The Health in Menopause Patient Journey
So you’ve read up about the symptoms of the perimenopause and menopause, decided that you think that this describes how you feel, but what next? You may already have tried some over the counter medications to try to help yourself. You may have spoken to friends, learned how they have managed this transition, and gained some helpful hints. But what if you are still troubled? Where do you go for help and what are you committing to if you do? Who can you trust?
I established Health in Menopause to help women just like you. This is what you can expect on your Health in Menopause Patient Journey:
Step 1 Booking an appointment
This can often be the hardest part. Admitting that you need help, that your quality of life is not as it was or should be, can feel like failure. But what would you say to a friend if she confided that she needed help? We are often our harshest critics and this can be amplified around the time of the menopause.
The process is simple – book online at any time of the day or night at www.healthinmenopause.co.uk/bookings or call 0115 9388828 where Lisa will be happy to book an appointment at a time to suit you. You can choose to have a face to face consultation or a video consultation that you can conduct from your chosen location. Payment for the appointment is taken at the time of the booking.
Step 2 The Confirmation
Confirmation of your appointment will come by email. If you have chosen a video consultation, your email will contain a link for you to click on at the time of the consultation and also a link to a pre-consultation form for you to complete in advance of your appointment. This helps me to understand a bit more about you and your medical history so that I can think in advance about what might help. This makes best use of the time in the consultation.
You do not need to have access to Microsoft Teams or Zoom.
The evening before your consultation you will receive a further email reminder of your appointment time; menopause forgetfulness is a true feature of the menopause and I would hate for you to miss the appointment.
Step 3 The Consultation
For video consultations, on the day, at the appropriate time, you simply click on the link in the email and you are taken to a Virtual Waiting Room. I enter from my side and there we meet – no travel, no parking, no stress.
In person consultations take place at the Health in Menopause Clinic at 5 College Street. Please come to number 5 (not number 3) College Street where there is a dedicated intercom for Health in Menopause. From there you will be permitted access to a small waiting room where I will come to welcome you into the consultation room.
The consultation is your opportunity to tell me how you feel, what symptoms have troubled you, what you have tried already and what you hope to gain as a result of your consultation. This is unique to you.
For my part, I will ask a lot of questions! These are to learn about you, your medical history, what medication you take, your allergies, how you live your life, what’s important to you, your family and social history and also the story of you as a female through the many hormonal challenges of life. This is to ensure that I can advise you on the best treatment for you.
I will ask what you already know about hormones and menopause, this allows me to build on what you already know. And if you do not know much, that’s not a problem – I do, I’m happy to share.
At the end of the consultation, I will clearly explain what I think will work best for you. In keeping with British Menopause Society and International Menopause Society guidelines, I prescribe Body Identical HRT. This is backed by research and evidence and it can be prescribed on the NHS. If you agree with the plan, I’ll do a prescription and this is sent electronically to an online pharmacy called CloudRx. There is no additional cost for this prescription but CloudRx will contact you by text or email usually the same day to take payment for the medication. The cost depends on what we decide together but as a rough guide, 3 months of HRT will cost around £60-70.
I will advise when I think I should see you again for follow up to assess your response to treatment, check that you have no further questions, and close the consultation.
Step 4 After the Consultation
On the same day, I will email you with clear instructions as to how you should use your medication when it arrives. This will come as a shared document from Health in Menopause. Once CloudRx have taken payment for the medication, your medication will be posted to you First Class and will usually arrive within 24-48 hours, ready for you to start.
Within 7 days you will also receive notification of a shared document from Health in Menopause and this will be a more detailed letter that summarises what we discussed during the consultation, the health benefits of HRT, your treatment summary and the plan for follow up. I will send a copy of this letter to your GP for your medical record.
Step 5 Blood Tests
Blood tests are not always necessary. For women aged 45 or above, no blood test is needed to diagnose the menopause. Sometimes in women aged 40-45 blood tests are useful to exclude other causes of the symptoms and in women aged 40 or under, blood tests are required to make a diagnosis of Premature Ovarian Insufficiency.
Some women will be advised to have a blood test to exclude anaemia, an under active thyroid gland or Vitamin D deficiency. The symptoms of these conditions are similar to those of the menopause and are common in midlife. They are easily treated.
If bloods are required, or a woman wants a health check, these can be done at the time of the consultation if you are attending the clinic. Alternatively, I will request these through Nationwide Pathology. You will be asked to call Nationwide Pathology to book a convenient appointment at a location near you. The cost of the blood test is in addition to the consultation fee. You will be told the cost of the blood test before this is booked. A fee is also payable to the phlebotomist who takes the blood, you will be advised by Nationwide Pathology what this cost will be at the time of booking. Payment for the blood test is taken at the time of booking.
The results of blood tests are usually received and processed within 7 days. I will share these results with you along with an explanation of what they mean and a plan of action if this is required.
Step 6 Follow Up
Follow up after 3 months is recommended for everyone. This is the length of time that it takes for the full effects of HRT to be established. This appointment is booked as before, online or by telephone. The Follow Up can be in person at the clinic or by video using the same video link format established at the New Patient consultation. This is a chance to assess your response to HRT and to check for any side effects. Adjustments to the dose or type of HRT are made if required. A discussion about vaginal symptoms, libido, sexual satisfaction etc is often incorporated in this consultation. The role of Testosterone in normal female sexual function is discussed if appropriate.
If no alteration has been made to the HRT, women will generally be asked to make a follow up appointment in 6 months. At this point, if everything is stable, an annual review is all that is required. It may be that you will have had an opportunity to discuss your care with your GP. If your GP is happy to continue with prescribing your HRT, you can be discharged to the care of your GP for annual review.
If however you prefer to be followed up at Health in Menopause, or your GP has declined to prescribe your HRT, I am very happy to continue to prescribe your medication on an ongoing basis and see you for annual review or at any time as required. Prescription requests between appointments carry an admin fee of £30.
If a change to the HRT regime has been made at this follow up appointment, you will be recommended to be seen for review again in 3 months to assess your response.
Even if you are discharged to be followed up by your GP, you can come back anytime. You are always welcome.
Dr Alice Duffy
Updated October 2021