In conversation: Mariella Frostrup on perimenopause, rage and rethinking gut health

When broadcaster and campaigner Mariella Frostrup sat down with The Better Menopause co-founder Debbie Wosskow CBE, the conversation moved from misdiagnosis and two years of unexplained anxiety to Westminster, gut health, and why a self-confessed supplement sceptic hasn't missed a day of Better Gut in three years. Mariella co-chairs the campaigning group Menopause Mandate and is the UK government's Women's Employment Ambassador, a role that grew out of her work as Menopause Employment Ambassador.

In this article

• "I thought I was losing my marbles"
• From rage to campaign
• Anxiety, brain fog and the fear underneath
• HRT, food and what works in Mariella-world
• "I am a supplement sceptic": the Better Gut conversation
• Laughing together, at last
• Frequently asked questions

"I thought I was losing my marbles"

DEBBIE: Mariella, tell me about the world of menopause and your work in it. How did you get started?

MARIELLA: I should start by making clear it hasn't been a burning ambition of mine since I was a teenager to work in the world of menopause! I went through a rough patch at the end of my 40s where I felt really anxious, which was quite alien to me, and became quite an insomniac. The combination of the two meant I slightly felt like I was losing my marbles. And when I tried to find out what was happening, it was really, really hard. I had blood tests to see if I was menopausal. One said I was perimenopausal. One said I wasn't menopausal at all. One said I was post-menopausal. All in the space of about four months.

My doctor at the time finally said, look, this isn't really working, is it? I'm going to send you to a gynaecologist. And I was one of the lucky people who could afford to go private, because I'd spent a long time trying to resolve things through the NHS and I just felt I wasn't being listened to.

DEBBIE: What did you think it was?

MARIELLA: I thought I was going through a total midlife crisis, a mental crisis, because the only symptom I'd ever heard about was hot flushes.

DEBBIE: Did you have those?

MARIELLA: Two, in the space of those two years. And you're not even sure if it's a hot flush, or you're just hot, or just stressed. The worst time for me was those two years when I was totally bewildered. I had no concept it could be menopause, because I thought menopause was this unwanted present you got on your 51st birthday. And then you stepped away from the world at large, went into cloistered living, and died. That was all I knew about it, really.

DEBBIE: Had you ever spoken to your mum about her menopause?

MARIELLA: Not really. My only memory is her telling me, in her 50s, that she'd gone to the doctor and been given this patch. She kept it on for about three weeks, said it made her feel bovine, took it off, and that was the end of that.

When I finally saw the gynaecologist, I told her what I'd been experiencing for about five minutes. She put her hand on my knee and said, "We can't have you feeling like this." Then she said she was sending me for a bone density scan, and I thought, I haven't slept for two years, who cares about my bones? It was at that moment she began to explain all the subliminal symptoms, and I understood I was going through a passage of life I knew absolutely nothing about.

And why so few people, even in the medical profession, seemed to know what was happening or how to support women through it. It made me angry. That's when I started talking about it.

From rage to campaign

MARIELLA: I started talking to the BBC about making a documentary, bearing in mind that 55% of their viewers are women of 50 and upwards, and the reluctance to touch the topic was pretty dispiriting. It took nearly three years. I was finally allowed to make it, but it had to be about new breakthroughs rather than the centuries of shame and the societal side that makes women feel so uncomfortable. Kirsty Wark had made a documentary a couple of years before, and mine got quite a bit of attention. It felt like the beginning of something. Then other women started coming forward.

Through somebody else I was introduced to Carolyn Harris, the Labour MP, who was kick-starting a campaign on HRT prescription costs. We wanted HRT to be free; what we ended up with was a single annual prescription charge. Until then, women were paying a separate charge for each hormone, every month. For an awful lot of women that was simply unaffordable.

Jo Cox was a friend of mine, and she was an incredible advocate for working together. When she was at Oxfam she got all the charities working together to combat global poverty. I had her voice ringing in my ear, this idea that we have so much more power together. So I put together a call with all the main menopause campaigners, to pull our expertise and strengths into one pot. That was the beginning of Menopause Mandate, which I now co-chair with Tina Backhouse, who's brilliant.

That's when it became something more than me being angry, puzzled and frustrated that so many women were going through a perfectly normal life passage that really doesn't have to be as bad as it's portrayed, if you know what's happening to you. My two years of misery would have been easily navigable if I'd understood it was perimenopause and that support was available. So: no plan, no real decision to become a campaigner. Just spurred by rage.

DEBBIE: Which I think is often the ultimate motivation. Angry women aren't considered very acceptable, but actually that anger is the motivator for so much good. If you look back a decade, almost, to the documentary, what has changed?

MARIELLA: The conversation has changed dramatically. It's opened out and it's definitely on the menu. The government appointing me as Menopause Employment Ambassador...

DEBBIE: What does that mean?

MARIELLA: It means I talk to business. An estimated £1.7 billion a year is lost through women feeling unsupported during this passage of time and leaving the workforce, generally not returning. It's about helping business understand that these women are assets, at the peak of their professional capabilities. If you invest all that money and time in an employee and then let them slip through your fingers because they're having a rough time for a short period, that's economic madness.

The frustration is getting the message through every layer of society. Most middle-class, educated women know about menopause now and can push back when a doctor says "I don't rate HRT" or "you're too young to be menopausal." It's much harder for women who don't feel they have a voice, who are used to not being listened to. That's what I'd like to see change next.

But there have been real wins. We have an NHS health check at 40 that's meant to predict future conditions and mitigate them. Except that half the people going for that health check will inevitably face menopause. It's compulsory. And yet it wasn't mentioned at all. It was a no-brainer. We campaigned, I went to see Wes Streeting, and we managed to push it through. So hopefully the next generation of women steps into this phase of life with more of a toolbox, understanding that the symptoms are a very broad spectrum and you need to join the dots in a holistic way.

Anxiety, brain fog and the fear underneath

DEBBIE: And for you, what were the main symptoms, through perimenopause and menopause, and now?

MARIELLA: The particular standouts were the anxiety and brain fog, because my grandmother had dementia and my mother has dementia. So one of my great fears was, am I going through dementia? Is this the beginning of something really bad? And then just a general feeling of not really being myself. A bit bloated, less energy, tiring more easily. Mood swings I don't really remember.

DEBBIE: You thought you were fine.

MARIELLA: I thought I was fine. My family beg to differ. My mother said she had no menopause symptoms at all; we remember that time rather differently. I sat next to a woman at dinner recently, about eight years older than me, who said, "Honestly, Mariella, I don't know why you keep going on and on about menopause. We just went through it, and it makes women look weak." Two glasses of wine later, she started telling me about the severe depression she'd experienced in her late 40s. I asked whether it had ever occurred to her that it could have been connected to menopause, and we got into a deep discussion. By the end she was saying, "Maybe it's not such a bad idea, all this talking."

HRT, food and what works in Mariella-world

DEBBIE: So over the last 15 years or so, what have you actually done? HRT, supplements, diet. Give me a little bit of how it works in Mariella-world.

MARIELLA: I went on to HRT as soon as I saw the gynaecologist, but I had to try a few different versions before I found what worked, and you don't find out until it's not working. Some forms some people just don't absorb particularly well. The pill version didn't really work for me. I hated the patches, couldn't handle the three-days-on, two-days-off thing. Now I use a daily oestrogen gel sachet, take progesterone at night, and occasionally remember to do testosterone.

Then diet. When I was about 50 I went to a health retreat in Devon called Yeotown. What was revolutionary for me, because I've always been reasonably fit, was the food, which cut out six or seven food groups. I ate like a horse for five days and thought, how am I going to lose my belly eating this much? Two days after I left, I had a flat stomach for the first time since perimenopause began. My whole digestion was working differently. I went on to write a cookbook, Menolicious, with Belles Berry, based on that learning but made easier for busy women. Much more about gut health: a lot more beans and fibre, no ultra-processed food, getting rid of white flour. It definitely made me feel better.

Supplements, I've never been very good with, mostly because I forget to take them. I've been sent a lot over this menopause period, taken most of them for a couple of weeks and then forgotten. But the thing that kept bothering me was that anything I ate that wasn't really healthy just sat on my stomach, and the bloating carried on. HRT helped the brain fog, but I still felt I wasn't functioning fully.

"I am a supplement sceptic": the Better Gut conversation

DEBBIE: Which brings us to Better Gut. And I wanted to ask you about it precisely because you're a sceptic.

MARIELLA: I am a supplement sceptic. I think lots of people are, because it's a huge industry, and a lot of people have got into menopause-washing: they stick "menopause" on the label, and you look at the ingredients and it's exactly the same as the supplement for teenagers. All of that makes the category lose credibility.

I took Better Gut because you gave it to me; I'm not a supplement buyer. What was really interesting was that I had tried other digestion and probiotic supplements, because I understood that might be part of what would help, and I didn't find any great difference. When I took Better Gut, I did feel different. The bloating definitely decreased, and I just felt a bit sharper. And it's easy to take: one at night before I go to sleep, which is when I actually remember pills.

MARIELLA: So let me turn this around. Why does Better Gut work?

DEBBIE: Where I started was four years ago, being very unwell. I ended up in hospital with pneumonia, came out, couldn't get better, didn't feel like myself, saw lots of doctors. And it was a throwaway line in the "you have perimenopause" conversation, which I found quite insulting at the time, because even four years ago I didn't know perimenopause was something that happened to women in their 40s. Then another throwaway line: of course, there's an inextricable connection between the female microbiome in midlife and your menopause symptoms. And I thought, what does that even mean? I eat sauerkraut. What else do I need to do?

Then I went down the rabbit hole entrepreneurs go down: how can I fix this problem for myself? I'm a very simple founder. Everything I've built, I'm the ultimate consumer. I bought 20 probiotics and compared them all, and asked around for a probiotic formulated at a level you could show to a doctor, that makes a difference in perimenopause. The answer was that no such thing existed. So I thought, if it doesn't exist, I'm going to make it, because I want it and I want my friends to have it.

A lot of my symptoms were gastro. But as I began to understand the science, some of the things that don't feel gastro at all, brain fog and, for me, massive anxiety, can be supported if you get control of your gut. So we set a clinical nutritionist, doctors and a manufacturer we trusted an essay question: can you create a probiotic from scratch that makes a difference to women in perimenopause and post-menopause? The answer is the six probiotic strains in Better Gut, put together for the first time to answer exactly that question. A probiotic also has to actually survive to reach the gut. If I'd known probiotics were so hard to get right, I'm not sure I'd have started with them!

MARIELLA: I was given a statistic the other day: women in the UK spend £129 a year on average on supplements. Do you think there should be more regulation? Because obviously yours are more expensive.

DEBBIE: I'd far rather women spent money on something that works than spend a lot of money on things that don't. You can't formulate with clinically studied ingredients at meaningful levels and sell it for a fiver. So my message is always: buy less that does more.

That's why all our products are compounds. We don't produce a single fish oil or a vitamin D, because when I started out, some women I knew were taking nothing and some were taking 20 different things a day, in a category that's very unregulated. Women need to take fewer things that do more. Better Night came from a totally selfish place: help me sleep, I can't sleep. Better Metabolism, because midlife midsection weight gain happens no matter how healthily you eat or how you train, which is why we often recommend taking Gut and Metabolism together. And Better Libido, because joy and relationships matter in midlife too.

Every ingredient we use has been through clinical studied, and we have the first menopause supplement in an NHS-sponsored clinical trial, which is really important to me. It has to be created by women, for women who are living it, with our all-female team and the nutritionists and doctors we work with always coming back to the same question: how do we create something that makes a difference to women's lives? And I take the products myself every day. Like you, I haven't missed Better Gut in three years.

Laughing together, at last

DEBBIE: And now you're taking all of this on stage.

MARIELLA: I'm doing a live show and taking it to the Edinburgh Festival. It covers all the things I would have liked to put in that early documentary, and more, because I've learned a lot over the last decade, but invested with some humour. It's a chance for women and men to come along, learn a bit more and have a laugh. Honestly, people have laughed at us for centuries; it's quite nice to laugh together and at ourselves.

The history of menopause is a history of the very sex that would never go through any of it misdiagnosing and misrepresenting what women were experiencing. Now we have women in positions in life where they can think specifically about women and understand what's happening to their bodies, because they're going through it themselves. That has to be a catalyst for really positive change.

Frequently asked questions

What menopause symptoms did Mariella Frostrup experience?

Mariella Frostrup's main perimenopause symptoms were anxiety, insomnia, brain fog, bloating and low energy. She experienced only two hot flushes in two years, which is why it took so long to connect her symptoms to perimenopause. Because her grandmother and mother both had dementia, she initially feared her brain fog was early dementia.

What is Menopause Mandate?

Menopause Mandate is a UK campaigning group co-chaired by Mariella Frostrup and Tina Backhouse that brings together menopause campaigners to push for better support, education and healthcare. Its wins include the single annual HRT prescription charge in England and the inclusion of menopause in the NHS health check offered from age 40.

What does Mariella Frostrup take for menopause?

Mariella Frostrup uses HRT (a daily oestrogen gel, progesterone at night and occasional testosterone), follows a gut-friendly diet high in beans and fibre with no ultra-processed food, and takes Better Gut, the six-strain probiotic from The Better Menopause, every night. She reports reduced bloating and feeling sharper, and says she hasn't missed a day in three years.

Why does gut health matter in perimenopause?

The gut microbiome and hormones are closely connected in midlife, which is why gut health is a foundation of managing perimenopause symptoms. As Debbie Wosskow explains in this interview, symptoms that don't feel gut-related, including brain fog and anxiety, can be supported by getting control of your gut, alongside gastro symptoms like bloating, you can find out more about the gut hormone connection here.

This interview has been edited for length. Mariella Frostrup is co-chair of Menopause Mandate and the UK government's Women's Employment Ambassador. Debbie Wosskow CBE is co-founder of The Better Menopause.