‘Menopause that bit more difficult for rural women’

“It’s not necessarily easy for women in rural Ireland to access the menopause services they need. Many are working full time. They may be working all hours on farms and we all know that farm work doesn’t stop.”

That’s the perspective of Dr. Deirdre Forde, founder of Ceilé Medical in Athlone, Co. Westmeath, which incorporates a dedicated menopause clinic.

“Many rural women may not have access to their own transport and public transport to Dublin may not be either suitable or readily available. Quite frankly, many may not even want to travel to Dublin and that is perfectly OK too,” said Dr. Forde.

The midlands clinic, she said, has seen a huge increase in queries from women whose menopausal symptoms are being exacerbated by the stress associated with Covid-19.

The effects of stress are severely impacting women in menopause and perimenopause,” said Dr. Forde. She said that she is working additional hours to keep up with the increased demand for her online consultations.

“The remote consultations are, quite literally, a lifeline for women. I started them during the last lockdown and while I was very busy then, this time round is even busier. I think lockdown two is different, stress has built up and we’re months into the upheaval that Covid is causing. Many women are desperate for help with their menopausal symptoms,” she said.

“We know that stress is damaging at any time but anxiety is one of the symptoms of menopause and this is definitely heightened by stress.

Psychologically, the stress and anxiety of perimenopause and menopause can have a truly devastating effect on women. It’s seismic. There are 34 symptoms of menopause and they’re not pleasant.

“The sleeplessness alone takes an awful toll on women, especially if they have family and work commitments and it feeds into any anxiety they are experiencing so it is a horrible vicious cycle. It’s no surprise that in less enlightened times women felt they were going out of their minds, and worse, were treated as if they were,” Dr. Forde said.

“Covid has really thrown up all sorts of problems for women going through the varying stages of menopause. Many continue to juggle work, family and other commitments.

“Now there may be the huge impact of greatly reduced finances; entire families working from home perhaps; the fear of elderly loved ones contracting Covid; fear of the unknown; and the fact that everything, for all of us, is just that bit harder,” she said.

‘Totally overwhelmed’

“The carefree aspect of our lives is changed completely for now. We have to think ahead, we have to plan and we have to be on alert. And let me tell you if you’re suffering from ‘brain fog’, planning ahead is not that simple. It can have a crippling, paralysing effect and women going through the menopause just feel as if they can’t cope. They are totally overwhelmed.”

Dr. Forde said that she chose her midlands location as it is so accessible from all parts of the country. “We have excellent infrastructure here in the midlands and border so many counties.

“Information is key and is a kingpin of our mission statement here. When a woman wants a consultation via clinic/phone or video [Doxy.me], I send them lots of information in advance and this is crucial. They can take a breath and fill in the forms at their pace.

I send them all they need prior to the remote consultation, including symptom screening, an osteoporosis questionnaire and information on HRT products.

A reduced fee applies to medical card patients going through the menopause. “It’s another fact of life that women in lower socio economic circumstances don’t always have the same access of care and I am so determined that lack of funds doesn’t equate to lack of care here at Ceilé Medical,” Dr. Forde said.

“We are offering medical card patients online consultations for €45 as opposed to the usual fee of €100. This is making a huge difference to them and it’s so rewarding for me to know that I am a light at the end of what can be a very long and dark tunnel for them.

“Physical, emotional and mental health can suffer hugely if there isn’t a clinical and correct diagnosis of menopause,” said Dr. Forde.

“As a menopause specialist, I can give women all the information they need on treatments, new treatments, lifestyle, diet and exercise. These are the foundations. There are so many different stages of menopause and it is vital that women know the stages, the symptoms and steps they can take to alleviate them.”

Recalling her own experience of menopause, Dr. Forde said some of the physical and psychological symptoms were devastating.

Stigma

“Even though it was much less than 20 years ago, there was a huge absence of information, a huge taboo and stigma around menopause and I personally really suffered unnecessarily because of this. I went through menopause in my early 40s and was postmenopausal at the age of 48.”

The brain fog, she said, was horrendous. “It was like a withdrawal from an addiction if that makes sense and I will never forget the drenching day time and night time sweats. There was no let up, it was relentless. I was no longer able to wear make up as my skin was so wet and my showers had to be cold to cool me down.

“Even then, the drenching sweats were so bad, the salt from my sweat used to drip into my eyes. Winter time was like any other day. I would wear the lightest of clothes, I couldn’t tolerate wool or anything around my neck as I would feel that I was suffocating,” she said.

“At that time I was working as a senior medical officer with the HSE [Health Service Executive] and rolling out the swine flu vaccine in Kildare / west Wicklow and having morning meetings with management at 8:00am in a t-shirt and trousers, dripping in sweat. It was a truly horrible time, embarrassing and I wouldn’t wish it on any other woman,” Dr. Forde said.

“Eventually my GP gave me HRT but I needed to see a gynaecologist due to severe bleeding caused by Adenomyosis in my uterus but being fed by my oestrogen. He told me that as I was post menopausal, to come off the HRT as that was feeding the bleeding but that if I was still having periods and finished having a family, that the only treatment was a hysterectomy.

“He refused to carry out a hysterectomy, and I had to seek a second opinion to have the surgery. I then realised that I was post menopausal at only 48 years old. Had there been more information on menopause then my treatment would have been vastly different and far more suitable to my physical make up,” she said.

“There is a huge amount of misconception around menopause. We in Ireland are finally beginning to talk about it, open up to it and embrace it. It’s a part of life, a huge part and I love how in Japan, for instance, it is literally known as the ‘second spring’; I think that’s lovely, it speaks of renewal and a new coming of being. Menopause doesn’t have to be miserable.”