Perimenopause: From pyjamas to pills, the range of treatments can be confusing. Are women getting the right information about how to deal with it?

The result, medics agree, is that women are overwhelmed by a tsunami of information.

Perimenopause has become big business in Ireland, particularly for women with a disposable income who have embraced the wellness culture that has filtered in from the US.

Symptoms of the perimenopause include brain fog, night sweats, mood swings, concentration issues, changes to the menstrual cycle and sexual desire.

Perimenopause can last for over a decade for some women and is classified as the timeframe leading up to when a woman fully enters the menopause — which occurs when periods permanently stop, usually when women are in their 50s.

We are finding that many women are more symptomatic in the perimenopause than the menopause itself

Some specialists in female health now believe perimenopause can be more of a challenge and an adjustment to women's lives than when their periods come to an end. "The perimenopause can be tricky. We are finding that many women are more symptomatic in the perimenopause than the menopause itself," said Dr Caoimhe Hartley, a GP specialist in women's health who is clinical lead at the complex menopause clinic in the Rotunda Hospital.

She also runs a private menopause clinic in Dalkey, south Dublin, which is in high demand.

"In recent years, there has been an explosion of private services for peri and menopausal women. This reflects a need for information. The perimenopause in particular is something women are suddenly very aware of, which is great. But we've gone from no information to the other extreme, we are now swamped," Dr Hartley added.

"I think it is very overwhelming for women trying to sift through all the information out there and trying to figure out what is evidence-based and what is bullshit. And this is all happening at a time in women's lives when they feel vulnerable and are looking for answers about why they might be feeling a certain way. There is every product out there. You can buy menopause pyjamas now."

Last year, Penneys launched its first collection of nightwear for menopausal women, aimed at alleviating night sweats and hot flushes. The high street retailer was mirroring online trends, which has seen a growth in the sale of every conceivable product for women entering this stage of their lives.

What perimenopausal women genuinely need, Dr Hartley said, can be complex as there is no "one size fits all" treatment for the onset of menopause.

Expertise in Ireland is growing, she added. Dr Hartley is co-chair of the Menopause Society of Ireland (MSI), which aims to grow Irish-based information and accreditation rather than medical professionals here relying on the UK.

The first port of call when people have a medical issue is generally their GP. But increasingly, women in Ireland in their late 30s who suspect they might be perimenopausal are booking consultations at private clinics, often at costs of over €100 for an initial consultation.

"I work in the public sector in the Rotunda and then in my private practice. There's no doubt, private services are fulfilling a need in the market," Dr Hartley said.

"An initial private consultation can be 45 minutes. Whereas, if you go to your GP, sometimes you can be lucky to get 10 minutes. They don't have the time, that's understandable. That's where private clinics have blossomed," she added.

"A decade ago, women only went to their doctor when they entered the menopause, when their periods stopped. That's all changed now and the perimenopause is recognised.

"Treatment has also changed. It can be about changing your nutrition, your exercise regime, caffeine and alcohol intake and sometimes Cognitive Behavioural Therapy (CBT). It's not just all about HRT these days."

One broadly welcomed measure in last week's Budget saw the introduction of free HRT

Hormone Replacement Therapy (HRT) is the medically recognised safe and effective treatment for women entering the menopause and perimenopause through the use of oestrogen.

​One broadly welcomed measure in last week's Budget saw the introduction of free HRT. The scheme will save women between €360 and €840 a year as these products can cost between €30 and €70 per month.

Through her work with the MSI, Dr Hartley said there's no doubt that GPs are interested in educating themselves further on various treatment options to help menopausal women presenting to their surgeries. A recent educational seminar hosted by the MSI could not facilitate a high number of GPs who wanted to attend.

"There is an appetite to learn, certainly. But there could be a lag and a delay with GP practices catching up with private services. Because as we know GP services are so busy and overstretched. But I strongly feel the appetite is there and that's because women are going to their doctor, looking for help and answers," said Dr Hartley.

Dr Ciara McCarthy, the Irish College of General Practitioners (ICGP) and HSE clinical lead for women's health, agrees. There's been a big increase in perimenopausal women attending their GP in search of information, she confirmed.

Most GP practices have a women's health service and if they do not, they should be able to refer patients to another service nearby. But anecdotal evidence suggests that some women, who can afford private treatment and consultations, are doing so because they didn't receive adequate care from their local GP. Is Dr McCarthy aware of instances of this?

"There has been an increase in the number of private clinics providing services for women entering the menopause. The reasons for this are multifactorial. A small number of women are doing so because they were not able to access care from their own GP," she said.

Patients do ask their GPs about some of these supplements now

Dr McCarthy added that "GPs are educating themselves", pointing out that the ICGP's online menopause course is its most popular by far.

"Between 2018 and 2022, HRT prescriptions tripled for medical card holders. That paints its own picture. The vast majority of GP surgeries provide menopause care services," she said.

The HSE provides a Complex Menopause Service at six hospitals around the country, designed to help patients with serious medical conditions to manage their menopausal symptoms. It caters for women with complicated menopausal needs but does have waiting lists, Dr McCarthy acknowledged. There has been a rise in the availability of online supplements, sachets and drinks which claim to help women manage their perimenopausal symptoms. Is this something GPs are regularly asked about?

"Yes, patients do ask their GPs about some of these supplements now. Some have evidence of efficacy and are safe. But others can have a detrimental effect. What GPs would recommend is vitamin D supplements, and sometimes calcium, depending on the patient," Dr McCarthy said.

Dr Michelle Hone, who has a PHD in nutrition, is the co-founder of Herology, which produces a range of supplements that aim to help women with hormonal changes. Through her work as a nutritionist for almost a decade, she has specialised in women's health. In January of this year, she launched Herology's range of supplements alongside Dr Sarah Kelly, a health research expert and physiologist. Business has been booming.

"Since launching in January of this year, we've helped over 3,000 women, with so many coming back every month," said Dr Hone.

"It's been wild. We did no PR, the women who are buying our products are coming back because they are working for them. We can't sell what we don't stand over. All of our testimonials are genuine.

"Supplements are not a replacement for HRT and I do think that the supplement industry can be very exploitative. We attach huge important to the integrity of our products and the science behind them. At the moment, we are just trying to keep up with demand."

Dr Hone agreed that perimenopausal women are overwhelmed by the array of treatment options, particularly online. She pointed to international evidence of the links between nutritional and lifestyle changes in helping women manage the menopause.

"Managing your health, particularly in the perimenopause and menopause, is about so much more than what's just in a GP's medical toolbox."