that reduction lasts for several decades after you stop taking it. So overall, we don't actually see the pill related to a higher risk of cancer. It actually overall reduces the risk. And we have to remember that we have screening for cervical and breast cancer. We don't have screening for ovarian or endometrial. There is some bowel cancer screening as well. So, yeah, and that's something that you never really hear about. And also, I just want to say that I'm not sponsored by any pill company. No, but like genuinely, I think that, you know, all I want is for people to find a solution that they feel comfortable with that helps them go about their life in the way that they want to. And there's never any pressure from me. I just want to make sure that people have the information that they need to make their decision. So, you stop, you stop taking the pill either because, yeah, you've been told by social media you're going to get cancer or because you want to get pregnant. And then suddenly you're paying so much attention to your menstrual cycle. And then suddenly you're like, well, now why is it suddenly heavy and why is it painful and why is it irregular and why have I got spots? It's nothing to do with the pill. It's actually that the pill was helping those symptoms before. And now they've kind of had a bit of a resurgence. So it's often, yeah, it's often kind of misconstrued that they are causing problems, but actually they're just reducing some symptoms that you previously had. And maybe that's not why you're taking the pill, but at that time when you were, it still helped with those symptoms.
Dr Rupy: Yeah. So from everything that I've heard so far today and read from your book, you're going to know what's normal, you're going to ensure that you're not, uh, missing any abnormal symptoms. Tracking would be a good thing. Uh, I would say, you know, I think generally what what gets measured gets managed. And I think for people who have periods in particular, it is really important, I think, to to to to measure that. I mean, I I think about like my wife measuring her periods and stuff and she does it with a with a tracker and stuff. And like, I'm so privileged that I don't need to add that to my list of things to do. And sometimes I think like I need to check that and just, you know, be really humbled by what she needs to do for us as a family as well. So, anyway, that's that's a side gig, but
Dr Anitra: I also, no, but I think that's nice that you brought it up and you've made it personal because I think it's so important when you can talk to the men in your life about your periods. And that might be your partner, but it might also be your boss, your colleagues, to try and understand what's going on. Because, you know, I've had times when, so I have a bit of adenomyosis, you know, compared to what a lot of people go through is not really anything that terrible. But sometimes when I have my period, I have so much pain that I feel sick and they can be just really uncomfortable. Sometimes I'll be operating and it's really interesting. There's this huge like mind over matter thing where I'll notice it at the start of the operation because it's all routine and you know, you're just kind of like cleaning, putting the drapes on, opening up those kind of things where you don't really, you do pay attention, but you're not really like deeply cognitively involved. So you're kind of like might be having other thoughts. And then I'll be doing the operation and you're concentrating so much and there's so much adrenaline. And then I'm like, oh, stop now. And then you get to the bit the part at the end where you're kind of like closing up and, um, you know, again, it's much more that that routine of what you're doing. So you don't have to be thinking as intensely. And I think, oh my goodness, I feel sick. I think I need to sit down. Oh my goodness, it's awful. And you know, it's just those, it's really fascinating. But yeah, so that that's why, um, you know, I had, uh, I did a post on social media once about how, you know, I had really bad period pain in the middle of the night and I had a really busy night on labor ward. This was a few years ago now. And it's really interesting because one of my colleagues who I know, he's a gynecologist, obstetrician and gynecologist, I wouldn't really talk to him about my periods, but he sent me this really nice message. And I was just like, wow, you're a hero. But he was just like, oh, you know, like, it's amazing that you, you know, you still work through this. Like, let me know if there's anything I can do. And I just thought, oh, that's awesome. If everybody could have that from their colleague. Yeah. That would be amazing. But also, you know, it's sometimes you need that, you need to have that conversation with somebody to prompt you to go and see a doctor, for example. And if your partner is telling you, look, have you realized how much you're suffering? Because when you're in that like, you know, you go into survival mode sometimes, don't you? Where sometimes you don't realize how much you're actually suffering. And then you look back on it and you think, oh, actually, and and so, you know, having somebody close to you who you can talk to and say, well, actually, the reason I'm in a really like foul mood is because actually I'm just like, I'm in so much pain. Yeah. And you know, then actually that that they can be like, well, you know, have you noticed that maybe this is going on too much? So sometimes you just need that prompt because we do, we do internalize so much of it often and we feel like we're not meant to moan and, you know, a lot of people just think that that's what they're supposed to put up with. So actually to have a partner, male or female, a family member, whatever their gender, to actually be able to talk openly about it and say, you know, maybe you need to go and see a doctor.
Dr Rupy: Yeah. I don't know whether it's because, um, I don't know whether it's because we do this podcast and we talk about women's health quite a bit, uh, or whether it's because, you know, I've been a GP for so many years. But we have a lot of women on our team of various ages and we have very open conversations, you know, as part of our just part of our working environment and it it feels so natural. Uh, and I perhaps have taken that for granted a bit, but it's really nice to know that even in your environment, you're working with other colleagues in women's health that, you know, you're you're you're feeling as sort of, um, supported as well.
Dr Anitra: So the Doctor's Kitchen is an equal opportunity employer. We would say so.
Dr Rupy: It's not always like that. So, you know, even though we are gynecologists, we're not always very supportive of one another. And there's so many other situations that I've been in where I thought, well, that wasn't very well handled where we didn't look after each other. And, you know, it's not always like that. So I'm very lucky that, you know, some of my colleagues are very supportive.
Dr Anitra: Absolutely.
Dr Rupy: Um, I want to let you go because I know you've got to pick up the twins, uh, and it's 5 past 5. But we had so much to talk about with regards to the commodification of women's health and, you know, this guise of female empowerment and actually selling products that are perhaps less necessary. We'll save that for another time, but
Dr Anitra: Am I the most featured guest on the Doctor's Kitchen podcast?
Dr Rupy: You probably are. I would say so.
Dr Anitra: I think there's a tie between me and Rangan Chatterjee.
Dr Rupy: Yeah, yeah, probably. And Rangan's been on three times, three, four times, I think.
Dr Anitra: Oh, he's beat me then.
Dr Rupy: So, well, you have to come back and then then you can take the crown. You can take the first prize. You're amazing. I appreciate you and you're welcome back anytime. You're you're doing your own pod from the same studio.
Dr Anitra: I mean, I basically live here.
Dr Rupy: Yeah, exactly.
Dr Anitra: You should stop paying me rent.
Dr Rupy: Much love. I really appreciate you, Anitra. Thank you so much for giving me your time. And the book's wonderful and everyone should have it, men, uh, and and women should all be having the conversations.
Dr Anitra: Oh, thank you so much. I really appreciate it.
Dr Rupy: My pleasure.
