What is the Menopause?
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 oestrogen, 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.
What symptoms might I get?
Women have oestrogen receptors throughout the body. Fluctuating hormone levels in the perimenopause can result in intermittent symptoms.
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
- 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, Dr Alice Duffy is happy to help.
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.
I have troublesome vaginal dryness. Can you help?
There are oestrogen receptors in the vagina, bladder and urethra ( the tube that drains urine from the bladder ). The lack of oestrogen after the 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 on passing urine?
If so, I 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.
How do I book a consultation?
The easiest way is to book online - Book a Consultation
Bookings can also be made by calling 0115 9388828 between the hours of 9am and 5pm, Monday to Friday.
You do not need a letter from your GP to have a consultation with Dr Duffy.
How long will a consultation last?
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.
What do I need to bring to the consultation?
Please bring any medication or supplements that you are presently taking. If you have other medical conditions, details of these will also be helpful – you can request a summary print out of your NHS health record from your GP.
If you have had any blood tests done by your GP, please bring copies of the results. This will avoid unnecessary repetition and cost.
Please also download and complete the Menopause Symptom Checker here and bring this to your consultation as this will help in the discussion of your symptoms.
What will happen at the consultation?
I 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. Examination will be undertaken as determined by your history. I will then discuss all management aspects relevant to improving and maintaining your health including the discussion of HRT or alternative therapies if HRT is contraindicated. Together, a plan of management will be agreed.
How often will I be seen at the clinic?
Following 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. I am happy to continue to provide ongoing care to all women who need it.
Is there parking at the clinic?
On street parking is available on College Street and Wellington Circus with payment by machine or RingGo.
Will you write to my GP?
The medical record held by your GP contains medical information about you, from birth to death. It is a written record of your problems and the treatments and investigations that you have received. It tells your medical story. As such, I feel that it is essential that details of your care, including details of any prescribed medication, are shared with your GP. This is for your safety. Consent to sharing of this information with your GP is a condition of receiving treatment at Health in Menopause.
Will I need blood tests?
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 before commencing treatment and on a regular basis for as long as the testosterone is continued.
The cost of bloods is in addition to the consultation fee.
Fees for bloods
|FBC (to exclude anaemia), Kidney function, liver function, lipids, Ferritin (to exclude iron deficiency), Thyroid function, HbA1c (to exclude diabetes), Oestradiol, Testosterone, SHBG (sex hormone binding globulin), Vitamin B12, Folate and Vitamin D||£220|
|Oestradiol, SHBG, Testosterone, Thyroid function||£120|
|Oestradiol, SHBG, Testosterone||£95|
|Thyroid function including free T4 and free T3||£85|
|FBC, Thyroid function, testosterone, SHBG||£80|
Will you prescribe HRT there and then?
Looking after your health in menopause involves reappraisal of diet and lifestyle factors alongside the prescribing of HRT when appropriate. Whiie the majority of women benefit from taking HRT that is personalised to meet their needs, some women choose not to take HRT and some cannot take it for medical reasons. If appropriate a private prescription will be issued at the time of your appointment. I will send your prescription electronically to a secure online pharmacy who will then contact you for payment and post the medication direct to you. Delivery is usually made within 48 hours with no need for you to leave the comfort of your home. Furthermore, you will not be faced with any HRT supply issues.
As an approximate guide to the cost of medication prescribed privately, 3 months supply of combined HRT plus postage costs in the region of £45-50.
Do you prescribe Testosterone?
Prior to the menopause women produce three times as much testosterone as oestrogen, this is produced from the ovaries and the adrenal glands. Following the menopause, the loss of hormone production from the ovaries leads to a reduction in circulating testosterone. Along with oestrogen and progesterone, testosterone contributes to overall wellbeing and sexual function in women. Low libido can be problematic for some women following the menopause but libido is multifactorial in nature and many women find that their libido returns when they receive adequate estrogen replacement as they feel better in themselves, more motivated to exercise, have improved sleep and more energy. Furthermore it is essential that women are adequately treated for vaginal dryness as this can contribute to painful intercourse and negatively impact libido. For women who have persistent low libido despite adequate estrogen replacement, a trial of testosterone may be advised. A full assessment of symptoms and treatment options will be discussed at your clinic appointment.
Do you fit Mirena coils at the clinic?
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 by searching at https://www.nhs.uk/service-search/find-a-sexual-health-clinic/.
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 oestrogen as a patch, gel, spray or tablet as part of combined HRT.
How much does HRT cost?
For women who are likely to benefit from HRT, an initial prescription for 3 months medication will be issued. As an approximate guide, including postage, the cost of combined HRT is £55-60, vaginal estrogen in addition to this will cost £30-35. However the cost of HRT will vary depending on the medication prescribed. Testosterone is more expensive. A 50g tube of Testosterone cream will cost £80 and will last for 3 months.
Is there a prescription charge?
The cost of your prescription is included in the cost of your consultation when you have a face to face or video consultation. If you require a prescription in between attendances at the clinic a prescription charge of £30 will apply.
Where can I find out more about the menopause?
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)
Health in Menopause is not responsible for the content contained in any of the websites listed above.