Frequently asked questions

Menopause is when a woman’s menstrual cycle stops, you no longer have a period. The amount of female hormones produced by our ovaries will drop sharply as we age, eventually, our ovaries will no longer release eggs, our periods will stop and we are not able to conceive naturally.

Around 85% of women will experience symptoms as a result of their hormones shifting. The type and intensity of these symptoms can differ. There are 34 commonly recognised symptoms, others are less common. Scientific studies have shown that the brain, stomach and skin are among the most affected areas. Changes in mood, increase in worry, thoughts of rage or tears might be among the most problematic. Some women have problems falling asleep, hot flushes and night sweats. Other symptoms include joint pain, foggy brain, itchy skin and palpitations in the heart.

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Menopause is indeed a significant and dynamic phase in a woman’s life, marked by various stages and a range of symptoms. It’s divided into three key stages: perimenopause, menopause, and post-menopause.

Perimenopause: This is the initial stage, typically starting in the mid-to-late 40s. It’s a time when the ovaries gradually decrease hormone production, and estrogen levels begin to dip. Perimenopause can extend up to 10 years and brings a wide array of symptoms like mood swings, headaches, hot flushes, and vaginal dryness.

Menopause: This stage is defined as the point that marks one year after a woman’s last menstrual period. Research suggests that the menopausal transition usually begins between ages 45 and 55 and can last around seven years, though it may extend up to 14 years. Factors like smoking, the age at onset, and racial and ethnic backgrounds can influence this duration.

Everything after: This is the phase following menopause, which, alongside perimenopause, constitutes the longer duration of the menopause experience.

Examining subtle changes in your body and menstrual cycle over time is one way of determining if you are approaching menopause or not.  Menopause is a gradual process and is officially when you have NOT had a period for 12 consecutive months, in the absence of pregnancy or other health issues. Above all, it’s common and affects all women.

During the first phase of this shift, called perimenopause, you may experience mild alterations that start in your late 30’s or early 40’s, or sometimes later. Early warning signs include changes to the menstrual cycle – shorter cycles and changes in mood or memory, such as trouble speaking or persistent PMS symptoms.

Menopause is typically diagnosed based on the symptoms you’re experiencing. Common signs include changes in period frequency and flow.  If you notice these changes or other symptoms associated with menopause, make an appointment with our menopausal practitioner.

They can offer you more insight into your health and confirm whether you’re entering the menopausal stage. This can help you understand your experiences and decide if it’s time to seek professional advice.

Every woman experiences the menopausal transition differently and the changes impact different aspects of your health and well-being.

• Metabolic changes: Changes in how we use and process energy. Women may experience changes in their fat distribution and storage resulting in gaining weight more quickly or finding it hard to lose the weight.
• Body Composition: Changes in muscle mass, fat distribution and general shape are brought about by menopause. You may find variations in the way your clothes fit or in the way your body fat is distributed.
• Physical function: Includes reduced energy levels, reduced stamina and changes in exercise tolerance.
• Cardiovascular Health: Menopause can impact on cardiovascular function, resulting in changes in blood pressure and cholesterol levels. It is essential to maintain a heart-healthy lifestyle.
• Bone Health: Reduction in the oestrogen levels increases the risk of osteoporosis and bone fracture.  It’s critical to prioritise bone-strengthening exercise and adequate calcium and Vitamin D.
• Other symptoms: Menopause can also cause a variety of other symptoms including vaginal dryness, mood swings, hot flushes, night sweats and cognitive problems.  The severity and duration of these symptoms differ from person to person

Menopause is a normal and predictable phase of every woman’s life.  By understanding these changes and taking proactive steps to support healthier lifestyles and better nutrition, you may effectively manage this transition with resilience and well-being.

The process happens slowly over 3 stages:

1. Perimenopause: You still have a period, however, it may be irregular but it hasn’t stopped. The average age is around 47 years

2. Menopause: This is when you have not had a period/bleed for 12 consecutive months. The average age is 51 years.

3. Post-Menopausal: This starts when you hit the year mark from your final periodƒcan

The drop in oestrogen levels can cause more frequent or worse headaches during the perimenopause stage. In some women, this may cause migraines which can lead to dizziness and vertigo.

Stay hydrated, and drink plenty of water/fluids. Maintain your blood sugar levels by eating small meals regularly and snacks, ideally whole grains and vegetables.

It’s crucial to monitor your menopause treatment and progress, which is why we recommend:

• Initial consultation
• First Review – at 3 months later
• Follow-ups – at 6-month intervals
• Annual Review

The regular check-in helps us monitor how you’re doing and make any necessary adjustments to your treatment plan — mostly because HRT often takes around 3 months to start working.

After this initial phase, we recommend settling into a yearly consultation. These annual check-ups are essential to ensure that your menopause care remains successful and to address any new concerns or changes.

Of course, you are always welcome to schedule an appointment if you feel the need for one earlier than planned. We are available to assist you as you navigate the menopause.

No, a doctor’s recommendation is not required for you to begin using Menoclinic. You can just get in touch and schedule an appointment immediately, the majority of ladies see us on their own recommendation. It might be beneficial to bring copies of any prior blood test results or letters from medical consultations to your appointments. As an alternative, you can send them to us in advance via email. This information can be very helpful in providing us with a fuller picture of your medical history, allowing us to better customise your care.

In most cases, you won’t need a blood test for us to determine if you’re in perimenopause or menopause. Symptoms are frequently used to diagnose these stages rather than results from a blood test.

If you’re young and are showing signs of menopause, we may recommend a blood test. This is to confirm the diagnosis and ensure that your symptoms are not caused by anything else.  Additionally, if we’re trying to get a better understanding of how your body is absorbing treatment or deciding on the best treatment approach, a blood test might come into play.

Yes.  The average age of menopause in the UK is 51.  However, for 1 in 20 women this will happen before the age of 45, known as early menopause. 1 in 100 will go through menopause before the age of 40 and 1 in 1000 before the age of 30.  This is known as premature menopause or primary ovarian insufficiency (POI)

Women should have the opportunity to talk about HRT for the protection of their long-term health.  It is well known that women who experience any form of early menopause are more susceptible to heart disease, osteoporosis, dementia and all causes of death.  These risks can be prevented with appropriate treatment.  Furthermore, women taking HRT up to the age of 51 do not have an increased risk of breast cancer.

epends on your family history and a number of lifestyle factors, smoking, alcohol and medical history.

Sadly, in this country, 1 in 7 women will unfortunately develop breast cancer at some point in their life. Most of us have a family member affected or know of someone who has had breast cancer. It is estimated that only 10% of the breast cancers that are diagnosed every year have a genetic or familial cause and these are often due to the BRCA 1 and BRCA 2 genes.

If your mother or sister has had breast cancer your baseline risk is doubled. Women with a family history of breast cancer should discuss it with their doctor if they are considering HRT.

Remember that 1 in 7 women taking HRT will get breast cancer – not because of the HRT, but because they would have developed it anyway. There is no strong evidence that having a family history of breast cancer puts you at any higher risk of getting breast cancer if you take HRT, compared to women who do not have a family history of breast cancer.

There is some evidence that women with a family history of breast cancer who take certain types of HRT have a lower future risk of developing breast cancer compared to women not taking HRT.

Recent studies by the Women’s Health Initiative (WHI) acknowledge “HRT as the most effective treatment for managing menopausal vasomotor symptoms and report Conjugated equine estrogen (CEE) alone reduces the risk of breast cancer by 23% while reducing breast cancer death by 40%.  The small remaining concern is a small increase in breast cancer incidence with CEE and medroxyprogesterone acetate (1 per 1000 women per year) but with no increased risk of breast cancer mortality.”

Before starting HRT, you will need to undergo a thorough discussion with your doctor and oncologist about the benefits and risks of the treatment.

Alternative non-hormonal treatments should be fully investigated in all women before any discussion about HRT though. Women with ER-positive breast cancers need to be aware that there is very little evidence regarding safety and risks associated with HRT to date but, non-hormonal therapies would be recommended to help manage their symptoms in the first instance.

Yes, Menstrual migraines may worsen throughout perimenopause.  If hormone levels are adjusted during the cycle things can become better.  It is far safer for women to receive oestrogen therapy via the skin, you can also add progesterone which is safe for migraine sufferers.

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Yes, the recommendation is to continue getting a smear test until you are 65 years old, unless you have a risk factor for cervical cancer such as HIV.  Even women who have had a hysterectomy may still need screening.

Most women at low risk of breast cancer can stop having a mammogram at 75.  It is important for you to discuss with your doctor and agree on when and how often you will be screened.  In the UK women are screened every 3 years from the age of 52-53 years.

It is Hormone Replacement Therapy.  The female hormones, oestrogen and progesterone fluctuate in women going through the perimenopause and menopause.

HRT balances the hormones by replacing or topping up the levels within the body.  This will relieve symptoms as well as bring short-term and long-term health benefits.

HRT may have some potential risks, these will be discussed with you during the consultation.

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Body-identical HRT has the same chemical structures that are found naturally in the female body.  These are produced under strict safety conditions applied to other prescription medicines. They have undergone thorough clinical trials and satisfied the safety and efficacy standards set by the MHRA, the UK’s national authority for medicine regulation.

Bio-identical HRT is a synthetic hormone that is chemically produced, like other medications.  These hormones have physiological effects on the body, but they differ structurally from naturally occurring hormones.

Body-identical HRT  is recommended by NICE (National Institute for Health and Clinical Excellence) and leading professional regulatory bodies, The British Menopause Society

These can be simplified into the following categories:

• • Symptom Control: Menopausal symptoms can be troublesome and for some women, they can be severe and severely impair quality of life.  A lot of the symptoms are treatable and can improve the quality of life.
  • Localised Treatment: There are treatments specifically targeting the vagina to alleviate symptoms, in addition to gels, pills or patches that replenish hormones throughout the body.  A targeted approach is beneficial for recurring urinary tract infections, painful intercourse, dryness, itching and soreness.  Women who are unable or unwilling to take body-identical hormones can use vaginal oestrogen, as the hormone does not enter the rest of the body.
  • Long-Term Health: Women are at risk of a range of health issues following menopause.  The risk of cardiovascular disease are more likely to develop, there is a chance of osteoporosis and fractures due to decreased bone density. There is a change in metabolism, increasing the risk of Type 2 Diabetes, high blood pressure and weight gain.  HRT may help with all of these long-term conditions.

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HRT is not a single medication, it is a group of different medicines that act on oestrogen, progesterone and testosterone receptors in the body.

The most common risks associated with HRT are:

• In Women with a womb, oestrogen will cause the womb lining to thicken, to keep it thin we provide progesterone. In the absence of progesterone, the womb lining will thicken, causing bleeding or development of some abnormal cells.  Progesterone also stops irregular bleeding which can be troublesome.
• Risk of breast cancer. Some women who use HRT may have a higher risk of breast cancer, but it is still far lower than the risk associated with regular alcohol consumption (2 units per day), smoking or being overweight.  Research has not shown a higher risk of breast cancer-related death.  Recent studies show, that after five years of treatment with body-identical medication, there is no increased risk of breast cancer.

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HRT, Hormonal replacement therapy is a safe and successful treatment for perimenopause and menopause.  Discuss the risks and benefits with our menopause practitioner.

HRT replaces the oestrogen and progesterone in the body.

Hormone Replacement Therapy (HRT) can be helpful for many women, but some women may not want to take HRT or cannot take HRT due to medical reasons.

HRT is not the only treatment for the menopause, and it shouldn’t be used in isolation without considering other treatments and lifestyle changes such as:

• Eating a healthy diet:
  • A balanced diet rich in calcium and Vitamin D is essential to keep our bones strong and healthy.
  • Reducing the amount of sugar in our diet helps our pancreas, which makes insulin and reduces the sugar swings.  Eating more low Glycaemic Index (GI) foods; oats and brown rice will help to manage these sugar high and lows
  • Eating less processed foods.  Make an effort to get healthy fats like avocado and nuts into your diet. Eat lots of fruit and vegetables as research indicates that gut health is critical not only for our physical well-being but also for our emotional state and general well-being.  During menopause, there is a decrease in the amount of beneficial bacteria in the stomach, resulting in poor food digestion and food intolerance.
  • Eating less spicy foods
  • Eat more foods that are high in phytoestrogens such as broccoli, kale, Brussels sprouts, flaxseeds, soy beans and tofu which have anti-inflammatory and anti-cancer properties.

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• Reducing alcohol: Alcohol consumption might worsen your symptoms, especially hot flushes. Keeping your intake to a minimum is healthy for many reasons, including the potential increased risk of osteoporosis, heart disease and certain types of cancer. Alcohol has hidden calories!

• Regular exercise: Regular exercise is very important for our cardiovascular and bone health.

It’s important that you find an exercise that suits you, you are more likely to stick with it.  It can be as simple as choosing the steps instead of the lift, it’s a positive step towards improving your health.

For me, I find a combination of weight-bearing exercise, walking and yoga has a positive impact on my well-being, physical fitness and mental health.

• Having enough sleep: Changes in our hormone levels will impact on our sleep patterns.  It is crucial to avoid screens in the bedroom, especially phones as they have blue light and this interferes with melatonin levels which are responsible for promoting sleep.

Avoid caffeine-containing drinks a few hours before going to bed, moderation in alcohol use is recommended as it potentially worsens the quality of sleep.

• Cognitive Behaviour Therapy (CBT):  There is evidence to suggest that CBT may help to lessen the frequency and duration of hot flushes.  This can also help with feelings that menopause can bring on, such as anxiety and low mood/depression.

• Acupuncture:  Appears to have some benefits in alleviating menopausal symptoms.
• Supplements: Black cohosh and Red clover may help to improve some symptoms, however, there has been very few studies in this area, and therefore no good evidence to suggest these preparations are helpful. They do not reduce the risk of cardiovascular or osteoporosis in the future.

Yes, premenopausal women produce both testosterone and oestrogen. Androgens, including testosterone are essential for development and maintenance of female sexual anatomy and physiology, and sexual behaviour.

The decline in testosterone level is linked to age due to the partial loss of ovarian function is partially. Also, menopause medically or surgically induced can cause a reduction in testosterone levels.

Many women with low levels of testosterone do not complain of distressing low libido or other symptoms. Therefore, it is important to speak to our specialist to determine if Testosterone Replacement Therapy is suitable for you.

Yes, we must check your current levels of testosterone to ensure the correct dose is prescribed to minimise side effects.
Blood tests are repeated 3 months after commencing treatment.

Side effects are uncommon if levels are maintained within the female range. The most common side effects are hair growth, acne and weight gain which are usually reversible with a reduction in dosage or discontinuation.

Alopecia, deepening of voice and clitoral enlargement are rare with testosterone replacement.

It usually takes 3 to 6 months to fully evaluate the efficacy of treatment. We undertake an annual review to weigh up the pros and cons of long-term use.

Gel is the safest way to take testosterone. The gel is applied to clean dry skin on the lower abdomen or upper thighs and allowed to dry before dressing. Wash hands after applying the gel. After using the gel, wait 2-3 hours before washing the area.

There is a lack of long-term safety data for cardiovascular and breast outcomes, and the reluctance of the pharmaceutical industry to finance clinical studies to achieve licensing of female androgenic products.

The recent licensing of 1% testosterone cream in Australia is encouraging. This is available in the UK.

During and after menopause it is crucial to make an effort to stay hydrated by choosing healthier drinks. Not only to help us lessen the effects of other symptoms but also to counteract symptoms such as hot flushes and night sweats where we lose moisture.