Q: What is perimenopause?

Perimenopause refers to the years leading up to the menopause where women may notice a change in their usual menstrual cycle and begin to experience menopausal symptoms. As reproductive hormones fluctuate during this time, symptoms can come and go from day-to-day and week to week. There can be good days and bad days. This can be confusing for women and mean they are less likely to seek help. Perimenopause can last from 2-12 years in length and therefore commonly occurs during a woman’s 40s.

Q: What is post menopause?

The menopause is 1 day in life when we have gone 12 months without a menstrual period. From this day onwards for the rest of our life we remain postmenopausal i.e. without functioning ovaries. This normally occurs in women age 45-55, the average age in the UK is 51.

Q: What symptoms might I get?

Women have receptors for reproductive hormones (i.e. estrogen, progesterone and testosterone) throughout the body. It can be helpful to complete a Menopause Symptom Checker. Whilst this does not contain all of the potential symptoms, it is helpful for joining the dots when you are considering your own health, and we use these questionnaires in gaining information prior to all appointments at the clinic. A woman’s experience of the menopause is individual; not all women will experience all of the symptoms but common symptoms are: Hot flushes Night sweats Difficulty sleeping Feeling unhappy or depressed Panic attacks Feeling tense or nervous Heart beating quickly or strongly Loss of interest in sex Muscle and joint pains Headaches including worsening migraines Poor concentration Feeling tired or lacking in energy Hair loss Formication (a feeling of insects crawling on your skin) Crying spells Loss of interest in most things Irritability Feeling dizzy or faint Parts of the body feeling numb or tingling Joint pains and muscle aches Loss of feeling in hands and feet Breathing difficulties Vaginal dryness and itching with painful intercourse Wanting to pass urine often Urinary urgency Hair and skin changes Dry eyes/dry mouth Weight gain This can be a time of doubt, loss of self confidence and confusion. But it should not be a time of isolation. Whether you seek advice, clarification or medication, our friendly team of doctors are happy to help.

Q: How long will my symptoms last?

The duration of symptoms varies from person to person but studies have shown that the average duration of symptoms is 7-8 years if left untreated. However many women continue to have symptoms for decades.The focus of your consultation will be to look at all the factors that are having a negative impact on your symptoms and your enjoyment of life. You will be given lifestyle advice to aid your efforts in improving your long-term health. If you chose to start HRT, most women notice relief of hot flushes and night sweats within 2-4 weeks. The psychological symptoms associated with the menopause can take longer to resolve and can take up to 3 months to improve. The response to Testosterone can take up to 3 months so perseverance with treatment is key to assess the effects.The full effect of the hormones will be assessed when you attend for your follow up appointment at 3 months and any necessary adjustment to the dose of HRT will be made.

Q: Can you help with vaginal dryness?

There are estrogen receptors in the vagina, bladder and urethra ( the tube that drains urine from the bladder). The lack of estrogen after menopause can cause many symptoms in the bladder and vagina, and the medical term for this collection of symptoms is Genitourinary Syndrome of the Menopause (GSM). Symptoms may start around your perimenopause but may not occur until several years after your menopause. Around 70% of women will experience these symptoms. Ask yourself: Have you experienced any vaginal soreness, burning or irritation? Do you have any itching around your vagina or vulval area? Is sexual intercourse painful or uncomfortable? Have you noticed changes in any vaginal discharge (either increased or reduced) or increased dryness? Have you noticed any urinary symptoms, such as increased urinary frequency or being less able to hold on to urine? Do you have any discomfort when passing urine? If so, we can help. Many women benefit from the use of vaginal moisturisers such as Yes or Sylk, these can be purchased at most pharmacies or online. Vaginal lubricants can be used to facilitate pain-free intercourse. However, for many women, this is not enough. The addition of vaginal estrogen has been proven to be very effective for the relief of these symptoms and is safe to use in the majority of women. This is available as a pessary, a cream or a ring so the treatment can be customised to best meet your needs. Many women who take HRT will also require vaginal estrogen to control their symptoms. Left untreated, symptoms of GSM will persist.

Q: How do I know if my symptoms are due to anxiety or depression, or to menopause?

Psychological symptoms are very common in both menopause and perimenopause and commonly include anxiety, irritability, lack of joy, flat mood, feelings of paranoia, loss of self-esteem and confidence. Often these symptoms are related to the fluctuations or low levels of reproductive hormones at this life stage. In consultation, we can consider your particular symptoms as well as other symptoms you may be experiencing, and this can be helpful in ascertaining the most appropriate treatment options.

Q: Do my symptoms have to be severe to seek help?

Absolutely not! Different women experience various symptoms in many individual ways, and this can have a huge variety of potentially detrimental impacts on our day-to-day functioning and quality of life. The knock-on effects of this may be on our relationships, our work and/or our ability to lead a healthy lifestyle. There is no arbitrary threshold for how we need to feel before considering seeking help. Delaying seeking help can be counterproductive as we may become less able to proactively tackle a problem eg having the confidence to make an appointment as menopause symptoms potentially worsen, implementing lifestyle changes to reduce symptoms etc.

Q: Is it ever too early or late to seek help?

Because the age of menopause can vary so widely, and because symptoms can be present for many years before and many years afterwards, there can be many reasons for seeking help at any stage. Some people like to be prepared in advance of menopause and booking an appointment to discuss your individual health concerns and priorities can be very beneficial. You don’t necessarily need to be experiencing any symptoms, or you may be unsure what your symptoms are due to. We can help you navigate these uncertainties. (We have all been GPs for many years!). You may be wanting to improve your health generally around midlife or beyond and we can help with considering how menopause may be having an influence, even if it is still ahead of you or was long ago.

Q: Does menopause influence my future health?

Yes! Most people are aware that menopause can be associated with troublesome symptoms but far fewer are aware that the lack of reproductive hormones after the menopause has a potentially adverse effect on almost all aspects of our health. Menopause can impact our risks of cardiovascular disease, diabetes and osteoporosis, for example. There can also be implications for our mental health and our genitourinary health as well as weight management. Ideally, every person would have an individualised assessment of their health at midlife to guide the best way forward for them.

Question 1

What is the menopause?

Accepted Answer

The menopause occurs when the ovaries stop producing eggs and periods stop. It is diagnosed as having occurred when a woman hasn’t had a period for 12 months or longer. The average age of menopause in the UK is 51 years with a normal age range of 45-55 years. An early menopause is when the menopause occurs between ages 40-45 years and Premature Ovarian Insufficiency (POI) is diagnosed if menopause occurs in a woman aged < 40 years. In the UK population approximately 1 in 100 women aged < 40 years and 1 in 1000 women aged < 30 years have POI. POI carries an increased risk of cardiovascular disease and osteoporosis. For this reason it is vital that women who have POI receive replacement hormones to secure their long term cardiovascular and bone health.All women, that live long enough, will experience the menopause. For most women this is a natural part of ageing but for some the menopause will be precipitated by surgery, chemotherapy or radiotherapy. As a result of the ovaries failing, levels of estrogen, progesterone and testosterone fall. Some women experience no symptoms but many do and in some women these are severe and impact on their quality of life, relationships and employment.Symptoms can begin several years before the menopause (the perimenopause) and persist after the menopause. The average duration of symptoms is 7 years but for some women these symptoms persist for decades. Furthermore, post menopausal symptoms of vaginal dryness, vaginal itch, painful intercourse and urinary frequency, if left untreated, can persist for life.

Question 2

What is perimenopause?

Accepted Answer

Perimenopause refers to the years leading up to the menopause where women may notice a change in their usual menstrual cycle and begin to experience menopausal symptoms. As reproductive hormones fluctuate during this time, symptoms can come and go from day-to-day and week to week. There can be good days and bad days. This can be confusing for women and mean they are less likely to seek help. Perimenopause can last from 2-12 years in length and therefore commonly occurs during a woman’s 40s.

Question 3

What is post menopause?

Accepted Answer

The menopause is 1 day in life when we have gone 12 months without a menstrual period. From this day onwards for the rest of our life we remain postmenopausal i.e. without functioning ovaries. This normally occurs in women age 45-55, the average age in the UK is 51.

Question 4

What symptoms might I get?

Accepted Answer

Women have receptors for reproductive hormones (i.e. estrogen, progesterone and testosterone) throughout the body. It can be helpful to complete a Menopause Symptom Checker. Whilst this does not contain all of the potential symptoms, it is helpful for joining the dots when you are considering your own health, and we use these questionnaires in gaining information prior to all appointments at the clinic. A woman’s experience of the menopause is individual; not all women will experience all of the symptoms but common symptoms are: Hot flushes Night sweats Difficulty sleeping Feeling unhappy or depressed Panic attacks Feeling tense or nervous Heart beating quickly or strongly Loss of interest in sex Muscle and joint pains Headaches including worsening migraines Poor concentration Feeling tired or lacking in energy Hair loss Formication (a feeling of insects crawling on your skin) Crying spells Loss of interest in most things Irritability Feeling dizzy or faint Parts of the body feeling numb or tingling Joint pains and muscle aches Loss of feeling in hands and feet Breathing difficulties Vaginal dryness and itching with painful intercourse Wanting to pass urine often Urinary urgency Hair and skin changes Dry eyes/dry mouth Weight gain   This can be a time of doubt, loss of self confidence and confusion. But it should not be a time of isolation. Whether you seek advice, clarification or medication, our friendly team of doctors are happy to help.

Question 5

How long will my symptoms last?

Accepted Answer

The duration of symptoms varies from person to person but studies have shown that the average duration of symptoms is 7-8 years if left untreated. However many women continue to have symptoms for decades.The focus of your consultation will be to look at all the factors that are having a negative impact on your symptoms and your enjoyment of life. You will be given lifestyle advice to aid your efforts in improving your long-term health. If you chose to start HRT, most women notice relief of hot flushes and night sweats within 2-4 weeks. The psychological symptoms associated with the menopause can take longer to resolve and can take up to 3 months to improve. The response to Testosterone can take up to 3 months so perseverance with treatment is key to assess the effects.The full effect of the hormones will be assessed when you attend for your follow up appointment at 3 months and any necessary adjustment to the dose of HRT will be made.

Question 6

Can you help with vaginal dryness?

Accepted Answer

There are estrogen receptors in the vagina, bladder and urethra ( the tube that drains urine from the bladder). The lack of estrogen after menopause can cause many symptoms in the bladder and vagina, and the medical term for this collection of symptoms is Genitourinary Syndrome of the Menopause (GSM). Symptoms may start around your perimenopause but may not occur until several years after your menopause. Around 70% of women will experience these symptoms. Ask yourself: Have you experienced any vaginal soreness, burning or irritation? Do you have any itching around your vagina or vulval area? Is sexual intercourse painful or uncomfortable? Have you noticed changes in any vaginal discharge (either increased or reduced) or increased dryness? Have you noticed any urinary symptoms, such as increased urinary frequency or being less able to hold on to urine? Do you have any discomfort when passing urine?   If so, we can help. Many women benefit from the use of vaginal moisturisers such as Yes or Sylk, these can be purchased at most pharmacies or online. Vaginal lubricants can be used to facilitate pain-free intercourse. However, for many women, this is not enough. The addition of vaginal estrogen has been proven to be very effective for the relief of these symptoms and is safe to use in the majority of women. This is available as a pessary, a cream or a ring so the treatment can be customised to best meet your needs. Many women who take HRT will also require vaginal estrogen to control their symptoms. Left untreated, symptoms of GSM will persist.

Question 7

How do I know if my symptoms are due to anxiety or depression, or to menopause?

Accepted Answer

Psychological symptoms are very common in both menopause and perimenopause and commonly include anxiety, irritability, lack of joy, flat mood, feelings of paranoia, loss of self-esteem and confidence. Often these symptoms are related to the fluctuations or low levels of reproductive hormones at this life stage. In consultation, we can consider your particular symptoms as well as other symptoms you may be experiencing, and this can be helpful in ascertaining the most appropriate treatment options.

Question 8

Do my symptoms have to be severe to seek help?

Accepted Answer

Absolutely not! Different women experience various symptoms in many individual ways, and this can have a huge variety of potentially detrimental impacts on our day-to-day functioning and quality of life. The knock-on effects of this may be on our relationships, our work and/or our ability to lead a healthy lifestyle. There is no arbitrary threshold for how we need to feel before considering seeking help. Delaying seeking help can be counterproductive as we may become less able to proactively tackle a problem eg having the confidence to make an appointment as menopause symptoms potentially worsen, implementing lifestyle changes to reduce symptoms etc.

Question 9

Is it ever too early or late to seek help?

Accepted Answer

Because the age of menopause can vary so widely, and because symptoms can be present for many years before and many years afterwards, there can be many reasons for seeking help at any stage. Some people like to be prepared in advance of menopause and booking an appointment to discuss your individual health concerns and priorities can be very beneficial. You don’t necessarily need to be experiencing any symptoms, or you may be unsure what your symptoms are due to. We can help you navigate these uncertainties. (We have all been GPs for many years!). You may be wanting to improve your health generally around midlife or beyond and we can help with considering how menopause may be having an influence, even if it is still ahead of you or was long ago.

Question 10

Does menopause influence my future health?

Accepted Answer

Yes! Most people are aware that menopause can be associated with troublesome symptoms but far fewer are aware that the lack of reproductive hormones after the menopause has a potentially adverse effect on almost all aspects of our health. Menopause can impact our risks of cardiovascular disease, diabetes and osteoporosis, for example. There can also be implications for our mental health and our genitourinary health as well as weight management. Ideally, every person would have an individualised assessment of their health at midlife to guide the best way forward for them.

Question 11

Where can I find out more about the menopause?

Accepted Answer

Have you seen our library of information booklets? The following websites provide useful evidence based information to enhance understanding of the menopause:​ NICE Guideline NG23: Menopause diagnosis and management Women’s Health Concern The Daisy Network Menopause and Women’s Health in Later Life (RCOG) Understanding Menopause Booklet (Menopause Support, PDF)   Health in Menopause is not responsible for the content contained in any of the websites listed above.

Question 12

What is HRT?

Accepted Answer

HRT stands for hormone replacement therapy, and it refers to medication used to either top up your own ovarian levels of reproductive hormones when you are in perimenopause or replacing them when you are post menopause

Question 13

Is HRT suitable for everybody?

Accepted Answer

At Health in Menopause, we believe that all who are experiencing menopause or perimenopause should be sufficiently aware of the correct information to decide about whether they would like to try HRT. HRT will not be recommended for everyone, and it may not be chosen by some, but there are plenty of ways of managing the menopause holistically and we can help you to understand various lifestyle choices as well as medications or supplements that can be used to help during menopause that are not HRT.

Question 14

I was told I can’t have HRT &#8211; is that correct?

Accepted Answer

There are many myths surrounding treatment for menopause and HRT. Older types of HRT have been associated with very small risks, e.g. of blood clots, and therefore some women have traditionally been warned away from considering its use. Newer types of HRT, i.e. body identical HRT, are very safe, and therefore many people can use them. Common groups of people who are advised not to use HRT are those who have high blood pressure, are overweight, suffer from migraine episodes or have a family history of cardiovascular disease or blood clots. All of these groups can, in fact, usually safely use body identical HRT following an individualised consultation. Another common group who are often advised not to use HRT are those with a family history of breast cancer. As breast cancer is very common, it is not unusual to have 1 or more affected relatives in a family. It is important to have an individualised discussion with anybody in this situation to determine their underlying risk, but many women in this situation will never develop breast cancer themselves. Use of HRT in women with a family history of breast cancer is usually an option. Please see Family History of Breast Cancer. Having a personal history of cancer is often not a barrier to considering the use of HRT. Some cancers, whilst not caused by estrogen, may be promoted by estrogen, e.g. some, but not all, breast cancer and gynaecological cancers. In these cases, HRT is usually not considered as a first-line choice. At Health in Menopause, our clinicians have particular expertise in helping patients with a history of cancer and discussing all the options available to them, which may or may not include HRT. Please see Menopause After Breast Cancer.

Question 15

Which types of HRT do you offer?

Accepted Answer

At Health in Menopause, we usually use body identical HRT as our first-line choice for those who opt to trial HRT. Body identical HRT refers to regulated, authorised (by the MHRA) HRT products which are derived from the Yam plant and are molecularly identical to ovarian reproductive hormones. It is deemed the most effective and safest type of HRT currently available for the vast majority of women. Occasionally other types of HRT may be considered for an individual (e.g. older, synthetic types of HRT) but this would always be carefully explained to the patient and all products prescribed are regulated and authorized.

Question 16

What is body identical HRT?

Accepted Answer

Body identical HRT refers to regulated, authorised (by the MHRA) HRT products which are derived from the Yam plant and are molecularly identical to ovarian reproductive hormones. It is deemed the most effective and safest type of HRT currently available for the vast majority of women.

Question 17

Do you prescribe bioidentical HRT?

Accepted Answer

At Health in Menopause, we do not prescribe bioidentical HRT. Bioidentical HRT usually refers to unregulated, compounded hormone products. Due to the lack of regulation, there can be concerns as to the safety of these products.

Question 18

Isn’t HRT associated with a risk of breast cancer?

Accepted Answer

This question is probably the most common one we face in menopause conversations, as the media has led us to believe for the past 20+ years that HRT is associated with an increased risk of breast cancer. Many studies have been carried out to consider this question, but all of the studies are imperfect and, in some cases, inaccurate and misleading, and most of them are not applicable to the types of HRT we use most nowadays, i.e., body identical HRT. There may be a very small risk associated with older types of HRT, but even this has not been clearly demonstrated. The most important thing to consider is that there are many lifestyle factors that affect our risk of breast cancer, e.g., exercise, alcohol and our weight. Menopause can cause us to have less healthy lifestyles (due to the challenging symptoms), and being able to tackle these issues will have a far greater impact on our breast cancer risk than whether we use HRT or not.

Question 19

How do I book a consultation?

Accepted Answer

You might find our The Health in Menopause Patient Journey resource helpful. The easiest way is to book online. Bookings can also be made by calling 0115 6463390 between the hours of 9am and 5pm, Monday to Friday. You do not need a letter from your GP to have a consultation with any of our doctors.

Question 20

How much does a consultation cost?

Accepted Answer

Click to view our pricing.

Question 21

How long will a consultation last?

Accepted Answer

Most initial consultations will last 50-60 minutes and follow up consultations 25-30 minutes. This will depend on the complexity of your individual symptoms and your past medical history. The consultation will be individualised to assess and discuss your needs.

Question 22

How should I prepare for a consultation?

Accepted Answer

Upon confirmation of your appointment, we will ask you to complete 2 short questionnaires ahead of your consultation. One is the Menopause Symptom Checker to give us a record of your current symptoms. This is useful for prioritising your care and for monitoring your progress. The other contains questions about any significant medical history, which helps us better prepare for your consultation. We will also ask you to provide any recent relevant blood test results if you already have some, and to obtain an up-to-date blood pressure reading. At the beginning of your initial consultation, we will also ask for photographic ID in the form of a passport or a driving license.

Question 23

What will happen at the consultation?

Accepted Answer

Your Health in Menopause clinician will take a full medical history with a focus on your symptoms and how these have impacted on your quality of life. A holistic approach will be taken with discussion of lifestyle factors and how these can be modified to improve health. A clinical examination may be undertaken as determined by your history. We will then discuss all management aspects relevant to improving and maintaining your health including discussions about HRT and/or alternative therapies. We base our consultations around Shared Decision Making where we aim to empower and support you to make decisions about your care. Together a plan of management will be agreed.

Question 24

How often will I be seen at the clinic?

Accepted Answer

You may find this dedicated resource helpful – The Health in Menopause Patient JourneyFollowing an initial consultation, most women are seen after around 3 months to assess the response to treatment. If this is altered, a further appointment is usually required again after 3 months. Once a woman is established on HRT that is effective, review is only required on an annual basis. For many women, their GP is happy to continue with the prescription of HRT and will carry out the annual review so there is no need for ongoing attendance at the clinic. However some women prefer to continue to attend the clinic and for some women this is necessary as their GP is unable to prescribe their HRT. We would be happy to continue to provide ongoing care to all women who need it. An annual review is required as a minimum. Women who intend to continue to have their medication prescribed at Health in Menopause must attend for annual review to ensure safe prescribing practice.

Question 25

How do I change my appointment date or time?

Accepted Answer

At present it is not possible to change your appointment online. You can cancel an appointment by calling 0115 6463390 or by clicking on the cancellation link contained in the email confirmation of your appointment. Please email info@healthinmenopause.co.uk if you wish to change the date/time of your appointment. Cancellations or amendments that occur with at least 2 full working days’ notice will be cancelled or rebooked without penalty or administration fees. However, cancellations or amendments made with less than 2 full working days’ notice will incur a 100% cancellation levy.

Question 26

Is there parking at the clinic?

Accepted Answer

Nottingham – On street parking is available on College Street and Wellington Circus with payment by machine or RingGo. Sutton Coldfield – There are limited parking spaces at the front of The Moat House. Access to the car park is via a secure barrier, please press the buzzer to contact the receptionist who will permit access to the car park. On street parking is available in the adjacent side streets.

Question 27

Will you write to my GP?

Accepted Answer

At Health in Menopause we believe that it is in the best interests of our patients to share information with your GP to ensure continuity of care and the maintenance of your comprehensive medical record. This will involve sharing clinic letters with your GP. We will ask for your consent to do this.

Question 28

Will I need blood tests?

Accepted Answer

For most women the diagnosis of menopause is a clinical one based on age, symptoms and a change in menstrual pattern. In women aged > 45 years, the diagnosis is a clinical one made by the doctor. However young women aged < 40 require blood tests to be taken to establish a diagnosis of Premature Ovarian Insufficiency (POI). In addition, blood tests may be suggested to exclude other causes for symptoms such as anaemia or an underactive thyroid gland. This will be discussed in full at the consultation. Some women also request bloods as part of an overall health check and this can be arranged. Women who are prescribed testosterone will require blood tests 3 months after commencing treatment and usually annually thereafter.

Question 29

Do I need blood tests before appointments?

Accepted Answer

If you have any blood results from your GP surgery from any recent blood tests it can be helpful if you can share them with us electronically before your initial appointment (at least 48 hours prior to ensure we have seen them) but we wouldn’t expect any particular blood tests to have been carried out in advance. Blood results can be forwarded to info@healthinmenopause.co.uk in advance of your appointment.If we advise any blood tests going forward we will explain how and when to get them done and it is not usually necessary to have them done prior to any appointment. We usually find it more helpful to do a blood test on the day of your appointment or at some point afterwards so that we can better interpret the result in the context of what you have told us at your appointment.

Question 30

Should I apply my medication on the day of my blood test?

Accepted Answer

On the day of your blood test, please omit your daily dose of Oestrogel, Sandrena, Androfeme, Testogel or Testim. Your daily dose of medication should be applied after the blood test has been taken.

Question 31

Will you prescribe HRT at my first appointment?

Accepted Answer

Looking after your health in menopause involves reappraisal of lifestyle factors alongside the prescribing of HRT where and when appropriate. While most women benefit from taking HRT that is personalised to meet their needs, some women choose not to take HRT based on their individual health history, views and choices. If appropriate a private prescription will be issued at the time of your appointment. We will send your prescription electronically to a secure online pharmacy, which will then contact you for payment for the medication and post it directly to you. Delivery is usually within 48 hours and will come to your home address. As an approximate guide to the cost of medication prescribed privately, an initial prescription of HRT including estrogen and progesterone would cost approximately £60 for a 3-month supply.

Question 32

Do you prescribe testosterone?

Accepted Answer

The level of testosterone in premenopausal women is higher than that of estrogen, but it starts to decline usually in our 30s. There is a further dip in testosterone at menopause. Testosterone, along with estrogen and progesterone contributes to overall wellbeing and sexual function in women. Low libido can be problematic for women in the perimenopause and menopause, but low libido is multifactorial in nature, e.g. being affected by hormones, poor sleep, fatigue, relationship issues and stress. Your symptoms may improve with estrogen replacement, but if this does not seem to be the case then we can consider the addition of testosterone replacement. Furthermore, before the addition of testosterone, it is essential that women are adequately treated for vaginal dryness as this can contribute to painful sexual intercourse and negatively impact libido. A full assessment of symptoms and treatment options will be discussed at your appointment.

Question 33

Do you fit Mirena coils at the clinic?

Accepted Answer

Unfortunately there are no facilities for the safe insertion of a Mirena coil at the clinic. Most women access this through their GP or local sexual health clinic. You can find your local clinic via the NHS sexual health clinic finder. The Mirena is particularly useful for women in the perimenopause when it has the following advantages: effective contraception for up to 5 years of use reduced menstrual blood loss. Heavy periods can be common in perimenopause. effective protection for the lining of the womb as part of HRT   The Mirena can be combined with estrogen as a patch, gel, spray or tablet as part of combined HRT.

Question 34

How much does HRT cost?

Accepted Answer

For women who are likely to benefit from HRT, an initial prescription for 3 months of medication will be issued. As an approximate guide, including postage, the cost of combined HRT (i.e. estrogen and progesterone) is £55-60. Most vaginal estrogen preparations cost £25-30. Testosterone, if prescribed, is priced separately — your clinician will explain the cost and options at your consultation. Initial medication and any repeat medication that is issued within the consultation do not involve any additional private prescription fee; however, repeat prescriptions ordered outside of a consultation will incur a £33 repeat prescription fee (this is separate from the cost of the medication).

Question 35

What will happen after my appointment?

Accepted Answer

There can be quite a lot of information to take in at your appointment, especially the initial one. Once your appointment is finished, your doctor will arrange any prescriptions and you will be contacted by the online pharmacy to make any payment for medication. If we have arranged a blood test for you, we will send you an invoice. Your clinician will dictate an individualised clinic letter about your consultation that will be emailed to you within a couple of working days of your appointment. We encourage you to book your next appointment in advance for the timeframe agreed with your doctor, as often people forget nearer the time, and our diaries can fill up in advance. Any medication should arrive within 24-48 hours of payment being made.

Question 36

How do I book a blood test?

Accepted Answer

To book your blood test please call the clinic directly. If it is not appropriate or convenient for you to have the blood test taken at our Nottingham or Sutton Coldfield clinics, then you can arrange your blood test with our laboratory provider, Nationwide Pathology. The laboratory has a nationwide network of phlebotomy clinics. Once you have received an invoice from us for the cost of analysing your blood, you will be given the telephone number for the Nationwide Pathology booking line (01858 571322). They will be able to let you know where your nearest and/or most convenient location is for having your blood test and will book you an appointment.

Question 37

How will I get my blood results?

Accepted Answer

Within 7-10 days of your blood test being taken, your doctor will email you to explain your results and any suggestions for your ongoing treatment. Most blood tests are done at the time of a consultation or soon after or with a pre-agreed plan of what implications the blood results may have on your treatment plan. If it has been some time since your last consultation and we don’t have an up-to-date assessment of how you are currently feeling, we may let you know that we will need to discuss your results in context with a further consultation.If you have had a blood test and not heard from us within 10 days, please contact us via email so we can investigate the issue.

Question 38

What should I do if I have questions after my appointment?

Accepted Answer

We aim to cover all the most common queries during your consultation. However, there may be issues that need clarification or that arise after your appointment. Most questions you might have will probably be covered in your clinic letter which should arrive within a few working days of your appointment. There is also a lot of information on our website, in our Information Booklet section and FAQs. If your question has not been answered via these resources, then please do send us an email. Our clinicians work on a variety of different days and will endeavour to answer your email within 5 working days. When considering how best to respond to you, we will consider your individual circumstances and the time that has elapsed since your last appointment and when you are next due to be seen for follow-up. We will judge the appropriateness of responding via email or whether, for your medical safety, it is best that we advise a further consultation to address the issue(s). Our clinicians are not available on an urgent basis. Any medical emergencies should be directed to your primary care provider or out of hours provider.

Question 39

Can I call my doctor with a query?

Accepted Answer

Our doctors have busy diaries and are not available for ad hoc telephone discussions. We are happy to answer email queries from our patients via email if deemed an appropriate response method for the particular query. If we feel that the query cannot be appropriately dealt with via email, we may suggest a further follow up consultation is necessary – this would usually be in person or via video; but can be via telephone at the discretion of your doctor.

Question 40

How do I order a repeat prescription?

Accepted Answer

At your first appointment, any prescription supplied will usually be for a 3-month supply of medication, to last until your planned follow up appointment. This is to allow sufficient time for any side effects to settle. We can then issue you a further prescription at your follow up appointment if you wish, once we have made any potential alterations to doses or types of HRT. Due to multiple HRT shortages affecting the UK over the past 4 years, we are limited to only being able to prescribe 3 months at a time for many of the common items. If you need a further prescription but your next agreed consultation is not needed for some time you can order a further prescription on our website. When you request a repeat prescription, one of our doctors will check your medical record and make sure the request is appropriate. For your medical safety, if you are overdue for a follow up consultation, we will let you know this and as a result, the provision of your prescription may be delayed or declined. Sometimes, the timing doesn’t work out exactly, for example if some medication is accidentally mislaid, or your dose has been changed in between appointments following the agreement between you and your doctor, or if an appointment is delayed by a few weeks. If this is the case, we may provide an emergency 1 month supply of medication to last until the next available consultation can be arranged.

Question 41

Why have I been charged twice for a repeat prescription?

Accepted Answer

If you have requested a prescription during a consultation, there will be one payment to make, direct to the online pharmacy we use, which covers the cost of the medication(s) and postage. The private prescription fee (ie the fee to the doctor for providing the prescription) is already covered by your consultation fee. If you are requesting a repeat prescription in between consultations, then you will still pay the online pharmacy for the medication(s) and postage; but there will also be a payment made to ourselves for the private prescription fee (currently £33).

Question 42

Can my GP prescribe my HRT?

Accepted Answer

Following your initial consultation, we strongly recommend that any prescriptions should be provided by us on a private basis. This is so that you can be sure the medication that is prescribed is what has been discussed and agreed with you and so we know you have enough to last you for the next 3 months. This arrangement also enables you to get your HRT and be able to start using it within 24-48 hours. As we prescribe HRT very frequently, we can be as up to date as possible with any supply issues and can take this into account when prescribing most safely and cost effectively for you. Going forward, once you are settled on your HRT, then you may choose to approach your GP surgery about them taking over the prescriptions. Whilst we aim to advocate for you in this situation, we must respect the fact that each GP will have their own views and opinions regarding the medical advice we have given you, and we cannot dictate or guarantee any particular outcome. We aim for our clinic letters to be comprehensive and reassuring for any GP to refer to.Depending on the individual circumstances, most GPs are willing to consider prescriptions for estrogen HRT, progesterone and vaginal hormones. However, some specific products we advise may not be on your GP surgery’s local formulary. Testosterone replacement for females remains an area of uncertainty within the NHS currently. There are widespread geographical variations in whether GP surgeries are prepared to issue some of the testosterone products that are licensed for males, at the dose that we advise for females. Currently, GP surgeries cannot prescribe Androfeme.

Question 43

Does the NHS HRT prepayment certificate cover private prescriptions?

Accepted Answer

No. The Prepayment certificate does not cover private prescriptions. Please also be aware it does not cover testosterone prescriptions. For further details see the HRT Prepayment Certificate page

Question 44

Which clinician should I see?

Accepted Answer

In order to maintain continuity of care, where possible, it is best that you book with the clinician whom you consulted with previously. If, however, your usual clinician is unavailable at a time that suits, you can see any of our clinicians. All clinicians are fully qualified and experienced in menopause care; they all have access to your medical record and will be able to continue with your treatment.

Question 45

Do I have to see the same clinician each time?

Accepted Answer

Please book with your usual clinician to ensure continuity of care. However, if your usual doctor is unavailable at a time that suits, you can see any of our clinicians. All clinicians are fully qualified and experienced in menopause care; they all have access to your medical record and will be able to continue with your treatment.

Question 46

Are there any other appointment slots available?

Accepted Answer

All of our appointment slots are shown here and are bookable online. These are the same slots that will be available if you book by phone.

Question 47

Which clinician should I choose to see?

Accepted Answer

If you are a new patient and wish to be seen in person, please book with either Dr Duffy at the Nottingham clinic or Dr Ball at the Sutton Coldfield clinic.If you are a new patient and wish to have a video consultation, you can book with any of our clinicians.If you are a patient who has previously been under the care of one of our clinicians at another clinic, either in the NHS or private sector, and wish to continue under their care, please book a New Patient appointment with the clinician concerned. This is required to ensure that all relevant information is recorded in your Health in Menopause care record. If you are a returning patient, it is best, if possible, that you book with the clinician that you saw previously. This is to ensure continuity of care, which is valued by patients and clinicians alike.

Question 48

What will happen once I&#8217;ve booked my appointment?

Accepted Answer

You will immediately receive a confirmation email with details of your appointment and a link to a new patient questionnaire to be completed if you are attending for the first time. Please save the info@healthinmenopause.co.uk email to avoid the chance of our correspondence going to your junk folder. You will then receive a reminder email at 6 pm on the evening before your consultation. This will contain a reminder to complete your Menopause Symptom Checker in advance of your appointment. You can read more about what is likely to happen during your care in our booklet here.

Question 49

Can I have my consultation in person?

Accepted Answer

Yes. At present Dr Duffy is seeing patients in person at our dedicated clinic in Nottingham. Dr Ball is seeing patients in person at our Sutton Coldfield clinic.

Question 50

How quickly can I get an appointment?

Accepted Answer

We typically have initial consultation availability within one to two weeks at both our Nottingham and Sutton Coldfield clinics. You can see live availability and book online, or call us on 0115 6463390 if you'd prefer to speak to someone.

Question 51

Do I need a referral from my GP?

Accepted Answer

No. You can book a private menopause consultation with us directly — no GP referral is needed. With your permission, we're happy to send a summary letter to your NHS GP after your appointment so they have your treatment plan on file.

Question 52

Is private HRT safer than NHS HRT?

Accepted Answer

HRT itself is the same regulated medication whether prescribed privately or on the NHS — what changes is the time and expertise behind your treatment plan. With us you get longer appointments, specialist-led decisions about which HRT and dose suits you best, and the option to fine-tune your treatment over time. That's where the real difference lies.

Question 53

What happens at my first consultation?

Accepted Answer

Your initial 60-minute consultation is unhurried and led by a menopause specialist. We'll talk through your symptoms, medical history and what you're hoping to get from treatment. If clinically appropriate, we can arrange blood tests. You'll leave with a personalised treatment plan — which may include HRT, non-hormonal options or lifestyle support — and clear next steps.

Question 54

How long does a consultation last?

Accepted Answer

Initial consultations are up to 60 minutes — long enough to take a full history, talk through your symptoms in detail and agree a treatment plan that's right for you. Follow-up consultations are up to 30 minutes. Brief telephone discussions are sometimes available for existing patients, but only by clinician recommendation — they cannot be booked online.

Question 55

Will my consultation be in person or online?

Accepted Answer

Both options are available. Online video consultations are available to women across the UK with Dr Alice Duffy, Dr Sarah Ball or Lindsey Lester, our menopause specialist pharmacist independent prescriber. In-person clinics are based in Nottingham with Dr Alice Duffy and in Sutton Coldfield with Dr Sarah Ball. You can choose what suits you best when booking.

Question 56

Can my NHS GP take over my prescription afterwards?

Accepted Answer

Sometimes. With your permission, we'll write to your NHS GP summarising your consultation and the recommended treatment. Whether your GP can then take over depends on the medication, their own prescribing policy and local NHS guidance — but many patients do successfully transition to NHS prescriptions after starting privately with us.

Question 57

Do I need a follow-up consultation?

Accepted Answer

Most patients book a follow-up around 8 to 12 weeks after starting treatment so we can review how things are going and fine-tune your dose, type or delivery method where needed. HRT rarely works perfectly first time — follow-ups are how we make sure it's working for you.

Question 58

Do you accept private medical insurance?

Accepted Answer

Unfortunately, medical insurance does not normally cover treatment for menopause care. We provide detailed receipts so you can submit a claim to your insurer where your policy allows, but most policies treat menopause as outside their scope.

Question 59

Do I need a GP referral?

Accepted Answer

No. You can book a private menopause consultation with us directly — no GP referral is needed. With your permission, we'll send a summary letter to your NHS GP after your appointment so they have your treatment plan on file.

Question 60

How long will my first appointment last?

Accepted Answer

Your initial consultation is up to 60 minutes. That's deliberate — it gives us time to listen properly, take a full history, and agree a treatment plan that's actually right for you.

Question 61

What happens after I book?

Accepted Answer

You'll receive a confirmation email with your appointment details. For video consultations, this also includes your call link and two short pre-consultation forms about your symptoms and history — completing these before your appointment helps us make the most of our time together.

Question 62

How much does it cost?

Accepted Answer

Initial consultations are £285 and include your prescription where one is issued. See full pricing for follow-ups and other services.

Question 63

Will I be prescribed HRT at my first appointment?

Accepted Answer

If HRT is right for you, yes — your private prescription is included in your consultation fee. We follow British Menopause Society guidance and primarily prescribe body-identical HRT. We won't prescribe HRT if it isn't clinically appropriate.

Question 64

What if I need to cancel or rebook?

Accepted Answer

Just contact our reception team on 0115 6463390 as soon as possible. We'll do everything we can to find you a more suitable slot.

FAQ’s

Understanding menopause

HRT explained

Booking a consultation

At the clinic & after your appointment

FAQ’s

Understanding menopause

HRT explained

Booking a consultation

At the clinic & after your appointment

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