62: Research Revelations and Insights with Dr Fiona Li

Welcome to Dear Menopause podcast, where we discuss the menopause transition to help make everyday life a little easier for women. Hey, i'm Sonya Lovell and I am your host. Today we will be chatting with Dr Fiona Li. Fiona is completing her PhD in management of postmenopausal vaginal symptoms with the Grace team at UNSW in Sydney. Don't get freaked out, though. This is a really, really cool conversation. Fiona is young, she is funny, she is whip smart and her research is fascinating. You're going to learn so so much from this chat with Fiona. Enjoy, hey, fiona. welcome to Dare Menopause.

Thanks so much for having me today, sonya. I'm really excited to be here.

I'm excited to have you here. Why don't you give yourself a little bit of an intro so that everybody gets an idea of who Fiona Li is?

Absolutely So. My name is Fiona. I am an obstetric and gynecology trainee in Sydney and I'm also doing a PhD with UNSW Sydney in menopause. Really passionate about menopause and have been since I was in med school, which is when I started doing some of this research in this area, in particular, focusing on management of vaginal symptoms in menopause I think I've taken quite an interest, especially over the years, talking to other women going through this journey, because I can see how much stigma I think women feel when it comes to this area and also how much fear I think there is talking about some of these things, and so I've become increasingly more interested in trying to find some answers and breaking some of these barriers to having these conversations and making it more comfortable for women moving forward.

Which is such exciting news. I mean, it's so incredibly exciting to know that there are women like you out there doing this research and choosing to specialise in menopause. You and I met when I was referred to you to take part in a study or a survey that you were doing as a part of your PhD, and then by the end of that we'd had a chat and I was like, oh my gosh, you totally need to come onto the podcast, because I really wanted my listeners and to know that this work is being done, because so many conversations I have with women just in general, but also listeners of the podcast, there's this feeling of, i guess, disappointment and almost a bit of downheartedness but nothing's being done and nothing's changing. It's all doom and gloom And I often feel like I'm like this cheerleader kind of going no, no, there is stuff happening, it is changing, there is a shift. It's slow, it takes time, the wheels are turning, but I promise there's stuff happening. You just can't see it. And then you know, i saw to get the opportunity to bring on someone like you to actually like really pull back the curtains and shine a light on the fact that this amazing work is being done. And you know if you're in a, we're on Zoom. So one of the things that I kind of also want to, you know not not kind of embarrass you, but I also want to highlight like you are younger than most of my guests on the on the show. I want to highlight that you know you're not a woman in her. You know 50s or 60s that's deciding to shine a light on menopause because you've experienced it. You're someone that's coming through right at the beginning of your career and choosing to highlight menopause.

That's right. Well, I mean my late 20s And I think certainly I met with a lot of surprise from a lot of women. Obviously, my patients majority are sort of middle aged or sort of getting there. A lot of my menopause patients, obviously, some of them are well into their later decades as well, And I think some women do initially feel that sort of tension of like, oh but you're so young, How can you understand what I'm going through? I think the most important thing, particularly coming as a medical practitioner or as a doctor and any sort of health practitioner, is that you know we do a lot of this stuff and we very well, I mean I'd hope we're trying to be open minded and we're trying to understand the experience of our patients. I think it's that knowledge and trying to work with our patients and providing that care and understanding that suits whatever our patient is coming with. That's actually probably the most important thing, And even just I mean to bring a bit of personal experience probably does change some of how we perceive that and how we interact with our patients. But so much of what I understand is actually just from what my patients tell me, from the experiences that they're sharing with me, And that is so invaluable to how I practice as a doctor. So I think that's where a lot of that comes from as well.

Yeah, Yeah, and that's awesome because you're so right. We can't rely on only finding doctors to support women that have experienced menopause. It would be a little bit like only finding a doctor to support you that had experienced cancer. That literally can't happen, unfortunately. We talk about this often on the podcast. We do have this global education gap when it does come to menopause and our GPs Many GPs in practice out in the public, in the more neighbourhood clinics tend to be the older kind of. Maybe they've been through I don't know a lot about the career of doctors, but they've probably been through their phases working in the hospitals and then they've perhaps had families and then they've settled down into that kind of GP practice mode. Is that kind of how it tends to work? Yeah, so you're not necessarily coming across the doctors your age, so therefore you're not speaking to the younger GPs. So I think it's so great to have a conversation with someone your age that is really focusing in on menopause. So let's talk, then, about what you're learning, what the surveys you've been doing, what you've learned as a result of that. Obviously, i know that your results aren't out, so this is just going to be anecdotal for now.

Yeah, So, in terms of my PhD, actually one of the biggest studies that we've done is focusing on a fractional carbon dioxide laser. Some people know it as the Mona Lisa Touch. There's a few other brands on the market, and so we've actually performed one of the world's first largest randomized trials, where the women who were very kindly dedicated their time and efforts to our study weren't told what group they were in, so whether they were receiving the laser active treatment or a placebo inactive treatment. And then we went through a trial that went for a year with a standard course of the laser, which is usually three treatments a month apart, and then we followed them up and tried to figure out how it impacted their vaginal symptoms of menopause, and I think there was so much hope around this treatment. This is a treatment that was introduced in around 2012,. Has worldwide uptake, has been really touted as a game changer, especially for breast cancer patients, women who aren't use warm and treatments, but also for women who've gone through natural menopause, who have tried so many treatments. We know you go through trying lubricants, moisturizers, a festin cream, endless passerings, all that kind of stuff. So I think laser was pretty hopeful that this would be a miracle treatment. But I think one of the red flags as investigators or sort of even as doctors and clinicians, that we felt was, you know, sometimes things can be, can sound too good to be true And unfortunately that's that is what our results have shown. So this is the sort of the strongest design of a study that we could possibly have, where we try and take as much bias out of study as possible. We found that the laser group and the placebo group had basically the same results. So the outcome was that there was no difference between the two groups And the main outcomes that we focused on was what women experienced in terms of their vaginal symptoms. So we asked them about painful sex, about burning, dryness down below, and then overall how they felt the vaginal symptoms and the severity was, and then also how this affected their quality of life, how this affected their sexual function, all sort of all the things that are key to, i think, what women really come to a doctor to ask about and why they're seeking these treatments. So that's really sort of the crux and the underlying part of this study of my PhD to begin with, and this is then led on to sort of other questions. So now my next question is so how do women feel about this information? How does this affect them? Do they still want a treatment that costs quite a lot You know, several thousand dollars a year if they know that there might only be a really small difference? And then what is the cost that they're willing to pay? And what kind of features about a treatment, or characteristics and things about a treatment, do they want? What's important to women? And hopefully, by answering all of these questions and exploring this, i'm hoping that this information will help women but also help to educate, like we said, other medical practitioners whose specialty is in menopause. You know we can't have everyone, especially like menopause, we need somebody. But hopefully some of this information will empower all the clinicians involved in women's health to be able to help women to travel through this journey and have the best evidence-based information to make decisions about their care, yeah, fantastic.

And even if it's just enough to have a clinician ask the question before the patient asks the question to prompt. Because I know from my personal experience and you know you and I have talked about this and I've talked about this on the podcast before with my dermatologist and when I had her on and we talked and just with other random guests Sandy Davis, who was on Happy Pause for me, and I know that other women experienced this as well it was a really difficult conversation to have with my GP. You know, it's a very intimate part of your body and it's a little bit embarrassing to kind of go in and say, hey, i've got this issue with my vagina And, yeah, there's discomfort and shame and fear and all sorts of things, you know, all kind of wrapped up in that. So if we have clinicians and doctors educated enough to the point where they can kind of ask the question or, you know, or even draw the information out of the patient in a way that is comfortable for the patient, i think that would even be a huge start.

Absolutely. And I think, like really with my research, i kind of have an ulterior motive And my view is that, you know, the more that people hear about stuff, the more it gets normalised, right? I mean, we see things on social media. You know, the more information we're provided with, it becomes normal, it becomes part of our culture. So I feel like if we're able just to like absolutely swamp research and get all of this information out there and people are reading it all the time, seeing it all the time, then also doctors and women are going to feel a bit more comfortable and realise that this is just becoming part of our culture and that it's okay to talk about this stuff. We need to talk about this stuff. You know, moving forward, we need to get rid of so many of these barriers. Women are living longer and we need to live better And we do not need to live in the shadows and fear of talking about sex and fear of talking about vaginas and dryness and discomfort. This is not how we should be living.

And this is what I love about your generation This is a huge and you know you're laughing, but I truly believe that this is a big differentiator.

Okay, wow, stopping on my words this morning.

This is something that I see as a significant difference that's a better word for me between my generation and your generation. I see this with my kids that there is less fear and stigma around speaking about these topics, and it's what fills me with hope for the work that I'm doing and many others that are so much better than me at this In this space of doing is so that your generation, the generations that come behind you, won't have to be having these conversations because you're already so much more comfortable with them, but we will have laid so much groundwork for you that they just won't exist. You won't have to worry about them.

Exactly. I think we have been able to get to this point because generations before us have been able to lay that groundwork and get us here And it's undeniable We wouldn't have been here had it not been generations before us who tried to break some of these barriers And women like you pioneering this stuff. We need to have that courage to speak about it and in order to change our culture And hopefully yeah, i hope that I'll be able to pass on and hopefully generations after me won't even be having this conversation.

No, exactly, It wouldn't even be a conversation. It'll just be so ingrained as a part of a woman's experience, experience as part of society's experience. Yes, exactly. So I was going to ask you I think we've just randomly touched on that anyway What your hopes are as somebody that is embedded in the research side of medicine and women's health, your hopes for what women can expect to experience in the future when it comes to menopause care.

Yeah, i think that's a great question because I think, even if you look at the last five to 10 years, even I think so much has changed in the menopause sphere. There are so many more services, there's so much more research, there's so much more acknowledgement, money from the budget going in from the Australian government. I think these are all really positive changes and there's always going to be more to be done, but I think it's always important to acknowledge the positives of what we have sort of been able to achieve so far. I think this leaves me to hope that all these women I've spoken to over my very short career so far, who've told me about their fears and these difficult experiences they've had and often scarring conversations they've had where they have asked and brought it up, had to work up that courage for weeks leading up to seeing their GP, gynecologist, nurse, whoever it is they've seen, and then being a bit shut down or made to feel a bit silly or ridiculous. Yeah, and I think I'm really hopeful that again, as this conversation changes, women will feel like they're being received with informed clinicians, people who are welcoming this conversation, but also that hopefully that clinicians will also start to feel a bit more comfortable knowing that they are equipped with the skills to be able to have this conversation, that they have the information to give, because I think sometimes it's a bit of a two-way thing. Sometimes people don't. Some clinicians may not feel that this is their specialty, they might not see it very much, so they might not know what to do, and so they might see it as oh, i don't really have very much to offer and so I'm not really sure what to send you, and sometimes that might be the barrier as to why they've had that response to a patient. And so hopefully, if everyone comes with a bit more information on board, we'll be able to change that conversation. I think what we're seeing as well lots more research, so I'm really hoping that there'll be a lot more evidence and also a lot more research into new innovations, so I'm hoping that there'll be more treatments coming out in the future, and so, whether that be safer hormones or sort of different medications, or changing the criteria and understanding more about who can have hormones and how we can keep it safe, which is already changing rapidly if you look at the last 20 years, right, Well, even if we look at, i was just going to say you know we've had the announcement recently of the FDA approving the first new drug to come out.

I think it might you know that I'm aware of that's and I can't pronounce the name of it, but it's the new drug that is not hormone dependent for treating hot flushes. So this is a huge win for women like myself that were unable to take any of the hormone therapies, because it works on the neurological pathways And it's just been passed by the FDA in the States. Obviously, we have to go through our own process here in Australia, but it's a technological win, i guess, in that respect, and that's exciting That's the new technology that's coming out, that's a new treatment that's going to be available. That within itself is a win. And yes, like you say, even in the last 20 years, mht, hrt everybody refers to it differently. In Australia we do call it MHT, but that has been dramatically overhauled in the last 20 years, thank goodness.

Yeah, all those attitudes, and as more information comes out, we feel more comfortable about where the limitations are and how to use it safely. So all of those attitudes are changing And I think, yeah, new innovations, like you said. I think things like laser and there are other things like we spoke about, things like the O-Shot and other technologies, other things that people are coming up with. I welcome all those sort of new ideas and innovations because I think it opens the potential for new treatment and new options for women, and I think that's fantastic, the most important thing, though, being that we get good evidence before, disseminate, before we potentially cause harm, and so I think that's my nearly caveat that we make sure that research continues in this area to make sure that we are providing good treatments, that we're not causing harm to women, particularly on a large scale, and we're not also not taking advantage of women in a really tricky time, when you really feel very vulnerable with these symptoms, especially if you're still not feeling comfortable and they're not sitting well with you And you're finding it hard to find a conversation and start the conversation with somebody. So I think that's really important.

Yeah, and I feel very much like we're on a little bit of an edge at the moment, where there is the potential for that being taken advantage of is almost a little bit of dangerous territory. The conversation has been cracked wide open. There is obviously a lot more women now seeking support and treatments and more curious and open to options, but that does often open the door for the people that perhaps aren't as evidence based or are a little bit less scrupulous to present opportunities that can cause harm and aren't as ethical, and we, just as consumers, have to learn to be very conscious and educated about what choices we make.

Yeah, exactly, and it's hard. There's so much information out there, yeah, so so much, and even as somebody who comes from a medical background, sometimes I can have a lot of trouble sifting through what is good evidence and what seems a little bit dodgy and what's just good marketing. That's right Exactly, and so much of it is a lot of it is good marketing, and so it then comes down to having to really understand and break down the nuances behind how a study has been performed, where they're getting the statistics, where they're getting that research, and I think that's then where a doctor can be really helpful, because, with our training, part of it is about translating that information into something that can be easily understood and input like where the important messages can be communicated to our patients. And so that is where, speaking to your healthcare practitioner, but also as a researcher, making that information easier to access for our consumers is going to be really important.

And so I think that's really key.

Yeah, I think myself having a really important role in that area.

Yeah, and I think that's great that you are, as a researcher, and your research community are recognizing that. This conversation I was actually having with someone yesterday, you know we were having this conversation about how we recognized that we are privileged in many ways because we're, you know, we're medically literate, you know, educated women that can decipher all the information in front of us to make good choices, And we also live in a city where we have opportunities to, you know, shop for good doctors. You know, if you're in a minority, if you're not from an English speaking background, if you live regionally or remotely, you know those. All of those things just become harder and harder for you, particularly in Australia, obviously.

Absolutely Yeah, definitely Yeah.

Puneet, this has been such a great chat I would like to finish with well, i've got two last questions for you. First of all, while we're on, keep on topic, how can women that are listening, that want to contribute to the research that you are doing, how can they keep you know, help you out, how can they stay in touch with you?

Absolutely. There's always so much opportunity, and so I work with a group called the Grace Research Team at UNSW Sydney And we predominantly focus on in benign gynecology, which includes menopause and also other topics like endometriosis and other research. So we do have a website, which I think will be posted in the bio. So if you're in the show notes, you're great. Yeah, if you look up UNSW Grace, we have a lot of information there And you can always reach out to Grace Research at UNSWeduau. That's our email And if you want to contribute to any of our research, if you're interested in hearing any about any of our research studies, reach out. We're more than happy to provide any sort of direction as well any advice about any of the studies we've sort of performed in the past. So we love sharing our research. We are a super passionate group made up of a lot of leading clinicians in this area, so it's a really great group to be part of.

Awesome. I love your passion. When you speak about the group that you're involved in, that's fantastic. I will link the website, your email address, all through in the show notes. The other thing that we'll mention is that the results of the survey around the Mona Lisa Touch will be available at the closer to the end of 2023. We're recording this kind of about mid-year. When those results are available, i'll update the show notes and there'll be a link in there through to those survey results for anyone that is interested, and I'll advise through social media and my newsletter and we'll republish the or we won't republish, but I'll repromote the episode as well, so that will be available to anyone that is interested specifically in that piece of research, which I think is amazing. All right, fiona, to tie things up, i'm going to hit you with my favourite question, oh and this will be interesting because you fall into an age group I don't usually have on here So what are you reading, listening to or watching right now that is bringing you joy?

Oh, so pleased to ask. I didn't even know you're going to ask me this question. I'm going to show you, i'm going to bring it up. I am listening to a podcast called How to Fail With Elizabeth Day.

How to fail with Elizabeth Day. Okay, who was Elizabeth Day?

because I don't know who Elizabeth Day is, so I've only had a couple of episodes and I think Elizabeth is maybe a journalist. She's British And essentially through this podcast there's actually heaps of episodes. I'm going to take my time going through it. She interviews amazing, incredible people. For example, i recently listened to her interview Jay Shetty and we talk about the failures in their life and how it's changed their habits And I think that's been a really quite incredible insight to get into a lot of really high, achieving, functioning people's lives.

That's such a flip on what they would normally be interviewing on, so talking about their failures as opposed to their successes. Incredible And that's where the learnings come from, isn't it? It's from our failures.

Absolutely Cool Where you're going to get a lot of your teaching from, so we should also view them as successes.

True, i love that. Okay, cool. So How to Fail With Elizabeth Day is a podcast. All right, i'm going to link through to that in the show notes as well. Good tip.

I love that. Sounds great.

Awesome. Fiona, thank you so so much for your time. I love everything that you are doing. I love your energy. I love your passion. Thank you so much for coming on to Dear Menopause and sharing with us.

Thanks so much for having me, sonya, and I love what we're doing here, getting this conversation out. I love contributing to this area and I really hope we'll be able to break some of these barriers.

Thank you for listening today. I am so grateful to have these conversations with incredible women and experts And I'm grateful that you chose to hit play on this episode of Dear Menopause. If you have a minute of time today, please leave a rating or a review. I would love to hear from you, because you are my biggest driver for doing this work If this chat went way too fast for you and you want more, head over to stellarwomencomau slash podcast for the show notes. And, while you're there, take my midlife quiz to see why it feels like midlife is messing with your head.