‘Anxious, snappy and afraid to drive on the motorway — my name is Audrey Kane and I am perimenopausal’
Like many women, perimenopause came as a surprise to journalist Audrey Kane. Seeking help for her symptoms was further complicated by a history of ovarian cancer in her family. Here’s how she got on
The changes were quite subtle to start. In fact, so subtle, I never even considered perimenopause was in play. It’s likened to puberty’s evil stepsister, because instead of hormones surging, they are jumping ship at an alarming rate and they are not going quietly either — taking down sleep, mood and your sex drive with them.
As someone who is already predisposed to general anxiety, trying to decipher whether feeling rudderless, along with my disturbed sleep and plummeting confidence was pandemic-induced, stress-induced, hormone-induced, or simply a combination of all the above was not straightforward.
Then there is the timing. It is not exactly convenient, considering these changes coincide with one of the most hectic times in a woman’s life. Many are already juggling family and careers, helping teenagers through their own changing hormones, supporting older parents and sadly, like myself, losing older parents. Which is why some of the classic symptoms, like tiredness, irritability and palpitations can be put down to life being, well simply, life. This can mean we tend to gloss over it and move on.
But whatever about missing the symptoms due to a heady mix of the above, I’d have imagined I’d have some inkling of what was going on. I mean I turned 50 this January, my ovaries had already received word to begin producing less hormones a few years back, only I had taken no notice.
I was expecting the hot flushes, irregular periods and at a push, the night sweats. But what I was not expecting was a slew of different changes entirely. Forgetting what I wanted to say mid-sentence, fatigue, an urgent need to pee, the rage, the tears, the frustration, surprise anxiety attacks, wishing I hadn’t made plans because I’m too exhausted to fulfil them and the sudden need for a nap.
"What I was not expecting was a slew of different changes entirely. Forgetting what I wanted to say mid-sentence, fatigue, an urgent need to pee, the rage, the tears, the frustration, surprise anxiety attacks, wishing I hadn’t made plans because I’m too exhausted to fulfil them and the sudden need for a nap.”
The physiological effects can be far reaching too — but the one that took me by surprise most was a sudden fear of driving on the motorway (quite a common one, as it turns out). I have been driving since my early twenties and test drove cars as a motoring correspondent in my early forties, so this crisis of confidence really shook me.
Prior to the more not-so-subtle changes, I had been getting myself in decent shape, having lost more than four stone on a nutrition and fitness programme called elate.ie and writing about it for this very paper in Health & Living (the irony of working for a health supplement is not lost on me).
After eight months on HRT, Audrey feels like she has her life back
I had made a lot of lifestyle changes as well, eating better, drinking less, exercising more, meditating, mindfulness, Tai Chi, you name, I did it. But there was one thing I had not done: prepared, and empowered myself with knowledge.
For me awareness of the severity of the 40-plus symptoms of the menopausal transition was sadly lacking; 75pc of women will be affected by them and 25pc will have symptoms that seriously affect their quality of life every day — I had fallen into the latter category.
I was completely unaware that perimenopause begins about eight to 10 years before menopause. It usually starts in your mid-forties, but it can start earlier. Perimenopause is when you still have periods (even if irregular) but have menopausal symptoms and menopause is when it’s been 12 months or more since your last period.
Once you enter perimenopause, your oestrogen levels start to decrease. As oestrogen decreases, it throws off the balance with progesterone, another vital hormone. These two hormones together are responsible for ovulation and menstruation. So, it’s common for hormone levels to fluctuate.
Perhaps if I had known this, I would have been a lot more likely to push back when my GP suggested in 2018, when I was age 46 and starting to feel something was off, to take bloods to check my hormones levels to see if I was in perimenopause. Spoiler alert — they came back normal.
Hormones go up and down like a yo-yo for the next few years and I do what most women do — stay calm(ish), carry on and go about my business. Fast forward to 2021, I am now 49 and a year working from home through the pandemic, and I was feeling slightly off kilter. Sure, wasn’t everyone at this stage?
"Hormones go up and down like a yo-yo for the next few years and I do what most women do — stay calm(ish), carry on and go about my business. Fast forward to 2021, I am now 49 and a year working from home through the pandemic, and I was feeling slightly off kilter. Sure, wasn’t everyone at this stage?”
Enter brain fog, a constant low-level feeling of anxiousness, difficulty concentrating, and just not feeling like myself came into the mix. I felt as though my whole equilibrium had shifted. The hot flushes which are now a daily creeping sensation, like a thermometer gone rogue, still don’t entirely convince me I need to do something.
I have always had a low tolerance for heat, so walking around the house in the middle of winter in a T-shirt and complaining that the heating was on too high was no surprise to myself or my partner... snapping his head off for clicking a pen too loudly may have been.
The light-bulb moment finally came when I heard Joe Duffy’s Liveline in May 2021. Kickstarted by Sallyanne Brady, who voluntarily co-founded The Irish Menopause group, she had written a letter describing how she lost five years of her life searching for ‘the answers.’ ’ It blew the lid off the menopause conversation in Ireland — hosting amazing women who shared their experiences with the nation.
This is when everything finally clicked into place — I am perimenopausal.
The Irish Menopause was set up by Sallyanne Brady and Claire Peel
Buoyed on by the Liveline discussion I decided to firstly join The Irish Menopause Facebook page and then make an appointment with a different GP.
Now at this point you would be forgiven for thinking that understanding what is happening is key, but unfortunately for some women it’s only half the battle. It is navigating through the health lottery and finding a GP with enough menopause knowledge that can be tricky part as lack of training in this area is a big problem.
While some are really clued up about menopause and HRT, unfortunately many are not, resulting in a constant back and forth before an acknowledgement that it’s the hormones or lack of at play. Many are fobbed off with out-of-date information. Throw in the fear mongering left over from the fallout of a study published in 2002 that linked HRT to increased rates of breast cancer, and it can be a very disheartening and disappointing process to get the right treatment.
Now to be completely transparent and fair to the GP, my beloved mum passed away from ovarian cancer in 2017 and there is a history of cancer on her family’s side, so I knew it would not be straightforward.
But I was confident she could help, or at the very least direct me to where I needed to go. Besides the clinic had ‘menopause management’ on their website. I got as far as medical history and was told there was no way I could have HRT. No other alternative offered, just NO.
I think what hurt me most about that visit was the sheer lack of empathy I received. I left bewildered, deflated, and cried in my car. Thankfully, I didn’t leave completely empty handed. I asked for a referral letter to a gynaecologist. I researched online and found one with the areas of expertise I was looking for.
I got a cancellation appointment at the start of December 2021, and it was worth the wait. Not only was my specialist incredibly reassuring and did an extensive consultation, but he also went through the risk/benefit balance of HRT before deciding on a three-month transdermal HRT, a patch called Evorel Conti. I was also referred to the Hermitage Clinic in Lucan for genetic testing (the results came back clear). Within the space of a week and just two patches later, I was starting to feel the benefits.
Now if it seems I went about things arseways, well you are right, I did. You can blame the brain fog for that. The information online can be a little overwhelming, so I decided I needed to know more about this life transition I was going through and signed up to the Menopause Basics course run by Sallyanne from The Irish Menopause, who gives evidence-based information.
It was only €13 for an hour and half and the amount of knowledge I came away with was outstanding. I really wish I had started there. Through the site, I found Dr Sarah Callaghan, who is part of a women’s health service specialising in menopause care at Complete Women’s Health.
I took that opportunity to make an appointment with Dr Callaghan, because while my gynaecologist was great, I felt I needed her expertise in other areas and I happened to be in the market for a new GP.
She was, as I had imagined she would be, brilliant, empathic, and a fountain of knowledge. She listened, I mean she really listened. At the time of my visit in February 2022 the shortage on patches had kicked in, so I felt it was was perfect timing to make a switch. We decided on the Oestrogen gel (now also in shortage) and a micronised progesterone tablet call Utrogestan. I was also put on a vitamin D called Desunin 800 IU.
I am not going to lie; the switching part (for some) can be like starting over again. The night sweats came back with a vengeance, the irritability, all the gang reunited — but only briefly. The difference this time around was, I knew what to expect and thankfully things have once again settled down. I’m now eight months on HRT and feel I’ve found my way back to the vibrant woman I was.
This really was a journey for me and throughout it I have been acutely aware that without my private health insurance I would not be at this point this quickly. Women deserve better treatment opportunities in menopause — whether they are public or private because crossing the midlife point is challenging enough.
Healthcare professionals simply must receive the most up-to-date, unbiased, evidence-based information, training and resources on peri/menopause, allowing them to help us, as patients, to make a joint informed decision/treatment plan so we don’t have to fight to have our own hormones replaced.
Medicated menopause should not be stigmatised, it should be a choice — and for now it’s my choice. So let’s keep the conversation going. My name is Audrey Kane and I am perimenopausal.
HRT for women with BRCA1/2 or Lynch syndrome
If you have a genetic mutation such as BRCA 1 or 2 or Lynch syndrome, you already have a high lifetime risk of cancer and taking HRT does not usually increase this further, says menopause specialist Dr Louise Newson.
When you have surgery to remove your ovaries, you immediately go into a surgical menopause because your body no longer produces oestrogen, progesterone and testosterone. Most women that take this step as a risk-reduction measure, will face menopause at an earlier time than the average age of a natural menopause — which is 51 years.
When making decisions around risk-reducing surgery and the consequences of removal of the ovaries, women often consider symptoms of the menopause but there are also health risks associated with the menopause in the long term, such as an increased risk of developing heart disease, osteoporosis, type 2 diabetes and dementia.
As well as improving symptoms, HRT lowers your future risk of developing these diseases. Even if you do not experience many symptoms from your surgical menopause in the short term, it is worth considering the long-term impact of having low hormones on your health in the future, and how HRT can minimise these risks.
Current menopause guidelines advise that women with high-risk genetic mutations having risk-reducing surgery to remove their ovaries — before the age of the natural menopause — should be offered HRT until at least the age of 51. This is because of the health risks of having low hormones. Many women then continue to take HRT for ever in view of the many health benefits HRT gives to women.
Women who have had ovarian cancer in the past can usually take HRT. There are some types of ovarian cancer that are oestrogen receptor positive, therefore, it is best to speak to your oncologist and find out whether you had this type of ovarian cancer or not.
If you did, the same advice applies as with ER+ breast cancer and healthcare professionals need to weigh up the benefits and potential risks to make decisions on a case-by-case basis and take your views into account.
Other women who have had ovarian cancer in the past can still safely take HRT. There is no good quality evidence to show that women taking HRT have an increased risk of developing ovarian cancer — which is very reassuring.
Extract from Dr Louise Newson and Ovarian Cancer Action booklet available from balance-menopause.com.
Books and podcasts
No matter where you are in your menopause journey, these books will help to provide insight, information, and advice with an eye-opening, no-holds-barred guide to everything you need to know.
Cracking The Menopause by Mariella Frostrup and Alice Smellie
