The Laura Dowling Experience

In this episode, consultant obstetrician and gynaecologist Dr Fadi joins Laura for an open, practical conversation about pelvic floor health, incontinence, prolapse and the realities of modern obstetrics.

Dr Fadi explains how childbirth, ageing and menopause affect the pelvic floor, and why so many women end up living with stress incontinence, prolapse and faecal incontinence in silence. He walks through the full range of treatment options — from physiotherapy and pessaries to urethral bulking, Botox, sacral neuromodulation, robotic surgery, and the mesh procedures paused in Ireland since 2018.

The conversation also takes in interstitial cystitis, vaginal oestrogen, the impact of long inductions on older mothers, and the trade-offs women now weigh up between a vaginal delivery and a caesarean section. Dr Fadi closes with a reflection on his time working with Syrian refugees, where he met 13-year-old mothers and a 26-year-old grandmother.

🔑 Key Points

1. Pelvic floor problems are common and treatable — Stress incontinence, prolapse and faecal incontinence are usually linked to childbirth, not an inevitable part of being a woman.
2. Mesh for incontinence has been paused in Ireland since 2018 — Ireland is the only country in the world where this procedure is currently unavailable, and patients are being sent to Spain to access it.
3. There is no single fix for incontinence — Treatment depends on the type, from physiotherapy and urethral bulking to mesh slings, Botox into the bladder wall, and sacral neuromodulators.
4. Prolapse is not just the womb — Bladder, womb and rectum can all prolapse, each with their own grade and treatment pathway.
5. Pessaries give women back some control — Different types of pessary can hold a prolapse in place, and many women can learn to manage their own at home.
6. Faecal incontinence is more common than women admit — Third and fourth degree tears at delivery can damage the anal sphincter, and primary repair at the time of birth gives the best outcome.
7. Vaginal oestrogen is a low-risk, high-impact tool — It can ease overactive bladder, recurrent UTIs, dryness, and slow the progression of prolapse after menopause.
8. Older mothers face different trade-offs — Long inductions, instrumental deliveries and unplanned caesareans are more common, which is why some women are now actively asking for a planned section.

📚 Resources

Love Your Vulva — Laura Dowling
fabÜ Hello Healing
Continence Foundation of Ireland

⏱️ Timestamps

01:46 — Introducing Dr Fadi and urogynaecology
02:49 — Why pelvic floor problems happen
04:14 — Assessing pelvis and baby size before delivery
05:09 — Robotic surgery and vault prolapse
06:34 — Stress incontinence and mesh as the gold standard
09:01 — Why mesh has been paused in Ireland
12:31 — Sending Irish patients to Spain for mesh
14:25 — Botox for overactive bladder and Interstim
15:43 — Faecal incontinence and tears at delivery
19:17 — Interstitial cystitis and hyaluronic acid
21:21 — Types and grades of prolapse
24:25 — How a pessary works
28:01 — Surgery for prolapse
34:18 — Vaginal oestrogen and pelvic floor
36:08 — Epidurals and instrumental delivery
37:25 — Why more women are asking for caesareans
45:00 — Working with Syrian refugees
48:32 — Advice for young people and the meaning of life
Thanks for listening! You can watch the full episode on YouTube here. Don’t forget to follow The Laura Dowling Experience podcast on Instagram @lauradowlingexperience for updates and more information. You can also follow our host, Laura Dowling, @fabulouspharmacist for more insights and tips. If you enjoyed this episode, please subscribe and leave a review—it really helps us out! Stay tuned for more great conversations.
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In this bitesize moment pulled from the Laura Dowling Experience back catalogue, GP Dr Sarah Carty explains why ADHD looks so different in girls and women — and why so many only recognise it years, sometimes decades, after it first showed up.

She tells Laura how the "quiet" presentation — daydreaming, internal restlessness, working twice as hard to look fine — slowly turns into anxiety, perfectionism, and a quiet erosion of confidence. It's a clip that gives language to something a lot of women have silently carried for years.

🔑 Key Points
Why girls are diagnosed much later than boys — and what gets missed
Masking, and how it shows up as perfectionism, daydreaming, or "just being quiet"
The link between unrecognised ADHD and anxiety, panic and exhaustion
How girls end up labelling themselves as "stupid", "lazy" or "not academic" — and why that's so far from the truth
Why the right diagnosis can change a person's whole self-story

🎧 Listen to the full episode here.
Thanks for listening! You can watch the full episode on YouTube here. Don’t forget to follow The Laura Dowling Experience podcast on Instagram @lauradowlingexperience for updates and more information. You can also follow our host, Laura Dowling, @fabulouspharmacist for more insights and tips. If you enjoyed this episode, please subscribe and leave a review—it really helps us out! Stay tuned for more great conversations.
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What does proper midlife care actually look like, and who keeps getting left out of it?

In this episode, Laura sits down with Dr Caoimhe Hartley - founder of Menopause Health in Dalkey, clinical lead of the Complex Menopause Clinic in the Rotunda, and clinical lead for women's medicine at the new BlackRock Health Women's Health Centre.

They talk about the women being told no - those over 60 who feel they have missed the boat on HRT, and those who have come through breast cancer and are still struggling with symptoms. Caoimhe explains where the evidence actually sits on bones, blood vessels and brain, why so much of what gets repeated still comes from the Women's Health Initiative, and how modern HRT differs from the older oral preparations.

The conversation moves through midlife weight gain and changing body shape, the rise in adult ADHD diagnoses, and the link between oestrogen and dopamine. They also dig into osteoporosis screening in Ireland, why there is no national DEXA programme, dietary calcium, and the histamine flare some women notice on HRT.

Throughout, Caoimhe keeps coming back to the same point - care should be personal, joined up and built around the woman in front of you.

🔑 Key Points

Guidelines are broad, not personal
They are starting points, not prescriptions, and individual risk-benefit has to lead the conversation.

Women over 60 are not automatically locked out of HRT
There is no longer evidence that starting later raises heart attack risk, and bone benefit is available at any age.

The WHI still shapes the conversation
A flawed 1990s study using Premarin and older progestins is still behind fears that do not map onto modern HRT.

The brain adapts after menopause
Hot flushes, night sweats and brain fog are not designed to last forever, and most women in their 70s and 80s are not symptomatic.

Breast cancer survivors deserve a real menopause conversation
Vaginal oestrogen is generally safe, complex menopause clinics exist for a reason, and non-hormonal options matter.

Body shape change is real and largely hormonal
Central weight gain is one of the top three things women raise, and no specific HRT fixes it, though better sleep and mood help.

ADHD is being unmasked in midlife
As oestrogen falls, dopamine regulation shifts and previously well-managed traits can come to the surface.

Ireland has no national DEXA screening
Despite international guidance over 65, screening here is opportunistic and goes through your GP.

80% of bone density is genetic
Peak bone density is in your 30s, with the remaining fifth shaped by vitamin D, calcium, weight-bearing exercise and not smoking.

📚 Resources

Menopause Health Clinic, Dalkey
BlackRock Health Women's Health Centre
Women's Health Initiative (WHI)
Danish Osteoporosis Prevention Study (DOPS)
International Osteoporosis Foundation calcium calculator
British Menopause Society
National BreastCheck

⏱️ Timestamps

00:00 — Why joined-up midlife care matters
03:20 — Women over 60 and HRT
05:10 — Bones, brain and the limits of the 60 cut-off
07:50 — Why the WHI still shapes the conversation
13:00 — The brain adapts after menopause
16:00 — Breast cancer and complex menopause care
20:30 — Cardiovascular health and nitric oxide
23:00 — Body shape change and central weight gain
27:00 — Ozempic and oral progesterone
28:30 — ADHD, oestrogen and dopamine
33:00 — Osteoporosis and DEXA screening in Ireland
41:00 — Histamine, HRT and hay fever
43:00 — Later motherhood and perimenopause overlap
54:30 — Advice for younger women
Thanks for listening! You can watch the full episode on YouTube here. Don’t forget to follow The Laura Dowling Experience podcast on Instagram @lauradowlingexperience for updates and more information. You can also follow our host, Laura Dowling, @fabulouspharmacist for more insights and tips. If you enjoyed this episode, please subscribe and leave a review—it really helps us out! Stay tuned for more great conversations.
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In this bitesize moment pulled from the Laura Dowling Experience back catalogue, menopause specialist Dr Deirdre Lundy walks Laura through how decisions about HRT and family history of breast cancer actually get made in clinic — and why a blanket "no" rarely tells the full story. If you've ever been handed that flat refusal, this is for you.

She unpacks the difference between "a family history" and a strong family history, why outdated fears around HRT and breast cancer have cost women years of their lives, and why surviving cancer shouldn't mean accepting a wrecked quality of life with no support.

🔑 Key Points
What "strong family history" really means — and why it isn't a blanket no
How specialists balance risk versus quality of life in real clinic conversations
Why so many women have been wrongly told HRT is off the table
The wider point: survivorship deserves more than "you should be grateful"
What to ask for if you've been refused HRT and want a second look

🎧 Listen to the full episode here.
Thanks for listening! You can watch the full episode on YouTube here. Don’t forget to follow The Laura Dowling Experience podcast on Instagram @lauradowlingexperience for updates and more information. You can also follow our host, Laura Dowling, @fabulouspharmacist for more insights and tips. If you enjoyed this episode, please subscribe and leave a review—it really helps us out! Stay tuned for more great conversations.
Hosted on Acast. See acast.com/privacy for more information.

Pamela Deasy was in her early 40s, working full time and volunteering with the RNLI, when fatigue started dragging her back into bed in the middle of the day. Her bloods were clear. She was told it was perimenopause, then depression. Months passed before a kinesiologist, of all people, pointed at her pancreas — and within days she was in a Cork hospital being told she had a tumour.

In this episode, Pamela sits down with Laura to walk through what happened next: the chemotherapy that made her legs turn to jelly, the five and a half weeks of daily radiotherapy that put her on her back in hospital, and the Whipple surgery that took out the head of her pancreas, part of her stomach, part of her intestine, her gallbladder and her spleen. Then the slower, quieter battle that came after — the seven and a half stone she lost, the survivor guilt nobody warned her about, the Survive and Thrive programme that helped her step back into the world, and the small camping toilet she now keeps in her car because that is the honest reality of life after Whipple surgery.

Pamela also shares why she co-founded Pancreatic Cancer Ireland, what the signs of pancreatic cancer actually look like, and why "listen to your gut and keep going back" might be the most important sentence you hear this week.

🔑 Key Points

Why fatigue was Pamela's only consistent symptom — and how easy it was to put down to a busy life, perimenopause and then depression
The signs of pancreatic cancer worth knowing: persistent tiredness, pain in the tummy that radiates to the back, floaty stools, dark urine, jaundice, an itch with no rash, new pre-diabetes
What Whipple surgery actually involves, and why it is described as life-saving but life-altering
The realities of life after a rewired digestive system, from packing a change of clothes to always knowing where the toilet is
The chemotherapy side effects that have lingered for years — neuropathy, Raynaud's, cold intolerance
Survivor guilt, the drop-off in support after the "all clear", and finding her way back through the Survive and Thrive programme
Why pancreatic cancer is projected to be the second leading cause of cancer-related death by 2030
Pamela's everyday philosophy: advocate for yourself, listen to your gut, and treasure the ordinary days

📚 Resources

Pancreatic Cancer Ireland
Survive and Thrive

⏱️ Timestamps

00:00 — Welcome
00:27 — Blackrock Health Women's Health Centre
01:34 — Introducing Pamela and trusting your gut
02:13 — 2018: fatigue, busy work and the RNLI
03:04 — Going back to the GP again and again
05:01 — A kidney scan and "the good news is there's no cancer"
06:00 — Being told she might be depressed
06:16 — A kinesiologist who pointed at her pancreas
07:17 — Jaundice and the alarm bell
08:51 — Friday 7th December: into hospital in Cork
09:22 — "You have a tumour in your pancreas"
12:02 — What Whipple surgery actually is
13:00 — Six rounds of chemotherapy
13:30 — Side effects: falling, neuropathy, Raynaud's
17:48 — Radiotherapy, gemcitabine and six weeks in hospital
21:51 — Whipple surgery on 15 August 2019
23:20 — What was removed during Whipple
24:17 — Losing seven and a half stone and severe cachexia
26:14 — Ascites and the slow road back
29:48 — From patient to survivor
30:23 — Survivor guilt and finding therapy
31:11 — The Survive and Thrive programme
31:38 — Life after a rewired digestive system
34:55 — Pancreatic cancer statistics in Ireland
36:00 — The signs and symptoms worth knowing
42:00 — Setting up Pancreatic Cancer Ireland
47:58 — Where to find Pamela
49:25 — Advice for younger people, and the meaning of life
51:38 — Blackrock Health Women's Health Centre
Thanks for listening! You can watch the full episode on YouTube here. Don’t forget to follow The Laura Dowling Experience podcast on Instagram @lauradowlingexperience for updates and more information. You can also follow our host, Laura Dowling, @fabulouspharmacist for more insights and tips. If you enjoyed this episode, please subscribe and leave a review—it really helps us out! Stay tuned for more great conversations.
Hosted on Acast. See acast.com/privacy for more information.