Many women will remember sitting through the ‘period’ talk at school. But when it comes to navigating the menopause and the perimenopause years preceding it, women are in uncharted territory and often feel alone.
dentifying what you’re feeling as symptoms of perimenopause and menopause is half the battle, according to Dr Caoimhe Hartley, who has set up a brand new menopause clinic. She believes that having conversations around this still taboo subject is key if women are to access treatment and realise they’re not alone in how they’re feeling.
After moving back to Ireland in 2019 after the birth of her son Conall (2) — she also has twin girls Zoe and Fiadh (5) — it was her dream to set up her menopause health clinic. Opening today, she already has a waiting list of 150 women.
It was while she was working in a women’s health medical practice in Canada that Dr Hartley first had the idea for a specialist medical practice for women experiencing symptoms of perimenopause. These are the years when a woman is transitioning towards menopause and menopause itself: literally the cessation of menstruation.
She recalls seeing women about the myriad issues they’d come in with. As they’d leave her surgery, when they literally had a hand on the door handle on their way out, they’d mention a symptom or something that was bothering them.
Dr Hartley says it was a classic case of ‘I know I shouldn’t be complaining about this — everyone goes through it but it’s really interfering with my quality of life’. She says these ‘door handle problems’ women were referring to could be things like not getting any sleep or prominent physical symptoms which they were almost dismissing and apologising for bringing them up in the first place. These symptoms of perimenopause were things they thought they’d just have to put up with, she says.
It was the conversations she had with women that led her to delve deeply into the area. Dr Hartley trained with and became accredited with the North American Menopause Society and is also now accredited with the British Menopause Society.
According to the North American Menopause Society, there are at least 34 symptoms of perimenopause — a stretch of time that can last anywhere from a couple of months to 14 years — as the body moves towards menopause. Menopause occurs where it has been one year since the last period and symptoms range from hair loss, allergies and even a burning mouth.
But according to the HSE, only one in 10 women seek medical advice when they go through the menopause and many do not need any treatment. However, if your menopausal symptoms are severe enough to interfere with your daily life, there are treatments that can help, the HSE says. It points out that the majority of menopause treatment is delivered via primary care through a woman’s local GP, who should be the first port of call for any woman experiencing symptoms.
But according to Dr Deirdre Lundy, who oversees menopause training for Irish GPs at the Irish College of General Practitioners, women don’t always recognise menopause symptoms. While she says the hot flushes and sweats are easy to recognise for most women, other symptoms like anxiety, irritability, poor concentration and focus are just as common as flushes, but women might not identify them as being symptoms and sometimes nor would their GP.
She says that, in theory, being able to discuss these symptoms and treatment options should be part of a GP’s normal activity, but very often it isn’t and the training in this area for doctors is “shockingly poor”. She also makes the point that, in her view, doctors are very anxious about treating the menopause. “I don’t know where it comes from, it’s not justified,” she says.
While Dr Hartley doesn’t believe the issue for women is not being heard by their GP — she says most women get a good reception from their GP — the issue is time constraints. And, of course, stigma. Western society’s obsession with youth makes it really hard for honest conversations about menopause to happen, according to Dr Hartley. But considering that the average lifespan of an Irish woman is now 84, with perimenopause symptoms starting around the age of 45, a woman is likely to spend around half her life in these phases. This fact alone makes these conversations necessary, she says.
For some women, these years of perimenopause and menopause can be lonely. The signals that fertility is coming to an end can have a psychological impact which some women feel keenly, particularly if they wanted children and were unable to have them or if they were plunged into premature menopause — menopause that occurs before the age of 40.
Dr Hartley believes that the lack of understanding of what’s going on during this time is partly due to the lack of information and awareness. But she believes that society’s attitude to ageing and in particular, women’s ageing, has a lot to do with it.
This, combined with the fact that women are likely to be juggling several balls as they enter the perimenopause years of their lives, such as working and caring for family members from teens to ageing parents, pushes their own needs to the bottom of the queue.
But having the conversation is vital to women’s health, and Dr Hartley says if we don’t acknowledge the productivity of women’s lives right into old age, we will continue to brush this topic under the carpet. “When women come into their 40s they’ve heard of menopause and they know that their periods will stop. They may not know that there’s a run into that where they will experience changes in hormone levels,” she says.
Over the course of women’s lives, our ovaries are churning out hormones. When we get to our 40s the rate at which these hormones are produced slows down, ovulation changes and women being to notice changes in their period, Dr Hartley explains.
“That change in period can be in any direction. They may see it become more frequent and heavier or it can get lighter and less frequent. It’s a change to what their regular pattern is.
“Perimenopause is those few years before your period stops. People tend to know about menopause, but they don’t know about perimenopause and the symptoms before their period stops,” she says.
Symptoms of perimenopause vary from woman to woman. While some sail through with hardly a problem, others experience a massive over-production of the hormone oestrogen — what Dr Hartley likens to the ovaries putting the gas pedal down hard. This makes women very symptomatic. They can experience bad mood swings, headaches and bloating. In essence it can make women feel like they’re on a rollercoaster being directed by their ovaries.
There are other symptoms of menopause, she says, when women become deficient in oestrogen, that they don’t find it easy to talk about and certainly won’t volunteer. Things like vaginal dryness, which can make intercourse painful, and low libido are generally only things that women will admit when they’re asked about them, says Dr Hartley.
“If you’re having painful sex, it’s hard to have any interest in having sex. Not everyone gets vaginal dryness but a surprisingly high number — some 60 pc of women — will have some vaginal symptoms. For some women, there may be an increase in urinary symptoms, they can leak with coughing or sneezing or they find it hard to control their bladder and are up 10 times a night to pee. Changes that are happening in menopause can contribute to these symptoms,” she says.
“Vaginal dryness can be irritating and uncomfortable and women don’t want to talk about it. It can be treated with local low dose vaginal oestrogen and it’s really safe,” she adds.
Anxiety is another really common complaint. “It continues to shock me the number of women who say, ‘I used to drive everywhere but now I can’t drive beyond the end of my road because I’ve lost confidence’,” says Dr Hartley.
She says that up to 80pc of women will get some symptoms of perimenopause, but only 25pc will experience severe symptoms that impact on their quality of life. Getting the information out there that major changes are going on within your body at this time of your life is important because it allows women to know they’re not alone.
New evidence from the US is emerging to show that hot flushes may be associated with heart disease in some women and Dr Hartley says we do see a decline in heart health in women around the menopause, with women at a higher risk of stroke or heart attack when they are post-menopausal. Bone health also decreases after menopause which is why lifestyle factors like eating well and exercising are so important for women entering this phase of their lives.
While hormone replacement therapy is one treatment option, Dr Hartley says there is no one-size-fits-all approach to treatment and it’s only in consultation with patients — sometimes linking up with a woman’s medical specialist — that she can devise a treatment plan.
The response to her new clinic has been overwhelming and something she didn’t anticipate. Based in Dalkey, she will be able to do virtual consultations as well as person-to-person consultations.
An initial consultation costs €175 with a cost of €75 for a follow-up appointment, 20pc of which can be claimed back from Revenue as part of health expenses. The clinic is currently not covered by any health insurer but there are two other dedicated menopause clinics in Ireland. Northern Ireland’s first dedicated clinic opened in Co Down in 2019. A small number of other medical practices in the Dublin and Wicklow areas run menopause clinics and provide specialist services in this area.
And while she’s not the first dedicated menopause health clinic in the country, Dr Hartley says she’s happy to be at the forefront of what she hopes will be a sea change in women’s health provision.
For more see menopausehealth.ie