Local female patients often visit their neighbourhood family doctor, presenting signs such as hot flashes, cognitive confusion, nocturnal perspiration or emotional imbalance. These indications are typically evaluated by their GP, and it’s common that hormone replacement therapy (HRT) is recommended to mitigate these symptoms, which are linked to menopause or perimenopause.
However, a significant portion of these women find the expense of this treatment to be obstructive, as reported by both medical practitioners and pharmacists. It has been observed that some women can expend between €30 to €70 monthly on HRT.
Dr Ciara McCarthy, who is the clinical leader in women’s health for the Irish College of General Practitioners (ICGP) and Health Service Executive (HSE), states that patients often disclose the financial burden these costs impose. “Though such amounts may not seem exorbitant to some, it’s clear they’re unattainable for certain women, leading them to either infrequently fill their prescription or not at all,” she explains. “An additional concern is that the potential cost of a menopause consultation may deter women who are experiencing symptoms but have other financial priorities. As a result, they might altogether avoid seeking care for menopause.”
HRT is provided in various forms, including tablets, skin patches, gels as well as vaginal creams or suppositories. These medications replace the hormones that decrease during perimenopause and menopause.
Menopause typically occurs between the ages of 45 and 55, with the mean age for women in Ireland to experience menopause being 51. The completion of menopause is determined when a woman hasn’t menstruated for 12 months, as per the HSE.
At present, Hormonal replacement therapy (HRT) is only funded by the government for those holding a medical card or under the drug payments mechanism (DPS), costing around €4 million annually. The Health Service Executive estimated that providing HRT free of charge to all requiring it would surpass €10 million each year, according to Donnelly’s 2022 statement. However, this prediction does not factor in potential lost income from prescription charges, anticipated demographic shifts, or the effect of introducing complimentary provision on uptake rates.
Still, even with the pair of existing Government schemes, expenses can pose an obstacle, says Dr Caoimhe Hartley, a family doctor specialising in women’s health who runs the intricate menopause clinic at the Rotunda Hospital. Hartley pointed out that HRT often incorporates two or three distinct hormones, each administered differently and carrying diverse costs, this makes some required medications inaccessible through DPS or medical card.
Particularly, women who transition into menopause or perimenopause prematurely are greatly impacted by these costs; this includes approximately 1 per cent of women under 40 and 5 per cent under 45. Hartley emphasised how crucial HRT is for the long-term health of these women, protecting their bones, heart and overall health until they reach the typical menopause age of 50. She hopes the new scheme would extend not only the reach but also the available options for women, specifically younger ones.
The distressing symptoms of menopause and perimenopause can significantly degrade a woman’s life quality, making HRT an indispensable aid for many. A survey in 2022, fielded by the B&A polling firm for the Department of Health, found that over half of the Irish women experiencing menopause or perimenopause perceive it negatively. On average, these women endure unremitting symptoms, coping with up to seven symptoms concurrently, the study discovered.
Women have revealed that they typically experience severe symptoms of menopause such as fluctuating body temperatures (76%), period irregularities (73%), fatigue (72%), sleep problems (68%), changes in bodily form (58%), cognitive struggles (56%), mood swings (54%) and aching joints (53%).
Victoria Jones, proprietor of Bonnybrook Pharmacy located in Coolock, Dublin, and an expert pharmacist in menopause, states that the most incapacitating symptoms amongst younger women – typically in their late thirties or early forties – include anxiety, mood fluctuations, sudden anger and depression.
“They lose interest in socialising with friends or participating in their usual activities. Driving at night or on large roads like the M50 becomes daunting,” Says Jones. “They simply don’t feel like themselves. They spend their nights overthinking or assuming the worst. These symptoms can linger up to a decade due to frequent daily, even hourly, hormonal shifts.”
However, despite the substantial number of people suffering from menopause in Ireland, there still seems to be a persistent silence around the issue, contributing to a widespread lack of understanding, says Loretta Dignam, CEO and founder of The Menopause Hub.
She argues that even though menopause directly affects 50 per cent of the population, the remaining percentage does experience its effects either “directly or indirectly” as they have women in their lives. She believes that everyone should comprehend how dramatically menopause can transform lives.
“In my experience, I was clueless about perimenopause. I only knew about absent periods and hot flushes, despite considering myself as relatively educated. Then the symptoms appeared without any warning. I was scared of using HRT and tried various alternative methods such as wearing magnetised underwear,” said Dignam.
“Eventually, I started HRT; I had around 26 symptoms that disappeared altogether, making me feel wonderful. But there’s a cost – it can range between €70 and €80 monthly. I’m fortunate that I can afford it but I know many individuals simply can’t.”
Dignam notes that many women who don’t qualify for different programs fall into the squeezed middle, with the significant financial obligation of HRT being overwhelming. Nonetheless, the cost isn’t the sole factor discouraging some people. In 2002, the Women’s Health Initiative published research linking HRT to the inception of breast cancer. Despite these findings being mostly refuted now, with contemporary HRT demonstrating an excellent safety profile, there remains reluctance among some women regarding the therapy’s utilisation, according to professionals in the field.
McCarthy remarks that patients having meaningful dialogues with their GPs is essential, enabling them to have all necessary facts to make an enlightened choice.
He explains that every treatment has its benefits and risks, so it involves striking a balance between these aspects. This holds particularly true for HRT, as some women suffer from debilitating symptoms, which profoundly impact their lives. Balancing this with a slightly elevated breast cancer risk if HRT is employed for a specific duration is crucial. McCarthy explained that the benefit might surpass the small increase in risk for numerous women, as the detriment to their general functioning and life quality is significant.
With Ireland poised to provide this “game-changing” medication free of charge to those requiring it, the question arises whether the nation is setting a trend or following other jurisdictions. Wales, Scotland, and Northern Ireland already offer free prescriptions, including HRT. England introduced a new scheme in the previous year named prescription prepayment certificate to decrease HRT cost, bringing prescription charges down to roughly €22.50 per annum.
This Irish decision could potentially help hundreds of thousands of women post-implementation. But field experts underline that HRT is merely one of the many available options, with a proportion of women undergoing menopause without any symptoms.
Pharmacist Victoria Jones emphasises that HRT doesn’t have a “one size fits all” solution, and menopause necessitates a “holistic approach”, including measures like exercise, stress reduction, and curbed alcohol intake. In conclusion, she says, “It’s also significantly concerned with those essential yet unglamorous matters your doctor advises you on.”