Menopause & HRT in Ireland — Patient Guide

What is menopause?

Menopause is the natural cessation of menstruation, occurring on average around age 51 in Ireland (range typically 45–55). The transition phase before — perimenopause — can begin years earlier and is often the time when symptoms are most disruptive. Early menopause (before age 45) and premature ovarian insufficiency (before age 40) have specific medical implications and warrant in-person assessment.

Common symptoms

Per NICE CKS and the British Menopause Society, common symptoms include:

• Vasomotor symptoms — hot flushes and night sweats, the most characteristic feature
• Mood changes — low mood, anxiety, irritability, brain fog
• Sleep disturbance — often driven by night sweats
• Genitourinary symptoms — vaginal dryness, soreness, urinary frequency, recurrent UTIs
• Reduced libido
• Joint and muscle aches
• Long-term: bone density loss (osteoporosis risk), cardiovascular risk changes

Symptoms can range from minimally disruptive to significantly affecting daily life — there is no one "right" experience, and no shame in seeking help for any of them.

Hormone Replacement Therapy (HRT)

HRT is the most effective treatment for vasomotor symptoms per NICE. It replaces declining oestrogen, with a progestogen added for women who have a uterus (to protect against endometrial cancer). Formulations include:

• Transdermal oestrogen (patches, gel) — increasingly first-line; bypasses the liver and carries no increase in venous thrombosis risk
• Oral oestrogen — convenient but small increased thrombotic risk
• Progestogen — combined into oral tablets, separate progestogen tablets, or the levonorgestrel IUS (Mirena) which doubles as contraception and progestogen for HRT
• Vaginal oestrogen (cream, tablet, ring) — for local symptoms only; not the same as systemic HRT; very safe and can be used long-term
• Tibolone — synthetic option for post-menopausal women

HRT risks and benefits — the honest picture

Older media coverage (after the 2002 WHI study) overstated HRT risks. NICE 2024 guidance is clear: for most women under 60 starting HRT within 10 years of menopause, the benefits outweigh the risks.

• Benefits: symptom control, improved bone density, possible cardiovascular benefit if started near menopause
• Small absolute risks: breast cancer (combined HRT — small increase, less with progestogen-only), venous thrombosis (oral oestrogen only — transdermal carries no increase), stroke (oral oestrogen only, small)
• Not a contraindication for most women — but personal and family history is reviewed individually

Contraindications include current breast cancer, undiagnosed vaginal bleeding, active venous thromboembolism, and uncontrolled hypertension. An Online Doctor will review these with you.

Non-hormonal alternatives

For women who can not or prefer not to use HRT:

• SSRIs/SNRIs — paroxetine, venlafaxine, citalopram help vasomotor symptoms (off-label use, established practice)
• Cognitive Behavioural Therapy (CBT) — effective for hot flushes and sleep
• Gabapentin — selected cases, particularly night sweats
• Lifestyle — regular exercise, layered clothing, cool bedroom, calcium and vitamin D, smoking cessation, moderating alcohol

Online Doctor consultation for menopause

An Online Doctor menopause consultation covers symptom assessment, personal and family history review, risk-benefit discussion specific to you, prescription where appropriate, and a structured follow-up plan. Most menopause care is well-suited to remote consultation; in-person review is appropriate for postmenopausal bleeding, suspected early menopause, or specific clinical concerns.