Embracing the change

Recent discussions on the effects of the menopause have thankfully brought the issue more into the open

It started with Sally Ann Brady on Liveline. She said she had lost five years of her life to menopause and wanted to talk to the Nation about it. The Nation listened and talked back. Women from all over the country contacted the show with menopause stories – flushes, sweats, anxiety, poor concentration, fatigue, no sex drive, increased sex drive, insomnia, depression, leaky bladders, sandpaper vaginas, cystitis, mood swings, depression, hair loss, and much more.

The menopause in all its nastiness was laid bare on the airwaves. And as if the symptoms were not punishment enough, they came accompanied by their cousins: Guilt, shame, embarrassment, frustration, plummeting self-confidence, and anger. A conversation had begun – and not before time.

Perhaps Sally Ann Brady had seen the recent Channel 4 documentary, Sex, Myths and the Menopause, presented by Davina McCall and nominated for a National TV Award. Perhaps she had listened to Dr Caoimhe Hartley, a GP turned menopause specialist and founder of the Menopause Health Clinic, speaking on the popular Good Glow Health podcast. Whatever prompted her to speak to Joe, she awoke a not so sleepy giant, and within a week, all forms of media were buzzing with the word menopause.

Across all media platforms, women described this phase of their lives as a train crash, a wrecking ball, a catastrophe. Doctors in general and GPs, in particular, were found wanting. We are not knowledgeable enough, not empathic enough. We do not have enough time to listen, examine, advise, and treat. In the Seanad, Senator Fiona O’Loughlin called for an end to the misdiagnosis and incorrect treatment of menopausal women.

As a woman of a particular age, I understand the frustration and anger. I know the difference that hormone replacement therapy (HRT) can make to quality-of-life. As a doctor whose career has surfed the peaks and troughs of the HRT journey, I also understand HRT hesitancy. When I started as a young GP in the UK in 1990, the advice was that no woman should have to suffer the symptoms of hormone deficiency, and pharmacies could barely keep the shelves stocked, such was the demand for this treatment.

By 2002, the Women’s Health Initiative (WHI) and Million Women Study reported that HRT could kill you, and almost overnight, 50 per cent of women stopped their medication. Some did so on medical advice, others as a reaction to the frightening headlines in newspapers linking HRT to breast cancer and heart disease. The WHI study was poorly designed, erroneously analysed, incorrectly reported by the media, and women were the victims for many years. But doctors were victims too. Many, including myself, contacted the women we had encouraged and persuaded to take HRT and advised them to discontinue it. Women were angry and confused and lost confidence in doctors. Doctors felt let down by science and found these consultations challenging.

A re-analysis of the WHI in 2015 reported that many women in the trial were over 60 and had pre-existing risk factors for heart disease and breast cancer. The recommendations of the study should never have been applied to a normal population. HRT was back on the agenda. In 2019, in a study reported in The Lancet, the HRT/breast cancer risk had been clarified further, but even this information is now outdated as the hormones used did not include the newer formulations with safer risk profiles.

The pathway from research to practice is long and hazardous. The evidence is constantly changing. As Dara Ó Briain says, “Science knows it doesn’t know everything. Otherwise, it would stop.” Patients and doctors need time to process new information and come to a shared decision that is right for them.

There are other reasons why managing menopause is difficult. In my experience, women seldom make an appointment solely to discuss menopausal symptoms. It is frequently a constellation of symptoms, presented as an afterthought, followed by the question, “Could this be menopause?” Each woman deserves time for an individualised history, examination, and risk assessment. These are often long and complex consultations that require time and commitment by the doctor and the patient. Ireland has no publicly-funded specialist menopause clinics for women with more complicated symptoms and many women cannot afford private clinic fees.

It was good to hear these women’s voices on national radio and even better to hear Dr Deirdre Lundy, Menopause Specialist and Medical Educator, responding to their stories with knowledge and empathy. Deirdre is a valued resource for many GPs. She has educated us through ICGP webinars and generously gives of her time and expertise on GP WhatsApp groups. The media carried damaging headlines in 2002. Today, thanks to women like Sally Ann Brady and doctors like Deirdre Lundy and Caoimhe Hartley, many social media platforms provide practical, evidence-based, up-to-date information on a previously misunderstood and debilitating condition. It is time to embrace the change.