We have 2 Clinic locations in Co Westmeath:

The Main Clinic is located at  3 Townhouse Centre, St Marys Square, Athlone Co Westmeath  N37P2P2

There is car parking right in front of the Clinic but remember to pay for your parking.

Ceile Medical 1 (Athlone) is open Monday, Wednesday afternoon & Friday

Ceile Medical 2 is located in  Kilbeggan on Relic Road  within a minutes drive from the new  Primary Care Centre which has recently opened. Cooney's Pharmacy is located at the Primary Care Centre. Free parking is available. The location is easily accessible from the M6 Exit 5.

Appointments for Ceile Medical 2 are also available for  In-Clinic (Face to Face)   as well as Video.  Ceile Medical 2  is open on Tuesdays and Thursdays (10am-5pm) and Wednesdays (10am -1pm)

INITIAL CONSULTATION- WHAT TO EXPECT

Fee is €195 (from 1/2/24) with a BOOKING DEPOSIT of €50 which is NON-REFUNDABLE but can be used to RE-BOOK another appointment provided you give 48 hours advance notice.

If you fail to cancel your appointment or fail to attend your scheduled appointment, you will lose your deposit.

You will be offered a CLINIC/VIDEO/PHONE or WHAT'S APP appointment. You can decide what suits you. Forms will be emailed to you in advance- CONSENT/SYMPTOM CHECKER/OSTEOPOROSIS QUESTIONNAIRE.

VIDEO APPOINTMENTS are via DOXY which is a secure medical platform and GDPR compliant. It is not possible to record Consultations so your data is secure. A link will be sent to your email on the day of your appointment.

ONLINE BOOKING

Irregularities in your menstrual cycle can happen any time through life for a bunch of different reasons. However, if you are in your 40s and notice irregularities in the pattern of your usual menstrual cycle, this could be one of the first signs of menopause. The reason is the declining levels of oestrogen and progesterone in the body, which can cause your periods to become more frequent or more spaced out, and also present itself as changes in period flow.

Anxiety

Dopamine and serotonin are neurotransmitters that play a crucial role in regulating mood. A decline in oestrogen levels during menopause can interfere with the production of these neurotransmitters, which can lead to anxiety. If you notice you can’t seem to relax or find calm, it’s best to talk to your medical professional. You can also add deep breathing exercises to your daily regimen, as it is one of the most researched interventions to help with menopausal symptoms.

Panic Disorder

For some women, imbalances in hormones during menopause can manifest as panic disorder as well. You may notice debilitating emotional episodes that come out of nowhere, accompanied by rapid heartbeat, irrational feelings of dread, anger and sadness, extreme terror and shallow breathing

Night Sweats & Hot Flushes

Are your hot flashes more frequent during the night? If you wake up sweating profusely and feeling extremely hot in the middle of the night, these hot flashes are called night sweats. They can interfere with your sleeping pattern, adding to stress and fatigue during daytime. Caused by the same hormonal imbalance, night sweats can be improved by wearing airy cotton pyjamas and changing bed linen to cotton.

 Fatigue

Feeling sluggish and tired all the time? If you feel fatigued despite spending 8 hours in bed every night, this could be another symptom of menopause. Menopause-related fatigue can affect productivity, sleep quality and mood, increasing your stress levels.

 Lapses in Memory

If you notice yourself becoming more forgetful, this could be another temporary sign of menopause. Diminishing levels of oestrogen and progesterone can result in memory loss as well as foggy thinking. Also, the additional fatigue brought on by menopause doesn’t help. Most women find that their memory improves as they transition completely into menopause.

 Inability to Focus

Along with memory lapses, fluctuating hormone levels can also cause difficulty in concentrating or focusing during menopause. You will likely notice these symptoms during the early phases of perimenopause. However, poor sleep and mood swings can also be contributing factors.

Mood Swings & Depression

As with PMS, menopause comes with its own set of mood swings. Fluctuating levels of sex hormones affect neurotransmitters in the brain – like serotonin and GABA, making you more irritable. Your mood swings could become more frequent as hormones are out of balance, adding to your stress levels

As progesterone and oestrogen levels fall during menopause, these hormonal changes bring with them a myriad of unpleasant side effects, which can negatively impact quality of life for some women. Add to that anxiety, mood swings, sleep disturbances and fatigue. This makes many menopausal women more susceptible to depression. Therapy and alternative treatments can help improve quality of life, treating depression in the process.

Insomnia

Menopause related insomnia is usually a direct effect of hot flashes, night sweats, panic disorder or anxiety. However, low levels of progesterone can also contribute to poor sleep, even when you don’t experience night sweats or anxiety. Many menopausal women report an inability to fall asleep after retiring to bed or waking up at 3 or 4 am in the morning and then being unable to go back to sleep. These disturbances are caused by the way that falling oestrogen and progesterone affect the hormone adrenaline.

Many women experiencing menopause report sleep-related disturbances as a symptom. This could be night sweats, insomnia, sleep-disordered breathing or a sense of anxiety, all of which disrupt a healthy sleep pattern.

 Vaginal Dryness

The natural decline in oestrogen levels during menopause can make vaginal tissue become dryer and thinner. This vaginal dryness the tissue becomes more easily irritated and more susceptible to infections as well.

 Loss of Libido

Changing hormone levels can decrease sex drive. For some women, this can be caused by vaginal dryness, as sex becomes painful. However, the primary reason behind low libido is declining levels of sex hormones.

 Frequent UTIs are another sign of menopause. As vaginal tissue becomes dryer and thinner, it becomes more susceptible to bacterial infections. Weakening of vaginal walls with waning levels of oestrogen allows bacteria easier access to the bladder, leading to urinary tract infections that could affect the bladder. The ureters and kidney too can be affected at times. Many women also experience both Stress & Urge Incontinence meaning that they leak urine.

 Frequent Headaches

Many menopausal women experience frequent headaches, which are linked to waning levels of oestrogen. These headaches might be mild to begin with, but can become more intense as hormone levels continue to drop with advancing menopause.

Thinning of Hair & Brittle Nails

Low levels of oestrogen can cause more hair to fall and also lead to thinning of hair. Healthy hair follicles need oestrogen for growth. So when levels of oestrogen start to deteriorate, your hair tends to become dryer, brittle and susceptible to breakage.

Oestrogen is vital not just for the health of your hair but also nails. Low levels can cause brittle nails as they become weaker and dryer. It is best to keep your nails short and use a hand cream regularly.

Weight Gain

Menopause related weight gain can come on suddenly and surprise many women. Hormonal imbalances can lead to unexplained weight gain as well as loss of muscle mass. Many women notice this weight gain around the belly. This is why a healthy diet and regular exercise plan are very important for menopausal women. Researchers have found that eating the right diet and getting the right amount of moderate exercise seems to help this problem better than crash dieting and intensive exercise that many women resort to, at this age. The sudden weight gain often scares women into going overboard, especially on exercise, and this can worsen the situation.

 Muscle Tightness & Joint Pain

Menopause can also be the reason behind muscle tension. Changing hormone levels can cause muscles in the back, neck and shoulders to tighten or strain. You may also experience muscle stiffness, soreness and aches throughout your body.

Declining oestrogen levels during menopause can contribute to joint pain. It is known to most women that menopause can lead to weaker bones due to declining bone density. This is often due to lower levels of oestrogen. The lowered bone mass and density when combined with muscle tightness and increased inflammation, can lead to serious joint pains. Many menopausal women complain of tightness in hips, soreness in knees, and joint swelling or fingers and toes.

 Digestive Issues & Allergies

Oestrogen and cortisol levels go hand in hand. Lower oestrogen lowers the buffer against the stress hormones of cortisol and adrenaline. Higher levels of cortisol in the blood signal to the brain that you are in danger, leading to non-essential functions like digestion being temporarily stopped, upsetting your digestive routine. You could experience abdominal pain or discomfort, constipation, bloating and other digestive problems while your hormones are out of balance.

Suddenly find yourself sniffling in the allergy season? Hormonal fluctuations can weaken your immune system, making you more prone to seasonal allergies. From sinus infections to rashes, itchy eyes, swelling and sneezing, menopause can exacerbate allergy symptoms.

 Dizzy Spells

Fluctuating hormone levels can also cause dizziness. These spells come suddenly and could pass in a few minutes or even become extended. If you are feeling more dizzy than usual, be aware of the risk of falling or accidents when driving or operating machinery. Avoid bending down or rising suddenly, since this period of life is associated with orthostatic hypotension or low blood pressure caused by sudden changes in posture.

Tingling Sensation

Many women going through menopause notice a sensation of tingling, burning or numbness in their extremities – fingers, toes, feet, hands, arms and legs.

Electric Shock Sensation

Suddenly felt like an electric shock went through your body? A sensation very similar to that of a rubber band snapping between muscle and skin can occur just before a hot flash. Though brief, these can be quite unpleasant and can warn you of an impending hot flash.

Sensation of a Burning Tongue

Fluctuations in oestrogen levels can cause a sensation of burning in the tongue, gums, lips or inner cheek. You may also notice pain or a metallic taste in the mouth throughout menopause.

Body Odour Changes

If you experience frequent hot flashes, chances are that you’ve noticed changes in your body odour. Menopause can affect a woman’s natural scent. Excessive sweating can lead to bad body odour, making good personal hygiene extremely important.

Itchiness

With age and changing hormone levels, collagen production slows down. As collagen is crucial for maintaining moisture and elasticity in skin, menopausal women may experience more skin dryness, irritation and itchiness.

Irregular Heartbeat

Falling oestrogen levels can sometimes overstimulate the circulatory and nervous systems. This may cause irregular heartbeat, heart palpitations and/or arrhythmia.

Breast Pain

 Fluctuating hormone levels can cause breast tenderness and soreness, and these same fluctuations can also cause breast pain during menopause. You may experience pain or soreness that is unpredictable and unrelated to menstrual cycle.

MENOPAUSE, also referred to as ‘the change’, happens when your periods stop permanently — signalling the end of reproductive function. Natural menopause usually happens when you reach your 50s (the average age is 51 in the UK). But some women may experience menopause much earlier (10% have early menopause between 40-45 and 1-2% have premature menopause before 40). Some women experience abrupt menopause due to medical interventions such as chemotherapy, radiotherapy or surgical removal of ovaries as part of medical treatments.

Natural menopause is a phase of physiological transition in midlife. Sometimes this change can be associated with distressing symptoms and they may last for a few months or sometimes several years. Treatment options for menopausal symptoms include lifestyle changes, alternative therapies, non-hormonal medications and hormone replacement therapy (HRT). You can decide whether to take HRT or not after considering its benefits versus risks in your unique situation

What changes or symptoms happen in the menopause and when is HRT needed?

As you approach menopause, the functioning of your ovaries reduces, and your body makes less of two hormones called ‘oestrogen’ and ‘progesterone’. Among other things, these hormones are responsible for bringing on your periods. You may notice your periods become less regular. They might be heavier or lighter and last for more or fewer days than usual. Your periods will become less frequent with time and eventually stop.

You may notice ‘hot flushes’ as you go through menopause (where you suddenly feel hot and go red in the face). This may be associated with bouts of sweating during the day as well as at night. It is also common to find that your vagina feels dry and uncomfortable, which may make sex painful. 

You may also experience: 

·      Tiredness

·      Irritability

·      Brain fog

·      Joint aches

·      Trouble sleeping

·      Depression

·      Weight gain 

·      Less interest in sex

These symptoms can be attributable to the changes in your hormones or to the changes in your life around the time of menopause. 

Not everyone experiences distressing menopausal symptoms and needs treatment. Some women find the symptoms do not bother them much, while others find them very distressing, and they negatively affect their quality of life. For most, the symptoms will pass within three to five years, although vaginal dryness is likely to get worse if not treated. For others, symptoms will persist for 15 years or longer.

What is HRT?

HRT stands for hormone replacement therapy. It is also abbreviated as MHT for menopausal hormone therapy. It consists of the hormone oestrogen either alone or combined with the other hormone progesterone. The aim is to replace some of the oestrogen that your body stops making when you reach menopause. Some women are also prescribed testosterone in addition depending on their symptoms.

What are the types of HRT?

Combined HRT (oestrogen and progesterone) is prescribed if you still have your womb. Taking oestrogen alone can increase your chance of getting cancer of the womb lining (endometrial cancer). Adding progesterone to oestrogen reduces the chance of getting this kind of cancer. 

Oestrogen only (no progesterone) is prescribed when you have had a hysterectomy or have a Mirena Coil. This is because you do not need progesterone to protect the lining of the womb (there are few exceptions such as severe endometriosis, endometrial cancer or symptoms specifically responsive to progesterone). You can take oestrogen-only HRT as there is no chance of getting endometrial cancer. 

This can be given in two ways:

1.      Continuous combined HRT — oestrogen and progesterone, taken together daily for 28 days. This means that there will be no monthly withdrawal bleeds.

2.      Sequential HRT — oestrogen only for the first 14 days then both hormones for the second 14 days. This usually results in monthly withdrawal bleeds as it tries to copy your natural cycle and give you a period.

Cyclical HRT is often prescribed for women who have menopausal symptoms but are still having periods or for those who stopped their periods less than one year ago.

Continuous HRT (without bleeds) is more suitable if you have not had periods for more than one year.

HRT is available for prescription in several different forms. You can take it as:

·      Skin patch 

·      Oral tablets

·      Capsules

·      Gel

·      Spray

·      Vaginal ring 

·      Progestogen-releasing uterine coil

·      Vaginal cream

·      Pessaries

Some types work best for certain symptoms.

 As transdermal oestrogen (patch/gel/spray) is associated with a lower risk of blood clotting than oral HRT, a transdermal route may be preferable for some women. This route is advantageous for women with diabetes,high blood pressure, high BMI and other cardiovascular risk factors, especially if you are over 60.

Progesterone types can vary in HRT. Body-identical or body-similar versions such as micronised natural progesterone or dydrogesterone appear to be safer than synthetic versions. Vaginal oestrogen creams or pessaries do not carry the same risks associated with oral or transdermal HRT. As the dose of oestrogen is low, they do not require the protective effect of progesterone. 

What are the benefits of HRT and how long after starting HRT do you feel a difference in symptoms?

For most symptomatic women, the benefits of the use of HRT outweigh the risks.

Benefits of HRT include:

·      Reduction in vasomotor symptoms such as hot flushes and night sweats — HRT is the most effective treatment for reducing vasomotor symptoms. These usually improve within three to four weeks of starting treatment and maximal benefit is gained by about three to six months.

·      Improvement in quality of life — HRT may improve sleep, muscle aches/pains and your overall quality of life. Many women experience improved mood, less brain fog, better libido and less depressive symptoms.

·      Improvement of urogenital symptoms — HRT significantly improves vaginal dryness and sexual function. HRT is also effective in improving stress incontinence (leaking urine when you cough or sneeze). It can also relieve the symptoms of urinary frequency and prevent frequent urinary infections, as it has some effect on the urinary bladder and urethral tissues. Vaginal oestrogen creams or pessaries are the preparations of choice for urogenital symptoms.

·      Reduction in Osteoporosis  (brittle bones) risk — HRT is effective in preserving bone mineral density. Women taking HRT have a significantly decreased incidence of fractures with long-term use. Although bone density declines after discontinuation of HRT, some studies have demonstrated that women who take HRT for a few years around the time of menopause may have a long-term bone protective effect for many years after stopping HRT.

·      Reduction in cardiovascular disease — The effect of HRT on cardiovascular disease depends on the timing and duration of HRT as well as pre-existing cardiovascular disease. HRT reduces the incidence of coronary heart disease if it is started within ten years of menopause.

Other benefits

HRT has a protective effect against connective tissue loss in tissues such as skin, bones, joints and mucous membranes. Some studies have shown that HRT has benefits for metabolic health and it may reduce the risk of diabetes for some women. 

There may be a possible reduction in the long-term risk of cognitive decline in specific groups of women who take HRT (for example those with certain genetic markers).

There is a need for further robust research to confirm these findings. Studies have demonstrated a reduction in the risk of colorectal cancer with the use of combined HRT.

Can you take HRT for the rest of your life?

There is no maximum duration of time you can take HRT. For the women who continue to have symptoms, their benefits from HRT usually outweigh any risks. As long as women have an annual review of their HRT with their healthcare professional and the benefits outweigh the risks — they can continue with HRT.

Most women aim to stop taking HRT after their menopausal symptoms diminish, which is usually three to five years after they start. However, for many, symptoms may continue longer for 10 years or beyond and take HRT for life.

 If a decision is made to stop, gradually decreasing your HRT dose is usually recommended — rather than stopping suddenly. You may have a relapse of menopausal symptoms after you stop HRT, but these should pass within a few months. 

If you have symptoms that persist for several months after you stop HRT, or if you have particularly severe symptoms, HRT may need to be restarted, usually at a lower dose. After you have stopped HRT, you may need additional treatment for vaginal dryness and the prevention of Osteoporosis

What are the risks associated with HRT?

Like other medications, there are side effects and risks associated with taking HRT. For most women, the increased risks are very small, but talk to us to weigh up the risks and benefits for you as an individual. 

Doctors are advised that women should take the lowest effective dose of HRT that controls their symptoms effectively. There is limited data on the use of HRT in women after 75.

Large studies such as the Women’s Health Initiative (WHI) and the Million Women Study (MWS) caused concerns and controversy over the use of HRT when their findings were published 20 years ago.

However, reanalysis of some of that data and findings from recent studies over the past decade have shown that in women who need treatment of menopausal symptoms — initiating HRT during perimenopause or early menopause will provide a favourable benefit-to-risk ratio.

Venous thromboembolism

Oral HRT (combined oestrogen and progesterone or oestrogen only) slightly increases the risk of venous thromboembolism (VTE – venous blood clots), pulmonary embolism (blood clot in lungs) and stroke. The risk of VTE is increased two to three times with oral HRT. In one big study, over five years, less than 1 in 100 women taking oral HRT got a blood clot in their lungs. But this was about twice the number of women who were not taking HRT. If you've had blood clots before, you should let your doctor know and talk about whether oral HRT is suitable for you. 

Overall, the risk of blood clotting with oral HRT is a lot lower than taking the contraceptive pill or risk during pregnancy. The risk increases with age (mainly over 60) and with other risk factors such as obesity, previous thromboembolic disease, smoking and immobility. In healthy women below 60, the absolute risk of VTE is low and mortality risks from VTE are low. The type, dose and delivery system of both oestrogen and progesterone influence the risk of thromboembolic disease. 

The VTE risk appears to be higher among users of oestrogen plus progesterone than among users of oestrogen alone. The risk is increased especially during the first year of treatment. Previous users of HRT have a similar risk as never users. 

Transdermal oestrogens and oral natural micronised progesterone or Mirena coil are thought to be safer concerning thrombotic risk as they do not seem to increase the risk of blood clotting above the background risk.

Stroke

The risk of stroke appears to be slightly increased when taking oral oestrogen-only or combined HRT although the absolute risk is very small below the age of 60. Transdermal oestrogen again seems to be safer. The effects of HRT on stroke may be dose-related and so the lowest effective dose is usually prescribed in women who have significant risk factors for stroke.

Breast cancer

Data regarding the true effect of HRT on the incidence of breast cancer are still contentious.

Combined HRT slightly increases the risk of breast cancer, The risk is a little higher for women who take HRT over the age of 60. The risk goes up slowly in the first five years you use HRT, then more quickly if you continue using it afterwards. However, the absolute risk is small at around one extra case of breast cancer per 1,000 women per year. 

Lifestyle factors such as smoking, excess alcohol intake and obesity have a similar or greater impact on breast cancer risk as compared to HRT. Mortality from breast cancer is not significantly increased in HRT users. Breast cancers found in women who take HRT are easier to treat than those in women not on HRT. 

The risk of breast cancer with oestrogen-only HRT is far less than with combined HRT. Most studies do not demonstrate an increased risk of breast cancer in women taking oestrogen-only HRT and some studies have shown a reduced risk.

It is also important to understand that the small increased risk of breast cancer with combined HRT does not apply to women who only use vaginal oestrogen and women who take HRT for early or premature menopause until the age of 51 years.

Endometrial cancer (Uterine cancer)

Oestrogen-only HRT substantially increases the risk of endometrial cancer in women with a womb (uterus). The use of continuous combined HRT (both oestrogen + progesterone) or cyclical progesterone for at least twelve days every month almost eliminates this risk. If higher than recommended (unlicensed) doses of oestrogen doses are used as part of HRT, these need to be balanced adequately with more progesterone doses.

Heart disease

Women who are over 60, start HRT more than 10 years after menopause and have cardiovascular risk factors may have an increased risk of heart disease.

But the risk is small and overall, no increase in serious morbidity or mortality attributable to heart disease is noted when transdermal and body-identical HRT preparations are offered. The data are limited and the decision to start HRT after 60 should be based on individual benefits versus risks assessment.

Other risks

There is a chance that taking HRT for a year or more could increase your risk of gallbladder disease (gallstones). Current data on HRT and the risk of ovarian cancer are conflicting. Some observational research suggests that HRT may slightly increase your chance of getting some types of ovarian tumours, although the risk seems to disappear when you stop using HRT.

What are the common side effects of HRT and how can they be minimised? 

Women react differently to HRT, so there is no one preparation that is better than any of the others. 

Some of the common side effects which you may experience on HRT include:

·      Oestrogen-related — breast tenderness, leg cramps, skin irritation, bloating, indigestion, nausea and headaches.

·      Progesterone-related — premenstrual syndrome-like symptoms, fluid retention, acne, oily skin, breast tenderness, backache, depression, mood swings and pelvic pain.

Nausea can be reduced by taking the HRT tablet at night with food instead of in the morning or by changing from tablets to another type of HRT.

Does HRT cause weight gain?

There is no evidence of weight gain with HRT. Researchers have found that, although women may put on some weight when they first start to take HRT (mainly due to fluid retention), after a while their weight is the same as it was before treatment. 

Women also tend to gain weight during the menopause, so any weight gain may not be a result of HRT. Your body’s fat distribution changes, with an increase in fat around the waist and less around the hips and buttocks. You can also experience water retention when on HRT.

Many of these common side effects simply go away when you have been on HRT for a while. Sometimes a change of product helps.

Monthly sequential preparations should produce regular, predictable and acceptable period-like bleeds. Erratic breakthrough bleeding is common in the first 3-6 months of continuous combined and long-cycle HRT regimens (with no regular period-like bleeds).

If bleeding tends to be heavy or irregular on sequential combined HRT then the dose of progesterone can be doubled or increased in duration to 21 days. If there is persistent irregular vaginal bleeding after six months of starting HRT, you will need to have further investigations and possibly a change of progesterone type or dose.

 If you experience predominantly progesterone-induced side effects, you can change the progesterone type, dose or frequency. 

If you experience significant nausea or migraine headaches with oral preparations, patches can often be a better option. Avoiding cyclical bleeds may also help with migraines. Progesterone-related side effects can sometimes be minimised if the Mirena coil is used as the progesterone arm of HRT.

When should HRT not be taken?

HRT is usually not prescribed in certain conditions such as:

·      Pregnancy and breast-feeding

·      Undiagnosed abnormal vaginal bleeding

·      Venous thromboembolic disease

·      Active heart disease

·      Current or past breast cancer 

·      Current or past endometrial cancer

·      Other oestrogen-dependent cancers 

·      Active liver disease 

Women who would like to consider HRT but have one of these conditions should seek specialist advice and they may be able to have HRT after input from relevant specialists alongside medications to treat the underlying condition



What tests are needed before or after starting hormone replacement therapy?

When you start HRT, the doctor or nurse will discuss your age, symptoms and medical conditions before looking at the risks and benefits of HRT which are specific to you. These can change and will be discussed in your yearly reviews. 

Tests are usually not necessary before starting HRT unless there is a sudden change in menstrual pattern such as persistent heavy/irregular periods, bleeding between periods or after intercourse and postmenopausal bleeding. In these situations, you will be asked to have a pelvic ultrasound to assess the lining of the womb and a biopsy of the womb lining may be performed. 

If there is a personal or family history of VTE, a thrombophilia screen (blood test to look for a tendency to develop blood clots easily) may be helpful. If there is a high risk of breast cancer, you will be asked to consider a mammography or MRI scan and referred to familial breast cancer services depending on the level of your risk. A blood test for lipid and glucose profile will be requested if you have risk factors associated with cardiovascular disease.

How to decide which preparation of HRT to start with - cyclical or continuous and systemic or local?

The choice of delivery route and type of HRT depends on your preference but there are advantages to certain delivery routes. It is recommended that you are prescribed sequential combined HRT (giving monthly periods) if your last menstrual period was less than one year ago. 

You can be prescribed continuous combined HRT (without periods) if you have received sequential combined HRT for at least one year, or if it has been at least one year since your last menstrual period. Local preparations such as vaginal creams and pessaries are highly effective for symptoms of vaginal dryness, painful sex and urinary frequency.

Around 10%-20% of women still have persistent symptoms with local oestrogen so they will require systemic HRT in addition

Is HRT a contraceptive?

HRT is not a contraceptive.

You may be potentially fertile for up to two years after your last menstrual period if you are under 50 years of age and for one year if you are over 50 years.

 You should therefore use appropriate contraception during this time to avoid pregnancy. A progesterone-only pill alongside combined HRT or Mirena coil with oestrogen are common ways of having both HRT and contraception.

What are the signs that HRT is not working?

Getting the right dose and combination of hormones to work for menopausal symptoms can take time.

 If your symptoms do not improve or persist despite taking HRT for more than 2-3 months or if you experience significant side effects, a change of dose or type of HRT is needed.

This is because the absorption of hormones from different HRT preparations may vary between individuals. Sometimes, your doctor may consider a blood test for oestrogen levels to assess this

What is the role of testosterone in HRT?

Testosterone levels drop gradually during natural menopausal transition (it is produced by both ovaries and adrenal glands in the body).

 Some women experience a persistent lack of libido despite taking HRT containing oestrogen. Testosterone can help in this situation. Some women notice improved energy levels, better mood and less brain fogging on testosterone however more research is needed to confirm these benefits.

 Testosterone is used in small doses and usually does not cause side effects. Excessive use can cause oily skin, excess body hair, scalp hair loss and deepening of voice

What is ‘bio-identical’ or ‘body-identical’ HRT?

Most commercially available combined HRT preparations contain progestogens — compounds which have progesterone-like actions but are synthetic.

Micronised progesterone is natural progesterone devoid of any androgenic as well as glucocorticoid activities and is considered safer than synthetic progestogens. 

This combined with 17-beta oestradiol is regulated body-identical HRT & are the components of prescription HRT

Bio-identical HRT refers to compounded HRT preparations which are combinations of plant oestrogens and progesterone-like compounds. These are currently not recommended in the UK by the British Menopause Society as long-term safety data is lacking for many of these.

What are the alternatives to HRT?

Whether you take HRT or decide not to take it, a healthy diet, good sleep hygiene, regular exercise in some form and stress reduction activities are key for good long-term health.

If you are unable to have HRT, other medications or treatments may be prescribed to help control unpleasant menopausal symptoms. For vaginal dryness and painful sex, vaginal lubricants and moisturisers are often effective.

For hot flushes and night sweats, antidepressants or selective noradrenaline and serotonin reuptake inhibitors such as Venlafaxine, Gabapentin and Clonidine (blood pressure lowering agent) are oral medications which are most prescribed.

They can be effective for some but do have side effects such as dizziness, dry mouth, low libido and constipation. CBT (cognitive behavioural therapy) can be effective for vasomotor, sleep and mood-related symptoms.

Alternative therapies including homeopathy, hypnotherapy and acupuncture are also offered at specialist clinics although the evidence base for these remains weak

Is a follow-up needed after starting HRT?

You will generally be asked to come for a follow-up consultation after starting HRT in about three months

Most symptoms are likely to have responded to oestrogen at this time, and any residual symptoms may require adjustment of treatment.

 If the chosen HRT suits you and appears effective, you may wish to see your GP or the specialist clinic once or twice every year to review the ongoing need for and safety of continuing HRT.

 Regular blood pressure monitoring is recommended at follow-up visits. Both mammograms and cervical screening as per national guidelines are recommended in postmenopausal women on HRT



We are expanding our Services

PRESCRIPTION REQUESTS

Please Phone Reception to request your Prescription. Requests via email are no longer accepted.

Script Fee €30 and must be paid at time of Request

Once payment is made, your script will be issued to your Pharmacy with an email copy to you for information

Links for useful information

MENOPAUSE & MENTAL HEALTH

https://www.hse.ie/eng/services/list/4/mental-health-services/mental-health-engagement-and-recovery/resources-information-and-publications/menopause-mental-health-report.pdf

MENOPAUSE & GENITOURINARY HEALTH

https://my.clevelandclinic.org/health/diseases/15500-vaginal-atrophy

MENOPAUSE & BRAIN HEALTH

https://www.healthline.com/nutrition/vitamins-for-brain-fog

https://www.ncoa.org/article/how-to-handle-menopause-brain-fog

MENOPAUSE & USEFUL EXERCISES

https://www.bupa.co.uk/newsroom/ourviews/menopause-exercise

Wellness Warrior & Dr Deirdre Forde

https://youtu.be/LjvodeaRYD4

Good Morning American with Halle Berry, Dr Pauline Maki and Menopause

https://m.youtube.com/watch?v=ugO0CO2yD7U