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A GP: Untreated menopause can be seismic for a woman, but help is at hand

GP Dr Deirdre Forde specialises in menopause and is urging women suffering to seek advice and assistance.

Dr Deirdre Forde

I WENT THROUGH the devastating effects of menopause in my early 40s and was postmenopausal by the age of 48, so I know what the menopause is all about. I was lucky though in that after several attempts, my GP eventually gave me HRT.

The brain fog was horrendous – it was like a withdrawal from addiction, if that makes sense, and there were drenching day time and night sweats. I was no longer able to wear make-up as my skin was so wet and, my showers had to be cold to cool me down.

Even then, the drenching sweats were so bad, the salt from my sweat used to drip into my eyes. Wintertime was like any other day – for T-shirt wearing only. I couldn’t tolerate wool or anything around my neck as I would feel that I was suffocating. 

While going through this I was working as a Senior Medical Officer with the HSE and rolling out the Swine Flu vaccine in Kildare and West Wicklow. That meant I was having morning meetings with management at 8 am in a T-shirt and trousers, dripping in sweat. Not an experience that would do much for one’s confidence! 

I needed to see a gynaecologist due to severe bleeding caused by adenomyosis in my uterus that was being fed by my oestrogen. He told me that as I was post-menopausal I needed to come off the HRT that was feeding the bleeding but that if I was still having periods and finished having a family, the only treatment was a hysterectomy.

He refused to carry out a hysterectomy though, and I had to seek a second opinion to have the surgery. I set up our clinic in December 2019 having identified that there was no service to treat menopausal women in the Midlands. I founded Ceile Medical, from the message of ‘Together for women’, and based it in Athlone to facilitate easy access for women travelling from all over the country. 

My take on menopause

Menopause, I have to say, is one of life’s scourges in women when they end their reproductive years. Their hormones just deplete and they are left with the devastating aftermath of no oestrogen, progesterone and even that tiny bit of testosterone.

Men also have hormone depletion but it’s just one hormone – testosterone – and it depletes at a rate of 10% from the age of 30. It’s gradual right into their 90s.

Women’s hormones start to become imbalanced early on (perimenopause) but at that point, they are still having periods and when they go to their GP with crippling anxiety and maybe poor concentration, they fear they have early dementia or a mental health issue.

Peri means ‘around’ so perimenopause means the years before their menses eventually stop. When they have had no periods for 12 months, it means the ovarian production of oestrogen has slowed.

Progesterone and testosterone have eventually quietened and not fluctuating in a major rollercoaster of hormones. It does not mean all the symptoms have gone, it just means they are calming a bit.

The women I meet

In less enlightened times, women in menopause were literally seen as going mad. It was terrible. They were locked away, locked up and often even burned at the stake, accused of being witches!

Now while we have, thankfully, evolved from that, there is still huge misunderstanding around the menopause and the huge upheaval it can cause in a woman’s life.

Untreated menopause is seismic; the mood swings can be absolutely horrendous and can cause even the most mild-mannered woman to snap. What is basically a hormonal imbalance can wreak havoc with women’s personalities.

She is navigating her way perhaps through a mix of hot flushes, weight gain, anxiety, thinning hair, dry skin, fatigue, loss of libido or any of the 34 nasty symptoms that can be part and parcel of this life stage.

Also, menopause usually occurs at a time when a woman may be flying in her career, she might have important responsibilities workwise and family-wise as she may be caring for elderly relatives and young adults, so she is dealing with lots of pressure at a time when untreated menopause is making her feel as if she can’t cope. It’s really a perfect storm.

Partners suffer too as they haven’t a clue what’s happening. I had a husband sit in recently on a video consultation to inform him about the devastating effects of what his wife was going through as she told me that their marriage was ‘going down the toilet’. I spent 20 minutes chatting to him and I firmly believe this is the way forward. LGBT women need to understand their partner’s menopause also – they may be completely unaware of why their loved one is so moody and out of form.

My consulting rooms are well stocked with tissues as women just bawl when they come to see me. I think this is because they have so many pent up emotions, it’s like a pressure cooker, and it is like a release for them than to sit calmly with me and have somebody who totally understands what they’re going through.

I am determined to inform the people of Ireland and open conversations about menopause as I hate to see unnecessary suffering, and with the right treatment women going through all stages can blossom. It can be a wonderful time of freedom for them.

From Peri- to Post-Menopause

Perimenopause towards post-menopause is like starting at the top of stairs, meeting a few landings on the way to negotiate before going down the steps (each step can last months) towards the bottom step.

In the medical approach, we are not stopping your menopause but rather helping you down each step as the hormones fluctuate. We would all love for it to be a slide down the bannister but it doesn’t happen that way.

Perimenopause is the early stage where the hormones are bouncing up and down and symptoms are particularly bad. Women may still experience normal periods but the anxiety is starting with hot flushes and maybe brain fog.

As this phase progresses, the woman’s periods are more erratic with maybe nothing for three months and then they start again. Symptoms are getting worse without HRT – brain fog; crying for no reason; anxiety; overwhelm; considering quitting their job; mood swings; relationship difficulties; urinary infections; itchy skin; drenching night sweats; no libido.

When a woman has had no periods for 12 months she is post-menopausal. She is now probably at the middle landing of the stairs analogy. As her natural hormones drop more, she is probably on the middle landing and might be fine for months. Every time she drops to another level her symptoms will fire off.

What role for HRT?

Hormone Replacement Therapy (HRT), otherwise known as hormone replacement therapy is exactly that. It replaces hormones that you have lost. These are bioidentical products that are available in tablet, patch or gel. 

The tablets are taken daily as are the gels which are applied to the skin. Patches are changed every 3.5 days and are placed on the skin below the belly button.

The progesterone is necessary if the woman still has a womb and taken at night time as it’s a calming hormone and makes sleep much better. The function of progesterone is to protect the lining of the womb from becoming thick and risking changes in its consistency.

Oestrogen will get rid of other symptoms. The oestrogen is estradiol and the progesterone is utrogestan. Localised oestrogen also is available for vaginal dryness and inserted vaginally at night. It will aid lubrication and reduce bladder leaking and urinary tract infections. HRT will ease all these symptoms; giving you back your hormones but you are still progressing through menopause.

To be clear, HRT does not stop the menopause – it just relieves the terrible effects of hormone depletion. The therapy benefits women protecting them from osteoporosis, heart disease and early dementia.

There are contra-indications with this so if a woman has hormone receptive breast cancer she cannot have HRT. Women who have a history of blood clots can have HRT in the form of a patch or gel. It’s transdermal so bypasses the liver with no risk of clots. In my practice, I also inform women that they should stay on HRT.

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Help is there

Sleep and exercise are our friends but I realise that menopause is the great sleep stealer. I am very much a fan of exercise, it relates to serotonin, our happy hormone, it’s great for our minds, our bones and nature does soothe.

Also, it can aid sleep. However, if you’re not able to sleep, practise some mindfulness, get up, read a book, catch up on some tasks – do what you like to do to help you. Omega 3 and Magnesium are vital supplements, water is powerful as 90% of our bodies are made up of water so it helps skin, hair and gives energy. Talk to other women and realise you will get through this and bloom!

Due to Covid-19 restrictions in March, I  started remote consultations via phone or video. I am passionate about helping women going through all stage of menopause – they don’t have to suffer alone and I urge them to seek help.

In Japan, menopause is known as the ‘Second Spring’ which I think is lovely; it conjures up renewal, regeneration and revitalisation and that is what I am really hoping for our menopausal women in Ireland.

Dr Deirdre Forde, MB BCH BAO is founder of Ceile Medical in Athlone, County Westmeath., Member of British Menopause Society, Member of The Irish College Of General Practitioners, MSc Child Health, Diploma Child Health, Masters in Public Health, Aesthetics Training medics Direct ( Harley Street, London). She is on the Specialist Register of the Irish Medical Council. For more, see CeileMedical.ie, call 090 6479748 or text 085 2143509.

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Dr Deirdre Forde

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