While the conversation around menopause has begun, many Irish women are still not getting the information they need about this important time in their lives. Women’s health is now spoken about more openly than in the past, but when it comes to menopause, many women are still unsure how to discuss it with their GP, or even what questions to ask.

Dr Rita Galimberti trained in Obstetrics and Gynaecology in Italy and then completed her training at the National Maternity hospital and at the Coombe Womens’ Hospital in Dublin before founding the Femplus Clinic in Dublin, where she is medical director. She is an expert in menopause and community gynecology.

Dr Rita Galimberti and Dr Suzanne O’Sullivan.

“Menopause is a physiological state, which happens to all women,” explains Dr Rita. “At a certain point, a woman’s ovaries start working less and that is the start of perimenopause. Levels of the hormones oestrogen, progesterone and testosterone, previously produced by the ovaries, begin to drop.

“There is no fixed age when perimenopause starts and it can be hard even for medical professionals to pinpoint exactly when it begins. It is generally accepted that the beginning is when periods stop and menopausal symptoms start. For some women perimenopause is very quick, and for others it can last as long as ten or 15 years.

While some women sail through with very few symptoms, for others it is a different story. Symptoms are many and varied; Dr Rita’s approach is to focus on whatever is most important to each individual woman.

“The four main symptoms are hot flashes and night sweats; feeling tired – a different kind of tiredness to anything the woman has experienced before; mood changes, anxiety and depression, feeling down for no reason; and lack of sleep, which can often be related to night sweats.

“Women often ask me what stage of perimenopause or menopause they are at, and I tell them that doesn’t matter – what matters is if you have symptoms that are bothering you. You can do something about them if you want.”

Dr Rita advises women with symptoms that are affecting their quality of life to be open-minded about hormone replacement therapy. In the past, HRT got a bad rap and some women remain nervous, but things have come a long way.

“In essence, HRT is putting back into your body the hormones that it is not producing any more, and enabling you to function in the way that you did before those hormones started to deplete. For many women, life is significantly better with treatment and they find it empowering to take control of their symptoms.”

At Femplus, Dr Rita prescribes body identical hormones which are much safer than unregulated bio identical hormones, for which there is no data on usage and safety. She advises women to do their research and understand the difference between the two.

“The two main hormones women need are oestrogen and progesterone,” says Dr Rita. “Oestrogen is what I call the happy pill, while progesterone is needed to protect the uterus. Women who have a womb need to take both, while women who have had a hysterectomy just need to take oestrogen.”

HRT is taken in three main ways: via oral tablets; through the skin via a patch or gel; and intravaginally, usually just for oestrogen. The form in which HRT is prescribed depends on risk factors, with the dose tailored to the individual woman and her needs.

How does Dr Rita describe the benefits of HRT?

“The first major benefit is the relief of symptoms,” she explains, “but the most important is the long term benefit to cardiovascular health and bone health. As we age and enter menopause, our cardiovascular risk increases – currently 50% of women in Europe die of cardiovascular disease. HRT also reduces the risk of osteoporosis, and there is a vaginal benefit, because during menopause vaginal skin changes and becomes thin, sex becomes uncomfortable and some women get a lot of urinary tract infections. This is called vaginal atrophy and can be very distressing for women. Together these benefits outweigh the minor increased risk of breast cancer associated with HRT and women can continue to enjoy the benefits for a long time with the correct medical supervision.”

For a variety of reasons, not every woman is in a position to visit a menopause specialist, and so Dr Rita has recorded a series of podcasts which can be heard at www.menopause.ie.

The podcasts cover the menopause in general, HRT, long term implications of the menopause, vaginal problems in menopause, and urinary problems.

Learn more about Dr Rita Galimberti’s work at www.femplus.ie.