With so much focus on the menopause of late Clare asks if women are receiving the support they need when she talks to an expert in Women's Health Dr Sarah Callaghan.
Claire
Menopause has been quite the hot topic of late from TV to radio to newspaper articles. It's getting more attention than ever before. GP Sara Callahan got in touch with the show to say that she has noticed that there has been a huge increase in women who have been living with symptoms for years. Who now feel empowered to seek support and help over the last couple of weeks. And Sarah joins me now. Hello, Sarah. How are you?
Sarah
I'm good. Yes, I think it's a really exciting time in women's health. I think it's a time when there's just been it you know, it's not an understatement to say that there's actually been a transformation in the way we're talking about this particular stage of women's lives and menopause. And now look, you know, the term perimenopause is coming out, which is just fantastic because this is a transition that every woman is going to make in their lifetime. And up until two weeks ago, there was only a handful of times that I've heard the word perimenopause come from women directly who came into my my surgery. So and we've really started a conversation around this. And you know, information is so important. If you have the right information, then you can see help when you need it. You can be informed about how best to manage your health and that that allows you to have the best possible quality of life as you go through this transition.
Claire
I mentioned Meg Matthews being incorrectly diagnosed and there were similar stories and statistics in Divina McCall's documentary. Why is this misdiagnosis happening? Why is it challenging to seek medical support during the menopause?
Sarah
Well, I think one of the issues is that, you know, traditionally we have all thought of menopause as something that happens around about the age of 50 or 52 and that your periods have stopped, and that you're probably presenting with hot flushes. But not every woman presents that way. And we're increasingly understanding that the transition into menopause can start as early as your late 30s Which is something that most women in their late 30s are not thinking about. So when you go to the doctor in your late 30s, early 40s And you're complaining, maybe your vagus symptoms not necessary or maybe still having regular periods, but you might be feeling tired. You might be feeling irritable, you might have sore joints or headaches. And sometimes you know, there may not be this may not be associated with the idea that you are now suffering from estrogen deficiency and that you are in this transition time towards menopause which we now know is perimenopause. So that's one reason and then I think as well for for older women sometimes there can be a somewhat of a you know, a block towards coming to the doctor and they may not want to accept that they have transitioned into this time in their life. It can there can be certain stigma attached to it. You know, often women up until recently have not actually felt comfortable talking about this with their friends. They talk about everything else. You know, they talk about contraception, they talk about childbirth, they even talk about mental health issues now. But menopause was that one remaining area where, you know, it just wasn't being spoken about. And I think that's the real change that has happened in the past fortnight. And that's the really important and transformation that that we've seen. And now we need to just keep that conversation going. And, and you know, continue to provide the support and education for women that they need.
Claire
Yeah, I think you're right. I think menopause has been looked on as the end or the beginning of the end and there's been such a stigma around it because of that and women have such an issue it seems with ageing with all our focus on you know, anti wrinkle creams and injections and you know, not that there's a problem if you want to use or get any of those but we don't really welcome ageing. We tried to slow it down and menopause felt like the ultimate ageing ?
Sarah
Yea, I think that's really interesting. I think it's true. This is all about aging and how we feel about aging. And I think that's one of the biggest problems as we know particularly in terms of this perimenopause. And if you're in your early 40s Menopause is something you've associated with being over 50 So you when I mentioned that word to patients, they feel like I've added 10 years to their age, and and it makes them feel like they're old before their time. But I think if you're properly equipped with information, you can actually reach out for help in the early stages of your of your transition. So perhaps you're having like mild symptoms of hormone deficiency. You can have an awareness okay, this could be related to an hormone imbalance and I know where to go to seek advice on this and if necessary to get treatment and that's okay. What that does is in that restores you It restores your feeling good. And I think that's where Meg Matthews maybe is coming from, like the the treatment that she received, improved her symptoms she felt back to herself. And once you're back to yourself, you you know your quality of life is restored everything that wasn't working well in your life, whether it's you know, your relationships were beginning to suffer because you were irritable, you know, you had libido so that was making you feel you know, lacking in confidence. You were losing your train of thought at work. So, and you know, through brain fog and that was beginning to make you think, you know, am I too old, should I not doing this job or they're younger people who are better at this. So then you get your estrogen restored, you bounce back and you start to feel like you know what, I actually you know, am back to myself and I can do all these things I can manage my home life I can parent my kids in a, you know, a happier easier way. And I can do well at work. And it's basically just restoring confidence, because you're no longer suffering from the hurdle of trying to get over all these symptoms every day. And when you're back to yourself, you realize you know what, this is this is my time. And I can manage this in a healthy way and I can manage this transition. So you're empowered at that stage. You've come through a difficult experience, but you're now empowered. But what I would like to see going forward is that women would seek help earlier. And by doing that, they wouldn't have to suffer whether it's months or years. And it's not an understatement to say that you can literally lose years of your life, whether it's you know, 47 to 52 or 41 to 47 or even unfortunately for some women, right through their 40s and into their 50s. And by the time you come through that stage your confidence may be in your boots, you know, you may have you know, not gone for those promotions at work, you may have run into relationship difficulties. You may have lost friendships simply because you were just feeling awful in yourself. And so that's why I think just you know, knowledge really is power when it comes to this. And then also, it empowers you to seek help. And then the key part is to make sure that you're getting the help in the right place. And that has to be with someone who has, you know, a knowledge and expertise of that of this whole area of women's health.
Clare
Can we talk about HRT then because I think any woman will know that your monthly cycle can be a bit of a roller coaster with your hormones. So as you're going through perimenopause, and then menopause, does that stop that roller coaster? Do you need HRT because I always wonder, isn't it quite a natural progression for us to stop having these hormones and and stop being able to have children so why do we take synthetic hormones? How does that help us?
Sarah
Well, basically, it is a part of every woman's life and transition will vary from person to person. So some women will sail through this they will have no symptoms, they will wonder what all the fuss is about. Their periods might become a little bit irregular around their 50s and then stop and that's, you know, that's great for them. And for 80% of women you'll have mild to moderate symptoms. And for 25% of women, you'll have severe symptoms which are distressing. And those symptoms may occur at any age, as I said, like from you know, 38 or right up to your 50s so if it happens earlier, sort of under the age of 50, it's typically due to fluctuations in hormones. So your ovaries aren't producing as much estrogen, which is the female hormone as they would have previously so the levels are going up and down. And that can bring on all these symptoms. As you get closer to your actual menopause, which is where the periods stop, the hormone is typically falling, the estrogen hormone levels are falling. And that will then and cause you to have, you know, to have symptoms around that stage, but they may have started earlier during that fluctuating time. So what we're doing when we get paid to a tee is we're restoring your estrogen so we're giving you back estrogen. And the idea there is that if the symptoms you're having are due to a lack of estrogen, we get back estrogen and that helps improve the symptoms and generally women bounce back very quickly if they're getting the right preparation of hormones. At the right dose. That is something that's really important. Like this, this idea of HRT is not a one size fits all. It's an individualized treatment plan. So you know when you start it up, it's not a single tablet that that is gonna suit everybody so you will need to follow up. I typically bring people back six weeks after I start them on any treatment plan just to check in because if you're going to have side effects you may have well have them in those first six weeks. Now, you won't necessarily have your full improvement in that time, but we want to check in and make sure that you're not having any issues that might need tweaking. It's a bit like the birth control pill like one pill can see one person and another person will really you know, it really will not suit them. So there has to be, you know, an individual individualized treatment plan and you didn't follow up and then once you're you know sorted on it and once it's suiting you, then from there on and you know we'll be maybe a six monthly follow up after that and then often a one year follow up. But but but the key is that it is that individualized treatment plan for each woman,
Claire
I read one study that linked HRT to breast cancer. Have things changed since then even with HRT and and with the research and the knowledge that we have ?
Sarah
Yeah, definitely like the research and the knowledge that we have has totally changed. But one thing that hasn't changed, unfortunately is that everyone who comes through my door talking about HRT, the, you know, the concern about breast cancer risk comes up every time. Now fortunately, we have really good information to give women and you know, it's actually possible to give this in a couple of short sentences. But the bottom line is that breast cancer is common. It's going to affect about one in each of us. And but the good news is that if you're on on HRT under the age of 51, there is no increased risk of breast cancer at all. So that's just a very straightforward fact. If you've had a hysterectomy and you're on breast cancer and you're on HRT, there's no increased risk of breast cancer. And then if you're over the age of 51, and you use some of the newer preparations of progesterone, there's no increased risk of breast cancer for the first five years that you're on it. And after that there is a very, very tiny increased risk of breast cancer. And, that has to then be taken in the context of the often huge improvements in quality of life that women experience and also the bone and protective effects so you're protected against osteoporosis and also the protection against heart disease that you get from HRT. The other big thing about that I see with women using HRT, even when they've been on for longer than five years is that like it when you're feeling well, you make better food choices you make, you know, you exercise more, you tend to make better choices around alcohol use because you're actually feeling good. And then all these factors impact on your health as well. So, overall, I think we can safely say that like breast the breast cancer and risk needs to be discussed, but there is certainly really good evidence now that it is that it is something that needs to be you know, that needs to be put into context, but that shouldn't be an undue concern for women.
Claire
That's a really good point about when you feel healthy, you make healthier choices because that is so true. But it's worth arming yourself with the knowledge ?
Sarah
Yeah, and it's really interesting like the obesity side of things. I mean, it's really hard to lose weight. If you're feeling unwell if you're not sleeping all night. You know what you're really irritable or you're feeling really low, you know, you turn to conferences, but like when you're obese, the risk of breast cancer the number of cases per 1000 Women is increased by 24 whereas compared with HRT use the number is four. So you know there's so there's a really good argument to be made that you know, you should be making every effort to take a treatment that helps you make better choices around managing, you know, your lifestyle measures, whether it's diet or exercise, so So I do think it's important that that we kind of have an informed conversation about that.
Calire
Well, I think ladies let's focus on it as being the start of something exciting instead of the end of something and something to fear and dread. If you want to find out more. from Dr. Sarah Callahan. You can go to completewomen'shealth.ie Sarah, thank you so much for talking to me today.
Sarah
Thanks, Claire. My pleasure.
