Irish women have long been on the periphery of the medical world and as a result women’s healthcare has been underfunded, poorly understood and shaped by silence, wrapped up in a system that has been made by men for men. Conditions such as endometriosis frequently take years to diagnose, with women told their debilitating pain is “normal” or psychological. Menopause was until very recently a hush-hush word reserved for close female-only circles. As for pelvic floor problems, the majority of sufferers put up and shut up. The lack of clinical research focused specifically on women’s bodies and a society long dominated by the Catholic church with strict moral codes over women’s health served to compound this problem, leaving gaps in medical training and treatment options.
Talk to any Irish woman and she’s likely to have a medical story that involves being dismissed, overlooked, ignored or misunderstood. My own experience involved being quickly sent away with a prescription for antidepressants for perimenopausal symptoms, without even a cursory discussion of alternative options. I never took the medication and instead did a deep dive into the research until I found a female doctor who was willing to explore my symptoms and options.
In recent years we have seen a shift in a more enlightened direction. Call it “the Davina effect” or the Irish equivalent, “the Joe Duffy effect”. Women are now sharing the wild truth about midlife, menopause, menstruation, childbirth and all that comes with inhabiting the female body. Across the media spectrum there is a huge and healthy discourse around female health, especially menopause, and the medical world is taking note. Even Michelle Obama shared her “hot flash” moment on her podcast. What happens to women’s ageing bodies is, she concluded, “an important thing to take up space in a society, because half of us are going through this but we’re living like it’s not happening”.
Michelle Obama has drawn attention to issues around female health
MARTIN SYLVEST/RITZAU SCANPIX/AFP
The government’s Women’s Health Action Plan 2024-2025 included expanded access to contraception, menopause clinics, fertility and gynaecology services, and a full subsidy of HRT medications … finally. But real change will depend on redefining what it means to listen to and care for women’s health holistically and medically — built on empathy, evidence and equity.
Dr Hugh O’Connor and his wife, Fiona Healy, have placed these ideals at the core of the HOC, their new clinic in Dublin. It specialises in female health and wellness, from skin conditions and menopause to gynaecological issues, postnatal problems and sexual wellness, promoting optimal female health at all stages of life. “We’d like to think we’re not just a run-of-the-mill clinic,” Healy says, “but that we’re offering expert response to female medical issues with a proper road map of where to go.”
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O’Connor is an award-winning gynaecologist and obstetrician, who has been in obstetrics at Coombe hospital in Dublin since 1997, and he recognises the limitations of hospitals when it comes to the full gamut of women’s health issues. “We offer a great service at the Coombe but it’s a little tired. It has always struck me that if men had babies, the Coombe would be a tower to the Celtic tiger. But we don’t and I really wanted to offer women a good service in good surroundings, one that was comfortable and less rushed.”
Historically, women have had a raw deal when it comes to menopause care, he continues. “It’s still not what it should be.” And it goes beyond menopause. “When you’re a junior doctor, a vaginal delivery is considered to be the holy grail but there’s a cost to that, namely a woman’s pelvic floor. We are working with a lot of new technology that can help optimise that. My focus is always mother first and baby close second and in my experience once a woman has had a family they put themselves at the bottom of the priority list. They are more tired and their bladder might not work as well. They often don’t present with those complaints but when I probe them about the bladder they often tell me they can’t run or jump and they just put up with it. But they shouldn’t have to,” he adds. “There is technology that can help.”
Davina McCall has made two documentaries about the menopause
IAN WEST/PA
The HOC is a first mover in this area, but there are many others joining the fray, not least the soon-to-be-launched €16 million Women’s Health Centre from Blackrock Health on Warrington Place in Dublin 2. These signal the rise of consultant-led facilities for the thousands of women long frustrated with the gap in women’s healthcare. “GPs don’t always have the correct expertise to deal with menopause issues, for example,” O’Connor says.
The misconception around hormone replacement therapy hasn’t helped. The flawed analysis of the Women’s Health Initiative study in 2002, which found an increased risk of breast cancer and heart disease with combined HRT in older women, was misinterpreted and generalised to all women. The media picked up on the negative findings, leaving women in a panic about taking HRT. “Women were afraid to even talk about it,” O’Connor says. “I find that women who are on HRT are more aware of their health and get checked more regularly. If the benefits outweigh the risks then there is a strong case for taking it. The good news is there are a lot more GPs now who are increasingly interested in this area of medicine so it will improve, albeit slowly.”
When O’Connor started at the Coombe there were only two female doctors. Now the majority are female. “I’ve four daughters, a wife and one son,” he says. “I look at how brilliant my wife and daughters are and can’t help but feel if girls were guys they would be looked at and remunerated differently. The premise behind the clinic is to make things better, healthcare is getting better and there are lots of areas being addressed but we’re not there yet.”
As a mother of five, Healy knows only too well the consequences of childbirth on the female body. “It was really our daughters and their future that helped spur our decision to open the clinic. For the past ten years Hugh and I have been discussing the fact that there really hasn’t been a facility for women like this in Ireland. I’ve been through it all and really felt there was something missing; we wanted to fill the gap.”
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In the eight months since the clinic opened a huge volume of patients have come for the reassurance of practised hands and expert advice. But being able to visit a clinic like the HOC might not be possible for a lot of women, so what can they do? “In the Coombe and in other hospitals there are menopause clinics run by consultants and teams specialising in complex menopause issues. My daughters also help us provide online information, which we will continue to provide free of charge,” O’Connor says.
The expanding network of clinics also includes “see-and-treat” gynaecology clinics with more due to be rolled out in the coming year. It’s timely given the new public-only contracts for hospital consultants signalling an end to in-hospital private maternity care. “A pregnant woman will soon no longer have the option to pay for private obstetric care,” he says. “You can argue that it’s a good thing, everyone under the one banner, but I disagree. In an ideal world everyone could go private and get that one-to-one care but sadly, that isn’t possible. But the option shouldn’t be taken away from women who want that service. Pregnant women should have that choice, especially when men have the choice to go public or private in every aspect of their healthcare.”
“Women want to live as good a life as they can live,” Healy says. “I would love to see proper postnatal care for women following childbirth, including better physio care and a greater awareness of perimenopause and menopause issues. Surely everyone needs and deserves access to that.”
Perimenopause device gains momentum
Science now suggests that symptoms of perimenopause — frequency of night sweats, for one — have strong links to cardiovascular disease and even to Alzheimer’s disease, writes Elaine Prendeville. Enter Peri, a wearable tracking device designed to equip women with more information.
Heidi Davis was on a work trip in America when her inbox lit up. “The waiting list for Peri was exploding,” she tells The Sunday Times. “And I couldn’t work out why.” Peri, a wearable sensor designed to track symptoms of perimenopause, had been revealed on Oprah Winfrey’s website, which suggested that the device “could offer tangible, personalised insights to help you keep track of what’s going on with your body and empower you to be an advocate for your own health”.
American women wanted in, and fast. “That was without a single marketing dollar,” Davis, a Dublin-based scientist and Peri co-founder, says. “Which suggests to me that our timing is right.”
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Peri is a small device that is worn at the ribcage below the breast. It is the result of a five-year research and development process in Ireland, and will become available for the first time to US customers this autumn. Designed for the woman who is experiencing symptoms of perimenopause or believes that she may be, Peri tracks everything from night sweats, hot flashes, anxiety and sleep disturbances. It also tracks lifestyle and activity variables such as dietary habits, menstruation and exercise, putting all the data points together to deliver weekly and monthly reports. The idea, Davis says, is that women can use the data to better inform themselves about the impacts of various choices — including HRT — on perimenopausal or menopausal symptoms, and ensure a trip to the GP can be a more fruitful experience. “Many women are told they are fine by doctors who are not especially good on this subject,” she says. “And while HRT is one solution, and it is very effective for a lot of women, it is not the only solution. For women in perimenopause and in menopause, more knowledge is most certainly more power.”
Why not an Oura ring, though, or other wearable devices? “We tried to develop Peri to be worn on the wrist or a finger and it simply does not work,” Davis contends. “Other smart-tech wearables that are entering this peri or menopause space, they rely on self-reporting, not genuine sensor tracking in the correct physical location.” You can’t pay for your coffee with a Peri, Davis concedes, but what you do get is a device that is optimised for the job intended.
The only catch? You can’t buy it in Ireland or the UK yet. But you know where to join the queue. And wonder what we’ll wear, and track, next. myperi.co