Symptoms, Solutions, and Your GP's Role with Dr. Deirdre Forde

Anxiety, depression, loss of confidence, brain fog, weight gain, and pelvic health are just some of the many symptoms of perimenopause. On your own journey, the starting point is essential - that starts with your GP.

This week’s on The Menopause Uprising Podcast is with Dr Deirdre Forde, who is based in Ceile Medical Centre Athlone where she runs a thriving practice and shares with me her passion for menopause. Listen here to why anti-depressants are not the answer and the practical forms of Hormone Replacement Therapy (HRT) that women can utilise. How to get the best from your GP visit? The common symptoms Deirdre sees in her practice and those hardest to manage symptoms. The lifestyle tips that will help on this journey and finally we chat 'bottom drawer', 'butter for your vagina' ‘ churning anxiety and much more!

Welcome to Menopause Uprising with me, your host, Catherine O'Keeffe. Today I am chatting with Dr. Deirdre Ford and we're talking all things HRT and especially we're talking about what is butter for your vagina? I hope you enjoy it. Menopause is, as everyone knows, is I live, dream, sleep it, eat it, the whole thing.

So, um, I'm forever talking about it. So, One of the things I guess that, um, comes up Deirdre quite often is, you know, the management of symptoms and what are the symptoms that HRT in particular can be quite helpful for, but what in your clinic, what would you see as the most common symptoms that women come to you with?

I think the predominant one has to be anxiety and palpitations. That seems to be the very first one that seems to come up. And, you know, women from the early age of, in their early forties, this is the first thing that they can actually start to feel is this churning anxiety and they can't really understand why.

And it's the start of that early perimenopause and it's really trying to, trying to deal with those. But there are so many symptoms, both physical and emotional, um, in menopause, but perimenopause being the most difficult time of a woman's life. Yeah. So the anxiety that I find is always linked in with the palpitations, this sense of, um, you know, adrenaline rush or beating in their heart or their heart skipping a beat and having difficulty breathing.

Taking, you know, having to take a big breath in to sort of try and settle out that palpitation that comes up, but that's the anxiety part of things. And I find women too might actually wake up in the middle of the night. It might wake them say at four o'clock in the morning with this sense of churning anxiety or palpitations.

And that is part of the whole menopause anxiety part. Okay. Yeah. That's part of our sort of our, our, um, emotional, um, you know, part of it. You've got the brain fog, which is like cotton wool. It's like somebody stuck cotton wool into your head because there is nothing connecting. And I remember it even myself when I was 48.

Oh my God. It was like a withdrawal from, if anyone had ever smoked, it was like that, nothing in my head, you know, from withdrawal. Yeah, you've got that terrible brain fog. You've got that memory loss, poor concentration. The, that sharpness of mind is completely gone. Yeah, you've got low libido, um, poor motivation, just can't function in the workplace.

You're not the person you used to be in the workplace. You've got that terrible crying for no reason, overwhelming feeling, and they're all very, very typical of menopause. When you go to the physical side of things, then you've got The drenching night sweats. Oh yeah, yeah. Drenching, drenching. And we're talking about that saturation between your, between your breaths, back of your head, um, really, really bad.

You wake up in the morning and you're saturated, your hair is saturated, but you've got this hot flush. That's usually the one of the first symptoms that, that women will say, you know, I feel a bit warm. But the flush that I describe is. It's like that first flush when you're blushing when you see somebody that you fancy as a teenager Yeah, that's warmth that overcomes you and then you get very cold all of a sudden.

So you've got the hot flushes Sleep issues are a huge thing Woman may be able to get off to sleep, but by God when three o'clock in the morning comes she's wide awake. Yeah You know, and it's trying to get back to sleep again. The fatigue that's associated with menopause, exhaustion, um, PMS, headaches, migraines, headaches.

Yeah. The migraines coming on. Um, you've got, um, itchy skin. And some people describe this sort of crawling, like insects under their skin crawling. And when you consider this is all part of the pain pathway, it's another form of pain. Any of those sensations are, are regarded as a pain. Um, so you've got this itching.

And it's usually associated with nerves, okay, itching under the skin. But when you consider that in menopause, everything is drying up from the top to the bottom, including the collagen under your skin, nerve endings being more exposed than that. The terrible vaginal dryness that you get, um, and then as a result of all the vaginal dryness and part of the lack of obesity down there, you've got a.

stress incontinence, meaning when you cough or sneeze, you're going to wet. And then you've got an urge incontinence, which means that you want, you know, you want to go to the toilet, but if you don't go now, you're going to leak. That's an urge incontinence. So they are. The most common. Yeah. And I think that's really, really interesting what you were saying about anxiety, because I've been saying this for a long time that I'm finding.

majority of women I speak to, um, it's the anxiety that comes first and I'm all, I would always kind of say, you know, don't be waiting for the typical symptom like the hot flush or the change in your periods. I'm seeing that a lot of women like you just mentioned Deirdre, like in their early forties who are starting to see that little shift, they've never been anxious before, they've been really confident, then all of a sudden 43, 44 and a little bit of anxiety starts to come in.

And, um, I, I think the anxiety is nearly the first thing. I'd say absolutely the very first thing. Yeah. Yeah. And I remember Yeah. From, you know, working one day with a nurse friend of mine I know I was working in, in general practice down the country, and she was only probably about 42 at the time. And she said, I have this terrible churning anxiety and I just don't know how to get rid of it.

You know? And yeah, of course we didn't know, and I was only in my early forties at the time, too much about menopause. You know, back then, um, and I used to say, look, try and walk more, you know, get the good endorphins going in your brain and that, but, but in hindsight now, that was probably the start of her menopause.

Yeah. Yeah. Yeah. And then, and then women will go to the GP and they'll seek out help. But the first thing the GP will, you know, um, put them on is probably, you know, an antidepressant. Yeah. Yeah. Like, you know, an SSRI. And I mean, the SSRIs can be good in their own way if we've got a very difficult menopause, you know, women who are so, and I have seen so bad with menopause that we needed to probably tweak it at the very end.

with the low dose SSRI, which is for anxiety, depression, not the fact that you're depressed, but it deals with that terrible anxiety, that churning that still may be remaining there. And that would be the last one that I would be tweaking when I do a consultation. Okay. Yeah. Yeah. That makes, that makes sense.

It's, it's, it's when you think about it, if it's the first thing to come on, it's probably the part, the last thing that you can actually kind of get it, get it, get a handle on. Um, and there's, there's my dog in to join me. Um, what, what, when you look at, um, HRT, what's your kind of preference in terms of Uh, treatment.

Do you, do you, um, generally start with gels, patches, or, um, how do you work it? Obviously, I know it's very individual and, uh, you know, whether uterus and so forth. Okay. So the way I usually go is I tell them what's the cheapest form and what's the most expensive form. So it's really down and what's available on the medical card and what's not available now.

That's very good. Nice and practical. That's great. Yeah. Yeah. So, you know, most of them will be available on the medical card, but I might have to tweak it a little bit. But the cheapest version is always going to be a tablet version like, you know, um, uh, Fematab for somebody who doesn't have a uterus or feminine.

So basically the box is going to look like that in some shape or form. There are different forms, but they all have that kind of coloring to them. Yeah, so they're about 10 euro a month. Okay for the tablet form now the only time I will never put a woman on a tablet is if you know, say well it would Covid kind of Putting a spanner in the works.

Say a lady who was a Neurolingus hostess and she was doing an awful lot of flying. I wouldn't put her on a tablet because of the risk of clots Yeah, yeah Yeah. Um, and the other, so somebody who smokes, I won't put them on a tablet. Somebody who's overweight, I won't put them on a tablet. Um, or somebody who has, um, a history of clots in the past.

Yeah. Tablet is complicated. So after that then, so they're about 10 euro for the month and then after that it's really um, It's really a personal choice then about you know, do you want to go up, you know, the transdermals are a patch or a gel Yeah, yes So if you want to do the transdermal and you've got a busy lifestyle that you can't remember to to When to put things on yeah, it may suit you to actually just use the gel every day Bring out a patch here.

It may suit you. Choose the gel every day because it's going to be, you know, on your arm, part of your routine in the morning after you shower. It's dried in. That's the end of it. And that's, it's like a bit like deodorant, isn't it? It's start brushing your teeth. It's like, yeah, yeah, exactly like that. Now for the, for the lady then that maybe has a little bit more time, uh, maybe a bit more organized, not rushing around the place, you've got patches and they're tiny little things.

Um, and, but you really got to remember to change them every, you know, three and a half days. Um, a lot of the manufacturers will say, you know, you'll get To put one on for four days and one on for three days because you use two patches a week But I say no split it down the middle and do three and a half days.

Okay, because you know It'll start to dwindle the efficiency of it. Okay. Okay, that's good. Yeah So, um, and on top of that then we just add in their progesterone, which is a little capsule for those who need it And and with with progesterone, I know in the uk you can get the the progesterone cream. Um, is that, is that available here?

Probably not on the medical card anyway. And there's no progesterone cream available, unfortunately, not in this country. So you'll get the only combination where you've got estrogen and progesterone is actually the Everol Conti patch. Yeah. You know, which is like goat lust at the end of the day. Yeah. I, I, I heard, um, I heard from my friend Laura, the fabulous pharmacist, I, I believe there was a supply back in, uh, the end of last week, but I'm sure it's probably gone already.

Oh, I'd say well gone. It was probably well, yeah, yeah. So what we use then is because, you know, that was, that's the only progesterone we've got to add in progesterone, but this is. This is eutrogestin and it's a white little capsule and, um, if you burst it, you can see there's actually cream inside it. So it's micro ionized.

It's as close to your own body progesterone as you're going to get. Okay. So it's either eutrogestin or another tablet at nighttime called Dufustan. They're the only two products that we have in Ireland. Okay. Okay. At the moment. Yeah. So that's the basis of your HRT. For women then who want to, you know, you've probably heard of the women adding in some testosterone.

Yeah. So, let's do, you know, testosterone gel, so a little sachet like that, but that's a man's product. So we only use about a seventh of that, which is a pea sized, pea sized amount. And then there's another lovely one that came out. so much. Uh, probably about a year ago, uh, it's called Androthem, and you've probably, the women are probably wondering about this.

This is female testosterone. This is manufactured especially for females, and it's in a pink tube like that with a lovely syringe and you just take out exactly the dose that you need and you put it on your leg. Okay. Now that, that tube is expensive. It's a hundred euro. Androthem. Wow. And how long would that, would that last you Deirdre?

Probably about three months. Okay. Okay. Yeah. Probably about three months. So about 30, 33 per month. Okay. And how, what's, what's your kind of, how do you work with, Um, the Androfem versus the testosterone gels, you kind of, is it just a preference or how do you? It's just a preference because this is just in now and I suppose women like the fact that they can just put it into their handbag, although you only need one dose a day, you know what I mean?

Okay. But the testosterone, you know, pea sized amount, this is so much cheaper. Right. Androfem is not on the medical card, but testo gels are. Okay. So your treatment, you would, you'll certainly get your treatment with your, with your uterogestin, your Dufustan, your testogel, your tablets. And there are two, these two products are the same.

One is Estrogel, which is 34 euro, not available on the medical card, but this is made by the same company and it's called Estrodose. And that is on the medical card. Okay. Okay. Okay. And there's another gel called Dippy Gel. It's like a little sachet. Yeah, a little sachet like the testosterone too. And that's available on the medical cart.

So they're all available. Okay. So really, I think the one thing for, for, for, for anyone watching is You know, do ask your GP what's available on the medical card versus what isn't. Although, you know, I guess that should be part of the conversation. And would you also then fall into, you know, the drug payment scheme where I think if you hit over 120 per month, so they would also apply under that, would they?

Good. Yes. Yeah. Okay. Yeah, absolutely. Yeah. And just, um, Deirdre, when you were talking about the testosterone there, where, um, what, um, symptoms would kind of point you towards, um, including testosterone as well as, you know, whether it's oestrogen and progesterone that you've already gotten the treatment protocol.

Okay. So once I've had them on, say, oestrogen and progesterone for You know, three or four months because we want to make sure that there's something working. Like if I decided to stick in testosterone, then at the very beginning, I don't know what's working. Yeah. Yeah. So it's a woman who will tell me that libido didn't come back.

Okay. That she's still totally exhausted and that she, she feels her brain still isn't sharp enough. So that's when I'll add it in. Okay. Okay. Testosterone. Yeah. Yeah. Yeah. And what about, um, I mean, that's a fantastic overview of the different, um, uh, treatment methods. And I guess then the other kind of layer underneath it is the local estrogen, say for, with vaginal atrophy.

That's right. So the local estrogen then that we have. Vagifem is available on the medical card and it's, it's got a blue applicator, tiny little white tablet at the top of it. So you insert one of those every night for two weeks and then twice a week after that. And that will be for women who are actually experiencing this terrible dryness.

Urinary tract infections. Now, if you go to, if your GP sends you to a urologist because of recurring urinary infections in our age group, in menopause age group, the first thing the urologist will do is put you on Vagifem, which is local oestrogen. Yeah. Yeah. So. All of that, because now it's actually putting the estrogen back down where it belongs, tightening up all those muscles again, working around the neck of the bladder.

And if you consider like the whole pelvic floor area is like pair of knickers, it's pulling everything off. We're just putting the, we're putting the elastic back into the pair of nickers again. Yeah. That's brilliant. I love that. I, I'm going, I'm definitely gonna quote you on that because, um, every, everyone knows I'm always.

talking about vaginal atrophy because I find so many women message me about it and people aren't talking about it enough so, um, I'm forever talking about it, but that's a, that's a brilliant analogy. There you are now, perinaturalism, I've just put the elastic back into it again. Yeah. So vagism is really good for that.

Now I have come across women who have been so dry, and I mean this is terrible, that They used to bleed. Yeah. Yeah. Can you imagine? Yeah. Yeah. Yeah. Or, um, you know, a woman who might bleed after just having a speculum examination because, you know, the walls of the vagina are bleeding. Yeah. Okay. Now, in women, uh, like that, they might find that even the Vagifem is not enough because you've got that dry applicator that you have to put in.

Yeah. So we have another product called IVAs. So if Mm-Hmm. , if women might remember when their kids were very small, if they had children buying the Parly, a posties for the high temperatures of the babies. Yeah. Yeah. I had them. Yeah. Had what? So this looks like Alyx Posty, and it's called IVAs, I-M-V-A-G-G-I-S.

And it's like butter for the vagina. We, who speak Irish, and um, you put this up every night for three weeks, just with your finger, just pop it in, every night for three weeks, and then twice a week after that, and that melts. Okay. So it's easier, easy. Yeah. It reduces the moisture immediately. But one of the side effects of it is that it can cause this very bad burning sensation for about five days.

It's not the you allergy to it, it means it's working because it's so dry. Okay. It's so dry. Yeah. So, so, so that's for someone who's not getting the results on um, va. Yeah. Yeah. Yeah. And that's good to know because I've often spoken to, to women who have tried that and they've actually stopped it because they found themselves like feeling that stinging feeling and they thought, Oh God, they're reacting.

to it, whereas in actual fact, like you just said, it's not, it's kind of a settling down period. It's a settling down and it's, it's literally that it's just reactivating those cells again and getting them going, you know, so don't be afraid of any kind of a burning sensation. This is a common side effect, so just stick with it, it'll pass.

Yeah, get, get day six. Yeah, yeah, yeah, yeah, exactly. And, and Deirdre, with, with, you know, obviously these, there's been huge, um, talk, you know, in the media and so forth over the last number of years in relation to the risks, um, uh, in relation to the risks and benefits of HRT. Um, you know, what, what would you say to women who are concerned, um, from that perspective?

Okay, so the risk, so women should know that, that um, HRT replacement therapy, hormone replacement therapy will reduce and, and stop your risk of osteoporosis, okay? That is a known fact. It'll reduce your risk of osteoporosis. Especially for women, young women who are, um, post menopausal, you know, at the age of 44, they really, really need their HRT because they're more at risk of heart disease than the older ones of us.

And the other thing then is, uh, dementia. Okay. So very simply, and I'm just going to do this very simply. Women over the age of 50, and it's for women over the age of 50, are more at risk of breast cancer, um, in the general population. So you've got 23 women per thousand developing breast cancer over a five year period.

That's why we have baseline dex, um, mammograms starting at the age of 50. Yeah. This is a lovely chart that you, you can actually find online. Yeah. I've seen that from the BMS. Yeah. Yeah. Yeah. Yeah. Yeah, from, from, and even any woman who Googles understanding the risks of breast cancer, this chart is going to come up.

Okay. And they can have a look at it. So anyone who has, is on a combined HRT, the risk goes up by about, it goes up by four, but it's the very same risk as somebody who smokes or somebody who's on the pill. And half our women in this country are on the pill. The risk decreases with oestrogen alone. So if women have a Marina Coil in, happy days, because that's the gold standard.

Marina Coil with oestrogen only therapy. But the risk starts to increase with alcohol consumption. It starts to go up here. And then if you look at the very bottom, all that red there, that's a BMI over 30. So there's the real risk of breast cancer, not everything else. You can reduce all of that risk by walking.

That's all you've got to do. One will negate the other. So all you've got to do is get out and walk. Yeah, yeah, I mean, the, the, I, I'm forever harping on about the lifestyle side of it, regardless of, you know, whether it's HRT or not HRT, you know, You still have to do the lifestyle. You have to do the exercise.

You have to do the good food. You know, you have to do the sleep. You have to keep social and it's so, so important as you go through perimenopause. You have to keep all of that going. Absolutely. So important. And you know, sleep is such sleep is so important if you don't get that sleep, you know, you're definitely going to need seven, eight hours.

Yeah. You have to. If you don't get good quality sleep, you know, you're not worth talking to at the end of the day. Yeah. Yeah. Get that sleep in. Yeah. Um, but you know, at the end of the day, we're not living our ovaries. We've got half our lives to live. Um, yeah. Life is actually quite good. Believe it or not, it really is good.

I'm 12 years on HRT now and it's wonderful. Right. Yeah. I'm going to stay on it. Yeah. Until the day I die. In my bag. And, and what about, because I'm always, I'm very, very conscious of a lot of people, you know, that I work with and chat to that for personal reasons, they've decided, you know, HRT isn't an option for them.

And my whole, um, the way I work with women is, um, for me, I, I want to be a conduit for information. So it's given women the information of all of the choices that they have, whether it's HRT, acupuncture, herbalism, whatever it is, so that they've got the information and then they can make an informed decision.

I just think that's so, so important. Um, But what would you say for, you know, women out there who, who have made, you know, who don't want to look at HRT? Okay, so for the women who, who don't want to go down that road, okay, so it's going to be a case then of tweaking the symptoms individually. Yeah. So that's what we're going to have to do.

So, um, you could do something like, um, clonidine for those torrential night sweats. And I've had women who literally just came to me with the night sweats. They didn't want to go in anything else. So I gave them clonidine and it stopped. Right. Okay. We have to treat every symptom now individually. Yeah. But definitely evening primrose oil, sage tablets.

Yeah. Get them, get the, the over the counter Menopase, Menomin, any one of those. They've got phytosoya in it. Yeah. So they're fine. If you decide yourself you don't want to go on HRT, they will all help you feel an awful lot better. Yeah. Exercise. I can't stress it enough. That will just bring those natural endorphins back into your brain again and you'll have that feel good factor.

Yeah, I'm um, I don't know if, if, if you've seen like I'm a huge running runner. I love running. So running is my go to, you know, so I get up early, I go running in the morning and stuff like that. And, you know, or else if it's evening time, I might go hiking up the mountains or something. But that's to me, that's my, that takes my mental health box.

It kind of, it is, you know, as we, as you were saying, it releases all those good endorphins. And at the same time, you know, Like you just were showing on the chart, it's keeping your BMI in check and it's, you know, it's keeping the weight down. Yes. It's keeping the weight down and it's reducing any risk that you may have.

Yeah. Absolutely. Any risk. Um, I always say too, if you're going to, if you're going to do the walking, you know, do it early in the morning. That's what I've started to do. I'm too tired, especially after work. It's hard to welcome home in the evening and especially if I see it's dark, forget about it. You won't get me outside the door.

But I will gladly do a frosty morning in the dark or I'll gladly do the rain in the morning so at least I can have the shower when I get in. And then go to work. But do it early. Yeah. And once, you know, it only takes three weeks. to, to get a new habit going or to break a habit. So once you start doing this, you won't stop.

Yeah. Yeah. Yeah. It is. Isn't it that sweet spot of three weeks to, to cultivate either get yourself off sugar or get yourself moving. Yeah. Yeah. That's it. That's it. One of the other things, you know. And Deirdre, what advice would you give to, you know, a lot of women will, and I'm sure you've seen and experienced this, a lot of women will say to me, you know, look, I've gone to my GP, I'm just being offered antidepressants, which we talked about earlier.

They're not really happy. Um, you know, they'd like to look at HRT, but they feel they can't push it with their GP. Any, any advice you can give them? I would, I would actually say to, you know, if they're women going to see their GP, whether male or female, because there's good, there's really good male GPs out there who are very understanding and who are clued into all of this, that if somebody is not really listening or offering antidepressants and that, and just say, look, I have read up about menopause.

I know symptoms of menopause and I want help and antidepressants are not what I want. Yeah. Now you might get a doctor then who will say, Oh, let's see what's in the book. You know, and the next thing you might be put on the wrong product or something like that. But Uh, i've heard women who have actually educated their gps.

Yeah, I I'm i'm hearing that the whole time And do you know one thing I I do have to say I I i'm so excited though that in the last year the amount of Um, GPs that people are telling me about and raving about, that have either gone and sought additional training in relation to menopause, are just really interested in it, like yourself, and you know, have got the expertise, and have got the knowledge, and You know, I'm, because I'm based in Dublin, I'm all, I'm very, very conscious of the fact I don't like women to think everything's in Dublin because I'm certainly, I'm certainly finding around the country, there's brilliant GPs coming up who are, you know, who have got the experience, who've got the knowledge.

And it's just a matter of kind of, I guess, women getting on their waiting lists and finding them, you know. That's it. Yeah, absolutely. That's it. And I guess the other thing is in Ireland, we, we're, we're, we're pretty traditional. And I think we get very comfortable with our GPs. And I would say like, I, I love our family doctor.

I just love the bones of him. He's a fabulous man. But he wouldn't be as experienced in menopause, so I now go to a different, um, doctor. Um, and that works, but all the family still go to him, you know, so I think you have to kind of move with the times of, in terms of where you're at with your life. And that totally works and an awful lot of GPs totally understand that.

Yeah. Um, I remember when I, when I was working with the male GP, oh, years and years ago. And, um, there was only himself and he didn't have a nurse or anything like that. So I was working with him, um, because he didn't do bottom drawer. Oh, I love it. So I dealt with the bottom drawer then. Oh, you have it all.

You've got all the little, I love your little sayings. It's so Irish. You are so Irish. So yeah, it's totally, it's totally fine to go and, you know, and see whoever needs to, whoever needs to, and if you want to. Whatever doctor to go back to your other doctor to say, well, this is what we have them on or whatever, you know, all being transparent and in the best interest of the patient at the end of the day.