Women’s Healthcare Q3 2023 | A promotional supplement distributed on behalf of Mediaplanet, which takes sole responsibility for its content
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“Don’t forget to exercise your brain.”
“Being a sympathetic listener can be a source of comfort.”
Catherine O’Keeffe, Menopause Workplace Consultant and Founder of Menopause Success Summit
Carmen Bryce, Communications Manager, Mental Health Ireland
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If you embrace change and take steps for long-term brain health, you can set yourself up to thrive through the decades ahead. Catherine O’Keeffe Founder of Wellness Warrior, Creator of Menopause Success Summit, and a Menopause Workplace Consultant
Image provided by Menopause Success Summit
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IN THIS ISSUE
“Making journeys easier for women after cancer treatment.” Helen Forristal Director of Nursing Services, Marie Keating Foundation
Yvonne O’Meara Irish Cancer Society
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Living better with metastatic breast cancer: how to find a supportive community “The daughters of women who couldn’t legally access contraception can now freely control their reproductive health without cost.” Stephen Donnelly The Minister for Health
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“Regular screening is important for everyone who is sexually active, as many people have no symptoms following infection.” Dr Caitríona Henchion Medical Director, Irish Family Planning Association
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Metastatic breast cancer (also known as secondary, advanced or stage 4 breast cancer) is cancer that has spread to another part of the body.
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etastatic breast cancer (MBC) can be advanced at first diagnosis; known as ‘de novo’ cancer. It can also come back sometime after the initial diagnosis; known as ‘recurrence.’ Breast cancer can spread anywhere, but it most commonly spreads to bones, lungs, lymph nodes, the liver or brain. Metastatic breast cancer in Ireland Being diagnosed with MBC as a first cancer diagnosis is not common, but it can be incredibly difficult to process this news. With almost 3,400 female and 29 male cases of breast cancer diagnosed in Ireland each year, approximately 30% will present with MBC. It is not a curable cancer; treatment aims to control it, relieve symptoms and maintain quality of life.
Supportive group for metastatic cancer patients The ‘Positive Living’ programme aims to help those who have metastatic cancers share the ups and downs of life — addressing things that both support them and impinge upon them. There are many commonalities shared in this space; many are now more aware of the stage and subtypes of their cancers. This allows an appreciation for the various available treatments (or not, as the case may be); the complexities of MBC treatment; and living longer despite cancer, with an improved quality of life. Positive outlook on metastatic breast cancer Positively, survival rates are also climbing. According to an analysis published in 2020 in the Journal of Cancer Research and Clinical Oncology, which included more than 1,030 women with metastatic breast cancer, survival rates rose from 24.42 months to 37.8 months over the last two decades. Positive Living provides specialised support and connects patients with both experts and those affected similarly. We have witnessed empowerment and motivation to live their best lives, as they live for today, make special memories and plan ahead.
Breast cancer can spread anywhere, but it most commonly spreads to bones, lungs, lymph nodes, the liver or brain.
Unmet needs for people with metastatic breast cancer There are many unmet supportive care needs of individuals with MBC. It can happen to anyone, including men and LGBTQI groups. A lack of services contributes to unmet needs for patients themselves, as well as supportive care for their families. Existing services are oversaturated, and healthcare systems fall short of meeting these care needs. The Marie Keating Foundation provides a safe place for people to come together to explore their own cancer journey and identify the physical, practical and emotional aspects of living with MBC, professionally facilitated by an oncology nurse.
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Convenient breast cancer treatment: how it’s improving the care pathway
We are seeing better success with each treatment.
New ways of administering breast cancer treatment can enhance women’s quality of life while alleviating hospital capacity issues.
F Dr Ciara O’Hanlon Brown, Consultant Medical Oncologist, St James’s Hospital Dublin
Niamh Kelly Senior Oncology Pharmacist, St Luke’s Hospital Kilkenny
Maureen Kyne Clinical Nurse Specialist, University Hospital Limerick
Contributors were not remunerated for their participation.
M-IE-00001642 Sept 2023
or years, it was typical for breast cancer patients to sit for multiple hours in busy infusion suites to receive their treatment intravenously. This time-consuming treatment could be disruptive to the lives of patients, making it difficult for them to continue their normal daily routines. For some, it was exacerbated by the need to travel long distances to the nearest infusion clinic. Each treatment required significant time and attention from busy nurses, placing a heavy burden on the capacity of the hospital system. However, recent innovations in cancer care have led to a shift in how some treatments are administered, allowing patients to spend more time living their lives. These new methods of administration also benefit the healthcare system, through cost-saving and resource capacity in the oncology pathway. Better treatment options available Ciara O’Hanlon Brown, Consultant Oncologist in St James’s Hospital Dublin, says: “Breast cancer treatments have improved greatly in my 15 years working in this area. We are seeing better success with each treatment. Increasingly, patients are on less toxic treatments, which they are responding well to, and are living longer. “We are increasingly giving oral treatments and some treatments given intravenously are administered subcutaneously (beneath the layers of the skin).” These treatments require patients to spend much less time in the infusion suite, sometimes reducing the time from hours to minutes. She says this approach can ultimately improve quality of life for patients with breast cancer. “There was a time when a patient’s life was dictated by their treatment. We now have opportunities to fit treatment around their lives, families and work.”
She adds that: “As we are treating patients earlier and for longer in their disease, we have more pressure on our capacity. Anything we can do to administer treatments more easily is a win-win.” Maureen Kyne is a Clinical Nurse Cancer Specialist at University Hospital Limerick: “Some patients still need to come into our hospital to receive treatments if they require blood tests, for example. However, we have seen a reduction in the time patients spend in hospital, which now can be as little as 10 minutes. This was particularly important during Covid when we could treat breast cancer patients more quickly and focus our resources on day care.” Maureen adds: “By moving breast cancer treatment closer to where patients live, we are fulfilling the Irish Government’s SlainteCare ambition. This is a 10-year plan to put people at the centre of the health system by delivering primary and community health services so people can stay healthy in their homes and communities as long as possible. She adds: “We are finding patients are less sick, so are less likely to be admitted to hospital. In general, they are leading fuller lives, which was not the case even 10 years ago.”
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We now have opportunities to fit treatment around their lives, families and work.
Administering treatment in a ‘patient-friendly’ way Many cancer units are moving toward options which allow administration to be given closer to where patients live without them having to travel frequently to specialist hospitals. “Breast cancer treatments are every three weeks or so. Rather than patients taking a day or half a day out, we want to give them treatment closer to home, so they can go and see a nurse, have an easy injection or an oral treatment and go home. This has a huge impact on their quality of life,” says Dr O’Hanlon Brown.
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Improved storage and efficiencies Senior Oncology Pharmacist Niamh Kelly is dispensing cancer treatments in Kilkenny with her nurse colleagues who prepare and administer the vials to eligible patients. “These new vials take about 10 minutes to prepare. We can also keep them in our fridge for up to 18 months,” she explains. “It has freed up time for ordering and preparing other therapies.” Dr O’Hanlon Brown concludes: “It’s a sign of a revolution in cancer treatment that we have patients on effective treatments who are living well. Having the drugs administered in a simpler way means they can start to be rolled out in a non-hospital environment. They still have to be dispensed by a trained healthcare professional but, hopefully, we can roll it out locally.”
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We hope that it will eventually lead to the development of a national programme for cancer survivors.
Making journeys easier for women after cancer treatment The Women’s Health Initiative (WHI) began in 2020 as a project aiming to improve overall health and wellbeing for women following a cancer diagnosis.
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first-of-its-kind project for Ireland supported by the Irish Cancer Society, the WHI is based across three locations nationwide in Dublin (Mater Misericordiae University Hospital, St Vincent’s University Hospital and the National Maternity Hospital), Cork (Cork University Hospital) and Galway (University Hospital Galway). Initiatives and studies As well as offering access to in-hospital clinics and virtual support for the many complex — yet often unaddressed — issues facing women during and after their cancer treatment, the WHI includes a range of innovative studies focused on specifically identified areas of need. We hope that it will eventually lead to the development of a national programme for cancer survivors. In the WHI’s Dublin team led by Prof Donal Brennan, Professor of Gynaecological Oncology at UCD, this involves studies into the effects of menopause after cancer; how women’s sleep is impacted after treatment; and our Diagnosis Delivery Project, which sees all newly diagnosed patients who attend a gynaecological clinic receive a business card with details of their diagnosis, treating doctor and nurse on it, along with an image of where the cancer is.
Yvonne O’Meara Systemic Psychotherapist, UCD Women’s Cancer Survivorship Research Coordinator, Irish Cancer Society
Customisable platform Another novel aspect of the WHI has been the development of the thisisGO.ie platform. Its primary objective is to provide relevant, reliable information to patients and survivors of gynaecological cancers and related genetic conditions. It is a multimedia platform available for five cancers: cervical, ovarian, uterine, vulvar, vaginal and two inherited cancer predisposition syndromes: BRCA and Lynch Syndrome. Healthcare professionals can also create their own specialised profiles on the platform. As per the needs identified by patients consulted by the project team, thisisGO.ie provides the following: • An individualised, blended platform, including over 300 pieces of written information material and 40 videos, podcasts and patient stories, allowing users to develop a bespoke profile based on where they are on their journey from diagnosis, to surveillance and recurrence • A national directory of services for Irish women living with and after gynaecological cancer • A symptom tracker • A ‘decoding the science’ section describing seminal trial results The platform has over 100 collaborators including national and international experts, all of whom donated their resources and time free of charge. These innovations can help make life during and after cancer easier to manage for women, specific to their personal needs.
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To enquire about the programme, or if you are a patient or public member who would like to get involved, contact Yvonne O’Meara at yvonne. omeara1@ucd.ie
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Surviving endometrial cancer has a huge impact mentally and physically.
Why prevention is better than treatment for any gynaecological cancer Endometrial cancer is the most common gynaecological cancer. According to the National Cancer Registry Ireland, 80% of patients have a five-year survival rate. Despite this, people with a uterus should take the necessary prevention measures.
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n endometrial cancer, malignant cells form in the tissues of the endometrium. The endometrium is the lining of the uterus — a hollow, muscular organ in a woman’s pelvis.
Dr Sharon O’Toole Senior Research Fellow, Trinity College Dublin
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Endometrial cancer prevention As a Consultant Medical Oncologist at Cork University Hospital, Dr Dearbhaile Collins encourages people with a uterus to take effective prevention steps. In her experience, she says the disease is both highly preventable and manageable. “Risks of getting it can be minimised by patients improving physical activity, such as being moderately active for 30 minutes, five days a week.” A good diet is also a huge influence. There is no screening, so the condition is symptom-led. Bleeding, bloating, pelvic abdominal pain and changes in urinary symptoms or bladder control are all signs to look out for. If any of them are a concern, it’s best to consult a GP who can make the appropriate referral. Positive news on treatments Dr Collins, who is also Chair of the Cancer Trials Ireland Gynaecological Cancer Trials, says: “It is an exciting time in gynaecological cancer because 10 years ago, we were mainly limited to chemotherapy, but now, we are seeing new drugs targeting the immune system. Also, targeted treatments against cancer mutations
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and novel combinations of drugs.” All of this leads to better survival rates with advanced or metastatic disease and a higher quality of life as treatments are better tolerated. “Surviving endometrial cancer has a huge impact mentally and physically. Patients who adopt good lifestyle choices after surviving treatment are much less likely to see a return of cancer and more likely to experience a return to a happier mental state,” she adds. Awareness of all gynaecological cancers Dr Sharon O’Toole is a scientist who coordinates the Irish Network of Gynaecological Oncology. This includes charity and support groups across Ireland. “As a network, we want to increase awareness that there are five gynaecological cancers. Worryingly, our survey told us that 34% of women in Ireland believe cervical screening covers all gynaecological cancers. However, it only addresses the risk of cervical cancer,” she says. There is no other screening for other gynaecological cancers, which is why symptom awareness is so important. Ovarian cancer signs are bloating, eating difficulty, abdominal pain and toilet changes. Cervical cancer is characterised by bleeding or discharge. Uterine cancer can cause bleeding and pelvic pain. Vulval cancer can include itching, burning pain and tenderness symptoms while vaginal cancer can be spotted through unusual discharge, bleeding
or urgency to go to the toilet. Dr O’Toole adds: “Four in five women wouldn’t be confident to recognise the symptoms of ovarian cancer, so there’s a huge knowledge gap. People should know their family history and communicate that to their GP because, for example, the BRCA1 and 2 gene mutations increase your risk of developing ovarian cancer.” Seeking treatment through clinical trials Launching more gynaecological clinical trials, including with better representation from patients outside of Dublin, is one of Dr Collins’s big hopes over the coming years. “Ireland currently only has two studies open in gynaecological cancers; one in endometrial cancer and a surgical study in ovarian cancer. But there are two new studies opening soon in ovarian cancer, which are testing new treatments and will give more options to patients with these cancers.” Ultimately, she urges patients affected by gynaecological cancer to always ask their oncologist about available studies because participation can mean access to new and innovative drugs. While treatments are improving for advanced gynaecological cancers, not all are curable and, thus, prevention is all the more important.
Dr Dearbhaile Collins Consultant Medical Oncologist Cork University Hospital and President of Irish Society of Gynaecological Oncology (ISGO)
Visit thisisgo.ie for more information on gynaecological cancers.
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Find out why prevention is the best approach to osteoporosis Osteoporosis is a chronic condition that causes the structure of our bones to become thinner. It causes bones to break or fracture more easily after a minor bump, fall or while carrying out everyday tasks.
About 3 out of 4 women report brain fog as the most challenging menopause symptom You go to the press, but you have no clue what you were looking for. You’re talking to someone familiar and completely forget their name. Even just trying to decide what’s for dinner or what to wear becomes an immense struggle; thanks to brain fog. Catherine O’Keeffe Founder of Wellness Warrior, Creator of Menopause Success Summit, and a Menopause Workplace Consultant
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Brain-fog-banishing tips Neuro nutrition: Prioritise brain health with nourishment. Follow the Mediterranean diet to support brain function and keep yourself hydrated. Your brain is mostly water, so dehydration is not a friend to perimenopause. Avoid excess alcohol; even one glass of wine can worsen brain fog.
fracture caused by osteoporosis is called a fragility fracture. The most common fractures occur in the wrist, hip and back bones. With an estimated 300,000 people in Ireland having the condition, only 20% of cases are diagnosed.
clinical trials about three years ago found that FLS markedly improves screening and treatment rates for osteoporosis as well as reducing the risk of another fracture in the future,” says Professor Dockery. Moreover, patients are monitored for 12 months. Follow-up data shows that only half of people are still Helping to prevent osteoporosis taking osteoporosis medication “Anyone over the age of 50 who has after a year, despite the fact that it broken or fractured a bone should has a significant role in reducing view it as a potential warning for re-fractures,” she explains. “We the condition,” continue to educate says Professor patients and work With an estimated Frances Dockery, with them to take the national clinical preventative measures 300,000 people lead for Fracture including medication, in Ireland having Liaison Services diet and lifestyle the condition, only (FLS) Database. She changes.” explains: “At least a 20% of cases are third presenting with diagnosed. a fragility fracture Rolling out support to hospital say they across Ireland had a fracture already but were not The National FLS Database monitors screened or treated for osteoporosis. each hospital on how many patients With an estimated annual direct with a fracture they are seeing versus and indirect cost of €450 million how many they should be and how treating fractures in Ireland, it’s well they are managed. Professor in the whole healthcare system’s Dockery concludes: “We are still only interest to diagnose and treat the halfway to a fully funded FLS across condition.” She advises people to Ireland. We would like it to be equal take a ‘multi-pronged approach’ to across Ireland. It should be the norm reduce the chances of a fracture. that every person with a fracture “Smoking is a no-no, and excessive aged over 50 gets a comprehensive drinking is very bad for bone health. screening for osteoporosis and falls Regular weight-bearing exercise is a risk to reduce their chance of a repeat good idea as it improves bone density fracture ahead.” and muscle strength which can weaken with age,” she adds. Steps to reducing re-fractures The FLS identifies people with new fragility fractures, investigates them for osteoporosis and treats them if needed, as well as assessing a person’s falls risk. “Analysis of
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he conditions for brain fog are set as we age. Our circulation slows down, so less oxygen is circulated around the body and the brain. Changing hormone levels that come at midlife, particularly the drop in oestrogen, slow down the neurotransmitters that stimulate the brain; the result is that our brains aren’t as sharp as they were in our 20s. Many women report fears of dementia and fear of losing their minds. It certainly feels like that.
Exercise: Aerobic exercise has been linked to a significant increase in brain volume and cognitive function in midlife. Don’t forget to exercise your brain as well with mental exercises including language learning, puzzles and diverse reading. Meditation and mindfulness: Sitting quietly for just five minutes with your eyes closed can have a positive impact on brain health. Sleep: Review your sleep routine and consider making small tweaks to ensure you get your required six to eight hours per night. Consult your doctor: Ask your doctor for help with menopause symptoms. Know that age-related medication like sleep aids and antidepressants can affect memory and brain function. Let your doctor know if brain function worsens, so you can discuss your options and consider discussing HRT. Socialise: Stay connected with others. Building your community of support is one of the best things you can do during this life phase.
During menopause, your body is going through two processes that affect cognitive health: ageing and the transition of menopause itself.
Prof Frances Dockery Fracture Liaison Service Database Clinical Lead, Consultant Geriatrician, Beaumont Hospital Scan the QR code to find out more
What can I expect after menopause? During menopause, your body is going through two processes that affect cognitive health: ageing and the transition of menopause itself. Ageing alters memory and cognition while menopause resets the brain, changing how you process information. Your brain will continue to shift post-menopause, and you might notice its function is slower than before. But if you embrace change and take steps for long-term brain health, you can set yourself up to thrive through the decades ahead. Menopause care isn’t just symptom management; it’s about safeguarding your cognitive health and protecting your future wellbeing.
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Cervical smear tests: how to educate and encourage more women to attend With a third of young women not attending cervical smear tests, opportunities for early intervention are missed. Doctors are reassuring women that screening is done with utmost sensitivity and saves lives.
C Dr Declan Quinn MRCOG Consultant Gynaecologist & Obstetrician, Mid Ulster Clinic
WRITTEN BY James Martin
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ervical smear tests are free for patients in the UK. They are offered every three years for 25 to 49-year-olds and every five years thereafter until age 65. Yet, fears or ignorance mean it’s common for women to have gaps in their smear tests — with under 30s, in particular, resistant to attending. They are typically afraid of being hurt, worried about feeling embarrassed and scared of bad news.
to patients’ dignity, anxiety and sense of privacy.” According to the National Institute of Health, 46% of patients with cervical cancer had missed a recent smear test.
Further examinations by specialists Patients who obtain an abnormal smear test result will have a colposcopy. Dr Quinn explains: “My role is detection and management of early Possible signs of cervical cancer gynaecological cancer and cervical Signs of cervical cancer include new or screening. If we detect changes at We need to talk irregular bleeding, such as after sex or screening, we can prevent progression more openly with during menopause; vaginal discharge to cancer in a vast majority of cases.” with unusual appearance or smell; a He also treats ovarian cancers, which young women change in bladder symptoms; new pains start in the female reproductive system because it is the best and share similarities with cervical across the lower tummy or pelvis. cancer. However, ovarian cancer causes protection against Prevention through smear testing several distinctive symptoms, such as cervical cancer. Dr Declan Quinn, consultant feeling full too quickly, bloating and gynaecologist and director of Mid pain. “Patients experiencing symptoms Ulster Clinic, says: “We need to talk more than 12 days in the same month more openly with young women because it is the are urged to contact their GP,” stresses Dr Quinn. best protection against cervical cancer. When reality “I will continue to work with colleagues to reach out to television star Jade Goody tragically died of cervical communities to make the case for cervical screening. We cancer, there was a higher uptake; but it since has take people’s concerns very seriously and believe that slipped back down.” we can work with young women to encourage them to He adds that: “Nurses and doctors are highly take up free testing.” experienced at performing smear tests and are sensitive
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Find out more at midulster clinic.com
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Reproductive rights and sexual health: contraception now free for 17 to 30-year-old women Free contraception is now available to women aged 17–30. This initiative was introduced last year, initially for 17 to 25-year-olds and from 1 January, for 26-year-olds. Underpinned by €31.5 million in funding this year, it was expanded on 1 September to include women aged 27–30.
T Stephen Donnelly The Minister for Health
he scheme marks a significant stride towards an equitable health service that supports women through all life stages, a goal I have prioritised since becoming Minister for Health. The evolution of women’s reproductive rights in Ireland is a long and difficult story, and I’m thankful that, today, we are far removed from the era when contraception was illegal and women were denied the dignity of bodily autonomy. Five years on from the referendum on the 8th Amendment to the Constitution that triggered a government commitment to introduce contraception, I’m very proud that the State is funding a fully end-to-end service for women aged 17–30. What’s included in the 17–30 free contraception scheme? The scheme covers the cost of consultations with GPs, family planning, student health and primary care centres and prescriptions for the wide range of contraceptive options available on the Health Service Executive (HSE) reimbursable items list. These options include long-acting reversible contraception (LARCs), injections, implants and hormonal and copper intrauterine devices and systems (coils). The scheme also includes emergency contraception in addition to the oral contraceptive pill, patch and ring. LARC fittings, removals, injections and checks are also free of charge.
Responding to public demand So far, almost 2,400 GPs and 1,950 pharmacies are providing services and products under the scheme, with tens of thousands of women accessing it every month. In the space of just one generation, the daughters of women who couldn’t legally access contraception can now freely control their reproductive health without cost. Investing for the future The prioritisation of women’s health is further reflected in the substantial developments in services for endometriosis, fertility and menopause — to name just a few achievements under the Women’s Health Action Plan. But, we cannot stop here, and I look forward to continuing to deliver on my commitment to providing quality, equitable healthcare for all.
— food should be fun and pleasing; that way, they are more likely to stick with it,” she explains.
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Customised, healthy gourmet meal deliveries can help individuals boost their health and wellbeing. It allows them to take a step back from meal prep and still incorporate a healthy diet every day.
I Emma Buckley RNutr, Director of Nutrition, Gourmet Fuel Ltd WRITTEN BY James Martin
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ncorporating a healthy diet into our daily lives has a positive impact. The opposite is also true as running on empty by not fuelling correctly can negatively impact productivity and health. The solution may rest in getting customised, healthy gourmet meal deliveries that can help boost productivity. Customised approach to healthy meal delivery Nutritional needs are highly subjective. One person may need support recalibrating their whole diet; another may simply be lacking time and in need of certain weekly meals to be delivered. Emma Buckley, Director of Nutrition at
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Healthy meal delivery service can help women struggling to make time for themselves
The breadth of options allows women to choose the contraception most suited to their needs, regardless of the price tag. In the context of the current cost-of-living crisis, this benefits not just women but their partners and families also.
nutritional meal delivery service Gourmet Fuel, says: “Planning, preparation and accountability are critical to get right if someone wants to improve their nutrition and lifestyle. We help with all of these aspects — not just advising people what to eat but doing the cooking, too.” The supportive approach begins with the option of an introductory session, which can be over the phone or through ‘The Fuel Wizard’ tool. “We assess people’s goals; for example, whether they’re trying to lose weight or need the convenience of delivered, healthy meals. We also look at people’s calorie intake and their likes and dislikes. We want to know what people enjoy eating
Helping women to put themselves first Buckley says that many of their approximately 1,000-a-week customers are women. “Typically, women of all ages tend to think of their own needs last. What we allow them to do is consider having someone look after them for a change and put their own nutritional needs first. Ultimately, a person can only be productive if they are fuelling themselves properly.” She adds: “We’ve helped many customers with their weight loss and wellbeing journeys; the overarching sentiment is that they can’t believe how much food they can eat, feel satisfied and still lose weight. Women tend to think less is more, but the reality is: the right amount of food will nourish, fuel and help you feel energised.” Buckley concludes by expressing her passion for helping people. “We know that people are spinning many plates and, usually, the things that require a bit of work are abandoned, like eating well. We help our clients by managing one of those plates for them and supporting them along the way.” Gourmet Fuel is a healthy meal delivery service in Ireland, with a team of professional chefs and qualified nutritionists working to create delicious, nutritious meals and meal plans. Book a free consultation today with a qualified nutritionist to start looking after your own health and wellbeing at gourmetfuel.com
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