I thought it might be helpful to reflect on my experience of working with these new groups and how we can apply our practice to daily life in everyday ways, by ‘catching’ ourselves in the moments that make up our lives. Over eight wonderful weekly sessions together we practiced mindfulness meditation and explored our thoughts, feelings, emotions and sensory experiences. We reflected honestly and shared our experiences openly. We felt our feelings, laughed, cried and discovered our common humanity, realising that we were all much more similar than different. We practiced some mindful eating and mindful movement. We learned that our minds are busy, but by practicing meditation, they will gradually begin to settle.  

Alongside our growing awareness of ourselves and others, we practiced gratitude, self-compassion and loving kindness for ourselves and all living beings. We discovered that, even though taking our time and moving slowly, we still covered a lot of ground. By examining our habits in terms of which were nourishing or depleting us, we all committed to paying more attention to how we were spending our time. I was struck, and very often moved, by everyday examples that people shared of what they had been noticing between one week and the next. Often, on the face of it, little things, but I see them as ‘little big things’, or even huge things, because, once brought into awareness, they invite potential change, growth, softening.

Some of the benefits that participants shared were so rich and impactful. Examples include, stopping to have breakfast quietly, sitting eating meals slowly and tasting the food, driving slower, improved sleep, enjoying time on holidays better, noticing that we have a choice if we ‘catch’ ourselves in the moment. This ‘catching the moment’ can work in two ways, catching ourselves about to react to a situation, in our usual, habitual way or catching a special moment in our lives and really savouring that moment, as if ‘banking’ it, making a deposit in our long-term memory for our future.  

One example of a habit noticed that perhaps we can all identify with, was of feeling annoyance, even intolerance towards, slow drivers or slow-moving vehicles. Habitually, our response might be to get too close to the offending vehicle, to feel a build-up of impatience, frustration, anger as we wait to overtake. But bringing mindfulness to the situation and noticing or catching the moment of annoyance as it arises can bring an awareness of choice. Hang on, we have a choice here. We can either get highly stressed which takes a toll on our wellbeing or we can simply take our time and wait behind the lorry or tractor until we can find a safe place to pass, then breathe, feel our hands on the wheel and overtake without hardly any stress at all.

Conversely, a striking example of a participant catching themselves in a ‘good’ moment, was someone who was about to go sea swimming off a rock but was finding it impossible to get in.  Because of the tide, she would have to wait or go to a different beach. Instead of rushing off to another spot, she had the realisation in her own mind that, hang on, “This is a moment in my life”.  So, with this awareness, she chose to stay on that rock until the tide changed and had her swim.

Reassured, affirmed and encouraged by this generous group sharing, I was repeatedly reminded that mindfulness meditation really matters, it has meaning and long-lasting impact on people’s everyday lives. Mindfulness meditation can be this grounding, steadying, joyful, lifeforce, providing us with skills we can all learn to help us on our life’s journey.  Skills that, once the foundation has been laid, require consistent practice to grow and strengthen, both formally, through meditation, and informally, through how we live our everyday lives. It is pure privilege to be a conduit of these practical yet life-changing skills and practices, and something that I will be forever grateful for. The simple, yet profound, quote from writer Annie Dillard seems fitting here. “How we spend our days is, of course, how we spend our lives.”

Mindfulness in April

Drop-in mindfulness hour at CECAS, Myross Wood, Leap on Tuesday mornings 10-11am, April 14, and 2h. €12.  Beginners, returners and newcomers are always welcome.

A free three-week compassion-based mindfulness programme for family carers will run at Mossie’s in Adrigole, Beara beginning Thursday April 23, 12-3pm.

For more information: phone: 087 2700572 or email: susanoreganmindfulness@gmail.com 
www.mindhaven.ie

Suffering is part of the human condition. We cannot know joy without sorrow. To be self-compassionate, according to Neff, is to move from over-identifying with our suffering to being mindful of it. What does this mean in practice? It means that we recognise our unique suffering and we notice it rather than falling fully into it and identifying with it as the only thing we are experiencing. She writes that the next step towards self-compassion is to move from the experience of isolation in our suffering to common humanity. This is to recognise that every human on this planet is just that, a human. That we all have humanity in common. When we can recognise this fact, then we can also know that every human suffers. This can open a new aspect of suffering that can alleviate the sense of isolation we can feel. It is easy to think “I’m all alone in this suffering” yet by recognising common humanity we can move out of that isolation.

The last step according to Neff is to move from self-hate or self-criticism to self-kindness. In practice, this is very much about being kind to one’s Self. This does not mean that we become egotistical or display narcissistic traits. If you think of the person you are closest to, that might be a friend, family member or partner, I can hazard a guess that you would go to the moon and back and move mountains for that person if they shared their suffering with you. You would do everything in your power to alleviate their suffering. Self-kindness is about turning that move to alleviate a person’s suffering on oneself. To become one’s own best friend instead of one’s own worst enemy. What is important here is not simply the presence of kindness but the stance of openness to one’s experience. This is not about correcting or fixing something. It is about allowing an experience to be held without immediate judgment. In practice, this often runs counter to how many have learned to relate to themselves, particularly those who carry histories of shame or trauma. Intentionally creating self-compassion doesn’t stop suffering, rather it means you can have the skill of not making your own suffering worse.

Christopher Germer, an American clinical psychologist who has co-authored books with Neff, writes how the apparent simplicity of self-compassion can obscure its difficulty. In my work, I often notice that for many clients, especially those who are actively suicidal or deeply self-critical, offering kindness inwardly can feel unfamiliar or even unsafe. In this sense, self-compassion is not a skill to be learned. Rather, it is often through the experience of being met with compassion by another, in this case a therapist, that a person can take what is offered and turn it inwards. This is where the work of Paul Gilbert, a British clinical psychologist and founder of Compassion Focused Therapy, becomes particularly relevant. Gilbert situates compassion within an evolutionary framework, describing how human beings have developed multiple affect regulation systems.

He suggests that “compassion is a sensitivity to suffering in self and others with a commitment to try to alleviate and prevent it”. This definition places emphasis on sensitivity rather than positivity and acknowledges that turning toward suffering requires capacity. Often that capacity is not easily accessible to everyone. For individuals who have spent much of their lives in threat-based states, the idea of responding to themselves with care can activate fear rather than relief as they would have experienced their needs and wants as leading to danger once upon a time. Gilbert’s work invites a more nuanced understanding of the challenges to practicing self-compassion and explains why it can be protective to not practice it if shame, trauma, suicidality and/or abuse are part of one’s experience.

The mindfulness component of self-compassion draws heavily on the work of Jon Kabat-Zinn, who introduced mindfulness into Western clinical contexts through Mindfulness-Based Stress Reduction. He describes mindfulness as “paying attention in a particular way, on purpose, in the present moment, and non-judgmentally”. Within self-compassion, this quality of attention allows one to notice suffering without becoming overwhelmed by it or pushing it away. It creates a kind of internal space, or capacity, where experience can be witnessed. Without this, attempts at self-kindness can become entangled with avoidance or self-criticism.

Research on self-compassion has found how it functions psychologically, that it is associated with greater emotional resilience, not because it removes distress, but because it changes how distress is processed. Research in 2007 found that “self-compassionate people appear to be more willing to acknowledge and accept negative aspects of themselves”. This willingness is clinically significant, as it is often the avoidance of internal experience that maintains suffering. Self-compassion, in this sense, is not about feeling better, rather it is about being able to feel without becoming defined by what is felt. An existential perspective, it has also been explored in research and situates self-compassion within a broader engagement with suffering and meaning. Research in 2016 found that “the healing power of self-compassion lies in its ability to transform suffering into a meaningful human experience”. This framing moves away from symptoms and notes that suffering is not something to be eliminated but something to be understood and held within the context of a making meaning of one’s life.

The roots of these ideas can be traced back to Buddhist psychology, where compassion is considered a fundamental orientation toward suffering. The teachings associated with the Dalai Lama often emphasise that compassion involves recognition of shared humanity. As he writes, “if you want others to be happy, practice compassion; if you want to be happy, practice compassion”. While simple, this reflects an understanding that the boundaries we draw between self and other are often more permeable than they appear.

Across these perspectives, there is a consistent theme of self-relating. This has implications for how things work in therapy and how people can change by attending therapy. Many therapy approaches focus on modifying thoughts or behaviours, which can be effective but may leave underlying relational patterns intact. Self-compassion, by contrast, speaks to the way a person meets themselves in moments of difficulty. It is less about what is thought and more about how those thoughts are held. People who experience persistent self-criticism or shame are often not lacking in insight. They may already understand the origins of their distress or recognise the distortions in their thinking. What is often absent is a sense of internal safety. 

This is why the relational context matters. Self-compassion is often first encountered interpersonally, through the experience of being understood and not judged. Over time, a person can begin to internalise the experience. The therapist’s stance becomes a kind of model that can be followed, not in a prescriptive sense, rather as a lived experience of another way of being. There is also a need to be cautious about how self-compassion is framed culturally. In some contexts, it can be misunderstood as self-indulgence or weakness. Neff addresses this directly, noting that “self-compassion is not a way of judging oneself positively, self-compassion is a way of relating to oneself kindly”. This distinction matters, particularly for individuals who have been misled to believe that their worth is contingent on performance or achievement.

Self-compassion is not a technique to be applied forcefully. It involves turning toward what is difficult, recognising it as part of being human and responding with care for one’s Self. For many, this is not an intuitive process. It requires time, safety and often the presence of another. Whether therapy is focused on addressing a person’s challenges cognitively, relationally or somatically, to name a few ways, the question of how a person relates to themselves remains central. Self-compassion offers one way of engaging with that question as an ongoing practice of meeting oneself, again and again, in the midst of experience. A powerful stance to take in a world that is currently so polarising and harmful to so many. Self-compassion is gentle and courageous thing to engage in and therapy can be a safe place in which to practice.

For more information on Leo’s services, phone: 085 1300573, email: info@leomuckley.com.  www.leomuckley.com, social media: @leomuckleypsychotherapy.

In a world governed by an unwritten code of behaviour and appropriation, it can feel, as an autistic person, permanently unsafe. Unsafe to be yourself. You find yourself asking: Am I getting it right? Replaying conversations and interactions, wondering if you’ve offended someone, then breathing a sigh of relief when you see them again and they don’t seem unhappy with you. But even then, doubt creeps in. Maybe they’re just pretending.

This is a familiar place for many neurodivergent people who have learned, from a young age, to wear a mask. To suppress their natural way of being because they’ve been told, directly and indirectly, that it isn’t acceptable. I’ve spoken often about these unseen systems, the structures that shape how we operate as a society. But who created them? And why are we expected to fit into one or two narrow, binary ways of thinking and behaving?

As an autistic person, I can see how hard I’ve worked to be malleable, to become what I thought others wanted me to be. I learned to people-please, to avoid confrontation, to stay below the radar. Being quiet, compliant, even docile felt safer. In recent years, with a deeper understanding of my neurodivergence, I’ve realised I don’t need to bend myself to maintain relationships with people who only accept me on their terms. In fact, I’ve come to recognise the hollowness of relationships built on control and subtle manipulation.

Over the years, I’ve been fortunate to find a small number of friends who accept me as I am, and whom I accept as they are: human, generous, and imperfect. Around these people, I don’t feel judged, and I don’t judge them. That doesn’t mean we always agree. We don’t. We disagree, we fall out, but we’re willing to talk, to repair what’s been misunderstood. We don’t take disagreement as a personal attack. We can say hard things, and we can hear them, because we remain open to the possibility that we might be wrong.

This, to me, is the great value of friendships among neurodivergent people. There is a shared directness, an honesty. What we say and how we behave tends to reflect what we genuinely think and feel. If I ask a friend something, I trust I’ll get a truthful answer. Sometimes that truth is uncomfortable, but the safety it creates far outweighs the discomfort. There is no need to perform, no need to pretend. And that is a profound gift, especially in a world where I have, at times, believed relationships were genuine only to discover, painfully, that I had misread them.

By contrast, relationships shaped by mixed signals can be deeply confusing. When someone appears warm and engaged in person but withdraws or excludes you elsewhere, it creates a disorienting contradiction. As a neurodivergent person, I find it far easier to accept that someone simply doesn’t like me. That’s okay. It’s not possible to like everyone. What’s difficult is the pretence.

We don’t need to be unkind, but we also don’t need to perform connection where it doesn’t exist. We can be honest, compassionately. The idea that we’re meant to be friends with everyone is both exhausting and untrue. We won’t connect with everyone, and that’s natural. It doesn’t prevent coexistence. It doesn’t rule out the possibility that, over time, circumstances might change and connection might grow. Difference is not a deficit; it is simply difference.

Real relationships involve friction. Disagreement is not the problem. How we navigate it is what reveals our humanity. Do we retreat into silence, blame, or gossip? Or do we step into honesty, expressing how we feel while remaining open to perspectives that differ from our own?

For me, real relationships are places where I can finally relax, where I can show up as myself and feel accepted. I don’t have to shrink or edit who I am. My friends feel the same, and that mutual freedom is a gift.

Perhaps, as humans, we might pause the next time we are tempted to silence, ridicule, or dismiss someone, and ask ourselves: why does this feel acceptable? If we are to become truly capable of collaboration, we need to embrace honesty. We don’t have to like everyone, but we can still relate with respect. Real friendships will include friction and, at times, hurt, but it is in how we repair those moments that our humanity is most clearly revealed.

The pelvic floor is a complex and vital group of muscles, ligaments, and connective tissues that stretch across the base of the pelvis, supporting the bladder, uterus, and bowel. For women, the health and strength of the pelvic floor are crucial throughout life — from puberty through pregnancy, childbirth, and menopause. Maintaining a healthy pelvic floor is essential not only for physical wellbeing but also for emotional health, confidence, and overall quality of life.

One of the primary roles of the pelvic floor is to provide structural support to the pelvic organs. These muscles act like a hammock or sling, keeping the bladder, uterus, and rectum in their correct positions. When the pelvic floor is weakened — due to factors such as pregnancy, childbirth, aging, or hormonal changes — women may experience pelvic organ prolapse, where one or more of these organs descend and press against the vaginal walls. This can cause discomfort, pressure, or even pain, significantly affecting daily life and mobility. A strong functioning pelvic floor helps prevent prolapse and supports long-term pelvic health.

Another key function of the pelvic floor is maintaining continence. The muscles control the opening and closing of the urethra and anus, allowing for proper bladder and bowel control. Weakness in these muscles can lead to urinary incontinence, a common but often under-discussed issue among women. This can occur as stress incontinence — leaking during coughing, sneezing, or exercising — or urge incontinence, where there is a sudden, intense need to urinate. Strengthening the pelvic floor through targeted acupuncture has been shown to reduce or even eliminate these symptoms, restoring confidence and comfort in daily life. Perhaps most surprising incontinence affects many young female athletes and acupuncture can be a valuable tool to improve their bladder health.

The pelvic floor also plays a significant role in sexual health. These muscles are involved in arousal, orgasm, and overall sexual function. When the pelvic floor is strong and flexible, it can enhance sexual sensation and satisfaction. Conversely, when the muscles are weak or overly tight, women may experience pain during intercourse or reduced sensitivity. Acupuncture can relax tight muscles and reset and activate muscles that are not working. To contribute to a more fulfilling sexual experience and improved intimacy.

Pregnancy and childbirth place unique demands on the pelvic floor. During pregnancy, the growing uterus exerts increased pressure on these muscles, while hormonal changes make the tissues more elastic in preparation for birth. Vaginal delivery can stretch or even damage the pelvic floor, leading to weakness or dysfunction postpartum. Acupuncture postpartum aids recovery. Especially after surgery to reduce the risk of incontinence, promote healing and increasing the chances of a vaginal birth after a caesarean.

As women age, the pelvic floor can become more vulnerable, as oestrogen levels decline during menopause and muscles naturally weaken and the tissues lose elasticity. In conclusion the pelvic floor is a cornerstone of women’s health at every age. Influencing core stability, continence, sexual function and overall wellbeing. Despite its importance, it is often overlooked or discussed only after problems arise.

Education, awareness and regular pelvic floor acupuncture can empower women to develop a strong core, maintain bladder and bowel control, support pelvic organs and improve overall pelvic stability and strength. Enhancing function, confidence, comfort, and quality of life.

Amanda Roe is an acupuncturist and clinical hypnotherapist, who specialises in women’s health. She offers a range of therapies including acupuncture for pelvic floor dysfunction, pain and fertility. She combines this with clinical hypnotherapy to help people suffering with trauma, fears, phobias and eating disorders. For more information or to book a consultation visit www.roehealth.ie or call/text Amanda on: 087 6331898.

Understanding these patterns can help people recognise what their body is experiencing and choose more effective ways to manage it. Managing and eliminating symptoms can be key to better, longer-term health — and increasingly, identifying underlying food intolerances is becoming an important part of that process.

Food intolerance testing offers a simple and accessible way to uncover hidden dietary triggers that may be contributing to poor stool quality, sluggish bowel function, or irritation in the digestive tract. By identifying and reducing these triggers, many people can support more regular, comfortable bowel movements.

One of the most common forms of constipation occurs when the colon slows down. In this situation, stool moves through the large intestine more slowly than normal, resulting in fewer bowel movements and a persistent feeling that the body is ‘backed up’.

People experiencing this type often report bloating, abdominal heaviness, and the sense that the bowel never fully empties. They may still pass stool, but the process feels slow and incomplete. Over time, this can contribute to low energy and inefficient nutrient absorption, as the digestive system itself becomes sluggish.

Lifestyle factors frequently play a role. Diets low in fibre, insufficient fluid intake, lack of physical activity, and changes in routine — such as desk work, travel, or disrupted schedules — can all slow the movement of the colon. Certain medications can also contribute.

Simple adjustments are often recommended first: increasing dietary fibre, drinking more water, and maintaining regular physical activity. Even something as simple as daily walking can help stimulate the bowel’s natural contractions.

However, when these changes are not enough, food intolerance testing can provide an additional layer of insight. Certain foods — even those considered ‘healthy’ — may slow digestion or contribute to bloating and inflammation in sensitive individuals. By identifying and temporarily removing these triggers, the bowel may begin to function more efficiently, helping restore a more natural rhythm.

Another pattern develops when stool remains in the colon long enough for too much water to be absorbed. The result is hard, dry stool that can be painful to pass.

People with this type often notice small, pellet-like bowel movements and significant straining. The dryness can irritate the lining of the rectum, sometimes causing small tears known as fissures.

Dehydration is a common contributing factor. Diets very low in fibre, certain medications, and ageing can also make the bowel more likely to produce dry stool.

Treatment generally focuses on restoring moisture and softness to the stool. Increasing fluid intake and consuming fibre-rich foods that retain water — such as oats, seeds, fruits, and vegetables — can help improve consistency. In some cases, healthcare providers may recommend stool-softening support.

Food intolerance testing can also play a valuable role here. Some intolerances may contribute to low-grade inflammation in the gut, which can disrupt normal fluid balance and stool formation. By identifying foods that may be irritating the digestive lining, individuals can make targeted dietary adjustments that support better hydration within the stool and reduce discomfort during bowel movements.

A third pattern occurs when the bowel does not generate strong enough contractions to push stool out effectively. In these cases, stool may reach the rectum but still be difficult to pass.

People often describe feeling the urge to go but being unable to do so without significant straining. Some report a sensation of blockage or pressure.

This pattern can sometimes be related to problems with the coordination of pelvic floor muscles, which are responsible for helping the body expel stool. Nerve-related issues or long-standing constipation can also reduce the bowel’s natural responsiveness.

In these situations, a medical evaluation may be helpful. Some patients benefit from specialised pelvic floor therapy or treatments designed to stimulate bowel activity.

Occasional constipation is common and usually only temporary. However, advice should be sought if symptoms persist for several weeks, if there is blood in the stool, unexplained weight loss, severe abdominal pain, or a sudden change in bowel habits. These symptoms may signal conditions that require further investigation.

Constipation is not always the same problem and by understanding whether the issue is slow movement, dryness, or difficulty pushing stool out, individuals and healthcare providers can take more targeted steps toward relief.

Incorporating food intolerance testing into this process offers a practical and easy way to personalise that approach. Rather than relying on trial and error, testing can help identify specific dietary triggers that may be affecting stool consistency, bowel rhythm, and overall digestive comfort.

By combining lifestyle improvements with targeted dietary insights, many people can achieve more regular, comfortable bowel function — supporting not just digestive health, but overall wellbeing.

If any of the symptoms above are affecting you, get in contact with Michelle Ryan on 087 6704930 or email bwellhive.ie to book a consultation or food intolerance test, and understand what could get your bowel working better to function at optimum.

Energy-based treatments have come a long way, and the options available today can address everything from sun damage and pigmentation to texture, fine lines, redness, and scarring. A life lived outdoors in this part of the world, as much as we love it, does leave its marks — and treatments like IPL, laser resurfacing, and microneedling have become the most effective ways to address those changes without surgery or significant downtime.

IPL, or Intense Pulsed Light, is one of the most versatile of these. It uses broad-spectrum light to lift pigmentation — the brown patches and spots that accumulate from years of sun exposure — as well as tackling redness and broken capillaries. In the days after treatment, the skin can look a little flushed and pigmented spots may darken briefly before they clear, which is completely normal and a sign the treatment is doing its job. It’s also precisely why you want cloud cover and short days on your side while you recover.

For those dealing with more significant concerns — deeper lines, acne scarring, sun-damaged texture — Erbium YAG laser resurfacing is worth knowing about. It works by precisely removing the outer layers of skin, prompting a fresher, smoother surface to regenerate in its place. The results can be quite remarkable, but recovery takes a week and sun avoidance during that time isn’t optional, it’s essential. That makes this treatment one of the most time-sensitive in terms of when in the year to schedule it.

Microneedling works on a different principle entirely, rather than light or heat, it uses very fine needles to create tiny, controlled injuries in the skin, which triggers the body’s own healing response and a meaningful boost in collagen production. It’s particularly well suited to improving skin texture, softening fine lines, reducing pore size, and helping with scarring, and it tends to suit a broader range of skin types than laser treatments do. Most people need a course of sessions a few weeks apart, so starting now means you can complete that course comfortably before the height of summer.

Whatever you choose, or even if you choose nothing at all, there’s one thing that matters more than any treatment: daily SPF. Not just on holiday, not just when the sun is out. Every single day. The UV index in Ireland is lower than in southern Europe, but it is never zero, and the slow accumulation of daily UV exposure is responsible for the majority of skin ageing. For those who form pigmentation you must also think about High Energy Visible Light (screens and overhead lights) and for this reason should be wearing a mineral SPF; mineral SPFs are also good for those with more sensitive skin. And finally a wide-brimmed hat, as unfashionable as it might feel, remains one of the most effective things you can put between your skin and the sun. The weather around here is so unpredictable I carry a roll up one in my handbag in case I get caught out sitting outside Bushes in Baltimore on what started as a grey day and ended with a tropical sunset!

So if you have started thinking about treatments for your skin now is a great time to start.

Women’s Health by Dr. Paula Stanley

If we ask our aunties and mothers what their menopause was like, the answer is usually ‘what menopause?’!

In the 60s, 70s and 80s, midlife female health was not an area, in medicine or in our society, that got any attention: women were expected to get on with it and they did. 

Many women feel that the now infamous Joe Duffy week-long radio feature on menopause in 2021 marked the beginning of permission for Irish women to speak the ‘M’ word aloud. Davina McCall also highlighted the importance – on both sides of the water – of talking about menopause.

So, it is great that women now seek out information on menopause and HRT and are becoming aware of the benefits of HRT, not only for current symptoms, but for their general health over the next 30 years:

Evidence from recent studies and Cochraine analysis suggests that HRT started under the age of 60 or within 10 years of the Last Menstrual Period (LMP,) is associated with a reduction in atherosclerosis progression, coronary heart disease and death from CVD causes, as well as all cause mortality. It is thought that starting HRT within six years of LMP is a sweet spot for optimal cardiovascular benefit.

Four to five years of HRT use is associated with almost halving the risk of osteoporotic hip fracture under the age of 65 and will reverse pre-existing osteoporosis.

The bogey man of HRT and breast cancer has been scared off and current evidence suggests that being on HRT for four to five years does not significantly increase the risk of breast cancer over background population risk.

What to read?

There is a huge problem with women accessing high quality, evidence-based information. Unfortunately, many go to social media and it can be easy to mistake perky enthusiasm for expertise; a smooth-skinned 50-year-old influencer, who swears by a supplement or a certain HRT brand, is not an expert.

Go to valid, evidence-based sources for your information and then go to see your GP with all your questions to figure out what is best for you.

womens-health-concern.org is the patient information arm of the British Menopause Society.

Definitions 

Perimenopause is defined as the time from onset of first menopause-type symptom to one year after your last menstrual period.

The term menopause is used if a woman has not had a period for 12 months.

A woman is said to be post-menopausal if it has been over 12 months since her LMP.

I like to use the term menopause transition, as that is what is happening; women transition from their fertile state to an infertile state. Talking about perimenopause and menopause like they are two separate entities and not a shifting continuum, is just confusing and misleading for women. This transition can take five to eight years, during which time there are many symptoms, not all of which will be fixed by HRT.

What hormones?

I want to go through the different components of HRT and the role of each.

Oestrogens: There are four natural human forms of oestrogen. Three,  Estrone, E1,  Estradiol, E2, Estriol, E3  are produced in the female adult, by the ovaries mainly, but some production also happens in the adrenal glands and  fatty tissue. The fourth, Estetrol, E4, is produced by the foetal liver in pregnancy.

The oestrogen in the normal contraceptive pill is oestradiol valerate, and in all HRT products is oestradiol hemihydrate; both are a salt of our own E2 oestradiol, so are pretty much body-identical.

Oestrogen production in our ovaries reduces, slowly initially, from mid-40s, then more rapidly after 45. Post menopause we do still produce small amounts of oestrogen from our fat tissue and adrenal glands.

Progestogens: Progestogens is the group name. The progestogen produced in the female body is called progesterone. Progesterone does not fall off dramatically like oestrogen during menopause. Progesterone supports pregnancy so you may wonder why you need it in your HRT, as menopause is not a progesterone-deficient state.

We got the answer to that the hard way; in the 1960s in America gynaecologists started to treat menopausal women with oestrogen therapy. Within six months they saw a sharp increase in cases of endometrial or womb lining cancer. When a progestogen was added in, this ceased. Oestrogen has a stimulating or proliferative effect on the endometrium which, if left unchecked, leads to hyperplasia, a pre-malignant condition, then womb cancer. Progestogen prevents this so its role in HRT is endometrial protection. Not all progestogens are lisenced for endometrial protection. Those that are,  are included in HRT products.

Testosterone: Studies have shown a gradual, slow fall in testosterone levels in women from age 30. There is no sharp drop during menopause transition like with oestrogen. Menopause is not a testosterone-deficient state. Testosterone production then increases in women over the age of 65. In studies, the only symptom that testosterone has been proven to benefit is low libido; not energy, fatigue, bone or muscle strength. You can read the article on Testosterone that I wrote previously online (westcorkpeople.ie) for more information on testosterone therapy through menopause.

I want to take HRT, what can I expect?

The answer to that question depends on two really important factors: 1) What you  think HRT will do for you?; and 2) When are you planning  to start  HRT? 

Expectations – laying good foundations for therapy: Some women might find me a bit blunt, if not brutal. I advise she is never going to feel better unless she also starts exercising regularly, loses weight if needed, takes up some form of resistance training and eats a healthy diet. I tell her HRT is not a magic potion and will not turn us back into our 25-year-old selves, sleeping eight hours at night, with a big libido and with the energy that goes with that. Neither will it fix all the stresses in our life, be they family, work or partner-related and it won’t make us lose two stone. I spend a long time discussing not only her symptom but what her beliefs and expectations are, before starting HRT.

I emphasise the timeframes to expect for various symptom improvement, as well as possible side effects. I explain that bleeding might happen and is not a reason to panic, as it usually settles in the first three months.

So when should I start HRT?

Over the last five years there has been a real push, powered by content on social media rather than by any science, that women should start/must start HRT, as soon as any symptoms occur; not true! Studies show that the benefits for the cardiovascular system of reduced heart attacks and strokes and for bones of reduced osteoporotic fractures are gained by starting HRT under the age of 60 or within 10 years of  LMP. More recent evidence indicates that starting HRT within six years of LMP is more beneficial.

So, what hormones do I need in my HRT and how do I take them? 

If you still have your womb, or if you have had a hysterectomy and have a history of endometriosis, you need to take a progestogen along with your oestrogen.

If you do not have a womb and don’t have a history of endometriosis, you will be prescribed oestrogen alone.

Oestrogen: You can take oestrogen as a patch, a gel or a spray. HRT is also available in tablet form but we tend to use this less often because oral oestradiol may put your blood pressure up and will increase your risk of a leg or lung clot by two to four times. There are a few different brands, the only difference is the size of the patch. 

You need to change the patch  every three to four days; the gel and spray are used daily.

Lenzetto, the spray, you  apply to the same place because this works by building up a reservoir of oestrogen under the skin that is then released into the body.

Oestrogel, the gel, can be applied to different places, as it is absorbed pretty much immediately. For all forms, avoid applying anywhere near breasts.

Progestogen: You  can use  a combination patch with oestradiol,  EVOREL CONTI,  which contains norethsterone, a synthetic progestogen also found  in many contraceptive pills.

Utrogestan is an oral progestogen, which is most similar to our natural progesterone. It contains peanut oil, so is not suitable if you have peanut allergy. Utrogestan capsules can also be used inside the vagina but is not licensed for use in that way. 

Duphaston is the other licensed oral progestogen containing didrogesterone.

Both rarely result in side effects but, if that happens, we choose a different delivery system or a different progestogen. Utrogestan often results in improved quality of sleep, a welcome side effect for many.

If it has been more than a year since your LMP, you take a progestogen every day.

If you are still getting periods, or it has been less than 12 months since your LMP, you will be told to take the progestogen two weeks on and two weeks off. This is because your endometrium or womb lining is still active and the on/off pattern allows the womb to bleed and avoid a chaotic bleeding pattern.

If using EVOREL CONTI, you change the patch every three to four days. This represents a continuous dosing with progestogen, so will be appropriate for women who have not had a period in 12 months. 

The Mirena coil contains levonorgestrel progestogen and is licensed for endometrial protection for five years.

How much do I need?

There is no one size fits all and it’s a load of rubbish that everyone should have 75 mg oestrogen. We go by symptoms and doctors usually start with 25mg or 50mg oestrogen, then review three months later. The dose of progestogen is dictated by the dose of oestrogen; if oestrogen dose goes up, so may your progestogen.

Starting HRT after my periods have stopped

Symptoms: Hot flushes, night sweats, brain fog, dry skin/itching generally on the body and aches dan pains in muscles and joints are directly related to oestrogen deficiency:

Genitourinary Syndrome of Menopause (GSM) is the term given to oestrogen deficiency symptoms affecting three areas: the skin of external genital area, the vagina and the urinary tract.

The urethra or wee pipe, the bladder, and  the pelvic floor muscles can all be affected. All these areas contain oestrogen receptors. Symptoms can be; dryness, soreness and itching of vulval skin and inside  vagina, resulting in painful sex; frequent  urination, getting up at night to pee, urgency, leaking and urinary tract infections, UTIs. 

Women rarely volunteer these symptoms so I always ask. If present, I prescribe vaginal oestrogen as a cream and/or pessary, as well as HRT.

The following symptoms – low mood, anxiety, low energy, poor sleep and low libido – are more complex and multifactorial although they are made worse by falling oestrogen levels: 

What to expect on HRT

Hot flushes reduce or disappear quite quickly.

GSM symptoms affecting skin and vagina typically similarly resolve quite quickly with vaginal oestrogen.

The urinary symptoms often take  longer, sometimes up to three months. Think of it as filling an empty tank; your bits have been without oestrogen for some time, so I recommend daily use for four weeks then x two to three times a week.

Studies have shown longterm vaginal oestrogen use is linked with reduced risk of incontinence and  recurrent UTIs in our later years. Vaginal oestrogen is not absorbed into your blood  and is safe to use by women with a history of breast cancer. 

One of the slowest symptoms to respond to therapy can be brain fog but most women are fine with that, as long as they know what to expect.

How much and how fast mood, energy and libido improve varies hugely, as these symptoms result from a combination of many issues – poor sleep, life worries and stresses – not just oestrogen deficiency.

Menopause transition happens to women with teenagers and ageing parents; often they are still working, have a mortgage, house, car, family and relationship to maintain but absolutely no libido…so there is a lot going on.

Most women find they generally feel better in themselves on HRT but some do not.

Clinical depression is common in midlife women and there is no shame to using an antidepressant, as well as HRT if needed, even for a short period of time like for six to 10 months, to see you through. The modern prozac-type meds now are safe, non-addictive and not sedating. 

Starting HRT when still having periods, during menopause transition or perimenopasue: what to expect?

For women still having periods it will be helpful to read the article on Perimenopause I wrote for West Cork People back in 2023 (westcorkpeople.ie)

Menopause transition/perimenopause can be hellishly symptomatic with brain fog, dryness and itching down below, painful sex, hot flushes, which can come for a few weeks, then vanish, or sometimes happen the week before the period, fatigue, poor sleep, low libido, new-onset anxiety, and migraines.

What is vital is that women understand that it is hormone chaos and not oestrogen deficiency that is causing these symptoms.

Not dissimilar to what happens to our motor after 200,000 miles: the complicated hormone-balancing machine stalls, splutters and does not run in the smooth cyclical fashion it used to;  some months we ovulate and all is good. Some months it skips, resulting in a low oestrogen/high progesterone state  causing bad PMS – mood swings, anger and the general urge to kill your husband/children comes and goes.  Other months, ovulation occurs twice giving high oestrogen/low progesterone state, which can trigger sore boobs, headaches and heavy, prolonged periods. Some women get migraines for the first time during menopause transition.  

Now, imagine introducing another set of hormones on top of this?

That is what using HRT at this time would do. 

Do you think that will make you feel better? 

Hormone therapy for perimenopause, yes; just not in the form of  HRT.

Oestrogen deficiency symptoms of dry sore vagina and uncomfortable sex, as well as urinary symptoms, are common early on in menopause transition. These can be safely and effectively treated with vaginal oestrogens, regardless of where you are with your periods.

Where there a re a lot of cyclical symptoms, be they emotional; anger, mood swings, what a patient once described as ‘PMS on steroids’; or physical; headaches, breast pain and monthly severe migraines, the solution is to switch off ovulation. That will eradicate the premenstrual phase and result in calm, steady-state hormones, stopping the hormone roller-coaster. It gets rid of PMS and usually migraines resolve.

Contraception is needed to age 55 and HRT is not contraceptive, will not suppress ovulation, may result in heavier bleeding and can end up giving you two bleeds per month. 

So how do we suppress ovulation? 

Any contraceptive pill will do, but I often use Drovalis. This contains E4, Estetrol, a natural human oestrogen, in combination with drospirenone. It is safe to use over the age of 40, as does not raise  blood pressure or increase risk of a leg clot. Women usually feel better because the hormone roller-coaster stops and periods are lighter

An oestrogen-free pill containing a progestogen-only desogestrel, if we want to avoid oestrogen, also works here. 

The Mirena coil is of huge benefit in the perimenopause, as it literally kills four birds with one stone: contraception, treats heavy periods, often suppresses ovulation and will serve as endometrial protection should you want to start oestrogen therapy down the line.

Most important part of starting HRT or any hormone containing therapy

See your GP again for a review after three months, as recommended by BMS, and NICE. I advise that women request a longer GP appointment  for any discussions on menopause transition; an average GP appointment time of 10 minutes is not adequate.

The three-month review is your opportunity to go through all symptoms, specifically addressing any that you are disappointed are not improving. You might not like the first form of HRT; maybe the patches are falling off or give you a rash. You might want to  change to the gel or spray. If your GP does  change anything, it is good to see them again months later.

I hope this is helpful.

For all menopause transition-related queries book an appointment to see your GP.

Herbal Healing by Rosari Kingston

April is the month we become very busy in the garden and notice gaps in borders and beds that need to be filled in. ‘Leonurus cardiaca’, or motherwort, is one plant that will return year after year and is usually available at markets or garden centres. It belongs to the mint family, and it has square stems, pinkish flowers, and deeply cut leaves.

Motherwort is an old European medicinal herb that, not only deserves a place in the garden, but is also useful in the home pharmacy. The Committee on Herbal Medicinal Products of the European Medicine Agency approved its use in 2010 for the relief of symptoms of nervous tension and “symptoms of nervous cardiac complaints such as palpitations, after serious conditions have been excluded by a medical doctor”.

Norway disagreed with the latter point, so we must wait to see if the EMA will consider their dissent in this year’s review of Leonurus.

Many women find this herb helpful during menopause because it has traditionally been used to ease tension and heart palpitations.

It was used throughout Europe to treat menstrual and menopausal symptoms, such as anxiety, irritability, and cramps, as well as anxious palpitations, moderate cardiac problems, and “weakness of the heart”. By the 17th century, English herbalists were referring to it as a herb that “comforts the heart” and relieves childbirth pangs. 

Nicholas Culpeper wrote in 1652’s ‘Complete Herbal’ that motherwort is the best way to treat “melancholy vapours” that affect the heart, make people happy, and make the spirit stronger. He says, “There is no better herb to drive melancholy vapours from the heart, to strengthen it, and make a merry, cheerful, blithe soul.” He calls it “Mother’s Herb” because it “makes women joyful mothers of children and settles their wombs as they should be”. 

He suggests using it to ease painful periods, and he sees it as a herb that warms and dries.

Culpeper suggests using it as a syrup or preserve, which makes it a staple in the store cupboard.

Its reputation has a significant “mother” component. According to monastic and cottage herbalists, it helps with postpartum recuperation, painful or short periods, and the anxious nerves of overworked mothers. It was considered a guardian against “heartache”, both physical and emotional.

Using motherwort at home

A simple home tea can be made by infusing about 1-2 teaspoons of the dried aerial parts in a cup of boiling water for 10-15 minutes, taken up to three times a day for short periods such as a few days around a stressful event:

Some people feel like their heart is “thumping” or have palpitations when they are stressed, but only after a heart problem has been ruled out.

Tension during or before your period that is accompanied by worry, restlessness, and a tight feeling in your chest. 

General “frazzled” feelings, especially when worry is felt in the chest instead of as thoughts that are going fast.

European guidance usually limits self‑care use to a few weeks before taking a break. The taste is distinctly bitter and slightly aromatic, so many people combine it with gentler herbs such as lemon balm or lime blossom to make it more palatable.

As Leonurus is quite bitter, I think Culpeper’s syrup suggestion is excellent.  It is easy to make a simple herbal syrup for any herb, including Leonurus, as follows:

To create a herb syrup, combine equal parts of sugar and water (e.g., 1 cup each) in a saucepan, bring to a simmer, and stir until dissolved. Add one to two cups of fresh herbs, simmer for two to five minutes, then let it steep for 30–60 minutes before straining, cooling, and refrigerating for up to four weeks

You can also make a herbal syrup by making a strong decoction (boiled infusion) and sweetening it with honey. 

Ingredients: 30 grams dried (or 60 grams fresh) motherwort aerial parts, 450 ml water, 225 ml honey.

Decoct: Combine the herb and water in a non-reactive pot. Bring to a simmer over low heat.

Reduce: Cover partially and simmer until the liquid is reduced by half (down to roughly 1 cup).

Strain out the herbs through a fine mesh strainer and discard the plant matter.

Sweeten: While the liquid is still warm (but not over 110°F to protect the honey), stir in the honey until fully dissolved.

Bottle & Store: Let it cool, bottle in a clean container, and store in the refrigerator.

Shelf Life: Four to six weeks, or up to six months if one part brandy is added as a preservative.

Dosage: 1 tablespoon added to water or sparkling water once or twice daily. 

Some caution is needed when taking motherwort.

According to new research, motherwort is mostly safe when used in small amounts for short periods of time. However, there are some important things to keep in mind as to possible side effects if used for too long or at high doses.

It could cause digestive problems, like loose stools or slight stomach pain, especially when the dose is higher.

If you are sensitive or use it too much, it can make you dizzy or cause your blood pressure to drop. 

Skin sensitivity or dermatitis has been linked, but very rarely, to touching the plant or high intake of it as medicine.

Motherwort should be avoided or taken only as directed in the following instances:

Pregnancy: it may stimulate the uterus and is considered unsafe in pregnancy.

Breastfeeding: there is not enough safety data, so it may be unwise to take it.

You already know you have low blood pressure, a slow heart rate, or heart disease that you are being treated for.

Use  of blood thinners or anticoagulants (like warfarin) because they may make you more likely to bleed.

Use of sedatives, including benzodiazepines, as motherwort can theoretically add to their effect.

When I was first asked for Shilajit, it seemed like a wellness fad – and a slightly suspicious one at that. It wasn’t until we were asked repeatedly that we decided to look into where it comes from and what it does. We cautiously brought some in, and then started getting interesting feedback, which prompted us to explore it further.

We’ve now been stocking Shilajit for two years, and it’s become one of our most popular products. Here are a few of the things people suggest it’s good for. I wouldn’t believe all the claims made online – but equally, we’ve seen no negative side effects and have had some very positive feedback.

Most recently, Petra Florence, the brilliant osteopath who works above Organico, recommended it to my teenage son for energy – and he’s doing very well on it, which encouraged me to look a little deeper into the benefits.

Shilajit comes originally from Ayurveda. When Rachel and her husband Keith were in India on a health mission, it was given to them by their Ayurvedic therapist.

In traditional Ayurvedic medicine, Shilajit is often referred to as ‘the destroyer of weakness’ and has been used for centuries as a tonic for energy, resilience, and longevity.

Shilajit is a natural, resin-like substance that forms over hundreds of years in mountainous regions, most commonly the Himalayas. It develops through the slow breakdown of plant matter, compressed and transformed by microorganisms and environmental conditions into a dense, mineral-rich compound. In its raw form, it appears as a dark, sticky substance that seeps from rocks during warmer temperatures.

What makes it unique is that it’s not a herb, nor a single nutrient – it’s a complex matrix of compounds, including fulvic acid, humic substances and trace minerals (often 80-plus in small amounts).

This complexity is part of both its appeal and the challenge in studying it. Much of the interest in shilajit centres on fulvic acid, a naturally-occurring compound formed during the breakdown of organic matter.

Fulvic acid is thought to support nutrient absorption, act as an antioxidant and help transport minerals into cells. These properties are often used to explain shilajit’s traditional use as a rejuvenating tonic. However, most of the evidence we have comes from laboratory or small-scale studies, so its effects in the human body are still not fully understood.

In Ayurvedic practice, shilajit is classified as a ‘rasayana’ – a substance used to support vitality, energy, and overall resilience. Traditionally, it has been used for: fatigue and low energy; cognitive support; fertility and hormonal balance; recovery and longevity.

Modern research has begun to explore some of these areas. There is early evidence suggesting that shilajit may support energy production and reduce fatigue; have anti-inflammatory and antioxidant effects; contribute to cognitive health; and support testosterone levels in men.

However, it’s important to be clear: most studies are small, and the evidence is still emerging rather than conclusive.

From a natural health perspective, the appeal of shilajit is quite different to typical supplements. Rather than isolating one nutrient (like magnesium or vitamin C), it offers a broad-spectrum, naturally occurring combination of minerals and bioactive compounds.

This aligns with a more holistic view of nutrition – that our bodies often respond better to complex, naturally balanced substances than to isolated compounds.

Many people describe it as supporting more stable, sustained energy, improved resilience to stress and general vitality rather than a quick ‘boost’.

One of the most important considerations with shilajit is purity. In its raw form, it can contain contaminants such as heavy metals, microbes, and environmental toxins. For this reason, it must be properly purified. 

At Organico, we’ve chosen to stock Kiki Shilajit resin, as we trust them as a company and know their product is pure. We also carry a couple of Ayurvedic Shilajits in capsule form, and a Shilajit gummy from Known – which can be a more accessible option for teenagers or anyone who struggles with taste or texture.

If you’d like more information on Shilajit, call in to us in Organico and have a chat! Or if you are not local to us, drop us an email on online at organico.ie and we will do our best to advise you. 

At any given moment in time, we are experiencing a multitude of information. Our sensory system is feeding information through the nervous system into the brain and back at all times. Far outside of our thinking, our full being is processing all sorts of information. Much more than we would be capable of thinking about and sorting through if we had to do so consciously. Therefore, the majority of what we experience is subconscious, with many functions of the brain operating interdependently and independent of our thought.

I cannot count how many people have sat across from me in my therapy room and stated “I am…”. A complete and ultimate expression of one aspect of their being in any moment. For example, people, including myself, often say things such as “I am anxious,” “I am sad,” “I am tired,” “I am not enough,” “I am depressed,” “I am stupid,” and so on. These statements are both true and untrue all at once.

Sixteen years ago, long before I even knew what therapy is, I stumbled across meditation practices. Not the ‘breathwork’, ‘box breathing’ and ‘mindfulness’, which dominates the Western world today, rather the practices in their original format. Meditation, in its Eastern origins, was never intended as a relaxation technique or performance enhancer. It was a disciplined inquiry into the nature of mind and reality. Within early Buddhist traditions, practices such as Samatha (calm abiding) and vipassanā (insight) were developed as pathways toward liberation from suffering, grounded in the recognition of impermanence (anicca), unsatisfactoriness (dukkha) and non-self (anatta). Similarly, in Hindu traditions, contemplative practices embedded within the Upanishads, and later systematised in Patañjali’s Yoga Sutras, oriented practitioners toward direct experiential knowledge of consciousness itself. In Daoist contexts, meditation was concerned with attunement to the Tao, cultivating harmony rather than control.

Across these traditions, meditation was relational and ethical, as much as it was attentional. When we trace meditation back to these roots, we see less a technique for ‘symptom’ reduction and more a truly radical invitation to observe experience without clinging. An invitation to fall awake to one’s experience and to loosen identification with transient mental states, and to encounter the fluidity of what we habitually call self. Far from telling a person to breathe in for four, hold for four and breathe out for four. The practice was stripped of its existential and inquisitive nature and translated into another tool through Western lenses.

When I discovered these practices, I quickly changed from stating “I am anxious” to “I am noticing that anxiety is part of my experience right now” or “I’m noticing that I am having thoughts of anxiety”. That change in internal dialogue and my relationship with my thinking was a powerful one, I was able to move from over-identification with thinking to noticing it for what it was, simply thinking. Buddhist’s say “I am the thinker, not the thought itself” because creating a space between one aspect of one’s experience and your very own consciousness can be life changing.

We call it the ‘train of thought’ or ‘stream of consciousness’ for a reason; it is always running and it does its own thing. As you read these words right now, your attention is on them and making sense of them to the best of your ability. Here is the shocker, your thoughts are still flowing in the background as you read this, they don’t go anywhere, and the mind certainly does not get ‘silent’. If you shift your attention from these words to your senses right now you might notice sensations, temperatures, sights, sounds, smells and much more that stick out to you. If at a given moment in time you are experiencing anxious thoughts or physical sensations of anxiety you could move your attention through each of your senses and notice that there is so much more happening moment by moment, breath by breath.

When I discovered the power of moving my attention around and checking out more than just one aspect of my experience, I found that thinking lost its power in the best way possible. At the time, all those years ago, I couldn’t help but wonder, what is really happening when I feel such an urge to qualify myself as anxious or sad or any one thing in its totality? I discovered quite quickly, through practice, that I am so much more than the singular thing my attention might be focused on in a moment. Does this mean I never experienced a thought or sensation that I relate to the concept of anxiety since? No. I often do professional things, which include speaking to many people at once. Right before I start, I sometimes notice a buzzing in my chest, my heart rate increasing, a flush of warmth, a little bit of dryness in my mouth, a tingle in my scalp, thoughts of getting it wrong and so on, believe me when I say that this is a non-exhaustive list! What does noticing all of that do for me? It brings me squarely into the present moment and becomes information that I am experiencing. No more and no less. Do I then say to myself “I am anxious” in my mind? No. I continue on with whatever it is I am doing holding an awareness of all that is present for me without judgement and with knowledge that it will pass.

You might notice that everything passes. Whatever has the nature to arise in one’s consciousness also has the nature to fall away of its own accord without us having to do a single thing about it. If you ever have had a scab and it was itchy; if you had simply paid attention to the itch without scratching it, then it would have probably reached a crescendo of itchiness and then reduced to nothing of its own accord. I would invite you to try this out for yourself; pay attention to smells or sounds or anything else you can and you will notice that by simply being present to what is, the experience changes of its own accord.

Everything is impermanent according to the Buddhists. Truly the only certainty that we have in our living is that of our dying. If we can do our best to not grasp on to experiences we enjoy, such as joy, pleasure and so on, and to not struggle against or avoid painful experiences then we would all have such a greater capacity for this living. To live is to suffer; suffering is part of this blessing and curse of the human condition. We cannot know what happiness is without knowing the other side of the coin, which is sadness, the same goes for all other experiences. Why make our existing more challenging than it needs to be by grasping or struggling against it? Leaning into the experience, trusting that simply being is enough and knowing that everything is impermanent can be transformative. I often bring these concepts into my therapy room when a client finds them useful. The shift of attention and shift of perspective can be all that is needed to simply say, I am. 

For more information on Leo’s services, 

phone: 085 1300573

email: info@leomuckley.com 

web: www.leomuckley.com 

@leomuckleypsychotherapy

In my last article I wrote about BPPV (Begin positional proximal vertigo), the most common cause of vertigo. Probably the next most common cause is vertigo caused during or after an inner ear infection.

There are some significant differences between these two diagnoses: BPPV is a vertigo which is bought on by a change of position such as rolling over in bed or moving from sitting to standing.  Another notable difference is that BPPV produces a true vertigo meaning that the room will be spinning around you. Whilst BPPV can produce very strong symptoms, it lasts for short bursts of about 30 seconds and then settles down, until you move position again. In the majority of cases this can be resolved with a simple repositioning manoeuvre in one session.

Dizziness induced during or after an ear infection is often slightly different. The first difference of course is the history of an ear infection. During the initial stages you should seek help from your GP, as getting the infection under control in this initial stage is going to be of the most help. It can sometimes be difficult to link dizziness to an ear infection that happened a long-time ago, but I find that it is not uncommon for someone who suffered with ear infections when younger to start to report these feelings many years later. Whilst it can be difficult to link an old infection to dizziness, it is possible to do some in-office assessments that would point to this being the most likely cause of dizzy symptoms. There are some simple bedside tests that will indicate if the output from a vestibular nerve has been impaired and more in-depth assessments that can help to rule out other causes of dizziness.

Why do ear infections cause dizziness?

When you have an inner ear infection it can affect both the cochlear and vestibular portions of the eighth cranial nerve and if it affects the vestibular part this can result in dizziness or more often a sense of wobbliness sometimes a long time after the initial infection. 

The vestibular nerve sends information from the semi-circular canals in the inner ear to other parts of the brain and has a direct link to eye movements.  If its function has been impaired the eyes may not move with the correct coordination and you can experience this as dizziness, wobbliness or sense of not being quite sure where you are in your environment.

For many people this feeling will resolve naturally after recovering from the initial infection for others it will not.  It is also possible for it to take a long period of time, sometimes decades after the initial infection, before symptoms appear. The reason for this is that an infection can often cause a reduction in functional ability of the vestibular nerve in the affected ear and as we age or have other issues impacting the vestibular nerve symptoms can start to appear. 

Unlike BPPV, dizziness cannot be corrected by one simple manoeuvre but it can be improved and resolved with some specific, focused rehabilitation exercises.

These exercises are focused on re-integrating the complex brain pathways that help you to understand where you are in the world.  They do often take some time to completely resolve the issue but they are simple to do and effective. Often there will be complete resolution of symptoms in one to two months.

Eoin Roe is a Chiropractor and Functional Medicine Practitioner based in Skibbereen, please feel free to contact him through the website www.roehealth.ie or call on 028 62081 and leave a message.

As a neurodivergent person, my sense of justice is not a quiet preference. It is not a polite opinion I can fold neatly away. It burns steadily within me. Fairness is not abstract or intellectual. It is visceral. When something feels unjust, I feel it in my body. It has a direct impact on how I am in myself and in the world.

Over the years I have learned that this intensity requires discernment. Without boundaries this becomes exhausting, leading to frustration and ultimately burnout. My wellbeing depends not on extinguishing the fire, but on deciding where it is most needed.

I have spoken previously about monotropic focus. Within an autistic cognitive style, attention narrows and deepens. When my sense of justice is triggered by perceived unfairness, that focus becomes sharp and sustained. I research. I analyse. I notice patterns and inconsistencies that might otherwise be overlooked. I identify biases that feel urgent to bring into the foreground of conversation.

In the world we live in, injustice is a constant narrative. It can be global, genocide, environmental collapse, government corruption. It can also be intimate and everyday, the imbalance within a relationship, the ambiguity of a commitment, social exclusion. For a neurodivergent person whose nervous system registers injustice so physically, this creates an ongoing intensity. It becomes essential to develop strategies, both to communicate effectively and to support ourselves when we challenge narratives shaped by bias.

When manageable, I experience this sense of justice as a low hum in the background. I can tend to it skillfully. But if I am overwhelmed, or if I repeatedly suppress what feels unjust, that hum grows louder. It can become all consuming, overwhelming, unable to focus onto other areas of life because of the injustice. At that point I need to take care of myself deliberately, through yoga, time in nature, or speaking with a trusted friend. Self regulation is not indulgence. It is maintenance.  

For example, I have spent over twenty years teaching yoga and living within that spiritual world. Over time I began to notice a pattern. Many of the most prominent teachers are men, and a large majority are white. What troubled me was not the existence of male teachers, but the system that seemed to elevate certain voices while marginalising others. It felt as though we had replaced the overt commercialism of capitalism with a softer veneer of moral spirituality, while power dynamics remained largely unchanged.

I want to be clear. I am not attacking individual white men. I am not interested in personal blame. What I am questioning is a system that historically and structurally favours certain identities, often unconsciously. Systems can perpetuate bias without every individual within them intending harm.

When the Epstein files were released and names such as Deepak Chopra and others associated with the wider spiritual wellbeing world appeared in connection with a known paedophile, what struck me most was the silence. Within communities that speak often about consciousness and ethics, there was little public reckoning. In some spaces, teachings of non dualism were used in ways that seemed to blur accountability. That silence activated my sense of injustice fully.

In those moments I have to turn inward as well as outward. I ask myself difficult questions. How might the way I teach be used, even unintentionally, to justify harmful behaviour? Have I ever leaned on spiritual language to remain in situations that were not right? How do I ensure that mindfulness and spiritual practice are grounded in ethics rather than bypassing them?

For me, justice is not theoretical. It is felt deep in the gut. When it rises, I have learned to pause and breathe before reacting. I ask, what can I do? How can I affect change skillfully rather than simply adding to noise?

I recently read a book by a man on death row. He described watching different news channels with the volume turned off. He saw people protesting, striking, shouting at each other. All he could see were angry faces. His point was simple. Ranting at someone rarely helps them listen.

As a neurodivergent person, speaking up about what feels unjust does not feel optional. Naming what others may prefer to keep hidden feels necessary. The work for me is not whether to speak, but how. How do I avoid being dismissed as just another angry face? How do I remain authentic, clear and grounded so that what I say can actually be heard?

More than ever, our voices matter. But volume alone is not power. Clarity, integrity and collective courage are. My task is to tend the fire of justice carefully, so that it helps rather than consumes, and so that when we speak, it contributes to meaningful change rather than more division.