All women go through the menopause at some point in their lives. It is a natural part of the aging process. However, for many, the symptoms of this natural process can bring anxiety and distress.
While menopause causes physical changes it isn’t just a medical condition, it is a personal experience. Many women find the changes in their body, their symptoms and hormone levels unsettling. Many don’t recognise themselves any longer and feel at a loss as to why.
We understand the emotional rollercoaster that can accompany the menopause, and that every woman’s experience is different. We are here to help to address those medical symptoms that arrive uninvited, when our oestrogen levels fall as we advance into our 40s and 50s.
At the Centre for Women’s Health in the Mater Private Network Cork, we have a dedicated menopause clinic delivered by our in-house GP, Dr. Alex O'Brien, who has a keen interest in menopause care.
The Menopause Clinic
Our weekly clinic provides both routine and complex menopause care. Women who attend the clinic have access to any additional testing, imaging and onsite specialist consultations that may be required. Because the clinic is in a hospital setting, your care is coordinated with specialists in general gynaecology and urogynaecology with the additional support of a pessary and continence nurse specialist on hand if required.
What to expect at the Clinic
The initial appointment with Dr. O’Brien gives you the time to talk through your symptoms, how you are currently feeling and what you are experiencing. During this appointment, Dr. O’Brien will also collect a summary of your medical and family history. Sometimes an examination may be required depending on the symptoms that you are experiencing. Dr. O'Brien will work with you to provide an individualised treatment plan based on your symptoms, goals and concerns. Blood tests may be taken, if it is deemed necessary during the consultation. Occasionally further tests, procedures and specialist supports will be recommended which may incur additional costs such as:
- Pelvic ultrasound
- DEXA scan
- Mirena coil insertion
- STI screening
- Incontinence or pessary nurse support
- Onward referral to a consultant
Patients are asked to bring a copy of any recent blood, breast, endocrine, cardiac or gynaecological tests to their appointment. If you have a complex medical history, it would be useful to bring a summary of your medical history which lists your background medical history and current medications . This can be requested from your GP.
A summary of the consultation detailing recommendations or medications prescribed will be forwarded to your GP afterwards unless you specifically request this not to be done.
The appointment can be booked online or by phone. A GP referral is not required for this clinic.
A follow up appointment will usually be arranged after the initial appointment. Frequently, this will be planned 3 months after the initial consultation. This appointment enables Dr. O’Brien to assess the change in your symptoms, review your treatment plan with you, and to alter it if required.
- First appointment: €200 (includes blood testing if required)
- Follow-up appointment: €100
Understanding the Menopause
Before the menopause is the perimenopause, which is when symptoms begin but the woman continues to have periods or has had a period in the last 12 months. Each woman’s perimenopause is different and can last several years. The menopause usually affects women between the ages of 45 and 55. To be diagnosed as postmenopausal, it must be 12 months since your last period. FSH levels in your blood may also be assessed to support the diagnosis.
Early menopause is a menopause before the age of 45.
Premature menopause (also called premature ovarian insufficiency (POI)) is a menopause before the age of 40 and treatment is usually recommended to prevent more serious long-term consequences such as osteoporosis and cardiovascular problems. If a patient with POI has not completed their family, then the patient would also usually be under the care of a fertility clinic; our clinic would work in tandem with their recommendations and treatment plans.
Symptoms of perimenopause and menopause are similar and can include some or all of these:
- Hot flushes
- Night sweats
- Insomnia and poor sleep
- Cognitive symptoms (“brain fog”, forgetfulness and poor concentration)
- Psychological symptoms (anxiety, feeling low, irritability, mood swings)
- Lethargy and lack of energy
- Loss of interest in activities
- Muscle or joint pains
- Vaginal dryness
- Painful sex
- Reduced libido
- Urinary frequency and incontinence
- Dry eyes, skin, hair and nails
- Hair loss
- Urinary frequency
- Irregular periods (shorter or longer cycle)
- Lighter or heavier periods
Hormonal /HRT treatments may involve prescribing:
HRT is the commonly used abbreviation for hormone replacement therapy. HRT replaces the female hormones no longer produced after menopause and involves taking small doses of these hormones; oestrogen and/or progesterone.
HRT can be taken in many forms: tablet; patch; gel; spray; intrauterine coil; cream or vaginally. It is important to find the correct type for your individual situation.
Common forms include:
1. Cyclical HRT
This is the type of HRT that imitates the natural menstrual cycle by causing regular menstrual bleeding every month, like a light period. It is used in women who are perimenopausal and have ongoing or recent menstrual periods. Both oestrogen and progesterone are taken at different stages throughout the month. The hormones trigger a reaction which causes the lining of the uterus to build up and then shed.
2. Oestrogen-only HRT
This is normally prescribed to women who have had a hysterectomy. Most types of HRT involve the use of both oestrogen and progesterone, where the benefit of the therapy is from the intake of oestrogen. Progesterone is only taken to protect the lining of the womb. In most cases, if the woman has had a hysterectomy, where the womb is removed, there is no need to take progesterone. Oestrogen-only HRT can only be taken if all of the uterine tissue has been removed.
3. Continuous Combined HRT)
Most women start by using cyclical HRT and then move onto continuous combined HRT once they are postmenopausal. It can be started in the first instance in women who are postmenopausal (have not had a period for 12 months). Both oestrogen and progesterone are taken every day, balanced so that monthly bleeding does not occur.
4. Local oestrogen such as vaginal tablets, pessaries or creams
This type of HRT comes in the form of creams, vaginal tablets, or vaginal pessaries. Oestrogen is absorbed locally in the vagina to treat vaginal or urinary symptoms such as dryness or irritation. The use of local oestrogen minimises the absorption of oestrogen into the rest of the body and its attendant side effects. Progesterone is not required with this as systemic absorption is minimal.
Tibolone is a synthetic compound. It is taken in tablet form and mimics the effects of oestrogen, progesterone, and androgens, which are male hormones.
Medications that do not contain hormones but can be used to improve menopausal symptoms. They may be of particular use in women for who the HRT is contraindicated or for women who do not wish to take HRT.
Non-pharmacological and lifestyle advice
This can include cognitive behavioural therapy (CBT) along with advice on your diet, stopping smoking, reducing stress, sleep hygiene, mindfulness and exercise.