Running the Menopause Clinic in Rotunda

During my training as Obstetrician/Gynaecologist I worked in many areas in the specialty. I ran a menopause clinic in the Rotunda as a senior registrar in the late 1990s early 2000s. This was before the drama surrounding the Women’s health Initiative (WHI) study and the Journal of the American Medical Association (JAMA) report. An editorial published on the interim reports of the WHI study suggested an increase in breast cancer in women on HRT. This was then reported in sensational fashion in the main media and HRT became a bad word! Needless to say, the menopause clinic in the Rotunda was closed.

During my time in the clinic, I learnt a lot about menopause; the difficulties and symptoms women were experiencing, and I was privileged to be able to help. This was a medical/gynae clinic focussed on medical treatment of physical symptoms and prescribing HRT was a big part of gynae practice at the time. However, as time went on, I saw more and more women attending the clinic with problems HRT was never designed to help. It became the panacea for everything, and long before the controversy I became increasingly uncomfortable with people’s expectations and prescribing practices at the time.

Medical definition of menopause

  • Cessation of spontaneous periods for one year. Menopause therefore by definition lasts a day!! The diagnosis of menopause can only be made retrospectively.
  • The average age in western society is 51 years.
  • Smoking cigarettes, chronic inflammation, diabetes, using cannabis, reduces the age at which menopause occurs.
  • Getting enough good quality sleep prolongs healthy oestrogen levels and may protect against early menopause.
  • A plant forward diet, regular exercise, healthy BMI and reducing alcohol can all help mitigate symptoms.


Now more commonly known as perimenopause. This is the time during which ovarian function is decreasing.  The run-in to menopause.  The age and duration of the perimenopause are highly individual. Symptoms usually develop around age 45 but may be earlier.

Induced menopause

Most commonly due to surgical removal of ovaries in a premenopausal woman.  Can also be due to treatment for medical conditions such as chemotherapy or radiotherapy. The sudden drop in oestrogen causes very intense symptoms and can be difficult to cope with along with all the other effects of treatment.

Post-Menopause is a normal physiological aging process

The prevalence of post-menopause is increasing as life expectancy in Western society increases. Living to age 84, which is the current life expectancy for women means that approximately 40% of her life will be lived in a post-menopausal state. In the next 20-30 years there will be a 50% increase in the number of women living until 80 years. Currently 17% of women in the UK are postmenopausal. In 2029 this figure will be 20% and is set to continue to increase as life expectancy increases.

Preparing for this stage is key to a healthy active life and goes far beyond HRT. The evidence for having an active lifestyle, enough sleep, plant forward diet is beyond any doubt for the promotion of healthy aging. And yes, when we become postmenopausal, we are beginning to age and no amount of hormonal treatment or Botox, or expensive face creams can stop it unfortunately.

I believe that considering this stage of life as being in a hormone deficient state is quite a negative stance. There is so much to be grateful for when one is post-menopausal. No periods, no concerns about fertility, no PMS with symptoms of acne, sore breasts, abdominal bloating. Once the fluctuating hormones have settled the emotional highs and lows usually stabilise. The university of Melbourne published a study following 400 women aged 50 for 20 years. This showed that women in their 60s and 70s often feel happiest at this stage of life.

Symptoms of climacteric (perimenopause)

Vasomotor symptoms (VMS) commonly known as hot flushes and night sweats. Often the most troublesome symptoms of perimenopause and can lead to many of the other symptoms experienced by women.

What causes vasomotor symptoms is not yet really understood!

We know it’s related to fluctuating hormones. Current theories suggest oestrogen deficiency, whereas in the past high FSH was considered the cause. Studies suggest that dropping oestrogen can change how the brain (hypothalamus) perceives temperature. When the internal thermostat is receiving conflicting messages from the fluctuating oestrogen it can be fooled into sensing the body is too hot and causes the blood vessels and sweat glands to open to cool the body off, thereby setting off a hot flush.

Another theory states that because our blood vessels contain oestrogen receptors, they will dilate erratically in response to fluctuating oestrogen levels causing hot flushes and night sweats.

As you can see medical science has a way to go in understanding the complicated physiology of us women!

What is a hot flush?

This is a medical symptom which can be the basis for much of the difficulty experienced by perimenopausal women. A sudden onset of heat and flushing usually in the upper body, face, neck, and chest caused by vasodilation (blood vessels near the surface of the skin becoming bigger to bring more heat to the surface of the body).  Sweating is also common during a hot flush as this also reduces body temperature. Being in a stressful situation can precipitate hot flushes which can make the work environment difficult to navigate.

When hot flushes occur at night, they are called night sweats and can be very debilitating as sleep is often entirely disrupted.  Having to change sleepwear, sheets, and pillowcases most nights really affect sleep and this lack of sleep could cause or worsen symptoms of brain fog, poor concentration, poor mood and all the symptoms that go along with a chronic lack of sleep.  Sleep deprivation and poor-quality sleep is associated with emotional and cognitive issues such as mood swings, irritability, anger, poor memory poor concentration also known as brain fog. Chronic sleep loss is also associated with increased levels of dementia and Parkinson’s disease. Research into the effects of daylight-saving time in the Spring have noted increases in mood disturbance, suicide, and road traffic accidents. And this is after one night’s sleep reduction!  Imagine what’s going on for perimenopausal women where chronic sleep deprivation is often the norm.

Treatment for vasomotor symptoms

We know that HRT is the best form of treatment for VMS.

Body identical oestrogen through the skin (patch, spray, or gel) is the safest form of treatment along with micronized progestogen (orally or vaginally). Both products are made by the pharmaceutical industry and the hormones are identical to those produced by your body. Within a week or so flushes and night sweats begin to ease, and the symptoms of brain fog and exhaustion begin to improve as sleep quality improves.

What’s a bit more difficult to establish is how long to remain on HRT. This is a conversation to be had on an individual basis with your own GP taking in to account your personal and family medical history.

The HRT which is now used is entirely different to that used back in the 1990s. Transdermal oestrogen is a much safer option with fewer known side effects. However, we do not have long term outcome measures for this oestrogen as it has only been available for approximately 10 years. I do have a concern that like the controversy in the 2000s there could be another problem coming down the tracks for women currently on HRT. Many women who have sailed through menopause without HRT are now concerned that that they should have been on HRT and wonder if they did something wrong.  I believe that big pharma is using a population of women as a research tool and that drug companies, whose bottom line is making money for shareholders, are on to a winner with the message that if we’re not on HRT we are idiots.

Balance as always is where its at. Everyone should decide for themselves if, when, and for how long, to go on HRT.  The best way to approach this is with individualised advice from your doctor.


Teen Gynae Health

Perimenopause and Puberty

For a long time now, I have been saying that puberty and (peri)menopause are two sides of the same coin, on either side of the reproductive lives of mature adult women. Both are characterised by fluctuating female hormones, leading to significant physical, emotional, and psychological changes. In 1996 most Irish women were having their first child at 20-24 years of age. By 2021 the average age of mothers having their first child was 33 years, the highest ever recorded. This means that both puberty and (peri)menopause frequently co-exist in the same household with interesting results! Many a husband/dad has taken to safety in the garden shed.

Spare a thought for the young girl going into puberty. She needs as much information as her mother about her changing body and mind. If mum and daughter were more informed and in tune, a better, more tolerant relationship may be fostered leading to a more harmonious household. We need to focus on the physical, emotional, and mental health of our young girls and encourage a positive and open attitude to their developing bodies. In the same way bringing a more positive outlook to what is happening in our own bodies as we age is a fantastic example to pass on to our daughters. The person you are, has a huge influence on the person your daughter becomes. We have a wonderful opportunity as mothers to be a positive role model for our daughters.

I don’t know how your relationship was with your mum when you were going through puberty, but my abiding memory revolved around trying to buy clothes at ages 12 to 15. I was always infuriated by my mum saying to shop assistants, in a confidential manner, that I was at an awkward stage! Bringing attention to my rapidly changing body was not something I appreciated! Fast forward to last week when I was visiting my hometown in Mayo. I was buying a coat in a shop where my mum used to shop. Now that’s a successful business model! My daughter was with me to advise.  I felt I was at another awkward stage, not wanting to look like an old lady but also not trying too hard to look younger. The phrase mutton dressed as lamb was in my head!! It really brought it home to me how close these 2 stages of life are emotionally.

Hormone treatment in Adolescents

There is a role for hormone treatment in adolescence just like there is in menopause. In my adolescent clinics over the years, I prescribed various forms of hormones for various issues. I always tried to use the lowest effective dose for the shortest amount of time possible. Many girls were extremely reluctant to go on any form of hormones. There was concern over side effects and long-term adverse effects from both mums and daughters. A lot of my time in the clinic was spent discussing the pros and cons of various medications. My aim was to bring a difficult clinical problem under control to allow time and space to address underlying issues.

I am interested in the contrast between the adolescent and the (peri)menopausal woman when it comes to hormonal therapy, and this is reflected societally and in the media. Finding the middle way, getting information and advice from reputable sources should hopefully keep us on the right track.

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  1. The Menopause by Dr Deirdre Lundy Published by Sandycove, Penguin Random House UK.