NIGHT SWEATS, HOT flashes, low mood, anxiety, crippling joint pain, depression, sleep disturbances, headache, cognitive difficulties, palpitations, and recurrent urinary tract infections: these are just some of the symptoms of a condition that will affect half of the population in midlife.
After decades in the shadows, the menopause is finally starting to get the attention it merits.
In general, women experience menopause between 45 and 55 years of age, with 51 the average age for women to enter the menopause. Some women experience what is known as early or premature menopause before the age of 40.
Until recently the menopause, much like a number of issues related to women’s reproductive health in Ireland, has been a taboo subject.
Women simply suffered in silence with little or no support as they went through ‘the change’.
However women today are more vocal and less prepared to remain silent when a treatable medical issue is negatively impacting their physical and mental health.
Society is finally beginning to talk openly about the menopause, thanks to women themselves speaking up and demanding change.
Women like Davina McCall in the UK opening up about her journey with the menopause have started an important conversation, while here in Ireland, women around the country picked up the phone in their droves last year and talked to Joe.
In May 2021 RTE’s Liveline was inundated with calls from women sharing their experiences of menopause. The topic was so popular that it was covered for five days straight by Joe Duffy who was rightly lauded for lifting the lid on one of the last taboos of women’s health in Ireland.
Dr Deirdre Lundy is a leading expert in the menopause and an advocate for women’s health.
According to Dr Lundy, one in four (25%) of women who go through the menopause will have symptoms so severe that they need to seek medical help and the majority of these can be treated by their GP.
“There is nothing that complicated about diagnosing, advising about and treating the menopause that a GP with all the time in the world could happily cope with in a GP surgery,” Dr Lundy said, while acknowledging the immense pressure GPs in Ireland are currently under, due to the manpower crisis and mounting demands on general practice.
When it comes to treating the menopause, Dr Lundy said Ireland was “getting much better”, thanks to the cohort of women in this country who have done their research, are well-informed about their symptoms and know what they need to relieve them.
The main treatment for menopausal symptoms is Hormone Replacement Therapy or HRT, which replaces the hormones women’s bodies no longer produce because of the menopause.
The two main hormones used in HRT are oestrogen and progesterone. Most women take a combination of oestrogen and progesterone but women who no longer have a womb can take oestrogen alone.
HRT comes in a variety of types and combinations and includes gels, creams, patches, tablets, vaginal pessaries or rings.
Supply and demand issues
Increased awareness about the menopause and the treatments available to ease symptoms is hugely welcome – however it has also lead to increased demand for HRT, leading to the medicines being in short supply.
In recent months in particular, there has been a severe shortage of HRT products in Ireland, leading pharmacists to call for a change in prescribing rules to provide them with increased options to supply these medicines.
This call by the Irish Pharmacy Union (IPU) follows a similar move in the UK where pharmacists are now permitted to substitute HRT products to patients.
According to the IPU, currently in Ireland “pharmacists cannot amend prescriptions for HRT and have to revert back to the prescriber or refer the woman back to her doctor if the medicine is unavailable. Pharmacists are medicine experts and have the clinical skills to provide this seamless care to women.”
Chair of the IPU’s Pharmacy Contractors Committee Kathy Maher said, “There have been serious supply issues with HRT products over the last number of years, which has accelerated in recent months. This is causing significant stress and frustration to women trying to source these essential medicines.
“By allowing pharmacists to dispense alternative HRT products without the requirement to revert to a GP, or send the patient back each time, pharmacists will be able to offer patients another product to relieve their symptoms if their normal HRT is out of stock.”
“This would save time for patients, pharmacists and doctors and help alleviate the huge anxiety felt by women over supply and access to essential treatments,” she added.
Maher also advised that women should talk to their pharmacist if they have any concerns about their HRT medicines.
The Health Products Regulatory Authority (HPRA) is the body in Ireland responsible for protecting human and animal health by regulating medicines, medical devices, and other health products here.
In a statement the HPRA said it was “aware of the current challenges regarding the intermittent supply of some hormone replacement therapies (HRT), notably transdermal patches.
“We have had regular and ongoing engagement with suppliers in this regard. The companies that place the products on the market have indicated that the current supply difficulties are due to a significantly increased demand for these medicines in Ireland in recent years. The suppliers have confirmed that they have increased the planned supply of HRT patches to Ireland during 2022 in response to this increased demand.”
“The current supply situation has arisen due to significant increases in demand for HRT medicines and is not linked to regulatory matters. However, the HPRA continues to review available options within our regulatory remit to facilitate increased supply where at all possible. In particular, the HPRA has advised the companies that we are open to providing accelerated regulatory approval to supply a product originally intended for other markets if available.”
Changing care
Coupled with an increased awareness of the menopause and resultant increased demand for HRT, there has also been further progress in menopause care in Ireland with the development of specialist menopause clinics.
While the majority of menopause care can be provided successfully in primary care by a GP or practice nurse, the new multi-disciplinary menopause clinics provide another layer of support for women experiencing complex menopause symptoms.
In recent weeks it was announced that the Women’s Health Fund (€10 million) will ring-fence €2.5 million for the National Women and Infants Health Programme in the HSE to accelerate service delivery in four critical areas in 2022 – one of which was the menopause.
The Women’s Health Action Plan 2022-23 committed to developing four specialist menopause clinics nationally in 2022. This latest announcement of further investment will support two additional specialist menopause clinics, bringing a total of six such clinics nationwide for women who require complex, specialist care.
To date, just one of the six promised specialist menopause clinics is operational and is in the National Maternity Hospital (NMH) in Holles St under the direction of Dr Lundy and her team.
While GPs are best placed to discuss menopause care including the risks and benefits of HRT, there is a cohort of women for whom HRT may not be straightforward. These can include women who have had a recent heart attack or stroke, women who have had a previous diagnosis of breast cancer or another hormone sensitive cancer, and women with a history of clots. It is these women who will receive care in the specialist clinics.
According to Dr Lundy, 50% of the referrals she receives in Holles St are women who have had a breast cancer diagnosis in the past.
She is also seeing women with a history of ovarian cancer, those who have suffered with thrombosis or clotting and women with a personal history of heart attack or stroke. She also sees women who are in early menopause.
The clinic is manned by Dr Lundy, Dr Nichola Cochrane, a GP with a specialist interest in women’s health, and Claire McElroy, a full-time Clinical Nurse Specialist.
However, the service has no dedicated accommodation in Holles St mainly due to the physical constraints of the building, and can currently only see patients one afternoon a week from 3pm to 6pm.
Currently, the clinic is accepting referrals from Wicklow, Dublin and Kildare but is also advising GPs across the country to support their patients until the additional 5 clinics are established.
The Department of Health says that the three further specialist menopause clinics this year will be in Limerick, Galway and Cork.
However it also noted that the plans for the two additional clinics for the eastern part of the country which were announced in recent weeks “will be dependent on resourcing the necessary staff, which is in progress”.
“Due to this, a definitive timelines for the opening of these new clinics is not available at this time.”
The development of the new specialist clinics coming as they do in tandem with increased awareness of the menopause is good news but it comes after decades of neglect and generations of women suffering in silence.
For Dr Lundy some of the most distressing symptoms of menopause are sleep disruption and mood changes.
“For someone who’s always been emotionally quite well to find themselves suffering, depression, rage, anxiety, irritability – really uncharacteristic mood changes, it’s quite scary. And then one of the most common things that people say after treatment is, ‘Oh my God, I got myself back…I’m me again.”
This work is also co-funded by Journal Media and a grant programme from the European Parliament. Any opinions or conclusions expressed in this work is the author’s own. The European Parliament has no involvement in nor responsibility for the editorial content published by the project. For more information, see here.
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