No sweat: the clinic raising wider awareness of the menopause

The head of the first public menopause clinic in Ireland says many women and medics are still not fully aware of the symptoms, which HRT could ease
No sweat: the clinic raising wider awareness of the menopause

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Ireland’s first dedicated public menopause clinic opened in the National Maternity Hospital in Holles Street Dublin in January. There are plans to open three more clinics in Cork, Galway, and Limerick before the end of this year.

Historically, women in Ireland haven’t always had access to helpful advice when it comes to menopause. When their bodies began to change and symptoms affected their lives, their only option was to visit their local GP or practice nurse.

“Many were shooed away,” says Dr Deirdre Lundy, the specialist in women’s health who leads the menopause clinic in Holles Street. “There is huge variation in GP care. Hundreds of GPs are fully engaged with menopause, but many are not interested and inexcusably out of date.”

In 2019, the Women’s Health Taskforce established by the Department of Health identified the need for better menopause care. It recommended the establishment of specialist clinics to treat women with more complex needs. The taskforce also recommended the development of a menopause reference guide for GPs so that all doctors had the same reliable information to help them treat their menopausal patients. It is due to be published later this year.

This is a huge step forward, according to Lundy. “What it means is that most women should be able to receive the advice and treatment that they need from their GP, their practice nurse, or family planning clinic,” she says.

Other women will receive the help they need from specialists. “About 20% of women experience little to no symptoms of menopause and require no treatment at all,” says Lundy. “Of the other 80%, about a quarter will be complex cases: women who have experienced surgical menopause post-hysterectomy, women who go through menopause at a younger age or those with conditions including thrombosis, cardiovascular disease, cerebrovascular disease, and hormone-sensitive cancers. They will be referred to clinics like ours to discuss management options.”

In Dr Lundy’s experience, menopause is still misunderstood by many women. “If they are still having their period, many think their symptoms cannot be menopause-related,” she says. “But menopause is when your periods finish completely and the vast majority of women have symptoms before then, during perimenopause.” Some GPs are confused about menopause too. “This can lead to women being misdiagnosed and treated in a way that doesn’t address the cause of their symptoms – the fact that they are approaching menopause.”

Wide range of symptoms

Many women are also not aware of just how varied menopause symptoms can be. “Most of us are familiar with hot flushes and night sweats which affect up to 85% of women, says Dr Caoimhe Hartley, owner of Menopause Health, a private clinic based in Dublin. “Mood swings and anxiety are also common. Vaginal symptoms such as dryness, itching, painful sex, and urinary symptoms including recurrent infections affect almost 50% of women. Joint aches and pains, dry skin, and headaches are common too.”

Even Dr Lundy, now aged 60, was slow to recognise her own symptoms. “My periods stopped when I was 44 but I’d been irritable and having panic attacks long before then,” she says. “I wasted time trying to figure out what was wrong with me when I should have put two and two together.”

GP Genevieve Ferraras, who works in the Dublin-based Menopause Hub, hopes that awareness is increasing.

“Because they didn’t know the symptoms of menopause, so many women in the past were either told there was nothing wrong with them or given treatment that didn’t improve their symptoms,” she says. “Today, we’ve got blogs, books, Facebook groups like The Irish Menopause, and podcasts. GPs are becoming more knowledgeable. Women are talking to each other about their experiences more too.”

They are also discussing treatment options. “Lots of things can help,” says Dr Lundy. “If you’re one of the lucky ones and have only one or two mild symptoms, you can treat them separately. Mood issues can be helped with cognitive behavioural therapy. So can hot flushes and sweats. Vaginal problems can improve with moisturising lubricants.”

Skip the vitamin supplements though. “They are an unproven waste of time,” says Dr Lundy.

Her main recommendation for treating most menopausal symptoms is hormone replacement therapy (HRT). “I would always suggest that women try HRT,” she says. “Menopause symptoms are caused by fluctuating/falling levels of the ovarian hormones oestrogen, progestogen, and testosterone. HRT is a combination of one, two, or all three taken in an effort to balance and supplement those hormone levels.”

Dr Ferraras is equally positive about HRT. “Women should definitely be encouraged to go on HRT,” she says. “It’s the most effective way to treat symptoms.”

Dr Deirdre Lundy, a specialist in women’s health who leads the menopause clinic in Holles Street, Dublin. Photograph: Moya Nolan
Dr Deirdre Lundy, a specialist in women’s health who leads the menopause clinic in Holles Street, Dublin. Photograph: Moya Nolan

Central role for HRT

The average age for menopause for women in Ireland is 51. According to Dr Lundy, most women suffer menopausal symptoms for between two and seven years around this age.

“This varies though,” she says. “By the age of 55, most women’s symptoms have settled, but I see women well into their 60s who are still suffering. Yet even for them, symptoms tend to be at their worst for those two to seven years. HRT can really help during that time.”

Such glowing endorsement of HRT may surprise those of you who associate it with disturbing headlines from the early 2000s. HRT had been popular in the US and Europe from the early 1970s. All of this changed in 2002 when the Women’s Health Initiative, an American study of more than 16,000 women, reported that breast cancer rates rose in HRT users. There were also suggestions that HRT contributed to an increased risk of dementia. This made headline news across the world and millions of women halted their treatment.

These reports have since been largely discredited. “The average age of women starting HRT in the Women’s Health Initiative study was 63, much older than the average age for starting HRT in the general population,” says Dr Hartley. “The medications prescribed were an older type of HRT (a synthetic kind rather than the body-identical HRT that is now prescribed) and would be considered to carry a different breast cancer risk.”

Yet the reports had a lasting impact. “The fear created at the time was unfounded,” says Dr Hartley. “But its effect was detrimental for generations of women.”

Rather than damaging our health, science is now proving that HRT may have a protective effect, even beyond the menopause. In 2021, a study by researchers at the universities of Nottingham, Oxford, and Southampton looked at more than 100,000 women over two decades and found no association between HRT and an increased risk of developing dementia. In fact, women who had been taking oestrogen-only HRT for more than 10 years were shown to have a 15% reduction in risk.

In 2020, when the Women’s Health Initiative finally published the results of its long-term trial, it reported that women who used oestrogen-only HRT had a reduced risk of breast cancer incidence and mortality. However, those taking combined HRT (where oestrogen, progestogen, and testosterone are combined in varying ratios) had a slightly increased risk of breast cancer, but not mortality.

According to the HSE, for every 1,000 menopausal women taking combined HRT, 27 will develop breast cancer. That’s compared with 22 in every 1,000 menopausal women not taking combined HRT.

Dr Lundy wants to assure women that in most cases, this slight increase in risk is outweighed by the health benefits.

“There’s a cost-benefit analysis with everything and we now know that even though there’s a very slight increased risk of breast cancer for those taking combined HRT, there is no increased risk of mortality from breast cancer,” she says. “That’s the risk but the benefits include protective effects for the heart, brain, and bones. For example, you have a 50% lower risk of heart attack if you’re on HRT. For most women, HRT brings far more benefits than risks.”

This is why she’s been on HRT since menopause. “I’ve taken a personal decision to take HRT because there are so many health benefits and I’m not worried about the risk,” she says.

Not everyone is as well informed as Dr Lundy. Until recently, GPs were still reluctant to prescribe HRT and women were afraid to request it. It was only when the National Institute for Health and Care Excellence in the UK published its guidelines for treating menopause symptoms in 2015, clarifying that hormones had a protective effect on women’s health, that this began to change.

“Then came the Davina McCall TV documentary and Sallyanne Brady’s email to Joe Duffy’s Liveline radio show in May 2021 which brought about a tidal change in our attitude to menopause,” says Dr Lundy.

She hopes the dedicated public menopause clinics do even more to change attitudes to women’s health. “The success of private clinics showed us that the demand is there,” she says. “We have only been open for two months but we are already getting 30 referrals a week, which is more than we can handle. We will need to expand even further to cater to women’s needs.”

Need for early education

In the future, Dr Lundy would love to see free HRT treatment offered to all menopausal women, just as it is in Scotland and Wales. Women can currently expect to pay between €30 and €50 a month for it here in Ireland.

She would also like to see menopause covered as part of general sex and fertility education. “Nobody tells girls about menopause, maybe because they don’t want to frighten them,” she says.

Yet there is no need for women to be frightened. “Menopause is not something we should be afraid or ashamed of,” says Dr Ferraras. “All women go through it, and none should suffer in silence. Every single woman in her early to mid-40s should make a point of learning about symptoms and then seek help early. This is starting to happen, and my hope is that it will mean that the current generation of women has an entirely different experience of menopause to their mothers and grandmothers.”

You’ve probably heard of hot flushes but how many other menopause symptoms can you name?

Dr Ferraras advises every woman in her 40s to become familiar with the symptoms of menopause so that they understand when their bodies are beginning to change.

Some of these symptoms can be linked to other health problems so you can’t always assume that everything that starts happening to you in your 40s and 50s is related to the menopause. However, if you are healthy but are starting to see a pattern of symptoms, it is likely that your hormone levels are changing as you approach menopause.

Here are the symptoms every woman should know:

  • Night sweats and hot flushes. These affect up to 85% of women.
  • Sleep disruption and tiredness.
  • Mood changes. including irritability, depression, mood swings, and anxiety.
  • Palpitations, dizziness, and headaches.
  • Menstrual changes such as heavier periods, skipped or irregular periods.
  • Loss of vaginal elasticity and lubrication. This can cause pain, a burning sensation, itchiness, and pain during sex.
  • A reduced sex drive and difficulty achieving orgasm.
  • A decrease in metabolism, leading to weight gain.
  • A decrease in muscle mass, known as sarcopenia.
  • Hair and skin changes, including thinning hair, dry skin, itchiness, and a crawling sensation on the skin.
  • Joint complaints such as aches and pains, especially during exercise.
  • Bladder complaints such as feeling the need to rush to the loo, peeing too often, painful urination, frequent urinary infections, and leaking.
  • Cognitive issues that include forgetfulness, memory loss, poor concentration, and brain fog.“It sounds like a lot, and it is,” says Dr Lundy. “But in most cases, HRT can help.”

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