In a historic shift for women’s health in Ireland, hormone replacement therapy (HRT) became free for all women on 1st June. This is a landmark change driven by grassroots activism, expert advocacy, and bold government policy. But while the announcement made headlines, the road to implementation has been far from smooth.
As someone who has lived through the confusion and isolation of unmanaged menopause symptoms, I know firsthand how badly change was needed. After years of debilitating symptoms with little guidance or support, I was struck by the lack of understanding and resources available to women during this critical life stage.
In 2018, I founded The Menopause Hub (TMH), Ireland’s first dedicated menopause clinic. My vision was to create a space where women could manage menopause on their own terms, with access to expert care, information, and support. TMH quickly became both a sanctuary and a springboard for systemic change. With three clinics now across the country and a workplace-focused Menopause Hub Academy, we’ve helped bring menopause out of the shadows and into the national conversation.
My work in menopause advocacy builds on a wider commitment to gender equity and women’s wellbeing. I’ve had the privilege of lecturing at UCD Smurfit Business School, chairing the Abbey Theatre’s Gender Equality Committee, and in recent years, I’ve been honoured with Tatler’s Woman of the Year award for Women’s Health, inclusion on the Forbes 50 Over 50 Global list,
and most recently, the Women in Pharma Award for Best Education Leadership.
Campaigning for change
In 2024, I joined forces with The Irish Menopause support group, co-founded by Sallyanne Brady, to launch a national petition calling for the elimination of financial barriers to HRT. For many women, the monthly cost of ¤30 to ¤70 was a serious obstacle. While 67% of users were partially covered under the Drug Payment Scheme (DPS), and 33% had Medical Cards, thousands of women found themselves in the “squeezed middle”, earning just enough to miss out on support, but not enough to afford consistent treatment.
The campaign captured public attention quickly. Women shared personal stories, signed the petition, and demanded action. Our advocacy efforts reached across political lines, culminating in a major policy breakthrough in October 2024, when then-Minister for Health Stephen Donnelly announced that HRT would be made free for all women as part of Budget 2025, with implementation set for January 1st, 2025.
A Breakthrough in May
On Friday, May 17, Minister for Health Jennifer Carroll MacNeill announced a long-awaited breakthrough. A revised scheme was now agreed upon and endorsed by the IPU, making free HRT widely available from June
1st, 2025. Under the updated arrangement, pharmacies will receive a ¤5 dispensing fee per HRT item and a ¤2,000 once-off grant to support system upgrades and the transition—up from an earlier ¤1,000 offer.
Why Free HRT Matters
This policy isn’t just about money. It’s about medical justice. Menopause symptoms can be life-altering: hot flushes, insomnia, mood swings, anxiety, brain fog, and more. For many of us, HRT isn’t a lifestyle choice, it’s a medical necessity. And yet, for years, treatment was financially out of reach for thousands of Irish women.
The Irish government’s move sets a new global benchmark for gendered healthcare access. By centring menopause in health policy and removing economic gatekeeping, Ireland is leading by example, placing women’s long-term wellbeing at the heart of national health strategy.
Looking Ahead
With free HRT now available, Ireland is poised to become a global leader in menopause care— not just in policy, but in practice. This milestone proves what’s possible when people power drives real change.
But success depends on delivery. Clear communication, pharmacy readiness, and public awareness are essential to ensure every woman can access HRT— easily, locally, and without cost.
Supply shortages also pose a real risk. Key products like Estradot 50mcg and 75mcg patches are currently out of stock, with availability not expected until the end of 2025, according to the HPRA. Rising demand from the Free HRT programme could worsen these shortages and strain an already pressured system, making it harder for pharmacists and doctors to manage care effectively. This was never just about medication. It’s about equality, access, and dignity. Menopause is not a niche issue; it’s a national one. Ireland is finally starting to treat it that way, but whether the system can rise to meet the moment remains to be seen.
Understanding Vaginal Atrophy
Vaginal atrophy, also referred to as genitourinary syndrome of menopause (GSM), is a common yet under-recognised condition that affects many women, particularly during and after the menopausal transition. Characterised by thinning, drying, and inflammation of the vaginal walls due to reduced oestrogen levels, vaginal atrophy can significantly impact quality of life, sexual health, and overall wellbeing. Given the sensitive nature of the symptoms and the stigma still associated with menopausal changes, many women suffer in silence, often without seeking appropriate medical or pharmaceutical advice.
Community pharmacists are uniquely positioned to identify, support, and guide women experiencing vaginal atrophy. With their accessibility and regular contact with patients, pharmacists can play a key role in improving awareness, encouraging open conversations, and supporting appropriate treatment and management.
Recognising the Symptoms
Pharmacists should be familiar with the common signs and symptoms of vaginal atrophy, which include:
• Vaginal dryness, itching, or burning
• Pain or discomfort during sexual intercourse (dyspareunia)
• Light bleeding or spotting after intercourse
• Increased urinary frequency or urgency
• Recurrent urinary tract infections
• General discomfort in the vaginal area
These symptoms often develop gradually and may be mistaken for other conditions, such as infections. Women may describe feeling “dry,” “irritated,” or “uncomfortable” without immediately recognising the hormonal basis of their symptoms.
Opening the Conversation
One of the biggest barriers to treatment is a reluctance among patients to discuss intimate health concerns. Community pharmacists should aim to create a discreet and supportive environment that encourages women to raise these issues. Displaying menopauserelated materials, offering private consultation rooms, or including questions about vaginal symptoms in medication reviews for menopausal women can help normalise the conversation.
Suggested openers include:
• “Many women going through menopause notice changes like dryness or irritation—have you experienced anything like that?”
• “Some medications or hormonal changes can cause vaginal discomfort. Let me know if that’s something you’d like to talk about.”
Being proactive and empathetic in addressing these concerns can lead to meaningful interventions.
Treatment and Management Options
There are several treatment pathways available for vaginal atrophy, ranging from nonhormonal over-the-counter (OTC) products to prescription hormonebased therapies. Community
pharmacists should be aware of the full spectrum of options and be prepared to offer advice or referral when appropriate.
1. Non-Hormonal Options (OTC)
• Vaginal moisturisers: Used regularly (every few days) to restore moisture and improve elasticity.
• Vaginal lubricants: Used as needed, typically before sexual activity, to reduce friction and discomfort.
• Hygiene advice: Encourage the use of unscented, gentle soaps and avoidance of douching or perfumed products.
Pharmacists should ensure patients understand the difference between moisturisers (routine use) and lubricants (situational use), and how they can be used together.
2. Local Oestrogen Therapy (Prescription-Only)
Local oestrogen treatments are often first-line therapies for moderate to severe symptoms. These include:
• Vaginal creams
• Vaginal tablets or pessaries
• Vaginal rings
• Vaginal gels
These products deliver low doses of oestrogen directly to the vaginal tissue, minimising systemic absorption and associated risks.
3. Systemic Hormone
Replacement Therapy (HRT)
While systemic HRT can also alleviate vaginal atrophy, it is not
usually the primary treatment unless the patient is experiencing broader menopausal symptoms such as hot flushes or night sweats. Pharmacists involved in HRT dispensing should monitor symptom control and provide ongoing support.
Key Considerations for Community Pharmacists
1. Understanding the Patient’s History
Pharmacists should consider:
• Menopausal status and age
• Medical history, particularly hormone-sensitive cancers
• Concurrent medications
• Lifestyle factors (e.g., smoking, which can exacerbate vaginal atrophy)
2. Counselling and Education
Patient education is critical. Pharmacists should explain:
• That vaginal atrophy is a common and treatable condition
• The importance of consistent use of moisturisers and oestrogen therapy for best results
• How to apply vaginal treatments correctly and hygienically
• The difference between UTIs and atrophic symptoms
Educational leaflets or referral to reliable resources can be helpful.
3. Referral and Signposting
If symptoms are severe, unresponsive to OTC products, or if the patient is unsure whether symptoms are due to atrophy or another condition (e.g., infection), pharmacists should refer to a GP or specialist menopause clinic. Patients with a history of breast cancer, unexplained bleeding, or pelvic pain should always be referred.
The Role of the Pharmacy Team
All members of the pharmacy team—pharmacists, technicians, and support staff—can contribute to awareness and patient support. Staff training on menopause and related symptoms can help ensure that women are treated with dignity and given accurate advice.
Encouraging women to talk about their symptoms, highlighting treatment options, and normalising the conversation around vaginal health are powerful ways the community pharmacy can support this often-overlooked aspect of women’s healthcare.
Written by Loretta Dignam, Founder & CEO, The Menopause Hub
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