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World Menopause Day falls on 18 October, and it is a good moment to say something many women already know. Menopause care is too often rushed, dismissed or left until symptoms are hard to live with. Our private menopause care in London gives you the time to talk it through properly, with a full hormonal health assessment, an honest conversation about treatment and ongoing review at our Harley Street and Sloane Square clinics.
Menopause is the point at which your periods have stopped for twelve consecutive months. Perimenopause is the stage before it, when hormone levels begin to fluctuate, and it can start several years earlier, often in your forties. Most women in the UK reach menopause between 45 and 55, and symptoms can continue for some years afterwards.
Hot flushes and night sweats are the symptoms most people expect. Many women are more troubled by the ones they do not expect, such as broken sleep, low mood, anxiety, irritability, joint aches, headaches, changes to their periods and the difficulty concentrating that is often described as brain fog. Some notice vaginal dryness, discomfort during sex or more frequent urinary infections, and these are among the symptoms women are least likely to mention to a doctor.
Because so many of these overlap with stress, thyroid problems and iron deficiency, they are easy to put down to a busy life. That is how many women go months, sometimes years, without a clear answer. If your periods have changed and you feel unlike yourself, it is worth a conversation, even if you are not sure the two are connected.
Menopause before the age of 45 is considered early, and before 40 it is known as premature ovarian insufficiency. Both deserve prompt assessment, partly for symptom relief and partly because the loss of oestrogen at a younger age affects long-term bone and heart health. Unlike menopause later in life, blood tests play an important part in the diagnosis for younger women, and we will arrange them as part of your first appointment.
Your first appointment is a conversation before it is anything else. Your doctor will take a full history covering your cycle, symptoms, sleep, mood, family history and any previous treatment, then examine you where appropriate. Blood tests can rule out other causes, such as thyroid disease or anaemia, and are arranged through our blood tests and diagnostic scans service. For women over 45 with typical symptoms, diagnosis is usually made on symptoms rather than hormone levels alone, and your doctor will explain why.
You will leave with a clear plan, whether that is starting treatment, trying lifestyle changes first or simply knowing what to watch for. Nothing is decided for you.
Hormone replacement therapy, usually shortened to HRT, replaces the oestrogen your body is producing less of. Oestrogen can be taken as a tablet, or through the skin as a patch, gel or spray. If you still have a womb, you will also need a progestogen, because oestrogen on its own can thicken the womb lining. For dryness and urinary symptoms, a low-dose vaginal oestrogen is often very effective and can be used alongside other treatment or on its own.
For many women, HRT is the most effective treatment for hot flushes, night sweats and many of the other symptoms above, and it also helps protect bone density. Like any medicine, it carries some risks. Oestrogen taken through the skin does not appear to raise the risk of blood clots in the way tablets can, which is one reason the route matters. Combined HRT is associated with a small increase in breast cancer risk that depends on how long it is taken. Your doctor will set these figures against your own history so that the decision is properly informed.
HRT is not right for everyone, and some women would simply rather not take it. There are non-hormonal medicines that can reduce hot flushes, and cognitive behavioural therapy has good evidence for helping with flushes, sleep and low mood. Regular exercise, strength training, cutting back on alcohol and protecting your sleep all make a real difference. Where mood is a large part of the picture, our mental wellbeing support can sit alongside this care.
Many of our patients are managing senior roles while their symptoms are at their worst. Poor sleep and brain fog in a demanding job can knock confidence badly. We can talk through practical adjustments, provide supporting letters where appropriate and help you plan treatment around a working life. Employers looking to support their teams can also find out more through our corporate services.
Treatment is reviewed after the first few months and then at least once a year, so your plan changes as you do. Menopause care fits naturally within a wider women’s health review or a preventative health screening, and follow-up appointments can take place by virtual consultation when that is easier.
To arrange a menopause or hormonal health consultation at Harley Street or Sloane Square, call The Nine Clinic on 020 3084 1600 or email info@thenineclinic.com. Appointment fees are listed on our services and fees page.
For most women over 45 with typical symptoms, no. Diagnosis is usually based on your symptoms and history. Blood tests are more useful for younger women, or to rule out other conditions that cause similar symptoms.
Yes. Symptoms often begin during perimenopause, and treatment, including HRT, can be started while you are still having periods if it is right for you.
For many women, the benefits of HRT outweigh the risks, particularly when it is started before 60 or within ten years of the menopause. Your doctor will look at your personal and family history before recommending anything and will review the decision with you over time.
Yes. Initial discussions and follow-up reviews can take place by virtual consultation, with in-clinic appointments arranged for any examination or blood tests.
There is no fixed limit. Many women take HRT for several years, and the decision to continue or stop is reviewed with your doctor at least once a year based on your symptoms, your health and your preferences.