Your questions answered
About your consultation
1. Am I able to self-refer?
National Institute for Health and Care Excellence (NICE) guidelines state that women can ask their GP for HRT and if necessary request to be referred to a Menopause Specialist. Women are also able to self-refer to us, and a referral letter is not necessary.
https://www.nice.org.uk/guidance/ng23/ifp/chapter/About-this-information
2. How do I book an appointment?
Please use our online booking system. Once you have booked, you will receive a confirmation email with some details about the clinic, along with a link to our new patient questionnaire. This will give us a clear picture of your health history and save time at your consultation, ensuring that we can spend the time that we need to on discussing your treatment.
We do accept referrals from GPs, but a referral is not necessary as you can also self-refer to the clinic.
3. Do I need blood tests before coming to my consultation?
If you are not on HRT and are over 45 years old, there is no need to have any blood tests prior to your first appointment.
If you are not on HRT and under 45 years old please ask your GP to test for the following: Oestradiol, Progesterone, FSH, LH, Testosterone, SHBG, TFTs (thyroid function tests).
If you are on HRT already please ask your GP to test for Oestradiol, Testosterone and SHBG. Please do not have the blood test on day 4 of a patch if you are using patches, because on this day levels can drop.
Please bring your blood test results with you to your consultation.
4. What happens at my consultation?
Currently we are conducting consultations remotely via video call or phone. If you feel you require an examination please email us.
If you would like to have your partner or a friend with you at the consultation please do - sometimes it’s difficult to remember everything that is discussed.
We may require blood test results to discuss with you. Please refer to question 4 below. We will then discuss your individual needs and come up with a suitable treatment plan.
With your permission we will send either a letter to your GP copied to you, or to you directly and copied to the GP. Please let us know which you prefer. These are usually sent within 7-10 working days of your consultation.
A prescription will be supplied for the agreed hormone therapy and you can either take this to your local pharmacy, or we can arrange for it to be sent to you by post with free delivery from the online pharmacy service that we use. This can be helpful as the supply of stocks are sometimes unreliable in local pharmacies.
Please take a photo of your prescription before giving it to the pharmacist. This will help you remember what you are taking and the correct dose as well as any instructions for administration. It will also mean you can check the pharmacist has written the correct instructions on the medication they have dispensed.
If you have any queries regarding your medication please refer to this and to your copy of the clinic letter, sent to your GP, where your medication will be clearly listed.
5. What about follow up consultations?
You may be asked to schedule a follow up consultation for a few months after your first appointment. This can be booked through our online booking system. It's advisable to book this as soon as you can, as slots can get booked up far in advance.
If you are an existing patient of Dr. Peers and require a follow up please email your requirements to Louise at info@menopauseconsultancy.co.uk She is currently only able to see her existing patients. Please book online for the Associate doctors.
6. How do I obtain my prescribed medication?
The Menopause Consultancy uses two online pharmacies - Pharmacierge and CloudRx, who dispense private prescriptions. There is a £40 fee for each prescription. Once the prescription is written, Pharmacierge will contact you for payment and then the medication will be couriered or posted to you. There is free same day delivery to London postcodes and next working day nationally within the UK. Same day deliveries outside London carry a fee. International deliveries are also available.
If you prefer, we can post or give your prescription to you so that you can obtain your medication from your local pharmacy.
Medical queries
1. How long can a woman stay on HRT?
National Institute for Health and Care Excellence (NICE) guidelines state that there is no arbitrary limit to the length of time a woman can stay on HRT. She should be supported in her decision to continue on the therapy if she so desires.
Studies show that women who stay on HRT have, on average, an increased life expectancy of 3.5 years.
https://www.nice.org.uk/guidance/ng23/ifp/chapter/About-this-information
2. If I have a Mirena should I have it removed before starting HRT?
No. Many peri-menopausal women need contraception as well as HRT. Contraception is recommended to the age of 55 years if you are still having periods or had them until you were 54 years old. The Mirena may have stopped all your bleeds and it may not be obvious to you that you are postmenopausal, or indeed still perimenopausal, so it is best to keep it if you are uncertain.
The Mirena can also be used in HRT for the endometrial protection. We can discuss this with you at your consultation.
3. Do you prescribe Testosterone preparations?
We do prescribe Testosterone preparations. A young woman makes 3-4 times more Testosterone than she does Oestrogen. It is an important female hormone.
From 2018 some testosterone gels are no longer being manufactured.
Testogel metered dispensers are NOT recommended for female use.
The recommended alternative is Tostran gel 2%. 1 metered dose = 10 mg and the usual daily female dose is 5 mg per day. Therefore Tostran can be used up to one metered dose on alternate days. Follow the instructions given to you at your consultation-the letter will remind you what these were.
Testogel 50/5ml each sachet being used sparing over 7-14 days according to individual need and side effects.
Apply testosterone to your wrists or, with your wrists to your lateral thigh. Wait for 10minutes before you get dressed.
The female replacement dose is approximately 5mg per day.
If you are on testosterone replacement, the International Menopause Society Guidelines recommend an annual blood test as a minimum, to monitor the levels.
Do not apply the gel the day before or the day of the blood test.
Please note that Testogel and Tostran are not licenced for use in women and therefore this is ‘out of licence use’. We have safety data to show that testosterone use, at the appropriate dose, is safe in women.
Androfeme is a licenced testosterone preparation for women and available privately.
Please refer to the following for more information on The Menopause Consultancy's policy on safe prescribing of Testosterone for women:
The below is an audit on safe prescribing of Testosterone for women prepared by Dr Lwin Mar Than:
https://www.menopauseconsultancy.co.uk/s/Safe-prescribing-of-off-license-Testosterone-in-Women.docx
There is further guidance available on the Chelwest website:
4. Do I need contraception still?
Contraception is still required when women are in the perimenopause, even if they are on HRT. HRT is not a contraceptive. It is safe to be taking HRT and using the minipill as your contraception. This will be discussed at your consultation, and you will be advised when it is safe to stop using contraception.
5. I've heard there is a shortage of HRT supplies?
This has been a particularly difficult time for women with regards shortages in HRT supplies.
We will endeavour to write on your prescription ‘or generic equivalent’ to ensure that the Pharmacist will provide you with an equivalent treatment for now.
Please refer to the British Menopause Society website for updates on the situation:
6. I have further questions regarding HRT
For further information on HRT, please see the excellent website for the Menopause Clinic at Chelsea and Westminster Hospital in London, where we have put together information leaflets for women on all aspects of HRT and Menopause Management:
On this site, under their FAQs there is a pdf of alternative non-hormonal options to HRT.