THERE HAVE BEEN calls for better supports for women in Ireland who are going through menopause, as the UK considers a proposal to make one of the treatment medications available over the counter at pharmacies.
The UK government last year announced plans to cut the cost of repeat hormone replacement therapy (HRT) prescriptions, a move that would save women hundreds of pounds per year. A new government Menopause Taskforce was also established in the UK as the government pledged to remove barriers to menopause support.
Here, Fianna Fáil TD Niamh Smyth, who has raised the need for better menopause supports a number of times in the Dáil, told The Journal that the focus in the UK on access and affordability of treatments should be replicated in Ireland.
“There have been some great developments here, we have a specialist clinic at the National Maternity Hospital and we want to see more rollouts like that,” she said.
“But I agree that easy access is important, not everyone has a female GP and of course, male GPs know about it as well, but some might feel like that’s not a conversation they want to have with a male GP.”
In the UK’s latest move, its health products regulator, the Medicines and Healthcare Products Regulatory Agency (MHRA) has launched a public consultation on a proposal from a drug manufacturer to make a vaginal atrophy treatment available over the counter at pharmacies.
Vaginal atrophy (VA) is a condition in which the decrease in oestrogen levels causes thinning of the tissues in and around the vagina resulting in dryness, pain, and itching.
The UK proposal relates to a treatment called Gina, a tablet that is used vaginally. If approved, guidance would be issued to pharmacies and the treatment would only be made available to women over the age of 50 who have not had a period in one year.
Smyth pointed out that many people in Ireland did not have face-to-face access to their GPs at all during the pandemic and pharmacists played a strong support role and built up trust in their communities.
“We have to be mindful that we’re talking about busy women, they have jobs they may have families and if it’s a big hassle to see a GP to keep going back to get prescriptions that doesn’t make it easy for them,” she said.
“Women generally put themselves last on the list of priorities after their families, after their jobs, so if this could support them I think it’s a great idea.”
The reclassification of any medicinal product in Ireland to allow sale without prescription can only take place following an application from a pharmaceutical company and then a benefit-risk review. The Health Products Regulatory Authority (HPRA) has said it has not received an application to reclassify this product, but it is “open to review any application requests”.
“This is in line with the HPRA’s policy to make medicines and health products available at the most convenient point of access for people, where it is safe and appropriate to do so,” it said.
Under the proposed UK legislation, women would only have to pay one charge for a 12-month supply of HRT. The British government has also committed to looking into combining two hormone treatments into one prescription.
Smyth said consideration should be given to the cost of treatments in Ireland, particularly now that the “cost of living is rocketing”.
“It’s something the State will have to look at in terms of affordable and free supports, this is not something that lasts just a few months, it lasts years and it inhibits the work-life, as well as physical and mental health.”
Dr Nóirín O’Herlihy, Director of Women’s Health for the Irish College of General Practitioners (ICGP) said the organisation is aware of the high cost of HRT in Ireland. Patients who do not have a medical card can expect to pay on average up to €30 per month for HRT products, though some are paying considerably more.
Dr O’Herlihy said the ICGP would support any move to make these medicines cheaper and more accessible for patients. However, she expressed reservations about changing the status of treatments such as the Gina product to make them available without a prescription.
“Vaginal oestrogen products are only prescribed if indicated,” she said. “The ICGP believes it is safer that they are not available over the counter as they do require regulation for patient safety.”
Dr O’Herlihy said GPs in recent years have been engaging with new menopause education resources and have a good understanding of the types of supports that are needed. The ICGP is writing a new guide on menopause treatment which will update the advice on the use of HRT for symptoms.
“HRT is now thought to have a beneficial effect on cardiovascular risk in women within 10 years from their menopause and carries a low risk of breast cancer,” she said.
Although most menopause care can be delivered in the community, she said there are some cases where GPs cannot deal with the symptoms and specialist care is required.
“Where there are needs for specialist care, there are significant gaps in services around the country,” she said.
Policies
Following a discussion on the issue on RTÉ’s Liveline programme last year, there were calls for a national awareness campaign on menopause and the Taoiseach pledged that the government would act on “driving on a progressive policy for women’s health”.
In June, Health Minister Stephen Donnelly announced that work had begun on the development of a menopause workplace policy.
The policy will include measures that allow work adjustments for women going through menopause, such as flexible working, guidance around sickness leave, and time off for appointments that might be needed.
Donnelly told the Dáil that a range of actions on menopause are being developed by his department which include the provision of specialist supports, as well as a national awareness campaign around menopause.
In September the minister announced the establishment of the country’s first specialist centre for menopause at the National Maternity Hospital in Dublin.
This followed a recommendation from the Women’s Health Taskforce, which was established in 2019. It is expected that other similar clinics will be established around the country.
In response to a query from The Journal, the Department of Health said the government recognises that “menopause is a key health issue for women in Ireland today, and work is underway to drive progress in this area” through the Women’s Health Taskforce.
“Hormone replacement therapy, and in particular the cost of hormone replacement therapy, has been highlighted by women as an area they would like further attention on,” the department said.
At present, GPs provide consultations without charge to women who have a medical card or GP visit card. Approved prescribed drugs and medicines, including HRT, are available free to medical card holders, subject to the statutory prescription charge. In addition, under the Drug Payment Scheme (DPS), no individual or family pays more than €100 a month towards the cost of approved prescribed medicines.
“Further research is required to understand the cost and benefit of such a development. This will be considered when planning for further menopause activity to take place in 2022.”
Lifting the stigma
Just before the pandemic hit, Breeda Birmingham, who is a former public health nurse, set up the Mid Life Women Rock Project. She has worked with over 500 women in the last two years, providing information in free workshops as well as access to guest experts such as nutritionists and yoga instructors.
She said the issue goes beyond the health system because menopause has been “shrouded in secrecy and silence and stigma and shame”.
“We do a massive injustice by not talking about it,” she told The Journal.
Fear and shame and denial came up again and again with women I interviewed for my thesis. The story that’s been handed down is that it’s a horrendous experience for women and it is for many women, but what I’ve found is that the lack of knowledge and support is often creating this horrendous experience.
She said there is a strong appetite among women for more information on how to navigate through this new phase in their lives – her own book released last year was a bestseller on Amazon – but this is not always available through traditional channels.
“The problem is that there is no education, there’s no widely accessible information and support and that’s what’s causing most of the issues around menopause, this huge vortex around education,” she said.
“When I started doing this, some people were a bit uncomfortable around me. There’s this sense that once women are post-reproduction we should become invisible, that once the role of reproduction is done after that we’re nothing.
“I think it’s fantastic that the Department of Health set up a specialist clinic in Holles Street and we have the women’s taskforce, but what we need is the whole of society understanding that this is nothing to be ashamed of.”
She said that while HRT will alleviate a certain number of symptoms, it “is not the answer to everything”.
“There are women who have been on HRT who still come to the cafes [online information meet-ups] for the psychological and emotional support, so it’s not just about managing physical symptoms,” she said.
She said wider supports are “very limited” when it comes to providing advice on nutrition or physical activity that can complement pharmaceutical treatments.
Birmingham said the State should be investing more in women at this age, particularly when it comes to keeping them in the workplace.
“In the UK private organisations are investing hugely in retaining their female staff who are going through menopause, putting money into webinars, training programmes, they have menopause champions,” she said.
“In Ireland, we invest thousands for example in introducing girls into STEM in earlier years, we need to be putting the same amount into retaining my age group, women in their 40s, 50s, 60s. They want more gender balance on boards, they want women in those board positions, well we’re the women – it’s our age group.”
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