For more than a week, listeners to Liveline have heard the stories of women in Ireland going through menopause and the majority of them have not had happy stories to tell. Women have spoken of being fobbed off by doctors, misdiagnosed, insulted and, in so many cases, left to suffer needlessly. Talking to Joe Duffy on Tuesday, Ann recounted what a GP said to her when she presented with symptoms of menopause:
“He held my hand and he said, ‘Well, you know, when women get older, they just like to be bitches.’ And let me walk out the door.”
Listeners have heard about menopausal women suffering mood swings, hot flushes, dryness, pain, depression, brain fog and many other symptoms. They’ve heard about so many women been put on anti-depressants when they should have been on hormone replacement therapy. And HRT itself has been wrongly characterised as causing cancer, with many GPs avoiding prescribing it on that basis. Call after call, it’s been deeply frustrating to hear how a condition that 50% of the population will go through at some stage is something that’s whispered about, misunderstood and drastically under-supported. The volume of calls to Liveline was so great that the show set up a dedicated number for WhatsApp voice messages.
Dr Deirdre Lundy, specialist in Women’s Health, joined Joe in studio on Wednesday to listen to women tell their menopause stories and offer advice on the best approach to take when the GP isn’t up to the task.
“There are so many people who are not being helped, who could easily be helped. But you need to be lucky. You need to have a great GP; you need to have resources that you can maybe pay in situations where it’s not available free of charge and, like, a lot of people don’t have those things.”
Joe told Dr Lundy that, by his reckoning, there could be up to 600,000 women in the age group that typically goes through the menopause in Ireland. And he asked the question, why the silence? Dr Lundy gave the example about TV presenter Davina McCall’s experience of the menopause:
“When she got menopause so bad she needed to do something about it and eventually took HRT, she didn’t tell anyone. What the heck? What’s that about?”
Dr Lundy says she loves showing her own HRT patches to her patients, to make the point that she has no problem with them. The example of Davina McCall keeping her menopause and its treatment a secret shows how, Dr Lundy says, women can sometimes be their own worst enemies:
“We expect so much from ourselves. Perfection. And when we fall short, we feel like we’re weak or less than and maybe if you can’t manage your menopausal symptoms with yoga and, you know, holistic therapy or something, you’re a failure? Which is so not fair – it’s not true and it’s not fair.”
Part of the problem with the discussion – or lack thereof – around menopause is the fact that Ireland has no faculty of sexual and reproductive health. Instead, Dr Lundy told Joe, “We have either have a gynaecology surgeon or a GP”. In the UK, for example, they have a faculty of sexual and reproductive health, whose job it is to manage menopause.
“I use their guidelines because we don’t have any Irish equivalent. Were I in the UK, I’d be a consultant in sexual and reproductive health, but we don’t have that, so I’m just a doctor.”
Joe asked Dr Lundy to address a now-widely debunked 2002 study that claimed a link between HRT and cancer. Although the study was less than rigorous and never actually concluded, it’s been responsible for so much misery.
“That study has a lot to answer for. That study condemned a generation or two of women to unnecessary suffering.”
The study was conducted in the US, looking to see if certain therapies would increase longevity and prevent disease in ageing women. 16,000 women between the ages of 50 and 80 were recruited and given large amounts of Premarin – made from pregnant mare’s urine – mixed with a strong progestogen tablet on top of it. That’s not done anymore. In fact, equine oestrogen is avoided wherever possible. And oral therapy is rarely used, unless a person is in tip-top health.
“The women in that study, the average age was 63, which is actually, pretty much beyond the worst phase of the menopause. And their main focus, their endpoint was, ‘If we give all women hormones, will we prevent fractures and heart attacks and premature death and ageing?’ And actually the answer was yeah, we probably would, but the problem was that strong oestrogen in that older cohort of women had an impact on breast cancer diagnosis.”
The impact, however, was very, very small, showing that the risk of breast cancer in some age groups went from 23 in 1,000 to 27 in 1,000 – not a significant increase, and not put into any kind of proper context by the study, but it’s all the headline writers of the day focused on and GPs avoided HRT as a result. And some are still avoiding HRT because of that nearly 20-year-old unreliable study.
You can hear Joe’s full conversation with Dr Deirdre Lundy, as well as callers’ queries on the menopause, by going here. And a week’s worth of Liveline episodes on the subject of menopause can be found on the RTÉ Radio Player and on the Liveline page on rte.ie.
Niall Ó Sioradáin
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