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It’s understandable that you may be put off your smear for fear of pain during the procedure if you are suffering from urogenital syndrome of the menopause but a course of local oestrogen for 6-8 weeks beforehand can really help to make the process more comfortable.
Vaginal oestrogen is not generally described as a form of HRT.
HRT will improve vaginal and bladder symptoms in many women but around a third of women will need vaginal oestrogen in addition to HRT to manage their urogenital symptoms specifically.
It is very safe to take both together for most women.
Laser beams inside the vagina is a newer therapy and is thought to increase blood flow to the vagina and help to rejuvenate tissues and can be hugely helpful in some women. It is not currently available on the NHS
Vaginal oestrogens are very safe for most women with minimal absorption around the body. Once the vaginal tissues begin to thicken again with oestrogen use, it is thought that absorption reduces to an even lower level and stays locally in and around the vagina.
If you have had an oestrogen receptor positive cancer you may be on certain medications that make prescribing a vaginal oestrogen more challenging but it is important that you explore the options available to you- there are always choices!
Replacing oestrogen in and around the vagina can alleviate both urinary and vaginal symptoms and can reverse some of the changes that may have already occurred.
These treatments can take up to 3-6 months to have a full effect and need to be used long term.
Vaginal oestrogen comes in lots of preparations including a cream, pessary, vaginal tablet and a vaginal ring. A discussion about your symptoms, medical history and personal preference will help to find a preparation that is right for you.
-Be aware of your own anatomy- have a look with a handheld mirror so you know what changes may be occurring and can tell your doctor where you are experiencing symptoms
– Don’t put anything else on your vulva- scented products, perfumes, soaps and wet wipes can be extremely irritant to the vulva and vagina and make the situation worse. Try and stick to products recommended or prescribed by a doctor.
-Moisturise-a simple moisturiser can go a long way towards making your vagina and vulva more comfortable and there are a range of products available
-Use a lubricant during sex and use the right lubricant- see our psychosexual information for more tips on lubricants
-Keep having sex if you want to! It’s a common concern that having sex will damage the vaginal tissues permanently and that it is better to stop being sexually active altogether- but if sex is not uncomfortable and you want to, then there is evidence that continuing with an intimate relationship can help to keep the vaginal tissues stretchy and supple around the time of the menopause and beyond- see our psychosexual information for tips on comfortable sex.
-ask about medications that may be making your dryness worse- some medications for other conditions can make vaginal dryness worse and some of these might be able to be changed or stopped.
A common misconception is that the symptoms will get better over time or improve quickly with treatment which can then be stopped. Unfortunately this is not the case and the changes in the vagina and bladder only worsen as women get older- unlike other menopausal symptoms which often improve after a number of years. Consequently the treatment needs to be long-term and any medication prescribed should be put on repeat. On stopping treatment symptoms will almost certainly recur.
Unfortunately the often late presentation of this condition means that the changes in the vagina and bladder are more advanced by this stage and thus more difficult to reverse. Like with everything, prevention is better and easier than cure!
If we can educate women about the genitourinary syndrome of the menopause- why it occurs, when it occurs, the symptoms and how to manage them, then many women will have a much more comfortable vagina and bladder 10 years+ down the line from their menopause.
The genitourinary symptoms can take longer to develop than many of the other symptoms of the menopause and because women often feel embarrassed to bring this up with their doctor it may take many years after that for a woman to access help. Consequently it is often 10 years or more before a woman plucks up the courage to speak to someone about their symptoms.
This time gap from menopause to vaginal and urinary symptoms can mean women and healthcare professionals alike may not immediately connect the symptoms to the menopause which occurred some years earlier, and thus vaginal oestrogen replacement is often missed as the necessary treatment for the symptoms.
Women may have been recurrently treated for thrush due to an increased discharge only to find it doesn’t help or have had many courses of antibiotics for urinary tract infections. An itchy sore vulva can drive women to use lots of different products to try and alleviate their discomfort- only to find that this actually adds to the irritation and soreness.
The gel should be applied either to the inner forearms or upper thighs and then wash hands with soap and water.
The site of application should be varied daily to prevent excess hair growth at the application site.
There is no need to rub the gel in- just wait around 5 minutes for it to dry before dressing.
No testosterone treatment is licensed for women in the UK.
The most commonly prescribed products are those that are licensed for men but are used at lower doses for women.
Testosterone comes in a cream, gel pump or gel sachet depending on which brand is prescribed and is applied daily or every other day (again depending on which preparation is being used).
It can take up to 6 weeks to start to notice the benefit from testosterone replacement and maximal benefit should be seen by 6 months.
It is important to have a blood test 3 months after starting treatment and then 6 monthly to monitor levels thereafter. Women on testosterone should have a clinical review at least annually whilst on treatment.
It is important to have a blood test before starting testosterone. This is to ensure that the levels of testosterone in your blood already are not high or at the higher end of normal where giving added testosterone is more likely to cause side effects.
Yes the current guidance is that testosterone should only be prescribed if a woman has adequate levels of oestrogen on HRT.
This is partly because replacing oestrogen to good levels often improves many of the symptoms (including libido) that may also have been attributable to low testosterone.
Whilst it has not been shown to be dangerous to use testosterone without being on oestrogen, the side effects mentioned above are more likely to occur if testosterone if used alone in peri-menopausal and menopausal women.
Knowledge is power and a little bit of education about what affects bone development and function goes a long way towards understanding the importance of lifelong strategies to protect our bones from osteoporosis. As with so many things in medicine, prevention is better than cure and with life expectancy extending all the time, maintaining mobility and independence into our elderly years becomes ever more relevant.
Every little helps and there’s no time like the present to start thinking about your bones.
The good news is there are many simple things that you can do at home to improve your bone health.
1.Diet- Having a healthy balanced diet with enough calcium and vitamin D is important. See below for more info.
Calcium plays a crucial role for our bones and it’s really important that we get enough calcium in our diet.
It’s recommended that we have around 700mg/d of calcium in our diet. If you are not sure how much calcium you are getting from food then use this handy calcium calculator to work it out.
Link to Edinburgh calcium calculator
If you are not getting enough calcium and are unable to increase this easily then you may need to take a supplement.
Vitamin D- vitamin D is vital for calcium absorption. We get 90% of our vitamin D from sunlight exposure and usually only 10% from diet. The sunlight exposure needs to be to strong midday sun at regular intervals.
The climate in the UK is such that we will not have enough sun exposure to have adequate vitamin D levels all year round- in fact we have usually run out of vitamin D stores by around Christmas.
It is advisable to take a vitamin D supplement through the autumn and winter months or if you are at high risk (dark skinned, clothing that covers skin all the time, stay indoors).
Foods that contain vitamin D include oily fish, eggs and cod liver oil.
**calcium and vitamin D alone are not adequate to treat osteoporosis
2.Exercise- in order to stay strong our bones need to be stressed with weight bearing exercise- this is anything that exerts a pressure through our bones. Even relatively short periods of immobility- a few days lying in bed when ill- has been shown to have an effect on bone density and whilst early changes such as these can be quickly reversed by becoming active again- longer periods of immobility will start to have a really significant effect on bone mass.
Osteoporosis can be a frightening diagnosis and the older we get the more worried we may become about breaking something by exercising.
But like other lifestyle factors, exercise is a scale- from sedentary to high intensity high impact aerobic exercise. And the further you get away from immobility the better. Even standing up is better than sitting and is a good start. You don’t have to suddenly start playing basketball 3 times a week if you have been relatively inactive beforehand. Start with walking and build this up over time as your confidence grows. Find something fun that suits your lifestyle.
Don’t forget your muscles- we need healthy muscles to support our bones. With good muscle strength we are less likely to fall, more likely to be able to stop ourselves falling if we trip, can get up more easily if we do fall and if a bone is broken we are much more likely to have a quick recovery with good strong muscles supporting our injured bone.
So any exercise that strengthens muscles is very important- things like cycling and swimming- whilst they are not weight bearing are actually also vital for healthy bones and should not be discouraged as being ‘the wrong type of exercise’.
The Royal Osteoporosis Society has excellent guidance on amount and type of exercise to best benefit our bones. (add link)
3.stop smoking and reduce alcohol
4.weight- maintain a healthy BMI- it’s actually being underweight that is a major risk factor for osteoporosis
5.HRT– is effective at preserving bone density around the menopause and significantly reduces the risk of having a fracture related to osteoporosis.
Women with premature ovarian insufficiency or an early menopause are strongly recommended to take HRT until at least the age of the natural menopause to protect their bones from osteoporosis.
HRT is now a first line option to treat osteoporosis in menopausal women under the age of 60.
To diagnose osteoporosis we use something called a DEXA scan. This stands for Dual Energy x-ray absorptiometry. This is a very low dose of radiation- no more than the background radiation in the world round us. It is a quick and non- invasive scan taking around 10 minutes and does not involve going into an enclosed tunnel.
It measures how much of the radiation the bone absorbs and thus gives a reading of how dense the bone is, looking particularly at the spine and the hip.
Currently only those at the highest risk of osteoporosis can be referred for a DEXA scan on the NHS.
If you think you may have risk factors that could affect you bone density then speak to a healthcare professional about a DEXA scan.
1.Genetics- if a parent had a hip fracture the risk doubles
2.Smoking and high amounts of alcohol (>3 units per day)
3.BMI <18.5 or previous anorexia
4.Some medications eg steroids or cancer treatments
5.Other medical conditions- eg rheumatoid arthritis, type 1 diabetes, chronic liver disease
6.Sedentary lifestyle
7.early menopause and premature ovarian insufficiency
Yes hormones again! Oestrogen plays a crucial role for women in maintaining bone density- it reduces the numbers and activity levels of the cells that lead to bone being broken down (osteoclasts) and keeps them under control. When oestrogen levels fall around the menopause these cells become much more active and break the bone down quicker than it can be reformed.
The rate of bone loss for women at this time is about 2-3% per year for the 5ish years around the menopause (though this varies hugely from woman to woman) with some women having a higher rate of bone loss for longer.
In a cruel twist of fate we know that women don’t achieve the same peak bone mass as men AND we lose bone rapidly at the menopause- so it’s a double whammy for female bones which is why osteoporosis is much more common in women than men.
Of course, the higher your peak bone mass in your twenties and the less bone you lose before the menopause accelerates bone thinning, the lower the overall impact of the rapid bone loss around the menopause will be.
This goes some way towards explaining why it’s so crucial to be aware of your bones as early as possible.
Our bones form our skeleton- literally the foundations upon which everything else in our body is hung and are critical to our health. Bones are a living part of our body and are filled with cells and blood vessels. They are dynamic- ever changing- constantly being broken down and reformed over time. Each small bit of bone is completely reformed around every 3-9 months.
Our peak bone forming years are up until our early to mid-twenties after which our bone resorption equals bone loss, keeping a roughly steady state of bone density until a few years before the menopause.
Around the time of the menopause, break down of bone overtakes bone formation and bones start to get thinner rapidly.
Knowledge is power and a little bit of education about what affects bone development and function goes a long way towards understanding the importance of lifelong strategies to protect our bones from osteoporosis. As with so many things in medicine, prevention is better than cure and with life expectancy extending all the time, maintaining mobility and independence into our elderly years becomes ever more relevant.
Every little helps and there’s no time like the present to start thinking about your bones.
HRT
Oestrogen will help to improve the symptoms of oestrogen deficiency that often interrupt sleep. Progesterone (if needed as part of HRT) has been shown to increase the amount of stage 3 (deep) sleep which will restore that ‘well rested’ feeling we all crave when we wake up and research has consistently shown that HRT can be hugely beneficial for improving sleep around the menopause.
If you have tried everything you can do yourself at home and nothing has worked for you then it is unlikely that these measures will suddenly help you to start sleeping well. At Chelvey Menopause we have the option to book a ‘lifestyle’ consultation where one of our skilled clinician will be able to take a careful history and try to unpick the cause of your insomnia and talk through other techniques (such as Cognitive Behavioural Therapy) which are highly effective at transforming sleep and can easily be put into practice yourself at home.
If you are having trouble sleeping there are many small changes you can make to improve the length and quality of your sleep.
Reduce caffeine- its difficult to tell someone who is feeling really tired that they cant have a cup of coffee in the morning but its definitely worth thinking about the timing of your caffeine. A shot of espresso has a half-life of 6 hours- that means that in 6 hours there will still be half of that shot of coffee in your blood system. So for example if you had a double shot coffee at 4pm there will still be an entire shot of caffeine in your blood stream at 10pm. Would you choose to drink a cup of coffee at 10pm if you were finding it difficult to sleep?! Remember many fizzy drinks contain high levels of caffeine also.
Alcohol-alcohol is a sedative and will help you fall to sleep but the sleep you experience is not as restorative as ‘natural’ sleep and you are more likely to wake up earlier.
Routine- going to bed at a similar time each night and waking at a similar time each morning can really help to establish a good sleep pattern.
Avoid daytime napping- we need our ‘sleep pressure’ to build through the day so that we are tired and ready to sleep at the right time and having a nap in the daytime will reduce the need to sleep when it comes to bedtime.
Sleep hygiene- try to avoid using screens just before bed as the blue pigment in the screen of the device can interrupt melatonin production which helps us to feel ready for sleep. Read a book, have a bath, listen to music- anything that helps you to unwind (that doesn’t involve a screen!).
Exercise- exercise can improve the way we sleep- try to avoid vigorous exercise in the two hours before you go to bed.
Sleeping environment- try to keep your bedroom cool and dark at bedtime and use the room only for sleeping and sex! Make your room and bed somewhere comfortable where you want to sleep.
Hormones
The two main hormones that quickly decline around the perimenopause and menopause are oestrogen and progesterone.
Our natural progesterone has a mild sedating affect within the body so as the levels of this hormone begin to fall the natural sleep cycles within the body can be disturbed.
Progesterone also has an anti-anxiety affect and an overall positive effect on mood. Lower levels of progesterone at the perimenopause and menopause may contribute to mood changes and anxiety which in themselves can affect our ability to sleep.
Oestrogen has been shown to improve deep sleep and reduce the number of awakenings through the night. Oestrogen is also associated with other substances in the brain (neurotransmitters) that regulate the sleep cycle. In addition Oestrogen helps to control the body temperature at night and keeps the body cool which in turn improves sleep. Unfortunately the reverse of this is that without adequate oestrogen levels you are more likely to have lighter sleep with more spontaneous wakeups through the night.
The symptoms associated with oestrogen deficiency unfortunately can have a part to play- hot flushes, joint aches and multiple trips to the toilet to pass urine are not the secret to a restful night of snoozing.
Melatonin is a hormone that helps our body to know when we need to sleep and helps us to stay asleep. Melatonin production is linked to oestrogen and progesterone so as these two hormone levels falls, so too does melatonin.
Anxiety and depression
Mood disturbance is a common symptom of the menopause (see our mental health information) and there is good evidence to show that mood disturbance and anxiety can severely disrupt sleep.
Menopause affects mental health and sleep, mental health affects sleep, and insomnia worsens mental health- so you can see the washing machine effect that can ensue for women around this time. Its easy to see how improving sleep can have such a dramatic effect on quality of life and why its so important for us to address insomnia as a serious and at times debilitating consequence of the menopause for some women.
Sleep apnoea
Sleep apnoea is a condition where your breathing briefly stops and then starts again during sleep. This leads to brief awakening though the night and less of the restorative sleep we all need to feel refreshed. Research has shown that women going through the menopause are more at risk of developing sleep apnoea. This may be in part due to perimenopausal weight gain in some women and there has also been a link to sleep apnoea and reducing levels of progesterone during the menopause transition. Sleep apnoea as a condition in itself can lead to fatigue, headaches, anxiety and depression.
Restless legs
Sensations of crawling and tingling at night are unlikely to help with sleep! Unfortunately restless legs is a common symptom of the menopause.
There are different ways that sleep may be affected during the perimenopause and menopause- you may have difficulty getting to sleep, problems staying asleep with frequent waking through the night, early morning wakening or less restorative type (deep ) sleep.
During the menopause we spend less time in stage 3 restorative sleep so a common complaint from women is that they suddenly seem to feel much less refreshed in the morning despite having seemingly slept most of the night.
Mood disorders are well known to cause early morning wakening and anxiety can really interrupt our ability to shut off our minds and drift off to sleep.
There are two types of sleep- Non REM and REM sleep and there are 4 stages of sleep which we cycle through several times throughout the night.
1.NREM stage 1- this is essentially dozing off and usually lasts around 5 or 10 minutes. The body hasn’t fully relaxed in this stage though the brain starts to slow down and there may be brief movements or twitches. It is easy to wake someone up from this stage of sleep.
2.NREM stage2- our bodies really start to relax and our temperature starts to drop, our heart rate and breathing slow down. This stage lasts for 10-25 minutes but each stage 2 that you experience through the night becomes progressively longer.
3.NREM stage 3- this is deep sleep and it is thought that this type of sleep is the most restorative and important sleep stage. It is when our brains remove waste and our cells repair themselves. We spend most of the time in deep sleep in the first half of the night and it is difficult to wake someone from this sleep stage. If they are woken there may be a period of disorientation lasting up to half an hour after waking. Each stage 3 lasts around 20-40 minutes but gets shorter though the night and more time is spent in REM sleep instead.
REM sleep- during REM sleep brain activity actually increases but our muscles are paralysed with the exception of the eye and breathing muscles. This is the stage of sleep when we have the most vivid dreams and REM sleep is thought to be essential for cognition, memory and learning. It is when our brains re-energize! You don’t enter REM sleep until you have been asleep for around an hour and a half and the REM stages get longer through the night- the first REM sleep stage may only last a few minutes.
No it does not. Menopause is an intrinsic process inside a woman’s body that goes on behind the scenes whether you’re taking HRT or not. HRT helps with the symptoms of the Menopause as well as offering the other benefits mentioned above but it does not change the overall process of a woman’s ovaries winding down to retirement.
There are different ways in which HRT can be given. The different routes of delivery have different risks associated with them and some women may be strongly advised to take one form of HRT over another due to pre-existing medical conditions. Personal choice also comes into which method would be prescribed.
In addition it is important to note that if a woman is taking combined HRT (with two hormones) then these can be given together in one route or separated out and given by different methods eg oestrogen as a patch and progesterone as a tablet or a combined patch with both hormones.
Oestrogen
- Transdermal (through the skin)
This is the safest way to give oestrogen as it has the lowest risk of blood clots and is a bioidentical form of oestrogen which has the same structure as the oestrogen we produce in our own bodies.
Transdermal oestrogen has the advantage that it is absorbed through the skin and thus avoids being broken down in the gut and the liver and may give fewer gastric side effects such as nausea.
It is also a better choice for women who have medical problems that affect their gastrointestinal tract such as Crohn’s disease and ulcerative colitis or in those with liver disease.
The options to take oestrogen in a ‘through the skin’ preparation are via a gel, spray or a patch.
The patches come as oestrogen only or as a combined patch with progesterone. The patches are applied twice weekly and there is a once weekly preparation available in the combined patch.
The spray and gel is oestrogen only and would require separate progesterone if a woman has a womb (and therefore needs both oestrogen and progesterone). The spray and gel are applied daily.
See below for progesterone preparations
- Oral tablets
These can be given as oestrogen alone or in a combined tablet with progesterone and is taken daily.
The tablets are broken down and absorbed in the gastrointestinal tract.
Progesterone
- Transdermal
Progesterone can be given through the skin in a combination patch with oestrogen. The progesterone in the patches is a synthetic progesterone (progestogen).
- Oral tablets
Progesterone is available as a combined tablet with oestrogen or can be given separately. Most of the combination tablets contain progestogen (synthetic).
Body identical progesterone (micronized progesterone) is mostly given as a separate tablet but there is one preparation that is a combined tablet with oestrogen.
Micronised progesterone has the same structure as progesterone we produce naturally in our bodies and is made from yams. It is not available as a transdermal preparation as it has not been shown to be safe in protecting the lining of the womb.
- Intrauterine device
The progesterone component of HRT can be given straight into the womb via an interuterine device. The only licensed option for this for HRT in the UK is with a Mirena coil and this can be used for 5 years as part of HRT and of course provides contraception at the same time. Here are other interuterine devices available for contraception but they are not licensed for use as part of HRT.
This is a very low dose of synthetic Progestogen  that mostly stays locally in the womb so for many women this option has fewer side effects than other synthetic progestogens in the patches or tablets.
Yes very easily. If a women starts on a sequential regimen we usually advise staying on this for a minimum of a year before trying to change over to a continuous type of HRT.
If a woman changes to a continuous HRT and develops irregular bleeding it is sometimes necessary to change back to the sequential hormones for a length of time before trying the continuous again.
There is good evidence to show that CBT can help improve low mood, anxiety, hot flushes and night sweats during the perimenopause and menopause. We will be offering doctor led specific menopause CBT therapy in the next few months. Please email us if you would like to join the waiting list for this at enquires@chelveymenopause.com
Sleep can become very problematic during the perimenopause and menopause. We can offer specialist advice and guidance on how to improve sleep in our lifestyle consultations. Simple but effective changes include, cutting down on caffeine and alcohol, a regular bedtime routine, reducing screen time, regular exercise.
On average a woman gains 10kgs during the menopause transition. There is however no evidence that HRT causes weight gain, in contrast it makes women feel more energised and therefore able to do more exercise and choose healthier food options.
The perimenopause/menopause is a difficult time for women, and we offer specific diet and lifestyle consultations where we can support you to make changes towards healthier living that will benefit you for years to come.
Yes. Most women experience perimenopausal symptoms for several years before their periods stop. One of the signs of the perimenopause is a change in your period (length, frequency, heaviness). If you are experiencing symptoms that are concerning, then you would benefit from a consultation with one of the doctors at Chelvey Menopause.
Common side effects include increased hair growth at the site of application; we will give you advice on how to apply your medication during your consultation to prevent this.
If you are experiencing weight gain, acne, hair loss on the front area of your head or a deeper voice then we would advise booking a review appointment with Chelvey Menopause because these side effects may indicate that you are taking too high a dose.
Testosterone is an important female hormone. Many women find it has a very positive impact on their libido. Although evidence is lacking with regards to using testosterone to treat other symptoms, many women find that testosterone also helps to improve energy levels, mood and concentration.
Yes. If a woman on a stable HRT regime is experiencing symptoms of low libido and loss of sex drive then, as per current NICE guidelines we can prescribe testosterone. In order to do this safely we will need to do some baseline bloods and then regular follow up bloods to monitor levels and ensure that these remain within the female range.
Yes, we will be offering this soon. Please email us to go on the waiting list for a Mirena coil appointment- enquiries@thecheley.com
This varies depending on the treatment prescribed. On average each medication costs £10-40 per month.
Please follow this link to our webpage on alternatives to HRT
1.Breast cancer– current research shows that HRT taken for 5 years or less has very little to no increased risk of breast cancer depending on the type of HRT used.
Oestrogen alone and combined HRT using oestrogen and micronized progesterone has no increased risk (oestrogen alone has actually been shown to reduce risk).
Combined HRT with a progestogen has a very small increased risk over 5 years.
After 5 years the risk of all combined HRT confers a slightly increased risk of breast cancer which reduces on stopping the HRT.
2.Blood clots– tablet form of HRT has been shown to cause a small increased risk of blood clots. This has to be taken into context with other risk factors for blood clots such as smoking and BMI and the pros and cons carefully discussed and in some circumstances a transdermal preparation may be suggested instead.
Some women may have a strong family history of blood clots or may be known to have a medical condition that increases the risk of blood clots in which case transdermal oestrogen would be strongly recommended.
There is good evidence that transdermal oestrogen does not increase clot risk.
Some progestogens are higher risk for blood clots than others and this may also need to be taken into consideration when prescribing HRT.
3.Ovarian cancer- we do not have good studies looking into the risk of ovarian cancer with HRT but one study showed a very small increased risk of 1 in 2,500. Other studies have not shown a significantly increased risk.
4.Heart disease- the relationship between HRT and heart disease has been one of controversy over the years. Current thinking is that there is a ‘window of opportunity’ where HRT is beneficial for the heart (within 10 years of the menopause or < age 60) and after this the effect is likely to be neutral on the heart rather than harmful. However in women who have unstable cardiovascular disease HRT is contraindicated until the heart disease is considered ‘stable’ and even then may require discussion with a heart specialist if restarting HRT is desirable.
5.Endometrial cancer- giving oestrogen alone to a woman with a uterus incurs a significant increased risk of endometrial cancer (cancer of the womb). This is reduced by using a progesterone/progestogen in a combined HRT but the risk is not completely removed and sequential HRT in particular has a very small increased risk of endometrial cancer if given for longer than 5 years.
Please follow this link to our webpage on risks of HRT
The current evidence suggests that 5 years of body identical HRT including oestrogen delivered through the skin does not increase your risk of breast cancer. After this time the risk of breast cancer increases very slightly (see link below).
Do not take the doses you have missed, just continue to take the next dose when you remember.
This is a very common initial side effect that can be due to either the oestrogen or the progestogen component of your HRT. These symptoms should settle with time. We advised all women to have their regular mammograms and to be breast aware and self-examine regularly. Many women find Starflower Oil very helpful for breast tenderness symptoms, this is available over the counter.
It is very common to experience some irregular and heavier bleeding when starting HRT or increasing your dose of HRT. This can take 3-6 months to settle. If symptoms persist or worsen after this time, we advise booking for a review appointment at Chelvey Menopause or with your own GP. Sometimes further investigations may be needed.
Current NICE guidelines state that there is no maximum or minimum time frame for a woman to continue taking HRT.
Every case is unique, and length of treatment will need to be considered on an individual basis.
Guidelines suggest an annual reassessment of HRT in order to provide safe prescribing and to discuss the risks and benefits of taking HRT for you personally.
Some women experience mild side effects when treatment begins including, breast tenderness, nausea, bloating, skin irritation, irregular bleeding. These side effects will usually disappear within 6-8 weeks of starting HRT. If they do not improve then a change in your type or dose of HRT may be necessary. Your doctor will be able to offer advice regarding this.
It can take several months to see the full benefits of HRT; however, most women feel the initial benefits after just a few weeks.
Body identical HRT or regulated bioidentical HRT is the safest form of HRT, with the lowest risk of adverse effects. This is what we prescribe at Chelvey Menopause. These hormones are structurally identical to the natural hormones we produce in our bodies.
The British Menopause Society and NHS do not recommend compounded bioidentical hormones. These hormones are not regulated and there is not enough medical evidence to support the safe use of this type of HRT.
We only prescribe regulated HRT as recommended by the British Menopause Society.
We do not prescribe compounded bioidentical hormones.
Certain bloods are available via your own GP; however, the more specialised hormone blood tests may not be available at your GP surgery.
Some GPs may not feel comfortable organising blood tests that they have not been trained to analyse. If this is the case, we can organise these tests for you at the clinic.
Bloods normally take 3-5 days to process. Your doctor will then review the results and upload these to your patient portal with advice and comments.
Blood tests are not recommended for diagnosing the perimenopause and menopause in women over the age of 45 years.
Hormone blood tests are sometimes needed to guide appropriate dosing of HRT, your doctor will advise if this is necessary.
Regarding testosterone prescribing, a baseline blood test is necessary prior to starting treatment and then follow bloods on a regular basis are recommended for as long as the testosterone is continued.
Certain blood tests may be suggested to exclude other medical conditions that could be causing your symptoms, such as anaemia or an underactive thyroid gland.
Some women may be keen to have an overall health check, and this can be arranged.
Ideally, we recommend asking for a repeat prescription 2 weeks prior to your medication running out.
If you run out of medication, then please send us an email to enquireies@thechelvey.com and we will do our best to arrange a repeat prescription for you.
You can ask your own GP if they are happy to prescribe your medication. Certain medications that we prescribe may not currently be available the local NHS formularies. It is also important to be aware that some GPs may not feel comfortable prescribing certain medications, such as testosterone. This may be due to a lack of training in this area. Ultimately it is up to the individual GP.
The cost varies depending on what is being prescribed but you can have this discussion with your clinician. Each prescription will provide you with 3 months medication. If you choose to continue to have your medication prescribed by Chelvey Menopause we will require you to attend an annual review appointment as recommended by NICE.
Please email (enquiries@thechelvey.com) with your requirements. We will check your records and then issue your prescription via Pharmacierge, our pharmacy partners
Full details of any recommended blood tests and the costs of these will be covered during your consultation.
An initial consultation costs £250 with follow up appointments costing £160
Yes. We can refer you for a scan if this is required, this will be an additional cost.Â
Our patient portal and website are designed to meet level AA of the Web Content Accessibility Guidelines (WCAG).
Patients with a physical disability will be able to book a remote consultation with one of the doctors via video or telephone from their home and therefore avoid having to travel into a clinic to be seen.Â
All patients with a disability, including those with a visual or hearing impairment are very welcome to email us prior to their appointment (hello@thechelvey.com) with their concerns and questions. We can offer options such as video consultation with closed captions or having a video consultation with a translator or sign language aid.Â
Depending on doctor availability and waiting times you are welcome to book an appointment with the same doctor. All doctors at Chelvey Menopause are menopause specialists and provide the same level of care. All your information from each appointment will be securely stored on our patient portal, therefore if you have a follow up appointment with a different doctor, they will have access to all your history, medication and results prior to your consultation and be able to continue your care.
With every consultation we include one free email to discuss any questions or concerns regarding your treatment. Further emails will be charged for.Â
You can choose to book a follow up appointment at any time you wish.
We normally suggest a follow appointment at 3, 6 and 12 months after your initial appointment.
Once your symptoms are stable, we advise an annual review thereafter as per NICE guidelines.
Following your first appointment we advise keeping a note of any side effects from your medication and monitoring your symptoms with our Green Climacteric Scale.Â
We need to verify your identity at the start of your appointment with either of the following
- Passport
- Driving or provisional driving licence
We ask for 72 hours notice if you want to cancel or reschedule your appointment. After this time we reserve the right to retain your appointment fee. You can cancel or change your appointment by logging into your patient portal.Â
If you cancel your appointment at least 72 hours before your appointment you will receive a full refund.Â
If this happens, we will call you on your telephone number. The consultation will be the same, so you do not need to feel that you have missed out.Â
The discussion around taking HRT after you have had breast cancer yourself is different from discussing additional risk of developing breast cancer from taking HRT if you have never had breast cancer.
Many of the current treatments used to treat breast cancer block oestrogen and cause a woman to experience menopausal symptoms. Women are often advised to stay on these medications for many years.
Unfortunately we do not have many studies looking at the risk of breast cancer recurrence when taking HRT and the studies we do have, have been criticised. However the studies we do have did show a small increased risk of recurrence of breast cancer in women taking HRT after breast cancer and current guidance is that HRT is contraindicated in women with a past history of breast cancer.
It is important to remember that a lack of solid evidence does not mean a lack of harm and the decision to take HRT following treatment for breast cancer needs to involve the cancer and breast teams and a menopause specialist. There may be changes that can be made to a woman’s current breast cancer treatment that on their own can improve menopausal symptoms.
Alternative therapies, both pharmacological (medication) and non-pharmacological can be very effective at managing menopausal symptoms and are usually recommended first line.
Vaginal irritation and dryness is a common symptom which can be quite disabling and may not respond to moisturisers and lubricants. In these circumstances a low dose of vaginal oestrogen can be extremely effective and is thought to be safe as barely any of the oestrogen is absorbed around the body.
An important message here is that every case needs to be managed individually as the type, stage and grade of breast cancer changes the risk of a recurrence along with the fact that the severity of a woman’s symptoms and response to other non-hormonal treatments varies. Shared decision making is vital and it is important that every women feels listened to and has the opportunity to fully explore treatment options and discuss the pros and cons with a specialist thereby feeling fully informed and comfortable with any decision that is made around treatment.
Occasionally a trial of HRT after breast cancer is the right decision for that individual due to the severity of symptoms and the impact of these symptoms on quality of life. This decision is generally made in a multi-disciplinary team setting after non hormonal options have been explored and the risks of HRT have been carefully outlined and discussed.
No- if you have premature ovarian insufficiency or early menopause we are simply replacing hormones that you have lost too early. We only start counting ‘years on HRT’ from the age of the natural menopause, around age 51. The ‘extra’ years on HRT if you have had to start it at a younger age are not thought to incur a cumulative risk of breast cancer.
Many women will have a relative who has had breast cancer because it is a relatively common cancer.
It depends on the strength of the family history of certain cancers. For the majority of women with a family history of breast cancer this will not change their background risk of developing breast cancer by much and taking HRT is unlikely to contribute to that risk much either.
In these women (the majority) the benefits of taking HRT are likely to outweigh the risks.
Women with multiple family members or close family members who had breast cancer at a young age may require advice from the genetics team before they take
No – vaginal oestrogen in thought to be very safe even for long term use as only a very small amount is absorbed around the body.
It is a common concern of women that HRT will make them gain weight but there is no evidence that HRT leads to weight gain. In fact HRT can have a positive impact on weight and metabolism. A small number of women will experience fluid retention which may be seen as weight gain but this often settles within 4-6 weeks.
No its not. Adding to our more sluggish metabolism in midlife is the fact that around the menopause women become less sensitive to the energy storage hormone (insulin). This changes the way we handle glucose in the body and causes more energy to be stored as fat. This fat is mostly stored around the middle (hence the term ‘middle aged spread’) which unfortunately is the type of weight gain that is most associated with developing high blood pressure, diabetes, high cholesterol and heart disease.
Fat around the middle also contributes to insulin resistance and insulin resistance itself can make it more difficult to lose weight so you can see how a vicious cycle may ensue.
HRT can partly help to reverse this process and there are changes that can be made to diet that can help to improve our metabolic profile and increase overall metabolism.
Basal metabolic weight decreases as we get older- so every calorie we eat will be a little bit harder to burn off. Unfortunately this means that unless we eat less or move more we are likely to gain weight at this time.
Once you have booked an appointment you will be sent an email with a link to complete your pre-consultation questionnaire. We ask patients to have a recent blood pressure, weight and height ready for their appointment, without this information we may not be able to prescribe certain medications. If you have any other medical problems, then a list of these is very helpful. You can ask your GP to print out a summary of your NHS health record. If you have had recent bloods done, then please share a copy of these with us via your patient portal. This will avoid unnecessary repeats and cost.
Unfortunately, menopause care is not covered by private health insurance.
You will be asked for card details at the time of booking.
No, you can self-refer to see one of our doctors. All you need to do is book an appointment using the link below.
We currently offer either telephone or video consultations. Soon we will also be able to provide face to face appointments.
The easiest way to book an appointment is online at a time and date that suits you.
Appointments
The easiest way to book an appointment is online at a time and date that suits you.
We currently offer either telephone or video consultations. Soon we will also be able to provide face to face appointments.
No, you can self-refer to see one of our doctors. All you need to do is book an appointment using the link below.
You will be asked for card details at the time of booking.
Unfortunately, menopause care is not covered by private health insurance.
Once you have booked an appointment you will be sent an email with a link to complete your pre-consultation questionnaire. We ask patients to have a recent blood pressure, weight and height ready for their appointment, without this information we may not be able to prescribe certain medications. If you have any other medical problems, then a list of these is very helpful. You can ask your GP to print out a summary of your NHS health record. If you have had recent bloods done, then please share a copy of these with us via your patient portal. This will avoid unnecessary repeats and cost.
If this happens, we will call you on your telephone number. The consultation will be the same, so you do not need to feel that you have missed out.Â
We ask for 72 hours notice if you want to cancel or reschedule your appointment. After this time we reserve the right to retain your appointment fee. You can cancel or change your appointment by logging into your patient portal.Â
If you cancel your appointment at least 72 hours before your appointment you will receive a full refund.Â
We need to verify your identity at the start of your appointment with either of the following
- Passport
- Driving or provisional driving licence
Following your first appointment we advise keeping a note of any side effects from your medication and monitoring your symptoms with our Green Climacteric Scale.Â
You can choose to book a follow up appointment at any time you wish.
We normally suggest a follow appointment at 3, 6 and 12 months after your initial appointment.
Once your symptoms are stable, we advise an annual review thereafter as per NICE guidelines.
With every consultation we include one free email to discuss any questions or concerns regarding your treatment. Further emails will be charged for.Â
Depending on doctor availability and waiting times you are welcome to book an appointment with the same doctor. All doctors at Chelvey Menopause are menopause specialists and provide the same level of care. All your information from each appointment will be securely stored on our patient portal, therefore if you have a follow up appointment with a different doctor, they will have access to all your history, medication and results prior to your consultation and be able to continue your care.
Our patient portal and website are designed to meet level AA of the Web Content Accessibility Guidelines (WCAG).
Patients with a physical disability will be able to book a remote consultation with one of the doctors via video or telephone from their home and therefore avoid having to travel into a clinic to be seen.Â
All patients with a disability, including those with a visual or hearing impairment are very welcome to email us prior to their appointment (hello@thechelvey.com) with their concerns and questions. We can offer options such as video consultation with closed captions or having a video consultation with a translator or sign language aid.Â
Yes. We can refer you for a scan if this is required, this will be an additional cost.Â
Menopause
Yes. Most women experience perimenopausal symptoms for several years before their periods stop. One of the signs of the perimenopause is a change in your period (length, frequency, heaviness). If you are experiencing symptoms that are concerning, then you would benefit from a consultation with one of the doctors at Chelvey Menopause.
On average a woman gains 10kgs during the menopause transition. There is however no evidence that HRT causes weight gain, in contrast it makes women feel more energised and therefore able to do more exercise and choose healthier food options.
The perimenopause/menopause is a difficult time for women, and we offer specific diet and lifestyle consultations where we can support you to make changes towards healthier living that will benefit you for years to come.
Sleep can become very problematic during the perimenopause and menopause. We can offer specialist advice and guidance on how to improve sleep in our lifestyle consultations. Simple but effective changes include, cutting down on caffeine and alcohol, a regular bedtime routine, reducing screen time, regular exercise.
There is good evidence to show that CBT can help improve low mood, anxiety, hot flushes and night sweats during the perimenopause and menopause. We will be offering doctor led specific menopause CBT therapy in the next few months. Please email us if you would like to join the waiting list for this at enquires@chelveymenopause.com
Bloods
Blood tests are not recommended for diagnosing the perimenopause and menopause in women over the age of 45 years.
Hormone blood tests are sometimes needed to guide appropriate dosing of HRT, your doctor will advise if this is necessary.
Regarding testosterone prescribing, a baseline blood test is necessary prior to starting treatment and then follow bloods on a regular basis are recommended for as long as the testosterone is continued.
Certain blood tests may be suggested to exclude other medical conditions that could be causing your symptoms, such as anaemia or an underactive thyroid gland.
Some women may be keen to have an overall health check, and this can be arranged.
Bloods normally take 3-5 days to process. Your doctor will then review the results and upload these to your patient portal with advice and comments.
Certain bloods are available via your own GP; however, the more specialised hormone blood tests may not be available at your GP surgery.
Some GPs may not feel comfortable organising blood tests that they have not been trained to analyse. If this is the case, we can organise these tests for you at the clinic.
Prescriptions
Please email (enquiries@thechelvey.com) with your requirements. We will check your records and then issue your prescription via Pharmacierge, our pharmacy partners
The cost varies depending on what is being prescribed but you can have this discussion with your clinician. Each prescription will provide you with 3 months medication. If you choose to continue to have your medication prescribed by Chelvey Menopause we will require you to attend an annual review appointment as recommended by NICE.
You can ask your own GP if they are happy to prescribe your medication. Certain medications that we prescribe may not currently be available the local NHS formularies. It is also important to be aware that some GPs may not feel comfortable prescribing certain medications, such as testosterone. This may be due to a lack of training in this area. Ultimately it is up to the individual GP.
Ideally, we recommend asking for a repeat prescription 2 weeks prior to your medication running out.
If you run out of medication, then please send us an email to enquireies@thechelvey.com and we will do our best to arrange a repeat prescription for you.
Cost & Pricing
An initial consultation costs £250 with follow up appointments costing £160
Full details of any recommended blood tests and the costs of these will be covered during your consultation.
