‘There’s too much talk about menopause? We’re just making up for the last 20 goddamn years when women suffered in silence’

In May 2021, RTÉ’s Joe Duffy devoted 10 days of his radio show Liveline to the subject of menopause. Dr Deirdre Lundy, one of this country’s foremost medical experts on the subject, was on a hike in Co Wicklow with friends when she started getting text messages about the show. They were alerting her to the unprecedented outpouring of women’s stories regarding this transitional time in their lives, sometimes referred to as “the change”.

Lundy’s name had come up several times in the radio conversations. “My immediate thought was, Oh no! because I have no filter and that can get me into trouble quite frequently,” laughs the author of a new book, The Menopause.

Then she listened back to the programme. A dedicated menopause phone line had been set up by Liveline to capture women’s experiences. Callers explained how they were completely unprepared for the symptoms that occurred due to menopause, a time when women’s periods become more erratic and eventually grind to a halt. They spoke of finding it difficult to access helpful information. Many were not happy with the support from their GPs: one menopausal woman had been told she was suffering from depression. Another that she was having a nervous breakdown. A woman who presented with menopause symptoms was advised to stop drinking coffee. Others told stories of GPs refusing to prescribe hormone replacement therapy (HRT). In many cases the women felt overlooked and sidelined by their medical professionals, reduced to helpless bystanders when it came to their hormones and their bodies.

[ Half of women in menopause describe it as ‘negative experience’, research finds ]

Some of these women also mentioned that, in happier news, they had been given sound advice and got good results when they went to see Lundy in her private clinic in Bray. On hearing this, Lundy got in touch with the programme herself to offer her expertise and also, she says, to correct some inaccuracies she had heard on air about menopause. For a couple of days she found herself fielding queries from women about her specialist subject live on national radio.

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On the final day of their menopause marathon, Joe Duffy’s team invited her into the radio studio to address yet another mountain of menopause queries. “I didn’t realise what an honour it was. Joe rarely invites people in as it’s mostly a phone-in show.” The straight-talking, American-born doctor, who works part-time in the recently established menopause clinic at the National Maternity Hospital, is full of praise for Duffy for giving menopausal women a platform and keeping the conversation active as long as he did. “The Gaza Strip had been invaded, there was a lot happening elsewhere, but he just kept it going.”

There was plenty to discuss as the floodgates opened on Irish women’s menopause journeys, from hot flushes and hormone treatment to painful sex and heavy periods. As Jennifer O’Connell wrote in this newspaper at the time, summarising the issues women were talking to Joe about on Liveline: “Hot flushes, tinnitus, mysterious body pains, joint aches, sore feet, migraines, vertigo, brain fog, forgetfulness, anxiety, digestive issues, insomnia, exhaustion, depression, apathy, isolation, loneliness, cognitive issues, weight gain, lack of sex drive, even suicidal ideation. One woman likened herself to a slow puncture. One felt as though she hit a brick wall. Another said it was like being hit by an exploding bomb. Callers said they knew something was wrong, they just never associated it with menopause. Many had never heard of perimenopause, the years leading up to menopause in which many punishing symptoms come crashing into women’s lives.”

Liveline was followed by an RTÉ TV documentary The Change: Ireland’s Menopause Story. These media moments felt like “turning points” to Lundy and to Irish publishers, several of whom got in touch to ask Lundy to write about it. An extremely busy medical professional, she baulked at the idea at first. Gradually, she was persuaded that her menopause expertise could be helpful if collected in a book.

The Menopause is a no-nonsense, practical guide, packed with everything you ever wanted to know about the menopause - and some things that you maybe didn’t (hello there, vaginal decay)

As a child, Lundy spent many summers in Ireland and always knew she wanted to be a doctor. Highly motivated and keen to escape her “circus” (she uses the word fondly) of an Irish-American family on New York’s Long Island, she was delighted to learn that studying medicine in Ireland would be cheaper. Later she discovered that without the Leaving Cert, she would still have to pay foreign student fees, even with her dual citizenship. So she came to Ireland alone at 15 and did her Leaving Cert at Alexandra College, “scraping” enough points to do medicine at UCD.

Her interest in menopause came in the 1990s, after many years working with the Irish Family Planning Association. “I began to notice a lot of women coming to me in midlife, really struggling with symptoms. I started to do some reading.” She was aware of a doctor working in the Rotunda Hospital who was offering menopause advice. “So I just knocked on his door one day, told him I was seeing all these women and I didn’t know what to do with them.” From her own research and shadowing the doctor in the Rotunda, she began to understand that menopause care was “actually not that difficult, and yet it’s done so badly all over the world. I sort of evolved into menopause.”

[ The menopause and how it affects ‘your brain, your skin, your heart’ ]

When she moved into a shared private clinic, Bray Women’s Health Centre, near her home in Shankill, Co Dublin, she began focusing even more on menopause, helping women who were experiencing debilitating symptoms. She now works part-time in the National Maternity Hospital on Holles Street, where she leads one of six newly established menopause clinics around the country, services funded by the Department of Health and the HSE’s National Women & Infants Health Programme.

Writing the book wasn’t easy, she says. “It was a freaking nightmare. It’s hard to write a book.” The result was worth all the pain. The Menopause is a no-nonsense, practical guide, packed with everything you ever wanted to know about the menopause – and some things that you maybe didn’t (hello there, vaginal decay). While it is dense in parts and exhaustive on the medical technicalities, symptoms and challenges of menopause, it is also candid and breezy about women’s experiences. “Does everyone have a horrible menopause transition? No. Does everyone need HRT? Again, no,” Lundy writes. There are chapters about early menopause, which affects some women, and about dealing with conditions such as endometriosis or diabetes while menopausal. Lundy also explores the menopause experience for trans people.

During those days of menopause revelations on Liveline, one concerned farmer rang in to talk about his wife. “He said he always listened to Joe Duffy when he was ploughing. And he told his wife, ‘I think this is what’s happening to you’ … I actually was in tears listening”

—  Deirdre Lundy

While most women will experience menopause by the age of 51 or 52, and 75 per cent of women will have symptoms of some kind, every woman’s experience is different. Lundy’s own menopause was difficult. It’s telling that despite being a doctor, she was not aware that her symptoms – crushing anxiety for one – were menopause related. Where is she with the menopause now? “I’m kind of finished,” she says. “I still use some hormones, for my own purposes, but I’m 62. At this stage, most of the crap is over.” Except, she adds, for a bit of menopause-related brain-fog: “Seriously, at this point, if I don’t write it down, it never happened.”

She hopes menopause becomes as normalised in conversation as periods are now. “We used to not talk about periods because it was embarrassing, but who decided it was embarrassing?” she wonders. “Life as we know it comes from our menstrual cycle and so it should be celebrated and welcomed ... periods and the menopause should become dinnertime conversation. For too long women have been apologising for our experiences and what we go through with our bodies. It was always ‘Sorry, you wouldn’t want to know’. But we’ve turned a corner now, and that has got to stop.”

Lundy had a specific woman in mind when she wrote the book, remembering how during those days of menopause revelations on Liveline, one concerned farmer rang in to talk about his wife. “He said he always listened to Joe Duffy when he was ploughing. That day he had brought the transistor radio from the plough into the kitchen. And he told his wife, ‘I think this is what’s happening to you’ ... I actually was in tears listening. And I just felt, you know what, I want to write a book for that woman.”

What Dr Deirdre Lundy wants everyone to know about the menopause

First, a basic explanation of the menopause stages ...

Lundy says there is often a lot of confusion as to what constitutes “the menopause”. It can mean different things to different people. Most non-medical people use the word to describe the transitional time in a person’s life when they go from having regular menstrual cycles and fully functioning ovaries to when the cycle starts to decline and eventually stops. The correct term for this process is “the climacteric” but not many people use that term.

The science bit: Many months or years before their last period, women’s ovaries start to release female hormones such as oestrogen and progesterone in a different way. Some days the ovaries will release the normal amount of sex hormone. Some days they will release a little too much. It is this hormonal fluctuation that starts off the symptoms of the menopause. The perimenopause means a woman is in transition, experiencing hormonal fluctuation but still getting regular or occasional periods, which may be quite irregular or heavy or painful.

Perimenopause is a relatively new word, but a legitimate one recognised by most menopause healthcare practitioners. The process towards stopping is perimenopause, the moment of stopping is menopause – the day after the last period, yes menopause is actually one day – and the time after periods have stopped completely is known as post-menopause.

Most women talk about “going through the menopause” and might be referring to any of these stages. Lundy’s book goes into great detail on the hormones that run a woman’s life: “The key when it comes to hormones is balance,” she writes. “Menopause robs you of hormonal balance for a while, and you might need help to artificially balance the hormones until your body has fully adjusted and made the transition to being post-menopausal. Some women may need help in balancing hormones for the rest of their lives.”

[ Menopause: ‘I genuinely believed I was slowly dying’ ]

A good doctor is essential. Find one who will listen

Lundy devotes a whole section of the book to the importance of women finding a good doctor to support them through the menopause. “If you have a supportive doctor, he or she does not have to be all that educated in menopause and HRT, not everyone is going to be an expert. But if they’re not open to discussion, if they are threatened by the fact that you read something or did research and you want to talk about it, you’re in trouble.”

She was worried the book might be “triggering” for a lot of GPs, medical colleagues she greatly admires. There is “a lot of defensiveness” in the medical community. The book, she says, deliberately leaves no medical menopause stone unturned so that women can pick out the parts that are relevant to them, and use the facts to back up their own experiences when talking to their doctor. Lundy’s firm warning to women: “If a doctor rolls their eyes when you talk about any of this stuff ... you need to find a different GP.”

HRT can help – but it is not for everyone

Hormone replacement therapy is commonly used as a treatment to relieve a great many of the symptoms of menopause, including anxiety, hot flushes and mood swings, by replacing hormones such as oestrogen and progesterone that are at a much lower level in women during these years. It can be taken in various forms including tablets, skin patches, gels and creams.

“HRT is not for everybody,” is the first thing Lundy says when I bring it up. “And you’re not missing out if you never tried it. If you got through the menopause and you’re in good health and you feel well, be happy. But if somebody has a lot of symptoms that are linked to their hormonal transition, a very effective way of fixing that is to get tiny doses of sex hormone to smooth out the fluctuations that the early menopause transition brings.”

Lundy refers to what she calls “the popular panic” about HRT. This began in 2002 when an editorial from an American medical study was published in the Journal of the American Medical Association suggesting there was a link between HRT and breast cancer. Researchers on the Women’s Health Initiative Study, apparently found an increase in breast cancer with combination HRT – a mix of oestrogen and progestogen.

[ Confusion persists around HRT and the perceived link with breast cancer ]

There were serious issues with the study, says Lundy. “It was poorly designed,” she says. “The women who took part were older, in their 60s, some almost 80 ... they only used a really old-fashioned form of HRT gathered from the urine of pregnant horses. So it was a shitty form of HRT and the study was not looking to see did these women feel better, because these women were older and did not have menopause symptoms any more ... what the study showed was that if you give a bunch of older women horse’s oestrogen, you give them the same risk of breast cancer as drinking a big glass of wine every night. So there is a connection there but the study was interpreted wrongly.”

Even though subsequent studies supported the benefits of HRT in menopausal women, in 2002, the damage was done. Lundy says the reporting of this study led to women throwing out their prescriptions, doctors refusing to prescribe HRT, and a whole generation of women suffering menopause symptoms in silence. “For years in the English-speaking world, you couldn’t give HRT away,” she says.

This began to change in 2015 when a UK government body published guidelines on how to manage the menopause: “They said, ‘Please do not allow this media-driven fear of HRT to affect your prescribing habits.’ The risks of HRT are outweighed by the benefit in almost all circumstances, certainly before the age of 60,” she says. Lundy, who has been on HRT for nearly 20 years, says while the product made from pregnant horse urine (Premarin) is still prescribed in Ireland, she favours “body identical” HRT made from wild yams.

The recent surge in popularity of HRT, driven by increased awareness of the benefits, has led to global supply challenges for the companies that produce it, shortages that continue to affect millions of women around the world.

For those who do not want to use HRT, Lundy recommends cognitive behavioural therapy, which is proven to have helped many women, including her, manage various symptoms including hot flushes.

Speaking of vaginas and vulvas, healthy ones should, Lundy says, be “pink and juicy and lush. Sort of like a ripe fruit, full of moisture and blood vessels”

Testosterone in small doses can be helpful for certain symptoms

According to Lundy and the British Menopause Society, of which she is a member, if a woman is experiencing menopausal symptoms such as low libido, decreased sexual desire and inability to orgasm, all the oestrogen in the world is not going to help. “She needs testosterone,” she says. And isn’t testosterone also really good for the brain and energy and muscle mass? “That may be true, if you use a lot of it, like drug-doping-in-the-Olympics amounts of testosterone, but that’s not how we do it. You’re not allowed to start a prescription for testosterone just because somebody wants to see if they’ll do better at Wordle.”

[ How to have great sex during the menopause and beyond ]

Vagina and vulva health is hugely important during menopause

Lundy loves working at the Menopause Clinic on Holles Street, outside of her private medical practice. “I like meeting people who wouldn’t otherwise have been able to afford to see me. So many of the women who come in, they don’t have smartphones or a laptop or an email address. That’s why I think the book is really important. Some women’s access to information is really poor and they would not be aware that it’s okay to say to a doctor, ‘My vagina is messed up’, or maybe they came from a family where you don’t say that word.”

Speaking of vaginas and vulvas, healthy ones should, Lundy says, be “pink and juicy and lush. Sort of like a ripe fruit, full of moisture and blood vessels.” Menopause can wreak havoc on the vagina and the vulva and be a cause of pain during sex. She talks about examining women “down there” and seeing bad cases of vaginal decay.

“I’ll go in with the speculum and see it’s all yellow and decaying, dry with broken blood vessels. That’s called vaginal atrophy and the good news is it responds amazingly to oestrogen. I tell women, ‘You know what, here’s two weeks of oestrogen, I want to see this,” she points south “ ... in two weeks.”

Bloody Hell: Mona Eltahawy on menopause myths and taboos

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The patient will see an improvement in vagina health “almost immediately”. “The vagina responds amazingly to oestrogen and the beauty is you can use it forever,” she says. There are oestrogen receptors in almost every tissue in the body but the vagina, she says, “is a very oestrogen driven animal”.

“As you go through menopause and then the far side of it, almost all of the menopausal symptoms, the flushes, the sweats, the moodiness will improve. But never the vagina. The vagina gets worse year on year. So if you’ve been troubled by vaginal problems through the early stages of menopause, that is not going to get better with time. It’s just going to get worse and you need to reach out for help.”

Your doctor – “God bless them, they work so hard” – may never think to bring it up, so she is almost evangelical about urging women to raise vagina- and vulva-related health with their doctors as an issue.

Your face might not be the only thing that needs to be moisturised

Lundy says that if someone has vaginal or vulval issues that are not profound, it makes sense to start with something natural and non-prescriptive. “There’s a whole range of really good water-based, hypoallergenic moisturisers that are uniquely designed for vaginal tissue.” She tries to avoid product placement as a rule, but can’t resist mentioning an Irish company Kora Healthcare which has a seaweed-based cream called Regelle which promises “soothing relief from, itching, dryness and discomfort” in that area. “It’s seaweed, it’s Irish, what’s not to like?” she says.

[ Mona Eltahawy: ‘You have to moisturise your vulva every day’ ]

Don’t be afraid to talk about your menopause symptoms at work

There has been a lot of talk about menopause leave lately. In the UK, legislation to protect the rights of women experiencing menopause was recently jettisoned due to fears it might discriminate against men. While Lundy is reluctant to advocate for specific leave related to the menopause – some Irish companies including Bank of Ireland have adopted such policies – Lundy says menopause should “definitely” be discussed in the workplace. “I cannot tell you the amount of women I’ve talked to who have turned down promotions, or gone part-time or into job-share arrangements because of the menopause. I think if a company wants to support female employees in midlife, giving them access to good menopausal care and support is essential.”

There are upsides to menopause. No, seriously

For a start, Lundy points to the fact that certain gynaecological illnesses can improve after a woman’s final period. Not to mention the fact that menopause means no more worrying about menstrual blood ruining clothes or furniture and for her “on one fabulous occasion the sheets in a B&B”. For others, she says the ability to have sex without worrying about unwanted pregnancy is both a relief and a joy.

“Personally, I felt a transformation took place, but that might have had less to do with lack of periods and more to do with just being of an older age,” she says. “I worried less about the judgment of others and spent more time just doing what I wanted. I stopped wearing mainly black clothes and now have a colourful wardrobe that would rival a Florida granny.”

She can only talk from her own experience about the upsides of menopause, because the women she sees are usually seeking help with debilitating symptoms. “The happy, liberated-by-the-menopause ladies are not generally beating down the doors to see me in my clinic, so I am not an authority on that experience,” she laughs.

Sick of all the menopause chat? Don’t be. It’s good to talk

Before Joe Duffy blew the lid off the menopause in Ireland, there was a serious lack of open conversation about this important and for many seriously disruptive time in a woman’s life. But have we now gone the other way and jumped the menopausal shark? “I’ve heard people saying: it’s all menopause now. It’s all HRT and hot flushes. Thanks very much, Davina,” she says, referring to English TV presenter Davina McCall. In May 2021, around the time of the Liveline menopause conversations, McCall made a widely viewed documentary on the subject, and subsequently wrote a best-selling book called Menopausing.

[ Davina McCall on menopause: ‘I couldn’t talk to anybody. I felt so alone’ ]

Lundy thinks there can never be enough attention given to menopause, and the more women “come out” about their menopause experiences the better. Other menopausal poster women include broadcaster Mariella Frostrup and model Penny Lancaster.

“When people say there’s too much talk about it, I’m like, ‘Hold the phone’. Is this not just a natural pendulum shift? Is this not us making up for the last 20 goddamn years when HRT was a bad word and women suffered in silence and lost relationships and lost jobs? And I get it, you don’t want to spend your whole life talking about the menopause. I understand. But maybe it’s time to let the pendulum go the other way for a little while and make up for all that lost time?”

The Menopause: The Essential Guide to Managing Your Health in Mid-Life by Dr Deirdre Lundy is published by Penguin Sandycove. Dr Lundy will be appearing with Davina McCall and others at The Menopause Summit on Thursday, March 23rd at the Round Room in the Mansion House, in Dublin. nationalmenopausesummit.com