Endometriosis is a chronic, progressive, inflammatory disease where tissue similar to the lining of the womb is found elsewhere in the body.

Estimated to affect 1 in 10 women, endometriosis can manifest in many different ways, making it difficult to diagnose and treat. It can wreak havoc in a person’s life, from the teenage years to menopause and, sometimes, beyond.

Possible effects of endometriosis

Pain, one of the main symptoms of endometriosis, can be daily or cyclical. It can also be chronic or mild. This pain can be experienced in different ways, including:

• Pelvic pain, which radiates down the legs or up the back
• Pain during intercourse
• Pain passing stool
• Pain passing urine

Chronic fatigue is frequently experienced. Living with endometriosis can also negatively impact mental health.

Endometriosis diagnosis and stages

A definitive diagnosis is only possible with a laparoscopy. The disease is graded based on prevalence: stage 1 (minimal); stage 2 (mild); stage 3 (moderate); and stage 4 (severe). However, prevalence does not correlate to pain; someone with stage 1 can suffer chronic daily pain while someone with stage 4 may have no pain at all. This complicates diagnosis, as it can be easily missed or confused with other conditions like irritable bowel syndrome (IBS) and ovarian cysts.

Finding the right endometriosis treatment

A GP will usually try hormonal treatment and pain medication first to suppress symptoms. However, many women will need an onward referral for surgical intervention, with excision surgery considered the gold standard treatment. Anyone who suspects they have endometriosis must be well-informed to ensure they get the right support.

Initial indications of endometriosis

Endometriosis is usually triggered by the hormonal shifts associated with a first period. Pain and heavy periods are the most common symptoms. This can impact school attendance and ability to participate in sports and attend social gatherings. It’s important that young girls know this is not normal and that they should seek medical advice and support.

Fertility considerations

Endometriosis is one of the leading causes of infertility and is thought to affect around 50% of sufferers. For some, diagnosis might only be triggered while undergoing fertility treatment, so early awareness is key.

Perimenopausal and menopausal considerations

Endometriosis can complicate hormone replacement therapy (HRT) administration, especially for those using the Mirena coil or those needing a hysterectomy. These patients are normally prescribed oestrogen-only HRT, yet women with endometriosis often benefit greatly from taking body-identical progesterone.

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It should be a time full of hope, but pregnancy can leave some women particularly vulnerable. Global research shows that domestic abuse during pregnancy is more common than pre-eclampsia and gestational diabetes.

The adverse impact of domestic abuse on pregnant women’s mental and physical well-being is significant and wide-ranging. It also directly affects children. Impacts include miscarriage, premature birth, delivering a baby with a low birth weight, self-medication with alcohol and/or drugs to cope with the abuse, postpartum depression, stress, anxiety, negatively impacted mother-child bond and behavioural and emotional problems in children. In extreme cases, domestic abuse can be fatal.

The case of domestic abuse in Ireland

In Ireland, one in eight women suffer domestic abuse during pregnancy. In 2022, our dedicated maternity outreach worker supported 53 pregnant/postpartum/post-termination cases where women were subjected to intimate partner abuse. However, we know that this is only the tip of the iceberg.

One in four women in Ireland experience some form of domestic abuse and unfortunately, domestic abuse does not stop in pregnancy. Every year, the Women’s Aid 24-hour National Freephone Helpline and Face-to-Face support services support hundreds of women who are coercively controlled, beaten and raped while they are pregnant.

Disclosing abuse is a complicated decision. For some women, there may be barriers, including language and interpretation. It is important for professionals working with victims of abuse to understand that while women may want to change their situation, their ability may be affected by their concerns and lack of resources.

One in four women in Ireland experience
some form of domestic abuse

Antenatal care opens opportunities for hope

While pregnancy may be a particularly vulnerable time for women in abusive relationships it also offers healthcare professionals a key opportunity to identify victims and support them appropriately, due to the routine nature of antenatal and postnatal care.

If any healthcare professional is worried about a patient, they should listen to what she has to say, believe her and support her on her journey to safety. The key step to take is to refer the woman to the hospital’s medical social work team and the Women’s Aid 24-hour National Freephone Helpline.

Maternity support for women

In 2021, Women’s Aid and four of Ireland’s leading maternity hospitals began an innovative partnership to enhance support for abused pregnant women who are accessing maternity services as well as women contacting Women’s Aid for support. This partnership is also supporting staff who may be subjected to domestic abuse.

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Confusion is the word that springs to mind when it comes to information about menopause. Wading through treacle while engulfed in brain fog is difficult enough without trying to decipher fact from fiction.

Menopause has always been under-discussed, under-recognised and swept under the carpet! But it’s crucial that correct information is easily available.

Menopause myths and facts:

1. ‘Menopause’ means you have not had a period for 12 months consecutively or 24 months if you’re under 50.
2. The average age for reaching menopause is 51 years.
3. The diagnosis of perimenopause is based on symptoms, not on blood results. As per NICE Guidelines and ICGP Guidelines, blood tests are not required.
4. Menopause will be brought on abruptly post-hysterectomy, including removal of ovaries and can also occur early if ovaries remain.
5. Perimenopause is the years leading up to menopause and will start many years before the final period. Most commonly, symptoms may present themselves during a woman’s early 40s, but they’re often not recognised as hormonal.
6. Menopause means you’re no longer producing hormones from the ovaries and will no longer have periods. We do not go through menopause, we go into it.
7. The most common symptoms not considered related to menopause are anxiety, tinnitus, insomnia, gut issues and — believe it or not — painful feet. Some will never experience a hot flush.
8. HRT means hormone replacement therapy; you are replacing something the body no longer produces. Hormones, if suitable for you, can be used for life, not just for the short term.
9. Some HRTs are referred to as ‘body identical’, meaning the hormones are identical to the human versions and are synthesised from plants. Talk to your doctor about the risks and benefits of different types of HRT.
10. Your periods don’t have to have stopped for you to start HRT if you wish. Perimenopause is when symptoms present, which can interfere with your quality of life.
11. Our gut has a very important role in health and can be affected by hormonal transition. Good diet and lifestyle are essential at this time in your life.
12. Menopause can affect your mental health. Speak with a medic as this can be helped.
13. So, as you find the keys in the cutlery drawer and the polish in the fridge, please don’t think it’s just you. Menopause brain fog is real; talk with your healthcare professional today.

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When seeking support in the workplace for menopausal symptoms, it’s important to realise that your direct manager may not have the same awareness or experience of menopause as you do.

It’s for these very reasons that I believe it’s extremely important to have a simple, straightforward process for holding a successful conversation with your manager. 

Here’s how to prepare for the conversation with your manager 

Awareness: Make your manager aware that you’d like to speak to them about your menopause symptoms via email or a quick chat to request a meeting. Give them time to prep by requesting a meeting a week ahead, so they can research should they need to. If you don’t feel comfortable, seek a menopause champion, HR colleague or health nurse’s advice. 

Prepare: When the meeting is scheduled, prepare yourself. Think about your main symptoms and how they impact your workday. For the initial meeting, one symptom that is impacting your workday is enough. Bear in mind that your manager may not be familiar with menopause symptoms, so having a possible solution to suggest is essential. 

Menopause guidance and policy: Check if your workplace has a menopause policy in place. If not, see if there’s a mental health policy that may cover some aspects of the symptoms you are experiencing. 

Notes: Make notes before the meeting, especially if you’re experiencing concentration issues. Having notes will help you discuss your concerns effectively. 

This is an opportunity for you and your
manager to work together to support
you through your menopause journey.

Role play: Practise your meeting with a mirror, partner, friend, or colleague. This will ease nerves and help you anticipate outcomes for the upcoming conversation with your manager. 

The meeting: A few minutes before the meeting, do a breathing exercise to prepare and calm yourself. Have your notes and water ready. Remember that you’re here for support, and your manager (ideally) wants to support you too. 

Time: Give your manager time to deliver solutions. Some solutions might take longer, so allow your manager time to come back to you. 

Follow up: Agree on another date to check in and monitor progress. 

Remember, the aim of the meeting is to gain support and practical solutions for the changing symptoms that may be impacting your workday. This is an opportunity for you and your manager to work together to support you through your menopause journey. If you follow the above steps and don’t get the desired outcome, it may be time to speak with an HR representative. 

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With a third of young women not attending cervical smear tests, opportunities for early intervention are missed. Doctors are reassuring women that screening is done with utmost sensitivity and saves lives.

Cervical smear tests are free for patients in the UK. They are offered every three years for 25 to 49-year-olds and every five years thereafter until age 65. Yet, fears or ignorance mean it’s common for women to have gaps in their smear tests — with under 30s, in particular, resistant to attending. They are typically afraid of being hurt, worried about feeling embarrassed and scared of bad news. 

Possible signs of cervical cancer 

Signs of cervical cancer include new or irregular bleeding, such as after sex or during menopause; vaginal discharge with unusual appearance or smell; a change in bladder symptoms; new pains across the lower tummy or pelvis.  

We need to talk more openly with
young women because it is the best
protection against cervical cancer.

Prevention through smear testing 

Dr Declan Quinn, consultant gynaecologist and director of Mid Ulster Clinic, says: “We need to talk more openly with young women because it is the best protection against cervical cancer. When reality television star Jade Goody tragically died of cervical cancer, there was a higher uptake; but it since has slipped back down.”  

He adds that: “Nurses and doctors are highly experienced at performing smear tests and are sensitive to patients’ dignity, anxiety and sense of privacy.” According to the National Institute of Health, 46% of patients with cervical cancer had missed a recent smear test. 

Further examinations by specialists 

Patients who obtain an abnormal smear test result will have a colposcopy. Dr Quinn explains: “My role is detection and management of early gynaecological cancer and cervical screening. If we detect changes at screening, we can prevent progression to cancer in a vast majority of cases.” 

He also treats ovarian cancers, which start in the female reproductive system and share similarities with cervical cancer. However, ovarian cancer causes several distinctive symptoms, such as feeling full too quickly, bloating and pain. “Patients experiencing symptoms more than 12 days in the same month are urged to contact their GP,” stresses Dr Quinn.  

“I will continue to work with colleagues to reach out to communities to make the case for cervical screening. We take people’s concerns very seriously and believe that we can work with young women to encourage them to take up free testing.”  

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Dr Dearbhaile Collins

Consultant Medical Oncologist, Cork University Hospital and President,
Irish Society of Gynaecological Oncology (ISGO)

Endometrial cancer is the most common gynaecological cancer. According to the National Cancer Registry Ireland, 80% of patients have a five-year survival rate. Despite this, people with a uterus should take the necessary prevention measures.

In endometrial cancer, malignant cells form in the tissues of the endometrium. The endometrium is the lining of the uterus — a hollow, muscular organ in a woman’s pelvis.  

Endometrial cancer prevention  

As a Consultant Medical Oncologist at Cork University Hospital, Dr Dearbhaile Collins encourages people with a uterus to take effective prevention steps. In her experience, she says the disease is both highly preventable and manageable. “Risks of getting it can be minimised by patients improving physical activity, such as being moderately active for 30 minutes, five days a week.”  

A good diet is also a huge influence. There is no screening, so the condition is symptom-led. Bleeding, bloating, pelvic abdominal pain and changes in urinary symptoms or bladder control are all signs to look out for. If any of them are a concern, it’s best to consult a GP who can make the appropriate referral.  

Positive news on treatments 

Dr Collins, who is also Chair of the Cancer Trials Ireland Gynaecological Cancer Trials, says: “It is an exciting time in gynaecological cancer because 10 years ago, we were mainly limited to chemotherapy, but now, we are seeing new drugs targeting the immune system. Also, targeted treatments against cancer mutations and novel combinations of drugs.” All of this leads to better survival rates with advanced or metastatic disease and a higher quality of life as treatments are better tolerated.  

“Surviving endometrial cancer has a huge impact mentally and physically. Patients who adopt good lifestyle choices after surviving treatment are much less likely to see a return of cancer and more likely to experience a return to a happier mental state,” she adds. 

Surviving endometrial cancer has a
huge impact mentally and physically.

Awareness of all gynaecological cancers 

Dr Sharon O’Toole is a scientist who coordinates the Irish Network of Gynaecological Oncology. This includes charity and support groups across Ireland. “As a network, we want to increase awareness that there are five gynaecological cancers. Worryingly, our survey told us that 34% of women in Ireland believe cervical screening covers all gynaecological cancers. However, it only addresses the risk of cervical cancer,” she says. There is no other screening for other gynaecological cancers, which is why symptom awareness is so important.  

Ovarian cancer signs are bloating, eating difficulty, abdominal pain and toilet changes. Cervical cancer is characterised by bleeding or discharge. Uterine cancer can cause bleeding and pelvic pain. Vulval cancer can include itching, burning pain and tenderness symptoms while vaginal cancer can be spotted through unusual discharge, bleeding or urgency to go to the toilet.  

Dr O’Toole adds: “Four in five women wouldn’t be confident to recognise the symptoms of ovarian cancer, so there’s a huge knowledge gap. People should know their family history and communicate that to their GP because, for example, the BRCA1 and 2 gene mutations increase your risk of developing ovarian cancer.” 

Seeking treatment through clinical trials 

Launching more gynaecological clinical trials, including with better representation from patients outside of Dublin, is one of Dr Collins’s big hopes over the coming years. “Ireland currently only has two studies open in gynaecological cancers; one in endometrial cancer and a surgical study in ovarian cancer. But there are two new studies opening soon in ovarian cancer, which are testing new treatments and will give more options to patients with these cancers.”  

Ultimately, she urges patients affected by gynaecological cancer to always ask their oncologist about available studies because participation can mean access to new and innovative drugs. While treatments are improving for advanced gynaecological cancers, not all are curable and, thus, prevention is all the more important.  

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Niamh Kelly

Senior Oncology Pharmacist, St Luke’s Hospital Kilkenny

Maureen Kyne

Clinical Nurse Specialist, University Hospital Limerick

New ways of administering breast cancer treatment can enhance women’s quality of life while alleviating hospital capacity issues.

For years, it was typical for breast cancer patients to sit for multiple hours in busy infusion suites to receive their treatment intravenously. This time-consuming treatment could be disruptive to the lives of patients, making it difficult for them to continue their normal daily routines. For some, it was exacerbated by the need to travel long distances to the nearest infusion clinic. Each treatment required significant time and attention from busy nurses, placing a heavy burden on the capacity of the hospital system

However, recent innovations in cancer care have led to a shift in how some treatments are administered, allowing patients to spend more time living their lives. These new methods of administration also benefit the healthcare system, through cost-saving and resource capacity in the oncology pathway.  

Better treatment options available 

Ciara O’Hanlon Brown, Consultant Oncologist in St James’s Hospital Dublin, says: “Breast cancer treatments have improved greatly in my 15 years working in this area. We are seeing better success with each treatment. Increasingly, patients are on less toxic treatments, which they are responding well to, and are living longer. 

“We are increasingly giving oral treatments and some treatments given intravenously are administered subcutaneously (beneath the layers of the skin).” These treatments require patients to spend much less time in the infusion suite, sometimes reducing the time from hours to minutes. 

She says this approach can ultimately improve quality of life for patients with breast cancer. “There was a time when a patient’s life was dictated by their treatment. We now have opportunities to fit treatment around their lives, families and work.”  

It’s a sign of a revolution in cancer
treatment that we have patients on
effective treatments who are living well.

Dr Ciara O’Hanlon Brown

Administering treatment in a ‘patient-friendly’ way 

Many cancer units are moving toward options which allow administration to be given closer to where patients live without them having to travel frequently to specialist hospitals. “Breast cancer treatments are every three weeks or so. Rather than patients taking a day or half a day out, we want to give them treatment closer to home, so they can go and see a nurse, have an easy injection or an oral treatment and go home. This has a huge impact on their quality of life,” says Dr O’Hanlon Brown. She adds that: “As we are treating patients earlier and for longer in their disease, we have more pressure on our capacity. Anything we can do to administer treatments more easily is a win-win.” 

Maureen Kyne is a Clinical Nurse Cancer Specialist at University Hospital Limerick: “Some patients still need to come into our hospital to receive treatments if they require blood tests, for example. However, we have seen a reduction in the time patients spend in hospital, which now can be as little as 10 minutes. This was particularly important during Covid when we could treat breast cancer patients more quickly and focus our resources on day care.” Maureen adds: “By moving breast cancer treatment closer to where patients live, we are fulfilling the Irish Government’s SlainteCare ambition. This is a 10-year plan to put people at the centre of the health system by delivering primary and community health services so people can stay healthy in their homes and communities as long as possible. She adds: “We are finding patients are less sick, so are less likely to be admitted to hospital. In general, they are leading fuller lives, which was not the case even 10 years ago.” 

Improved storage and efficiencies  

Senior Oncologist Pharmacist Niamh Kelly is dispensing cancer treatments in Kilkenny with her nurse colleagues who prepare and administer the vials to eligible patients. “These new vials take about 10 minutes to prepare. We can also keep them in our fridge for up to 18 months,” she explains. “It has freed up time for ordering and preparing other therapies.”  

Dr O’Hanlon Brown concludes: “It’s a sign of a revolution in cancer treatment that we have patients on effective treatments who are living well. Having the drugs administered in a simpler way means they can start to be rolled out in a non-hospital environment. They still have to be dispensed by a trained healthcare professional but, hopefully, we can roll it out locally.” 

M-IE-00001643
Contributors were not remunerated for their participation.

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People have sex for different reasons and enjoy different kinds of sexual experiences. Sex is about pleasure, desire, passion, and intimacy. It can involve genital to genital contact, vaginal or anal penetration, oral to genital or anal contact, and the sharing of sex toys.

Whatever kind of sex you like, there is a risk of sexually transmitted infections (STIs). This risk increases with multiple sexual partners, but it is possible to get an infection the first time you have sex.

The uncomfortable truth

STIs can cause discomfort and pain. Symptoms include lumps, sores, ulcers or blisters in the genital area or mouth, and vaginal or anal discharge. You might need to pass urine more often, feel a burning sensation when doing so, or feel pressure or pain in the lower abdomen. There may be discharge from the urethra or pain in the testicles. Left untreated, STIs can cause long-term problems, such as infertility, and you could spread the infection to someone else.

The good news

Using condoms and dental dams during sex significantly reduces the risk of an STI. However, no method provides 100% protection, and some infections can be passed by skin contact alone. Regular screening is important for everyone who is sexually active, as many people have no symptoms following infection. Testing is easy and all STIs can be treated.

Using condoms and dental dams during sex significantly reduces the risk of an STI.

Chlamydia, gonorrhea, and syphilis can be cured with antibiotics. HIV treatment can reduce a person’s viral load to the point where they are healthy and can’t transmit the virus. Hepatitis can be cured fully. The body’s immune system eventually clears the wart virus, and treatment can speed this up. Herpes virus remains in the body, but outbreaks can be treated and usually become less frequent and painful over time.

Dr Caitríona’s advice

If you are sexually active, get tested regularly. Inform all recent sexual partners if you are diagnosed with an STI. If a past or current partner tells you they have an STI, attend a doctor for testing and treatment.

Remember, if someone refuses to use a condom with you, it’s possible that they’ve had unprotected sex before. The best way to reduce your risk of STIs is to talk about your sexual health and to make sure that you both agree to use condoms.

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Customised, healthy gourmet meal deliveries can help individuals boost their health and wellbeing. It allows them to take a step back from meal prep and still incorporate a healthy diet every day.

Incorporating a healthy diet into our daily lives has a positive impact. The opposite is also true as running on empty by not fuelling correctly can negatively impact productivity and health. The solution may rest in getting customised, healthy gourmet meal deliveries that can help boost productivity. 

Customised approach to healthy meal delivery 

Nutritional needs are highly subjective. One person may need support recalibrating their whole diet; another may simply be lacking time and in need of certain weekly meals to be delivered. Emma Buckley, Director of Nutrition at nutritional meal delivery service Gourmet Fuel, says: “Planning, preparation and accountability are critical to get right if someone wants to improve their nutrition and lifestyle. We help with all of these aspects — not just advising people what to eat but doing the cooking, too.”  

The supportive approach begins with the option of an introductory session, which can be over the phone or through ‘The Fuel Wizard’ tool. “We assess people’s goals; for example, whether they’re trying to lose weight or need the convenience of delivered, healthy meals. We also look at people’s calorie intake and their likes and dislikes. We want to know what people enjoy eating — food should be fun and pleasing; that way, they are more likely to stick with it,” she explains. 

A person can only be productive if they
are fuelling themselves properly.

Helping women to put themselves first 

Buckley says that many of their approximately 1,000-a-week customers are women. “Typically, women of all ages tend to think of their own needs last. What we allow them to do is consider having someone look after them for a change and put their own nutritional needs first. Ultimately, a person can only be productive if they are fuelling themselves properly.”  

She adds: “We’ve helped many customers with their weight loss and wellbeing journeys; the overarching sentiment is that they can’t believe how much food they can eat, feel satisfied and still lose weight. Women tend to think less is more, but the reality is: the right amount of food will nourish, fuel and help you feel energised.”

Buckley concludes by expressing her passion for helping people. “We know that people are spinning many plates and, usually, the things that require a bit of work are abandoned, like eating well. We help our clients by managing one of those plates for them and supporting them along the way.” 

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The Women’s Health Initiative (WHI) began in 2020 as a project aiming to improve overall health and wellbeing for women following a cancer diagnosis.

A first-of-its-kind project for Ireland supported by the Irish Cancer Society, the WHI is based across three locations nationwide in Dublin (Mater Misericordiae University Hospital, St Vincent’s University Hospital and the National Maternity Hospital), Cork (Cork University Hospital) and Galway (University Hospital Galway). 

Initiatives and studies 

As well as offering access to in-hospital clinics and virtual support for the many complex — yet often unaddressed — issues facing women during and after their cancer treatment, the WHI includes a range of innovative studies focused on specifically identified areas of need. We hope that it will eventually lead to the development of a national programme for cancer survivors.  

In the WHI’s Dublin team led by Prof Donal Brennan, Professor of Gynaecological Oncology at UCD, this involves studies into the effects of menopause after cancer; how women’s sleep is impacted after treatment; and our Diagnosis Delivery Project, which sees all newly diagnosed patients who attend a gynaecological clinic receive a business card with details of their diagnosis, treating doctor and nurse on it, along with an image of where the cancer is. 

We hope that it will eventually lead to the development
of a national programme for cancer survivors.

Customisable platform 

Another novel aspect of the WHI has been the development of the thisisGO.ie platform. Its primary objective is to provide relevant, reliable information to patients and survivors of gynaecological cancers and related genetic conditions.  

It is a multimedia platform available for five cancers: cervical, ovarian, uterine, vulvar, vaginal and two inherited cancer predisposition syndromes: BRCA and Lynch Syndrome. Healthcare professionals can also create their own specialised profiles on the platform. 

As per the needs identified by patients consulted by the project team, thisisGO.ie provides the following: 

• An individualised, blended platform, including over 300 pieces of written information material and 40 videos, podcasts and patient stories, allowing users to develop a bespoke profile based on where they are on their journey from diagnosis, to surveillance and recurrence 
• A national directory of services for Irish women living with and after gynaecological cancer 
• A symptom tracker  
• A ‘decoding the science’ section describing seminal trial results 

The platform has over 100 collaborators including national and international experts, all of whom donated their resources and time free of charge. These innovations can help make life during and after cancer easier to manage for women, specific to their personal needs. 

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