# Summerhill Health > Private GP Clinic in Manchester & Cheshire ## Posts ### New Endometriosis Test Uses Revolutionary Saliva-Based Diagnosis Could a Simple Saliva Test Finally Give You Answers About Your Pelvic Pain? If you've been struggling with chronic pelvic pain, painful periods, or other symptoms that doctors can't seem to explain, you're not alone. Endometriosis affects 1 in 10 women of reproductive age.  That's approximately 1.2 million women in England and Wales alone, yet the journey to diagnosis can feel endless, with many women waiting 8-10 years for answers.  We understand how frustrating and isolating this experience can be. At Summerhill Health, we're here to support you through every step of your health journey. That's why we're excited to introduce the Ziwig Endotest®, a groundbreaking saliva-based diagnostic test that could provide the answers you've been searching for in just days rather than years.  This gentle, non-invasive test represents a significant advancement in women's healthcare, offering you a faster, more comfortable path to understanding what's happening with your body.   What is endometriosis, and could I have it? Endometriosis is a condition where tissue similar to your womb lining grows in other parts of your body, most commonly around your ovaries, fallopian tubes, and pelvis. This tissue behaves just like the lining of your womb, thickening and bleeding with each cycle, but because it can't leave your body naturally, it becomes trapped, causing inflammation, scarring, and often significant pain.   What symptoms might suggest endometriosis? Every woman's experience with endometriosis is different. Some women have severe symptoms that dramatically affect their daily lives, whilst others may have few or no symptoms at all.  If you're wondering whether your symptoms could be related to endometriosis, here are some signs to be aware of: Period-related symptoms Severe period pain that's getting worse over time Pain that doesn't respond well to regular painkillers Heavy or irregular bleeding Pain that starts before your period and continues after it ends Other pelvic symptoms Chronic pelvic pain that's present even when you're not menstruating Pain during or after sex Discomfort during internal examinations or smear tests Digestive and urinary symptoms Painful bowel movements, especially during your period Pain when urinating during menstruation Bloating, nausea, or other digestive issues Blood in your urine or stool during your cycle General symptoms Chronic tiredness that doesn't improve with rest Difficulty getting pregnant Lower back pain that worsens during your period Shoulder pain during menstruation (though this is less common) If you're experiencing any of these symptoms, please know that they're not "normal" period pain, and you deserve to have them taken seriously. At Summerhill Health, we believe in listening to your concerns and working with you to find answers.   Why has getting an endometriosis diagnosis been so challenging? If you've been struggling to get answers about your symptoms, you're certainly not alone. Traditionally, diagnosing endometriosis has been incredibly difficult, and many women feel dismissed or told their pain is "just part of being a woman." But this couldn't be further from the truth.  The challenges with traditional diagnosis include: Limited diagnostic tools Pelvic examinations and scans can miss endometriosis, especially in early stages. Symptoms often overlap with other conditions like irritable bowel syndrome (IBS). Many healthcare providers have limited experience with endometriosis. The surgical requirement Until now, the only definitive way to diagnose endometriosis was through laparoscopy (keyhole surgery) performed under general anaesthesia. This involves surgical risks, recovery time, and often lengthy waiting lists. Many women understandably prefer to avoid surgery if possible. Symptom dismissal Unfortunately, women's pain is often minimised or attributed to "normal" period problems. The wide range of symptoms can make endometriosis difficult to recognise. We understand how disheartening this journey can be, and we're committed to providing you with the compassionate, expert healthcare you deserve.   How could the Ziwig Endotest® change everything for you? The Ziwig Endotest® represents a completely new approach to endometriosis diagnosis. Instead of requiring surgery, this innovative test analyses tiny molecules called microRNAs in your saliva using advanced technology and artificial intelligence (AI).   How does it work? The science behind this test is fascinating. Women with endometriosis have unique patterns of microRNAs in their saliva, like a molecular fingerprint that can be detected and analysed. The test examines 109 different microRNAs to create a comprehensive picture of what's happening in your body.   How accurate is the test? The results from clinical studies are genuinely exciting: 96.7-97% sensitivity: This means the test correctly identifies endometriosis in nearly all women who have it. 93-100% specificity: The test accurately rules out endometriosis when it's not present. 97% accuracy: This approaches the reliability of surgical diagnosis. These figures mean you can have real confidence in your results, whether positive or negative.   Who can benefit from this test? The Ziwig Endotest® is suitable for women aged 18-43 who are experiencing symptoms that could suggest endometriosis. However, the test isn't appropriate for everyone. You might be a good candidate if you're: Experiencing chronic pelvic pain or severe period pain Having pain during sex or with contraceptive procedures Struggling with fertility issues Dealing with painful bowel movements or urination during your period Living with symptoms that are affecting your quality of life The test isn't suitable if you're: Currently pregnant Have a history of cancer Are HIV positive Outside the age range of 18-43 years If you're unsure whether the test is right for you, we're here to discuss your individual situation and help you make an informed decision.   What makes saliva testing so appealing? One of the most wonderful aspects of this new test is how simple and comfortable it is for you: Complete comfort No needles, no surgery, no hospital visits No anaesthesia or recovery time needed No uncomfortable internal examinations Quick results Results available within 4-10 days No lengthy waiting lists for surgical procedures You can get answers while your symptoms are fresh in your mind Practical benefits Significantly less expensive than traditional diagnostic surgery Can be repeated if needed No extended time off work required   How do you prepare for the test? The beauty of the Ziwig Endotest® is that it requires very little preparation from you. We'll provide you with a collection kit and clear, easy-to-follow instructions.    The most important things are: Following the collection instructions carefully Make sure you're feeling well when you provide your sample Being honest about any medical conditions or medications Taking care to avoid contaminating your sample The test needs to be requested by a healthcare professional.   What happens next if your test is positive? If your Ziwig Endotest® shows that you likely have endometriosis, please know that this is the beginning of getting the help you need, not something to fear. Early diagnosis opens up many treatment options that can significantly improve your quality of life. Treatment approaches we might discuss include: Hormone-based treatments Options to help manage your symptoms and slow disease progression Menopause-style treatments can be very effective for endometriosis Contraceptive methods that can help control symptoms Pain management Targeted approaches to help you manage discomfort Lifestyle modifications that can make a real difference Support for the emotional impact of chronic pain Fertility support Discussions about preserving your fertility if that's important to you Referrals to fertility specialists if needed Treatment approaches that consider your family planning goals Surgical options when appropriate Referral to experienced endometriosis surgeons Minimally invasive procedures to remove endometrial tissue Treatment of complications like adhesions   What if your result is negative? A negative result means endometriosis is unlikely to be causing your symptoms, but this doesn't mean we stop caring about how you're feeling. Your symptoms are still real and still deserve attention and treatment.   If your test is negative, we'll work together to: Explore other possible causes of your symptoms Arrange appropriate investigations to get to the bottom of what's happening Develop a health management plan to help you feel better Continue monitoring your symptoms over time Provide ongoing support for your wellbeing Remember, getting a negative result can actually be really positive news. It rules out a chronic condition and allows us to focus on other, potentially more easily treatable causes of your symptoms.   How does this fit into your overall healthcare journey At Summerhill Health, we believe in treating you as a whole person, not just a set of symptoms.  The Ziwig Endotest® is just one part of our comprehensive approach to women's health, which includes: Thorough health assessments that take your concerns seriously Fertility support and family planning discussions Menopause care and hormone management Preventive healthcare to keep you well Mental health support for the emotional aspects of chronic conditions Coordination with specialists when needed We understand that health concerns don't exist in isolation, and we're committed to supporting your overall wellbeing throughout your journey with us.   Why this test could be life-changing The introduction of the Ziwig Endotest® is fundamentally changing how we approach women's health. For too long, women have been told to "put up with" pain or that their symptoms are "all in their head." This test validates what you've been experiencing and provides a clear path forward. The potential benefits include: Getting answers years sooner than traditional methods Avoiding unnecessary surgical procedures Starting treatment earlier to prevent complications Preserving fertility in women who want children Improving your quality of life through proper management Providing peace of mind, whether results are positive or negative Reducing the emotional toll of uncertainty   Taking your next step towards answers If you're tired of not having answers about your symptoms, you don't have to wait any longer. The Ziwig Endotest® offers a new pathway to understanding what's happening with your body. One that's gentle, accurate, and respectful of your time and comfort. At Summerhill Health, Dr Natalie Summerhill and our caring team are here to support you every step of the way. We'll take the time to understand your symptoms, assess whether the Ziwig Endotest® is right for you, and guide you through the entire process with compassion and expertise. Your symptoms matter. Your pain is real. And you deserve answers. If you're ready to take the next step in your health journey, we'd love to help. Book an appointment with us today to discuss how the Ziwig Endotest® could provide the clarity you've been seeking. Together, we can work towards better health and a brighter future.   References Bendifallah, S., Dabi, Y., Suisse, S., Jornea, L., Bouteiller, D., Touboul, C., Puchar, A., & Daraï, E. (2022). A Bioinformatics Approach to MicroRNA-Sequencing Analysis Based on Human Saliva Samples of Patients with Endometriosis. International journal of molecular sciences, 23(14), 8045. https://doi.org/10.3390/ijms23148045  Bendifallah, S., Suisse, S., Puchar, A., Delbos, L., Poilblanc, M., Descamps, P., Golfier, F., Jornea, L., Bouteiller, D., Touboul, C., Dabi, Y., & Daraï, E. (2022). Salivary MicroRNA Signature for Diagnosis of Endometriosis. Journal of Clinical Medicine, 11(3), 612. https://doi.org/10.3390/jcm11030612  Bendifallah, S., Dabi, Y., Suisse, S., Delbos, L., Spiers, A., Poilblanc, M., ... & Descamps, P. (2023). Validation of a salivary miRNA signature of endometriosis - interim data. NEJM Evidence, 2(7), EVIDoa2200282. https://pubmed.ncbi.nlm.nih.gov/38320163/  BIONEXT. (2023). Innovation in the diagnosis of endometriosis. Retrieved from http://www.bionext.lu/en/espace-medecins/services/ZiwigEndotest  Euronews. (2024). France gives preliminary green light to endometriosis saliva test. Retrieved from https://www.euronews.com/health/2024/01/09/endometriosis-saliva-test-given-preliminary-green-light-by-french-authorities  TDL Pathology. (2025). Ziwig Endotest. Retrieved from https://www.tdlpathology.com/specialties/genetics/ziwig-endotest/  ### Navigating Perimenopause - Your Questions Answered Perimenopause marks a significant transition in a woman's life that often comes with questions, concerns, and sometimes confusion. As many as one-third of the female population in the UK are currently experiencing perimenopause or menopause. At Summerhill Health, we understand this journey can feel overwhelming, which is why we've created this comprehensive guide to help you navigate this important life stage with confidence.   What Exactly Is Perimenopause? Perimenopause means "around menopause" and refers to the transitional period before menopause when your body begins to undergo hormonal changes. During this time, your ovaries gradually produce less oestrogen, which can lead to various physical and emotional symptoms. When does perimenopause typically begin? Most women enter perimenopause in their 40s, but some experience it as early as their mid-30s. This phase can last anywhere from a few months to 10 years, with the average duration being about four years. What happens to oestrogen during perimenopause? As you enter perimenopause, your ovaries, i.e. the organs responsible for producing most of your body's oestrogen, begin to slow down. This means they release less oestrogen, and the amount produced can fluctuate unpredictably from month to month. Over time, these levels generally trend downward, but it's the erratic ups and downs that often trigger many of the symptoms women notice during this phase. Why does lower oestrogen cause symptoms? Oestrogen is a key hormone that affects many systems in your body, not just your reproductive organs. As levels decline, the body's usual balance is disrupted, which can lead to a wide range of symptoms, both physical and emotional.     Common Symptoms of Perimenopause Every woman's experience is different. Some may only notice mild changes, while others have perimenopause symptoms that significantly affect their daily life. The timing, severity, and combination of symptoms can vary widely, partly because oestrogen levels don't just fall steadily; they can swing up and down unpredictably before finally settling at a lower level after menopause. Here are common perimenopause symptoms you should be aware of: Irregular periods Your menstrual cycle may become unpredictable, i.e. shorter, longer, heavier, or lighter as hormone levels fluctuate. Hot flushes and night sweats Sudden feelings of warmth spreading throughout your body, often accompanied by sweating and sometimes followed by chills. Sleep problems Night sweats and general hormonal changes can disrupt sleep, which can lead to you feeling more tired during the day. Mood swings Oestrogen influences neurotransmitters in the brain, such as serotonin, which help regulate mood. As oestrogen levels drop, you may feel more irritable, anxious, or low in mood. Vaginal dryness Oestrogen helps keep the lining of the vagina healthy and lubricated, so lower levels can cause dryness, discomfort during sex, and even an increased risk of urinary tract infections. Decreased fertility While you can still get pregnant during perimenopause, fertility naturally declines. Changes in sex drive Your libido may fluctuate during this time. Cognitive changes Some women report "brain fog", i.e. problems with memory, mental clarity or difficulty concentrating. Low self-esteem and confidence Emotional changes can affect how you feel about yourself and your relationships Increased risk of depression and anxiety The risk of developing depression or anxiety is higher during perimenopause, particularly if you have a history of these conditions. Joint and muscle pain Many women notice new aches or stiffness, which is partly due to hormonal changes. Changes in cholesterol levels Decreased oestrogen can affect your heart health. Headaches Fluctuating oestrogen can make headaches or migraines worse for some women. Bone Health Over the long term, lower oestrogen levels increase the risk of osteoporosis, as bones lose density more quickly.   Are these symptoms normal, or should I be concerned? While these symptoms are typically normal aspects of perimenopause, they can sometimes mirror signs of other health conditions. That's why it's important to discuss any new or concerning symptoms with a healthcare provider like Summerhill Health, who specialises in women's health.   How is Perimenopause Diagnosed? There's no single definitive test for perimenopause, but several approaches can help confirm what's happening: Clinical assessment: Your GP will discuss your symptoms, medical history, and menstrual cycle changes. Hormone testing: While hormone levels fluctuate significantly during perimenopause (making single tests less reliable), certain patterns in blood tests can help support a diagnosis. These may include measuring the following: Follicle-stimulating hormone (FSH) Oestradiol (a form of oestrogen) Anti-Müllerian hormone (AMH) Exclusion of other conditions: Some conditions have symptoms that overlap with perimenopause, including thyroid disorders, depression, and certain autoimmune diseases. Your GP may recommend tests to rule these out.     How Can You Manage Your Perimenopause Symptoms? The good news is that there are many approaches to managing perimenopause symptoms: Lifestyle Modifications Regular exercise because physical activity can help manage weight, improve mood, promote better sleep, and strengthen bones; all particularly important during perimenopause. Balanced nutrition, especially incorporating whole foods, calcium, vitamin D, and phytoestrogens (plant compounds that can mimic oestrogen) may help manage symptoms. Stress management including practices like mindfulness meditation, yoga, or other relaxation techniques can help mitigate the effects of stress on perimenopausal symptoms. Sleep hygiene meaning a consistent sleep routine and a cool, comfortable sleep environment that can help address sleep disturbances.   Medical Treatments Hormone replacement therapy (HRT): For many women, low-dose hormonal treatments can effectively manage symptoms. These come in various forms, including tablets, patches, gels, and vaginal preparations. At our menopause clinic, we offer personalised HRT options tailored to your specific needs. Non-hormonal medications: For women who cannot or prefer not to use HRT, several alternatives can help with specific symptoms, such as certain antidepressants for hot flushes or mood changes. Vaginal moisturisers and lubricants: These can help address vaginal dryness and related discomfort.   Complementary Approaches Some women find relief through complementary therapies such as: Acupuncture Herbal supplements (like black cohosh or evening primrose oil) Cognitive behavioural therapy   Which approach is right for me? The best approach is highly individual and depends on your symptoms, medical history, preferences, and lifestyle. Working with a healthcare provider who specialises in women's health can help you develop a personalised plan.     When to Seek Professional Help While perimenopause is a natural transition, certain situations warrant professional attention: Very heavy or prolonged bleeding Periods that occur significantly more frequently than every 21 days Spotting between periods or after intercourse Severe symptoms that interfere with your quality of life Symptoms of depression or anxiety that are difficult to manage As women's health specialists, we can help you determine whether your symptoms are related to perimenopause or indicate another condition that requires attention.   How to Prepare for Menopause Perimenopause is a transition to menopause; the point when you haven't had a period for 12 consecutive months. You can help prepare by understanding what to expect: Bone health: Declining oestrogen affects bone density. Weight-bearing exercise, adequate calcium and vitamin D, and sometimes medication can help protect your bones. Heart health: Your risk of cardiovascular disease increases after menopause. Regular check-ups, a heart-healthy diet, exercise, and not smoking are important protective measures. Emotional wellbeing: The psychological aspects of this transition shouldn't be overlooked. Many women find this a time of reflection and reassessment, sometimes leading to positive life changes.   Why We Care About Women and Perimenopause Perimenopause represents a significant transition in a woman's life, but with the right knowledge and support, it can be navigated with grace and even embraced as a new chapter. At Summerhill Health, we're dedicated to providing compassionate, evidence-based care to women during all life stages. If you're experiencing perimenopausal symptoms and would like personalised advice, please don't hesitate to book an appointment or take our free menopause quiz. Remember, you don't have to navigate this journey alone.   References British Gynaecological Cancer Society & British Menopause Society. (2024). BGCS-BMS Guidelines on Management of Menopausal Symptoms after Gynaecological Cancer. https://www.bgcs.org.uk/wp-content/uploads/2024/08/BGCS-BMS-Guidelines-on-Management-of-Menopausal-Symptoms-after-Gynaecological-Cancer.pdf British Menopause Society. (2024). NICE Guideline. https://thebms.org.uk/publications/nice-guideline/ Cui, J., Shen, Y., & Li, R. (2023). Menopause is more than just loss of fertility. Frontiers in Endocrinology, 14, 10751372. https://pmc.ncbi.nlm.nih.gov/articles/PMC10751372/ Davis, S. R., Lambrinoudaki, I., Lumsden, M., Mishra, G. D., Pal, L., Rees, M., Santoro, N., & Simoncini, T. (2015). Menopause. Nature Reviews Disease Primers, 1, 15004. https://doi.org/10.1038/nrdp.2015.4 Monteleone, P., Mascagni, G., Giannini, A., Genazzani, A. R., & Simoncini, T. (2018). Symptoms of menopause - global prevalence, physiology and implications. Nature Reviews Endocrinology, 14(4), 199–215. https://doi.org/10.1038/nrendo.2017.180 Muka, T., Oliver-Williams, C., Kunutsor, S., Laven, J. S., Fauser, B. C., Chowdhury, R., Kavousi, M., & Franco, O. H. (2018). Symptoms of menopause - global prevalence, physiology and implications. Nature Reviews Endocrinology, 14(4), 199–215. https://www.nature.com/articles/nrendo.2017.180 National Institute for Health and Care Excellence. (2024). Menopause: identification and management (NICE Guideline NG23). https://www.nice.org.uk/guidance/ng23 Takahashi, T. A., & Johnson, K. M. (2021). Menopause preparedness: perspectives for patient, provider, and policy. Medical Clinics of North America, 99(3), 521–534. https://pmc.ncbi.nlm.nih.gov/articles/PMC8462440/ ### Why a Balanced Approach to Weight Loss Drugs Is Essential The recent coverage in the media, including a BBC article discussing the potential of GLP-1 weight loss drugs to address obesity on a national scale, highlights both the opportunities and challenges these medications present. NICE’s decision to restrict access to these drugs raises important points about missed opportunities for public health and the economy. As a private GP, I see firsthand the profound impact that these medications can have on patients’ lives. However, the conversation around their roll-out needs to be grounded in both optimism and caution. Here’s my perspective: 1. Yes, the benefits are significant, but they come with risks There is no doubt that GLP-1 drugs are a game-changer in weight management, offering significant health and economic benefits. However, they are not a one-size-fits-all solution. These medications can cause side effects, ranging from mild nausea to serious complications like pancreatitis, and require careful medical oversight. In my clinic, I have already had to stop treatments for patients who were prescribed these drugs inappropriately through other channels. Expanding access is crucial, but it must be done responsibly, with clear frameworks for patient monitoring and support. Simply broadening availability without safeguards could lead to avoidable harm, undermining public trust in these medications.   2. Innovative care models are key, but oversight must be central Of course, expanding access shouldn’t solely burden NHS GPs. Many patients can successfully manage their treatment through alternative care models like online pharmacies. However, these models must include proper oversight by qualified professionals to ensure safe use. What’s concerning is the growing trend of patients accessing these medications without sufficient medical guidance. GLP-1 drugs are powerful tools, but when prescribed without thorough assessments or follow-ups, they can lead to dangerous consequences. Any effort to expand access must include robust systems for patient safety, whether through the NHS or private providers.   3. Addressing inequalities requires more than access While improving access to GLP-1 drugs can help reduce health inequalities, it’s not the full solution. Obesity is often driven by a complex interplay of factors, including socioeconomic disparities, lifestyle, and mental health. Weight loss drugs can be a valuable part of the toolkit, but they need to be integrated with broader support services – like nutritional counselling, mental health care, and lifestyle programmes – to create sustainable change. As a private GP, I’ve seen how a holistic approach to weight management delivers better outcomes. Medications like GLP-1 drugs can play a transformative role, but they should never be the sole focus of treatment.   4. A collaborative future between private and public providers The NHS cannot address this issue alone, and the private sector is well-placed to support efforts to expand access. Collaboration between private providers, online pharmacies, and the NHS could create innovative care pathways that balance accessibility with safety. Shared-care models, where patients can seamlessly transition between private and NHS services, could help close the gap while ensuring appropriate oversight.   A call for thoughtful expansion The potential of GLP-1 weight loss drugs to transform public health and the economy is undeniable, but their roll-out must be carefully managed. As a private GP, I urge policymakers to take a balanced approach: One that embraces the benefits of these medications while ensuring patient safety and long-term health outcomes remain the top priority. Let’s expand access, but let’s do it responsibly. The stakes are too high to get it wrong. ### Testosterone replacement therapy for men What is testosterone replacement therapy? It is a treatment for low testosterone in men. (Women can also take testosterone as part of their HRT during the menopause transition). Some men have particularly low levels of testosterone or have a sensitivity to the normal slow decline that happens from your mid-to-late 30s onwards. You can read more about low testosterone in this blog. Testosterone therapy seeks to top up your body’s natural supply of testosterone with the aim of improving symptoms such as fatigue, weight gain, memory and concentration problems, low libido, erection problems, and mood changes. The hormone is absorbed into the bloodstream via the skin by rubbing a clear gel on your body on a (usually) daily basis. What are the benefits of testosterone therapy? There are a few ifs and buts to answer this question fully. It depends on the cause of your low testosterone and it’s important to note that there’s not many large scale clinical trials over a long time to provide strong evidence of what the possible benefits are. Some studies have shown – and many men would agree – that potential benefits include: Better sleep quality More energy and motivation Stronger libido (sex drive) Ability to get and maintain erections for longer Improved mood and more stable emotions Better able to concentrate and remember Increased muscle mass Less body fat Improved beard growth Stronger bone density How long will testosterone therapy take to work? You may notice some improvements within a few days or weeks of starting therapy, more commonly it’s around the 3-6 weeks mark that most men see changes. We would wait for 3-6 months before assessing the full level of improvement gained from the treatment. Improvements to erections and sexual function are often one of the later symptoms to improve. The pace of improvement also depends on: how low your T levels are to begin with the type of testosterone you’re taking and the dose how sensitive your body is to the hormone how well the hormone is absorbed through your skin. It commonly takes time, and sometimes a few tweaks of your dose or type of treatment, before the desired results are seen so it’s worth sticking with it and following the expert’s guidance. Are there any side effects or risks of testosterone therapy? Side effects: Side effects are rare but in some cases, there may be changes to your blood that can cause thickening of the blood. There may also be some benign (non-cancerous) changes to your prostate. Because of these two factors, your blood and prostate function will be closely monitored while on testosterone therapy. Other rare side effects may include: weight gain and/or increased appetite acne mood changes tiredness hot flushes and/or sweating. Risks: The risks of testosterone therapy depend on several factors including your age, life circumstances and the presence of other medical conditions. There are very few large scale, long-term studies on testosterone therapy, so definitive evidence about associated risks is not available. Most experts agree that if a patient has prostate cancer, testosterone therapy is not usually recommended, but this does not mean that the treatment causes prostate cancer in men who are healthy. Testosterone replacement therapy is not usually recommended if you’re interested in fathering children as it can affect sperm production. These effects are reversible once treatment is stopped. If you have a consultation with Dr Natalie, she will take the time to consider all aspects of your health and personal circumstances, recommend any other checks needed, and discuss any potential risks and benefits before starting treatment with you. She will then monitor you closely at 3 months, 6 months, and then 12-monthly intervals. If you do not see the improvements you were hoping for within 6-12 months, it is best to stop treatment. Where can I get testosterone therapy? Dr Natalie Summerhill at the Summerhill Health clinic in Hale, Greater Manchester sees male patients who may have low testosterone. She is experienced at diagnosing ADAM and prescribing testosterone replacement therapy under close monitoring and guidance and within a healthy lifestyle. Book a consultation with Dr Natalie today. How much does testosterone therapy cost? You can find out more about prices for a consultation with Dr Natalie, the necessary blood tests specifically for low testosterone and regular monitoring of testosterone therapy here. ### Low testosterone in men How common is low testosterone in men? Depending on what figures you read, between 20-40% of men will experience low testosterone (T) levels at some point in their lives. Symptoms of low testosterone can be quite general (like tiredness or weight gain) and overlap with many other health conditions. Because of this, low testosterone is often not considered or diagnosed in many men that go to see their doctor with possible symptoms, so we can’t be sure of exactly how many men are affected by low T. What causes low testosterone? It’s common for testosterone in men to steadily decline from the mid-30s onwards but only by small amounts, around 1% per year for example. This is not in the same way as a female menopause, which is a much more dramatic decline in several hormone levels. Some men may have particularly low T levels – or a heightened sensitivity to lower levels – and can develop symptoms of low testosterone, often when in their 40s or 50s. This is what is generally referred to when you hear talk of the male menopause or ‘man-opause’. The medical term used nowadays for this type of low testosterone is ‘Androgen Deficiency in the Aging Male’ or the handy abbreviation, ADAM. And it’s important to mention there are other causes of low testosterone apart from age related, including: injury to the testicles, cancer treatments, stress, alcohol abuse, kidney or liver disease, obesity or due to certain medications. What are the signs of low testosterone? Here are some common signs and symptoms of low testosterone – and it’s always worth remembering that many of these symptoms can be due to other health conditions too. Low sex drive – testosterone plays a key role in your libido. It’s normal for your sex drive to decrease a bit with age but if you have low testosterone, it will be a more significant drop in sexual desire and arousal. Difficulty getting and keeping an erection – there are many reasons why you can get problems with erections (known as erectile dysfunction) such as some heart conditions, diabetes, thyroid disorders, high blood pressure or cholesterol, as well as depression and anxiety, so this symptom would need to be investigated carefully before assuming it’s related to low testosterone levels. Fatigue and tiredness – it’s common to feel wiped out even if you’re sleeping well, or you may experience problems getting off to sleep or staying asleep and feel very tired as a result. Increased body fat – this may be due to an imbalance between estrogen and testosterone (men have estrogen too). You may notice more fat over your pecs and feel you’re developing man boobs. This is called gynaecomastia and is a recognised symptom of low testosterone. Memory and mood changes – testosterone helps your mental agility and skills like concentration, memory and speed of thinking. You might be finding it harder to focus and remember things. You may also notice mood swings, find it harder to regular your emotions, feel irritable or low and depressed. Hair loss – balding is a natural part of ageing for most men and it’s often hereditary but with low testosterone, there can be additional hair loss including loss of hair on the face and body. Hot flushes – you may feel sudden sensations of warmth spread over your body and perhaps sweating or reddening of the skin. You might get night sweats where the sweating is more pronounced, and you may feel cold rather than hot at these times. These are just some of the symptoms of low testosterone, there are other signs that may be less noticeable and accumulate over time like loss of bone tissue, causing weaker bones as you get older and a risk of breaking them more easily. There’s also a loss of muscle mass and definition, and low testosterone can also increase your risk of anaemia. How can I check if I have low testosterone? It’s relatively straightforward to diagnose low testosterone from a simple blood test but it won’t necessarily provide answers to what is causing your low T levels. A normal range of testosterone in men is 300 – 1000ng/dL (nanograms per decilitre) and a score of less than 300 would be considered low. At Summerhill Health, the ADAM screening tool is used before an appointment, which is just 10 quick questions about everyday life, covering things like your energy levels, your work and sports performance, and your sex drive. Following a consultation with Dr Natalie Summerhill, where you can talk in full about how you’ve been feeling and what symptoms you’ve noticed, you will then be offered a blood test. A series of measures will be checked in your blood including a full blood count, your levels of total and free testosterone (how much there is in total and how much active or available testosterone there is), luteinizing hormone, FSH (follicle-stimulating hormone) and blood prolactin levels. Dr Natalie will then discuss your results with you and you can decide next steps with her support and guidance. How do you treat low testosterone in men? If a blood test has confirmed you have low testosterone and ADAM is suggested as the most likely cause, Dr Natalie will discuss the possibility of trialling testosterone replacement therapy with you. This is a gel that you rub into your skin on a daily basis and the hormone is absorbed into the bloodstream through your skin. She will explain the potential benefits of the treatment and discuss possible side effects or any associated risks. There have not been large-scale clinical trials on using testosterone therapy for ADAM long term, but many men do experience benefits to their sex drive and function, their mood and energy levels and their improvements to muscle mass and fat distribution. Book a consultation with Dr Natalie to explore your testosterone levels further. For more information about testosterone therapy, read our follow-up blog here. ### Signs Your HRT Isn't Working Starting Hormone Replacement Therapy (HRT) often comes with the hope of significant relief from menopause symptoms. But what happens when you're weeks or months in and still feel that something isn't right? It's a common and valid concern. This article explores the key signs that your HRT might not be working effectively and what steps you can take. In Summary: Key Signs Your HRT Needs Reviewing Persistent Symptoms: Your original menopause symptoms (like hot flushes or brain fog) have not improved or are returning. Hormone Intolerance: You are experiencing side effects like mood swings, bloating, or headaches, which may point to an issue with progestogen. Poor Absorption: The way you apply gels, patches, or sprays can significantly impact how much oestrogen your body absorbs. Incorrect Dose: The most common reason for HRT not working is that the dose is too low for your individual needs. Blood Test Confirmation: A blood test is the only definitive way to check if your body is absorbing enough oestrogen.   How Do I Know If I Need a Higher Dose of HRT? This is one of the most frequent questions we hear, and often, the answer is yes. You might need a higher dose if your original symptoms have not improved after a few months, or if they are starting to return. This can happen for two main reasons: either the initial dose prescribed was too low to begin with, or your body is not absorbing the oestrogen effectively from your patch, gel, or spray. Absorption varies hugely between individuals. One woman might get excellent results from a low-dose patch, while another may struggle to absorb the maximum dose of an oestrogen gel. In these situations, it is vital to check your application technique. For example, with Oestrogel, each pump should be applied to a different limb (e.g. upper outer arm or inner thigh) over an area the size of a handprint and left to dry, not rubbed in like a moisturiser. The most definitive way to check your hormone absorption is with a blood test. Our clinic can check your oestradiol levels to ensure they are within the optimal therapeutic range (around 300-800 pmol/L). You cannot assume absorption is adequate just because you are on a maximum dose.   4 Common Reasons Why Your HRT Isn't Working as Expected In our experience as menopause specialists, when women feel their HRT is failing them, it is usually due to one of these four reasons.   1. Insufficient Oestrogen Dosing As discussed above, this is the primary culprit. If blood tests confirm your oestradiol levels are below the optimal range despite using a high dose, we would explore trying a different administration route, e.g. switching from a gel to a patch.   2. Intolerance to Progestogen or Progesterone HRT involves taking oestrogen for symptoms, alongside a progestogen or progesterone to protect your womb lining. However, a significant number of women do not get along with progestogen. Clues that this may be an issue for you include a history of bad reactions to contraceptive pills, severe PMS/PMDD, or postnatal depression. Side effects of progestogen can include low mood, anxiety, lethargy, and bloating. If you are struggling, it is crucial to work with a specialist. Solutions can involve: Trialling different types of progestogens to find one that suits you. Minimising exposure by using a Mirena coil or vaginal progesterone, which limits absorption into the main bloodstream. Considering Tibolone, a tablet with progestogenic properties that is a different type of molecule.   3. Intolerable Side Effects from HRT Aside from progestogen issues, other HRT side effects can include nausea, headaches, breast tenderness, and leg cramps. In these cases, it’s important to work with your clinician to balance the benefits against the side effects. Sometimes a simple change, like switching the brand of oestrogen or the type of progestogen, can make all the difference.   4. The Symptoms Are Not Caused by Menopause Sadly, for a small number of women, HRT does not resolve their symptoms even when blood tests show optimal oestrogen levels. If a symptom persists despite optimised HRT, it may not be caused by menopause after all, or it may simply not be a symptom that is responsive to HRT. This is why a thorough consultation to rule out other causes is so important.   Does HRT Work for Everyone? While HRT is a highly effective treatment for many, it doesn't work for everyone, and it is not a one-size-fits-all solution. Most of the time, when women feel their HRT is failing, it's because they haven't been prescribed the right type, dose, or formulation for their specific biological needs. When HRT is tailored to the individual, success rates are very high. However, HRT isn’t suitable for everyone, including those with certain medical histories. In some rare cases, it can trigger other conditions. Before starting any treatment, you must discuss your health in detail with a trained clinician to make an informed decision.   Find the Right HRT Plan for You Navigating these challenges requires expertise. At Summerhill Health, our Private Menopause Clinic specialises in creating personalised HRT plans. We can help you investigate your dosage, discuss different types of HRT, and arrange for the necessary Private Blood Tests to ensure your treatment is optimised for you. Menopause is a time to take stock and indulge in self-care, with or without HRT. To book a consultation with our menopause specialist, please get in touch today. ### How can we reduce the risk of Osteoporosis? Osteoporosis is a condition in which the bones become weaker, making breakages more common. In this blog, we’re looking into how we can reduce the risk of osteoporosis. What is Osteoporosis? The internal structure of our bones resembles a honeycomb. As we age, this structure becomes less dense, with enlarged gaps, increasing the risk of fractures from seemingly minor injuries. Throughout my career, I've observed elderly patients sustaining rib or spinal fractures from simple actions like coughing. This vulnerability is notably pronounced in women who experience a decline in bone mass, losing approximately 1-2% annually after menopause. Consequently, women tend to experience height loss and are at a higher risk of hip fractures, which are linked to elevated rates of severe illness and mortality. How can we check our bone density? FRAX assessment, employed by doctors, estimates fracture risk and guides further investigation. However, it's crucial to note that FRAX isn't definitive and acts as a guide, lacking consideration of all osteoporosis risk factors. For instance, a parent with osteoporosis who never suffered a hip fracture may not influence your assessed risk. Calculate the ten-year probability of fracture with BMD here. A bone density or DEXA scan is the most valuable test for assessing bone health. This painless and straightforward procedure involves lying fully clothed on an x-ray bed while images are captured. Surprisingly, research indicates that only 20% of individuals who should undergo a DEXA scan are actually referred for one. Summerhill Health can facilitate private DEXA scans in Altrincham upon request. Who should have a DEXA scan? All women 65 years of age and older All men aged 70 years and older Women under age 65 with an additional risk for osteoporosis. 1. Women discontinuing oestrogen HRT or oestrogen deficiency (peri-menopausal and post-menopausal women) 2. Early or premature menopause (before age 45 years old) 3. History of amenorrhoea (no periods) for more than one year under the age of 42 years 4. History of maternal hip fracture that occurred after the age of 50 years Men and women with other risk factors: 5. Eating disorders (current/past) 6. Men younger than 70 with testosterone deficiency 7. Adults of any age with fragility fractures – low impact fractures such as a wrist (colles) fracture 8. Men or women receiving or expected to receive steroid treatment for more than three months (e.g. >5mg Prednisolone for more than three months in a year) Individuals beginning or receiving long-term therapy with a medication known to affect bone mineral density adversely: Anti-coagulants – warfarin, heparin Anti-epileptics Aromatase inhibitors, etc. (many other medicines that may cause osteoporosis) Individuals of any age with x-ray evidence of: Low bone mass (osteopenia), Vertebral deformity (kyphosis) Presence of vertebral compression fractures. Men and women of any age with a disease associated with a defect in bone development, low bone mass or bone loss, such as: Osteogenesis imperfecta Hyperthyroidism (overactive thyroid gland) Inflammatory bowel disease (IBD) Rheumatoid arthritis Growth hormone deficiency Men and women of any age who have the following risk factors; Loss of height of more than 2cm BMI below 18 Poor or mal-nutrition Excessive alcohol intake (>14 units a week) Current or ex-smokers Excessive exercise, particularly with inadequate calorie intake. Medications that may cause osteoporosis Chemotherapy Radiation Levothyroxine Anticonvulsant therapy or anti-epileptic medications (phenytoin and phenobarbitone)- interfere with calcium absorption and production of Vitamin D Long-term heparin, Warfarin or lithium therapy GnRH analogues such as Zoladex LHRH analogues; testosterone suppression Prolactin-raising drugs such as antipsychotic medications, e.g. some SSRI and aromatase inhibitors for the treatment of Prostatic and Breast. Cancers e.g. Arimidex Diuretics such as Burinex and Lasix (furosemide) Proton Pump Inhibitors – omeprazole, lansoprazole What can we do to reduce the risks of osteoporosis? Educate young women To reduce the risks of osteoporosis, we must empower young girls by educating them on the importance of maintaining a healthy weight and regular exercise. Both high and low Body Mass Index (BMI) values pose risks, as does crash dieting. Adequate calcium intake through diet plays a pivotal role in supporting bone health. Dietary calcium is notably superior to supplements in promoting bone health. Assess your calcium intake with the following link to ensure adequate consumption: CALCIUM - Calcium Calculator | International Osteoporosis Foundation Consider vitamin supplements Consider a daily vitamin D supplement of 400-800 IU, particularly during winter or for women with limited sun exposure. Aim for 30 minutes of sun exposure twice a week to the arms, legs, and face without sunscreen to achieve adequate vitamin D levels. Regular weight-bearing and strength exercises are essential to promote strong bones and muscular support for the skeleton. Hormone Replacement Therapy - HRT Certain medications, such as Hormone Replacement Therapy (HRT), can aid in preventing osteoporosis during its use and even for a period after cessation. However, current recommendations advise against using HRT solely for this purpose, except for younger menopausal women. We can support you with all aspects of women’s health. Take a look at our wide range of services. Don’t hesitate to contact us if you have any questions regarding bone health and menopause - we’re more than happy to help. We hope this blog has been useful on how to reduce the risk of osteoporosis. ### What is the relationship between Menopause and Allergies? Some women notice heightened allergies when they reach menopause, and there are various reasons why this might occur. In this blog, we’re looking into the relationship between menopause and allergies. Can menopause cause allergies? Yes, menopause can trigger new allergies or worsen existing ones. Many women notice heightened allergic reactions to foods, environmental triggers, or substances they previously tolerated well during perimenopause and menopause. Why does this happen? Fluctuating estrogen levels affect histamine production Declining hormone levels impair the body's ability to process histamines Stress from menopausal changes can trigger inflammatory responses The connection lies primarily in histamine intolerance, which becomes more common in midlife women.   Estrogen allergy symptoms & what to look for Women experiencing estrogen-related allergic reactions during menopause may notice: Immediate symptoms: Skin flushing and itching Hives or eczema flare-ups Runny or blocked nose Sneezing and respiratory issues Systemic symptoms: Palpitations and dizziness Fluid retention and swelling Migraine headaches Digestive issues (bloating, nausea) Neurological symptoms: Brain fog and fatigue Anxiety and irritability Sleep disturbances These symptoms often worsen during perimenopause when estrogen levels fluctuate unpredictably.   What is Histamine? Histamine is a neurotransmitter or nerve communicator. It makes the blood vessels leaky to allow the passage of cells to attack an allergen. It also plays a role in sleep, mood, libido and thought processing and is critical to bodily functions. You may have heard of ‘anti-histamines’ such as Piriton that you can buy over the counter to combat the effects of histamines for people with hay fever, for instance.   What is Histamine Intolerance or HIT? HIT is often mistaken for an allergy when it is, in fact, due to an accumulation of histamine in the body due to a mismatch in its production and rate of excretion. Most sufferers will have tried to identify an allergic trigger for their symptoms and/or undergone inconclusive allergy testing. HIT is unpleasant but never fatal, like an allergy can be. It is more common in women and more common in midlife, and therefore, our hormones and, indeed, menopause may play a role. It is thought to affect at least one in every 100 people. Symptoms of Histamine Intolerance (HIT) may include: Skin: flushing, itching, hives, eczema Respiratory tract: runny or blocked nose, sneezing, coughing, wheezing and shortness of breath Blood vessels: fluid retention and swelling, palpitations, dizziness and fainting, migraine Bowel: heartburn, belching, bloating, nausea, diarrhoea or constipation. Neurological: insomnia, fatigue, irritability, anxiety, brain fog, migraines, tinnitus   How does Histamine accumulate in our bodies? Our bodies can produce histamine in response to a trigger, such as an allergen and even due to stress. Histamine is also ingested from numerous dietary sources, such as alcohol, fermented foods, cured meats, smoked fish and various fruits and vegetables. As a general rule, unripe and very fresh foods are likely to contain less histamine when compared to overly ripe or leftover food that is eaten later. Fermented foods, such as yoghurt, are best avoided by HIT sufferers. Histamine is excreted via two enzymes (DAO and HNMT), and in the ideal scenario, histamine production/ingestion equals its excretion. Some people simply have faulty or less effective enzymes due to their genetics or concurrent use of medications such as non-steroidal anti-inflammatories (ibuprofen, naproxen), painkillers and antidepressants. Bowel conditions such as coeliac, inflammatory bowel disease and even an impaired gut microbiome can also reduce the effectiveness of these enzymes.   What is the relationship between menopause and allergies, namely histamines? You might be wondering why histamine intolerance can become a problem at menopause, and we’re here to offer guidance and support. Women approaching menopause may start to perceive new allergies or intolerances to things such as alcohol. They may also develop new or worsening hayfever, eczema or asthma. Whilst overall, at menopause, our oestrogen levels are declining, at times, we will experience surges in oestrogen. Think of a car running out of petrol but at times being able to inject a final chug! Oestrogen and histamine have a relationship in which oestrogen triggers the release of histamine, and histamine then triggers the release of more oestrogen, thus entering a vicious cycle. To make matters worse, oestrogen impairs the enzyme DAO, which is pivotal in excreting these very same histamines. You may be able to identify times in your past when your symptoms have been at their worst during periods of high oestrogen. These times may include your teenage years when periods first started, mid-cycle at ovulation, during combined contraceptive pill use and now during peri-menopause with or without HRT. Interestingly, women often feel great during pregnancy despite markedly raised oestrogen levels. This is because the body has a mechanism of increasing the levels of DAO to excrete more histamine in order to protect the baby.   How to diagnose Histamine Intolerance Diagnosis is largely symptom-based. Since HIT is not an intolerance to one particular food, it can be very challenging to identify the triggers. It requires a very detailed food, symptom, and cycle diary over time and is best supported by a Dietitian or Nutritionist to ensure you don’t become deficient in nutrients. It may be, for instance, that at certain times in your cycle, you can tolerate a bottle of wine, but at other times a glass will cause significant symptoms. Equally, it can be that you cannot tolerate a meal consisting of multiple histamine-rich foods, but you can enjoy them individually. This causes great confusion and is why you may not have identified HIT previously and need help from an expert to interpret your diary. Unfortunately, there is no diagnostic test for HIT. There are several commercially available tests whereby you can check levels of the enzyme DAO or a substance called Tryptase (related to the activity of the cells producing histamine), but, like our hormones, these are unreliable as they fluctuate day to day. You can also check your genetic pathways for histamine production and excretion via companies such as Lifecode Gx.   Frequently asked questions for menopause and allergies Why do I suddenly have allergies during menopause? Estrogen fluctuations trigger histamine release whilst simultaneously impairing the DAO enzyme that breaks down histamine, creating a perfect storm for new allergic reactions. What are the most common menopause allergy symptoms? Skin reactions (flushing, hives), respiratory issues (blocked nose, sneezing), digestive problems (bloating, nausea), and neurological symptoms (brain fog, migraines) are most frequently reported. Do allergies get worse during perimenopause? Yes, perimenopause often brings the worst symptoms as estrogen levels surge unpredictably before declining, creating dramatic histamine fluctuations. Can HRT help with menopause allergies? HRT can help some women, but estrogen therapy may initially worsen histamine intolerance. Progesterone and testosterone often provide better symptom relief.   How do I manage HIT? Hopefully, your GP has already excluded other causes for your symptoms. This is especially true for changes in your bowel habits, so if you have not discussed this with your doctor, it is important to do so. Dietary modification This can involve trying to eradicate histamine from the diet for a minimum of a month and keeping a diary. It is incredibly difficult and, ideally, should be overseen by a Dietitian or Nutritionist. As a minimum, you will likely need to abandon alcohol, dairy products and fermented foods. This should improve gut health, but in addition, you may wish to take a probiotic such as Symprove, which is vegan. You may find this website helpful, especially the food diary. Histamine Intolerance: The Food Diary Low histamine foods – safe foods Medium histamine foods – OK in low quantities High Histamine Foods (best avoided!) Freshly served meat and poultry Processed, aged, fermented, cured meats such as salami, bacon, hotdogs Fresh fish Smoked or tinned fish Shellfish Oily fish – mackerel, sardines, herring, anchovies   Brown rice, quinoa and other gluten-free grains Gluten-free soda bread Foods containing yeast – bread, sourdough and cakes Foods containing gluten Eggs baked in food Goat or almond butter. Fresh cheese such as mozzarella, ricotta, cottage cheese Fresh milk, plant milks inc. nut milk Extra virgin olive oil, rapeseed or coconut oil, ghee Fresh eggs ‘Vegan’ cheese may contain artificial colouring and preservatives Fresh uncultured, unfermented butter All fermented dairy products from cow/goat/sheep Yoghurt inc. coconut, kefir, kombucha Fermented or cultured butter Fresh vegetables except-> Peas Sprouted legumes Vegetables; avocado, spinach, aubergine, mushrooms, pickled and canned vegetables Pulses; chickpeas, beans, lentils, butter beans, black beans, kidney beans. Including spreads and dips such as houmous. Fresh fruit except-> Most citrus fruits, bananas, pineapples, tomatoes and strawberries, kiwi Dried fruits containing sulphur dioxide or preservative Macadamias, pistachios, almonds, brazils, pecans, hazelnuts, chestnuts and pumpkin, sesame, hemp & chia, flax-seeds Most nuts and seeds except <- Includes nut butters and spreads Herbal teas Spirit – gins and vodka Green and black tea Coffee Alcohol Sugar and sweets except-> Honey, cane sugar and maple syrup White chocolate Chocolate, cocoa, cacao, artificial sweeteners Fresh and dried herbs, spices, distilled white vinegar, salt, pepper. Homemade vegetable stock & homemade white fish stock Garlic Hot spices – cayenne, chillies, curries Apple cider vinegar Pickled and fermented foods inc. vinegar, soy sauce, mayonnaise, tomato ketchup, olives, capers, miso, fish sauce, tamari, Marmite, cumin, bouillon, broth, animal/poultry stocks. Many artificial preservatives and dyes Antihistamines These act as an antidote to surplus histamine to reduce symptoms, but they don’t prevent its production. You can buy these over the counter: cetirizine, loratadine, and fexofenadine, and they can be taken up to four times daily. If you suffer from acid reflux, the addition of a prescription medication, famotidine, can be helpful. Lifestyle measures As previously mentioned, stress is a trigger for histamine production, and this should be managed with lifestyle techniques such as yoga, meditation and mindfulness as far as possible. Aerobic exercise can have a variable effect on histamine release and should be individualised. Supplements DAO supplements are widely available but can be expensive. They are most effective when taken shortly before a meal that is known to be high in histamines. Vitamin C and L-glutamine act as natural antihistamines. Quercetin, found in some fruits such as apples, can also be helpful. Hormone replacement therapy Whilst HRT is very effective at managing menopause symptoms, for some, oestrogen can exacerbate their HIT symptoms. For those women who need or want to take HRT, optimising the diet will often allow for the slow titration of HRT. Progesterone and testosterone may have a positive effect on HIT symptoms. You may find these links helpful regarding menopause and allergies: Search the Register - Association for Nutrition HIT > Introduction (histaminintoleranz.ch) Cookbooks | Emma's Nutrition | Low Histamine & Happy Hormone (emmasnutrition.com)   Quick facts about menopause and allergies 50% more likely: Women are 50% more likely to develop histamine intolerance during menopause Peak timing: Symptoms typically worsen during perimenopause (ages 40-52) Main cause: Estrogen fluctuations trigger histamine release whilst impairing breakdown enzymes Common triggers: Alcohol, fermented foods, and aged cheeses become problematic Management: Low-histamine diet, natural antihistamines, stress reduction Duration: Symptoms often improve post-menopause as hormone levels stabilise We hope this article has been helpful regarding menopause and allergies. Check out our blog on Crashing Fatigue during Menopause. Please don’t hesitate to contact our menopause specialists in Manchester - we’re happy to answer any questions and provide expert advice. ### Crashing Fatigue During Menopause Crashing fatigue is a real and challenging symptom that many women face during their menopause transition. In this blog post, we’ll explore the causes of crashing fatigue, its impact on daily life, and effective strategies to manage it.   What is Chronic Fatigue? Chronic fatigue isn’t just ordinary tiredness; it’s a profound and relentless exhaustion that can strike at any time, leaving women feeling depleted and unable to function optimally. This type of fatigue can occur even after a good night’s sleep, making it especially frustrating. During menopause, the body undergoes significant hormonal changes. Used to being flooded with oestrogen, the enforced withdrawal at menopause can shut you down. This fatigue can significantly impact daily life, affecting work, relationships and overall quality of life. The relationship between oestrogen, progesterone and the stress hormone, cortisol is complex and poorly understood. Increased cortisol levels during menopause can exacerbate symptoms and negatively impact heart and bone health.   Hormonal Causes of Menopause Fatigue 1. Hormonal Changes The primary driver of menopausal fatigue is the decline in hormone levels, particularly oestrogen. Low oestrogen in isolation leads to low energy, low mood and loss of resilience. Additionally, a cortisol imbalance caused by hormonal fluctuations can leave women in a simmering constant state of stress, further exacerbating fatigue. 2. Sleep Disturbances Sleep disruption is a major contributor to menopausal fatigue. Hot flushes, night sweats, anxiety and frequent urination can all interfere with a refreshing night’s sleep and result in daytime somnolence. Sleep apnoea, or breath holding, also becomes more common during menopause, in part due to weight gain. 3. Lifestyle Factors As women enter the menopausal years, they often face increased responsibilities, such as caring for ageing parents or grandchildren. Balancing these demands with work and personal life can lead to heightened stress and fatigue. 4. Physical Symptoms Other physical symptoms like joint pain, headaches, and weight gain can also contribute to the overall sense of exhaustion during menopause.   How to Manage Crashing Fatigue During Menopause While menopausal fatigue can be debilitating, there are practical strategies and lifestyle changes that can help manage and alleviate this symptom. Here are some tips for dealing with crashing fatigue during menopause: 1. Always Prioritise Sleep Establish good sleep hygiene including a consistent sleep schedule and create a comfortable sleeping environment. Consider using cooling bedding (cooling pet bedding is much cheaper than those marketed for menopause!) and clothing to reduce the impact of night sweats. Take magnesium glycinate. Reduce caffeine, stimulant drinks and alcohol intake, all of which are diuretics and increase the urine volume. 2. Regular Exercise Engage in regular physical activity, such as walking, yoga, or strength training, which can help improve sleep quality, boost energy levels, lift mood and reduce stress. 3. Balanced Diet Maintain a balanced diet that includes plenty of fruits, vegetables, whole grains, and lean sources of protein such as poultry, fish, and legumes. Avoid excessive caffeine and alcohol intake, as they can disrupt sleep and worsen fatigue. 4. Stress Management Practise relaxation techniques like deep breathing, meditation, yoga and mindfulness to manage stress and improve overall well-being. Try the Sleepio app. 5. Hormone Replacement Therapy (HRT) Consider HRT as a treatment which may aid sleep and alleviate fatigue. 6. Seek Support If your fatigue is severe or persistent, consult your Doctor to rule out underlying medical conditions such as anaemia or an underactive thyroid, which can all contribute to exhaustion.   FAQs About Menopause Fatigue Q: Why does menopause cause extreme fatigue? A: Hormonal fluctuations during menopause disrupt cortisol regulation, often leading to a cortisol imbalance that affects sleep patterns and lowers energy production. Q: Can HRT help with menopause-related fatigue? A: Yes. By restoring oestrogen levels, HRT can improve energy levels in many women experiencing menopausal fatigue. Q: What lifestyle changes help manage menopausal fatigue? A: Prioritising sleep hygiene, regular exercise (e.g. yoga), a balanced diet rich in nutrients, and stress management techniques are all effective.   Patient Experiences with Menopause Fatigue "I met with Dr Summerhill for assessment and later treatment for menopause symptoms. After starting medication, my symptoms improved significantly, with hot flushes abating entirely." – Rachel Knights   How Can We Help? Crashing fatigue during menopause can have a profound effect on your quality of life. By understanding its causes and implementing practical strategies for managing it, you can regain your vitality and navigate this transformative phase of life with greater ease. At Summerhill Health, we specialise in supporting women through their menopause journey with tailored treatments like HRT consultations and lifestyle coaching. Use our menopause assessment form to track your symptoms or contact our friendly team today for personalised support. We are menopause specialists in Manchester and can work with you to help manage your symptoms and improve your quality of life. Contact our friendly team today for support. ### Everything you need to know about HPV You may have seen reference to the human papillomavirus (HPV), otherwise known as the human warts virus, from a smear result in recent years. This blog contains everything you need to know about HPV. As the leading cause of cervical cancer, smears are now primarily checked for the presence of HPV before any further examination is performed. So convinced are we that smears will be normal in the absence of HPV infection that they can be discarded. I have had many a call from distressed patients questioning their partner’s fidelity on receipt of such a result. In fact, their exposure has almost certainly occurred years, if not decades, earlier and never caused changes to their cervical cells and thus smears. Only now it is being looked for, and for good reason; HPV is responsible for over 99% of cervical cancers. Fortunately, we now have an effective vaccination, in addition to our screening programme, in the UK. Everything you need to know about HPV What is HPV? HPV is a virus which is fiercely prevalent in the population; indeed, almost everyone who engages in sexual activity will develop at least one strain of HPV during their lifetime. There are over a hundred strains that collectively make up the HPV family, and only a minority are linked to cancers, including cervical, anal and oropharyngeal (mouth and throat). High-risk HPV types Strains 16 and 18 are the major culprits; responsible for most HPV-related cancers. These are known as high-risk strains. You might wonder, does high-risk HPV go away? Somewhat reassuringly, 90% of HPV infections are cleared by the body spontaneously within two years, but still, there are thousands of cases of cervical cancer each year, making it a significant worldwide health concern. How long has HPV been around? HPV was first discovered in the 1980s. Thanks to research and medical advancements, we can now offer a number of preventative measures for cervical cancers. How is HPV transmitted? HPV is transmitted through genital skin contact, oral sex and/or shared use of sex toys. You can catch HPV the first time you are intimate. What are the symptoms of HPV? Most people with HPV have no symptoms and thus do not know that they have it. Sometimes the virus can cause painless warts around the genitals or anus. Warts are caused by a different strain of HPV to those that cause cancer, so they are not a precursor. How is HPV tested for? Cervical HPV is tested in the cells taken from a cervical smear. It can also be tested on a self-taken low vaginal swab, but this should not substitute for a cervical smear test. There is no blood test for HPV. Can I cure HPV? For the vast majority, the immune system will eradicate HPV and even in those that don’t, it is unlikely that it will cause cancer, but of course, we can monitor the smear to ensure it. The NHS Vaccination programme - How long has the HPV vaccine been out? The development of vaccinations targeting the Human Papillomavirus (HPV) represented a significant advancement in preventive medicine. In 2008, the HPV vaccination was introduced for all girls aged 12-13. Since 2018 school boys were also offered vaccination. Previously it was administered as a course of three, but from this month, it has been reduced to a single vaccine. What is the HPV vaccine made of? The HPV vaccine contains a destroyed version of the human papillomavirus (HPV). This does not put you at risk of developing HPV from the vaccine itself. You will be asked to confirm any allergies before the injection is administered. Why is the HPV vaccine not recommended after 26? Research into the HPV vaccine concentrated on subjects aged between 16 and 26 and was clearly shown to be effective. NHS vaccination programmes must be cost-effective to be introduced and are therefore driven by research findings. In addition, HPV vaccination is most effective when given before a person is exposed to specific HPV strains i.e. before they become sexually active. However, it can also be effective in preventing infection with a strain that has perhaps not been encountered by the sexually active woman or man. There is also experimental data to suggest it may help mount an immune response to eradicate an existing HPV infection. HPV vaccine side effects for females and males As with many other injections, it’s normal to experience some mild side effects for a short while after. You should monitor these side effects and seek advice if you become unwell. Swelling or pain at the injection site Headaches Body aches Feeling dizzy Feeling sick Feeling tired We hope this article has been useful regarding everything you need to know about HPV. Don’t hesitate to contact us if you have any questions. ## Pages ### Endometriosis Test (Ziwig Endotest) ### Home Visits ### Vaccinations ### Children's Health ### Smear Tests (Cervical Screening) ### Our Mission and Values ### Visa Medical Certifications ### Health Screenings ### Family Health ### Men's Health During Your Consultation ### Private GP Services Summerhill Health provides private GP services to adults and children across Greater Manchester and Cheshire. We offer flexible consultations in person, by video, or over the phone, with same-day appointments often available.   Why Choose Our Private GP Service? We provide thorough, unhurried consultations that give you time to discuss your health concerns in detail. Our service includes: Same-day appointments when needed Longer consultation times Prescriptions and medication reviews Referral letters and specialist referrals Medical certificates Visa medical examinations Blood tests with quick results Health screening All consultations are with Dr Natalie Summerhill, ensuring continuity of care and a deep understanding of your health needs. We complement NHS services by providing quick access to medical care, diagnostic tests, and specialist referrals when you need them most. We aim to keep our services as affordable and accessible as possible, offering expert medical care that puts your needs first.   Cheshire Private GP FAQs How much does a private GP in Altrincham cost? Service Cost Starting From (£) Appointment with Dr Summerhill £85 Home visits £165 Family appointments (4 pax from same household) £200   The cost of a private doctor’s appointment in Cheshire covers the expert consultation as well as any necessary referral letters and a prescription if necessary. Depending on the particular requirements, there are varied rates for investigations, with blood tests starting from £30.   Do you make private specialist referrals? Dr Summerhill can provide you with referral letters for private specialists if required. Most insurance companies will accept these. She can refer to a wide range of specialists and private hospitals. Additionally, we can recommend specialists and refer patients for private investigations, such as MRIs, mammograms and DEXA scans.    Where is the private GP surgery in Altrincham, Manchester, located? Our private and discrete GP surgery is located to the south of the city in Hale Village, Altrincham. The surgery is a 20-minute drive or tram from central Manchester and provides excellent access to a range of specialist GP services for anyone living in the North West of England. The surgery is located at Summerhill Health on Broomfield Lane. It’s handily placed near Hale station, and on-street parking is available. The full address is: Summerhill Health 6 Broomfield Lane, Hale, WA15 9AQ ### Complaints Policy Complaints Policy 1.0 Policy: 1.1 All complaints will be dealt with quickly and effectively between the individuals concerned and any justified grievances will be promptly remedied. 1.2 If the Care Quality Commission wishes to investigate a complaint, Summerhill Health will provide adequate facilities for any authorised person to interview, in private, any patient. 1.3 A notice will be posted in the consultation room giving a clear indication to all Patients that should they wish to register a complaint they should in the first instance address it in writing to: Summerhill Health 6 Bloomfield Ln, Hale, WA15 9AQ c/o Dr Natalie Summerhill Email: contact@summerhillhealth.co.uk 1.4 The notice will also contain the name, address and telephone number of the Care Quality Commission.   2.0 Procedure for Handling of Complaints: 2.1 All complaints will be fully investigated by the clinic manager (Dr Natalie Summerhill). 2.2 All complainants will receive a written acknowledgement within 2 working days of the complaint. 2.3 The complainant will receive a written response within 20 working days or a written explanation of why the response is taking longer and when they can expect a response. A full response being made within 5 working days of a conclusion being reached. 2.4 All staff involved in a complaint will be informed of the outcome and advice on preventing recurrence. 2.5 On completion of a complaint a full written report will be made including any recommendations and actions by the clinic manager (Dr Natalie Summerhill). 2.6 Where a complainant is not satisfied at the conclusion of the complaint process they have several options depending upon the nature of the complaint:   Independent arbitration service (see below). Where the complaint may relate to a breach of professional standards of conduct, clinical competence or fitness to practise, patients can raise their concerns with the appropriate professional regulator (Doctors – General Medical Council, Nurses – Nursing & Midwifery Council (see below). Where the complaint relates to a breach of statutory regulations and the organisation is registered with the Care Quality Commission patients can contact the CQC (see below). Patients retain the option of seeking legal advice relating to a complaint about the service provided by any healthcare provider. 2.7 Any complaint proceeding to litigation will be notified to the Care Quality Commission.   3.0 Complaint should be made in writing to the clinic manager (Dr Natalie Summerhill) 3.1 The clinic manager (Dr Natalie Summerhill) will conduct an investigation and will gather information. 3.2 This will lead to a full written report being produced and made available to those concerned. 3.3 The investigation will include: Speaking to all persons concerned Reviewing records and other documents Producing a written summary of the facts of the complaint Producing responses to written complaints Completing the appropriate records of the complaint Informing all relevant parties as to the outcome of the complaint and any remedial action. 3.4 Staff will provide help to any patient or relative of a patient wishing to make a complaint. 3.5 Getting further help with your complaint Where the complaint cannot be resolved between the parties, external arbitration will be sought. Dr Natalie Summerhill is a member of the Independent Doctors Federation (IDF) and will refer to the IDF if internal resolution cannot be achieved. Should there still be an impasse then the IDF will refer the complaint to the Centre for Effective Dispute Resolution (CEDR). CEDR and its findings will be final to both parties. 3.6 Care Quality Commission   If you feel your complaint is not being dealt with in a satisfactory manner, you many also contact the Care Quality Commission.   CQC HealthcareCitygateGallowgateNewcastle upon TyneNE1 4PATel: 03000 616161Email: enquiries@cqc.org.ukWeb: www.cqc.org.ukmergency hospitalisation. ### Cancellations Policy Cancellation Policy We attempt to be available during the times our patients require.  At our clinic, we recognise that unanticipated events occur. However, out of respect for both our practitioners and our patients who are trying to rearrange their busy schedules, we try to encourage our patients not to cancel appointments last minute or not arrive for scheduled appointment. All patients when booking an appointment will be informed of our cancellation policy. It is important that everyone is aware of their rights to cancel. In order to ensure a smooth running of the service it is important that notice is given for any cancelled appointments to ensure that the time can be offered to those waiting.  All cancellations have to be made one working day ahead of the appointment to avoid 50% cancellation charge. If you do not advise us of your non-attendance, you will not receive a refund and will not be able to use the payment towards a new appointment. If you do need to change your appointment, please advise us as early as possible. For any rescheduled bookings, all consultation fees must be redeemed within 6 months of initial booking. All patients may cancel or reschedule an appointment without charge prior to 24 hours in advance or by the end of business hours (6:00pm) the day before the appointment. The only exception to our cancellation policy is emergency hospitalisation. ### Menopause Guide ### Services ### Your Health Resource Centre ### Contact Us ### Repeat Prescriptions ### Getting Here ### Fees ### Meet Dr Natalie Summerhill ### Women's Health ### Private GP Appointments ### Menopause ### Home ### Privacy Policy The policy: This privacy policy notice is served by Summerhill Health Ltd, trading as Summerhill Health, of registered address 6 Broomfield Ln, Hale, WA15 9AQ, under the website; www.summerhillhealth.co.uk The purpose of this policy is to explain to you how we control, process, handle and protect your personal information through the business and while you browse or use this website. If you do not agree to the following policy you may wish to cease viewing / using this website, and or refrain from submitting your personal data to us.   Policy key definitions: “I”, “our”, “us”, or “we” refer to the business, Summerhill Health. “you”, “the user” refer to the person(s) using this website. GDPR means General Data Protection Act. PECR means Privacy & Electronic Communications Regulation. ICO means Information Commissioner’s Office. Cookies mean small files stored on a user’s computer or device.   Key principles of GDPR: Our privacy policy embodies the following key principles; (a) Lawfulness, fairness and transparency, (b) Purpose limitation, (c) Data minimisation, (d) Accuracy, (e) Storage limitation, (f) Integrity and confidence, (g) Accountability.   Processing of your personal data: This practice keeps medical records confidential and complies with the General Data Protection Regulation. We hold your medical record so that we can provide you with safe care and treatment. We will also use your information so that this practice can check and review the quality of the care we provide. This helps us to improve our services to you. Under the GDPR (General Data Protection Regulation) we are required to provide you with the following information about how we handle your information.   The Personal Data we collect from you includes but is not limited to the following: When you enquire about our services, we will request Personal Data such as your name, date of birth, email address and telephone numbers and information about you to help us to register you to see a doctor and to contact you with further information such as results of tests and investigations.  When you register with us we will request detailed medical information relevant to you.  This information is stored within a hosted practice management system Semble.   Semble Technology Limited (CRN: 09891593)Huckletree Shoreditch 18 Finsbury Square London EC2A 1AHUnited Kingdom   Semble is UK-based and GDPR compliant with a number of key features: 256 bit encryption and servers based in London 2 factor authentication for users login with SSL encryption (the same level of security as used for online banking) Ability to offer video consultations where needed   If you visit our website and make enquiries through this website, your usage may be tracked by using “cookies” and other similar technologies to help us make improvements to the websites and to the services we make available.  Please see the Cookies section below for more information.   Where we receive or make phone calls on your behalf, we will collect call data records including the calling line identity passed, the call date and time, the number dialled and the duration of the call, the names of the parties to the call, and any message or other information given during the call.   Where we receive or send emails on your behalf, we may collect the names and email addresses of the third parties and any information contained therein.   If receive or send paper documents or other forms of communication on your behalf, we may collect the names and addresses of the third parties and any information contained therein.  When you make a booking through our online booking tool, we will collect information you enter into the booking tool and the IP addresses from which you accessed the website.   Where we provide relevant services to you, such as referral to specialists, we will provide you with these in encrypted format.   We will NOT at any time share any of your information with any third party for the purposes of marketing, advertising, website testimonials without specific consent.   In compliance with GDPR Article 6 (“processing is necessary for the performance of a contract to which the Data Subject is party or in order to take steps at the request of the Data Subject prior to entering into a contract”), we will use the Personal Data or purposes that include but are not limited to:   Processing any enquiries you have about our services; verifying your identity when you use our services or contact us; understanding, processing and executing instructions you give us in relation to the delivery of our services; delivering our services to you; notifying you about  changes to our website, services or terms and conditions or anything else we may be required or reasonably expected to notify you of providing you with accurate and detailed billing for using our services; and collecting payment, and recovering any monies you may owe to us for use of our services.   In compliance with GDPR Article 6 (“processing is necessary for compliance with a legal obligation to which the controller is subject”), we will use the Personal Data for purposes that include but are not limited to:   maintaining our business records and accounts; meeting our obligations to HMRC; preventing or detecting a crime, fraud or misuse of our services, and investigating where we believe any of these have or may have occurred; meeting our obligations under the Money Laundering, Terrorist Financing and Transfer of Funds (Information on the Payer) Regulations 2017 and the London Local Authorities Act 2007;   In compliance with GDPR Article 6  (“the Data Subject has given consent to the processing of his or her Personal Data for one or more specific purposes”), if you have given and not withdrawn consent we may use the Personal Data for these purposes:   to provide you with information about our other services, offers or products that you may be interested in; and to provide you with information about third party services, offers or products that you may be interested in.   Whilst storing your data we will use Appropriate Technical and Organisational Measures to keep Personal Data secure and to prevent it being accidently lost, accessed or used in an unauthorised way, altered or disclosed.   We will make reasonable efforts to ensure the data is accurate and up-to-date and will undertake to rectify any inaccuracies of which we become aware without delay.  All Personal Data we store is stored in the European Economic Area.   We may monitor and record your phone and/or video conversations with us and use this information for training and quality purposes, to ensure any verbal instructions you give us are properly understood, to enable us to investigate complaints, and to meet our legal and regulatory obligations.  All recordings are encrypted and securely stored shortly after completion of the phone call and access to recordings is controlled and monitored.   We may share information with third parties:   In response to properly made requests from law enforcement agencies for the prevention and/or detection of a crime, for the purpose of safeguarding national security or when the law requires us to, such as in response to a court order or other lawful demand or powers contained in legislation; in response to properly made requests from regulatory bodies such as the Information Commissioner’s Office and Ofcom; as part of the process of selling our business; as part of current or future legal proceedings; and with a company who is assisting us in providing services to you or who provides services to us which enable us to provide our services to you, examples of such services being billing and financial systems, telecommunications services and customer management systems. Where we use companies for this purpose we have contracts in place to ensure they remain GDPR compliant with your data.   Some of the organisations with whom we may share information may be outside the European Economic Area in countries that do not always have the same data protection laws as the UK.  However, we will have contracts in place with them to ensure that your information is adequately protected and we will remain bound by our obligations even when your personal information is processed outside the European Economic Area.   Where any data breach is identified that affects the information that we hold about or have processed from you, we will take urgent action in accordance with the GDPR and guidance issued from the Information Commissioner’s Office.  If you identify any data breach that affects data we have passed to you, you must notify us in writing immediately and provide full information about the data affected by this breach.   The time period that we will keep information for will vary depending on what the information is used for. Unless there is a specific legal requirement to the contrary, we will keep information in a form which permits identification of Data Subjects only for as long as it is necessary for the purposes for which we process it.  Once the requirement to hold the data is complete, appropriate measures will be taken to delete the data in line with the terms of the GDPR.   Internet cookies We use cookies on this website to provide you with a better user experience. We do this by placing a small text file on your device / computer hard drive to track how you use the website, to record or log whether you have seen particular messages that we display, to keep you logged into the website where applicable, to display relevant adverts or content, referred you to a third party website. Some cookies are required to enjoy and use the full functionality of this website. We use a cookie control system which allows you to accept the use of cookies, and control which cookies are saved to your device / computer. Some cookies will be saved for specific time periods, where others may last indefinitely. Your web browser should provide you with the controls to manage and delete cookies from your device, please see your web browser options.   Google Analytics Our website uses Google Analytics, a web analytics service provided by Google Ireland Ltd. If the responsible body for the data processing that occurs via this website has their basis outside of the European Economic area and Switzerland, then the associated Google Analytics data processing is carried out by Google LLC. Google Ireland Limited and Google LLC. will hereinafter be referred to as “Google”. Google Analytics uses “cookies”, which are text files saved on the site visitor’s computer, to help the website analyse their use of the site. The information generated by the cookie (including the truncated IP address) about the use of the website will normally be transmitted to and stored by Google. Google Analytics is used exclusively with the extension “_anonymizeIp ()” on this website. This extension ensures an anonymization of the IP address by truncation and excludes a direct personal reference. Via this extension Google truncates the site visitor’s IP address within member states of the European Union or other parties to the Agreement on the European Economic Area. Only in exceptional situations will the site visitor’s full IP address be transmitted to Google servers in the United States and truncated there. The IP address, that is provided by your browser in using Google Analytics will not be merged by Google with other data from Google. On behalf of Summerhill Health, Google will use the information collected to evaluate the use of our website, to compile reports on website activity and to provide other website and internet related services to us (Art. 6 (1)( f) GDPR). The legitimate interest in data processing lies in the optimization of this website, the analysis of the use of the website and the adaptation of the content. The interests of the users are adequately protected by the pseudonymization of their data. Google LLC. has certified their compliance with the EU-U.S. Privacy Shield Framework and on that basis, they provide a guarantee to comply with European data protection law. The data sent and linked to the Google Analytics cookies, e.g. user IDs or advertising IDs will be automatically deleted after 50 months. The deletion of data whose retention period has been reached is done automatically once a month. You may refuse the use of cookies by selecting the appropriate settings in their browser. You can also prevent Google from collecting information (including your IP address) via cookies and processing this information by downloading this browser plugin and installing it: http://tools.google.com/dlpage/gaoptout Further information concerning the terms and conditions of use and data privacy can be found at https://www.google.com/analytics/terms/us.html or https://www.google.com/analytics/learn/privacy.html.   Data subject access request Under the GDPR, a Data Subject has the right to request a record of the data held about him/her. To do this a request should be submitted in writing to the Data Protection Officer at the email address contact@summerhillhealth.co.uk. We may ask the Data Subject to provide us with proof of identity to make sure we are giving information to the right person.   Other rights of Data Subject The GDPR gives Data Subjects a number of other rights including the right to request the correction or erasure of Personal Data, the right to request the restriction of processing of Personal Data, the right to request the transfer of Personal Data (to the Data Subjector a third party), and the right to withdraw your consent to the processing at any time where consent is the lawful basis for processing.   Changes Please note that the ways in which we collect, use and protect Personal Data will be reviewed periodically and may change from time to time.  We will notify you by email should such changes occur.   Mailing List In accordance with GDPR regulations, we would like to inform you that unless you explicitly choose to opt out, we will add you to our mailing list to receive updates and promotional materials from us. Rest assured, your personal data will be handled with the utmost care and in compliance with all relevant data protection laws. If you do not wish to be included, please let us know, and we will promptly respect your preference.   Contact Us If you have any questions about privacy issues, want us to update your marketing preferences, or amend information, please contact us by email at contact@summerhillhealth.co.uk You can see more about these rights at: https://ico.org.uk/for-organisations/guide-to-the-general-data-protection-regulation-gdpr/individual-rights/   We are registered with the ICO under the Data Protection Register; our registration number is C1198247.   ### Private Blood Tests Fe ### Contraception ### Trucheck Cancer Test ## FAQs ### Are there any reasons I might not be eligible for the Ziwig Endotest®? Yes, a consultation with Dr Summerhill is required to confirm your suitability. The test has not been validated for patients who: Are pregnant Have a history of Cancer and/or Human Immunodeficiency Virus (HIV) Have an acute infectious disease or a condition transmissible via saliva Have a gynaecological infection that needs surgical management Dr Summerhill will discuss your medical history with you to ensure the test is appropriate. ### What happens after a positive diagnosis? A positive result allows for targeted care that can slow or stop the worsening of pain and other symptoms. While there is currently no complete cure for endometriosis, an early diagnosis means an optimised treatment strategy can be implemented to improve your quality of life. ### Can this test replace imaging like an MRI or ultrasound? No. The Ziwig Endotest® is a diagnostic tool and is not intended to replace pelvic medical imaging. After a positive diagnosis, imaging remains essential for mapping and classifying the location and extent of any lesions. ### How long does it take to get the results? Once your sample is sent to the laboratory, the analysis and processing take time. We will provide an estimated timeframe during your appointment and will contact you as soon as your results are available to book a follow-up consultation. ### How accurate is the Ziwig Endotest®? The test has demonstrated excellent accuracy in clinical trials. It has a sensitivity of over 97% and a specificity of over 93%. ### Yes, a consultation with Dr Summerhill is required to confirm your suitability. The test has not been validated for patients who: Are pregnant Have a history of Cancer and/or Human Immunodeficiency Virus (HIV) Have an acute infectious disease or a condition transmissible via saliva Have a gynaecological infection that needs surgical management Dr Summerhill will discuss your medical history with you to ensure the test is appropriate. ### Am I eligible for the test? The test is designed for women between 18 and 43 years old who are experiencing symptoms associated with endometriosis. A consultation with Dr. Summerhill is required to discuss your medical history and confirm your suitability, as the test is a prescription-only device. ### What is the Ziwig test for endometriosis? The Ziwig Endotest® is a new, non-invasive diagnostic tool that uses a saliva sample to reliably detect all forms of endometriosis. It is indicated for women aged 18 to 43. The test works by analysing a complex signature of 109 different microRNAs to provide a clear diagnosis. ### What is the HPV vaccine you offer? We offer Gardasil 9, which protects against the human papillomavirus (HPV). It's suitable for both males and females and can be given from age 9 all the way up to 45. ### How do I know which travel vaccines I need? This depends on where you’re going, for how long, and what you’ll be doing. We recommend getting advice for travel to parts of Africa, Asia, and Eastern Europe, or if you'll be somewhere with limited medical facilities. ### Should I postpone my jab if I feel unwell? Yes, if you have a fever or feel too poorly to go about your day, it’s best to wait until you’re feeling better before having your vaccination. ### What are the common side effects? Most side effects are very mild and don't last long. You might notice a bit of soreness or redness where you had the injection, or feel slightly under the weather with a headache or mild temperature. Serious reactions are extremely rare. ### How many doses will I need? It varies. Some vaccines, like a tetanus booster, are just a single jab. Others, such as HPV or Hepatitis B, need a course of two or three injections for full, lasting protection. ### Do I need a GP referral? No referral is needed, but a consultation with Dr Summerhill is required so we can understand your needs and make sure the vaccine is suitable for you. ### Who should have these vaccines? Our vaccines are for both adults and children. The right ones for you will depend on your age, health, job, and travel plans. Dr Summerhill will help create a personal plan for you and your family. ### Can I see a same-day doctor in Manchester at your clinic? Yes, you can. We prioritise accessibility and often have same-day appointments available for new and existing patients. You can book online or call us on 0161 552 2382 to check for immediate availability. ### How do I know if I need a prostate check? Men over 50 should consider regular prostate checks as part of their health routine. They are also advisable if you experience urinary symptoms such as increased frequency, difficulty starting or stopping urination, weak flow, or getting up frequently at night to urinate. ### What are the signs of low testosterone? Common symptoms include fatigue, reduced libido, erectile dysfunction, decreased muscle mass, increased body fat, mood changes, and reduced concentration. Our Low Testosterone Screening can help determine if your symptoms are related to hormone levels. ### Will my consultation be confidential? Yes, all consultations are completely confidential and conducted in a professional, discrete environment. We understand the sensitive nature of many men's health concerns and ensure your privacy at all times. ### Where can I get a coil fitted near me in Manchester and Cheshire? At Summerhill Health, we offer convenient coil fitting services at our private clinic in Hale, serving patients throughout Manchester and Cheshire. Dr Natalie Summerhill is fully qualified with specific competence recognition for fitting contraceptive devices, ensuring you receive expert care close to home. Our central location is easily accessible with: Dedicated parking facilities Proximity to public transport links Flexible appointment times including evenings Usually, same-week appointments are available We understand that having a coil fitted is a personal procedure, and many women prefer to access this service near their homes or workplaces. Our private setting offers both convenience and discretion, with comprehensive aftercare support following your appointment. Unlike some NHS services where waiting times can be several weeks or months, we can typically arrange your coil fitting within days of your initial enquiry. ### How extensively has this test been validated? The Trucheck cancer test has been clinically validated through testing of over 40,000+ samples at accredited laboratories, demonstrating high accuracy and reliability in cancer detection across multiple types and stages. ### What quality standards do the testing laboratories meet? The tests are performed at state-of-the-art partner laboratories that meet rigorous international standards including CAP, CLIA, and UKAS accreditation. These facilities maintain full compliance with international quality standards. ### What is the accuracy of the test? The test demonstrates: 88% sensitivity across all cancer types 96-99% specificity with approximately 1.5% false positive rate When positive results occur, the test can identify the specific tissue or organ where the cancer originated with 93.1% precision. ### What happens if something is detected? If a "Cancer Signal" is detected: You'll receive a comprehensive follow-up consultation. Further diagnostic evaluation will be recommended. Appropriate specialist referrals will be arranged. A detailed written report will be provided. Please note that a positive result requires confirmation through additional testing. ### What preparation is needed before the test? No special preparation is required. The test involves a simple blood draw of 16-20 mL of peripheral blood. ### Is the test suitable for someone who suspects they have cancer? No. If you have symptoms or suspect you have cancer, you should seek urgent medical advice. Trucheck is specifically designed for healthy, asymptomatic individuals. Those with clinical or radiological suspicion of cancer should consult their GP immediately. ### Do I need a doctor's referral? This test requires approval and prescription from a qualified healthcare professional. This involves an initial consultation to review your medical history and assess your suitability for the test. ### How often should I have the test? Annual testing is recommended as part of your regular health screening. Since the test is non-invasive, there is no disadvantage to regular testing, and it can be incorporated into your annual health check process. ### Who is Trucheck suitable for? The Trucheck tests are recommended for: Adults aged 40 and above Individuals without current cancer symptoms People with no previous cancer diagnosis or treatment Those seeking proactive cancer screening Please note that this test is not suitable for pregnant individuals or those currently undergoing active cancer treatment. ### Does Trucheck replace conventional cancer screening? No. Trucheck is designed to be used as a supplemental tool alongside routine cancer screening tests. It enhances rather than replaces standard screening methods, potentially providing additional detection capabilities for cancers that may not be covered by conventional screening. ### How long does the contraceptive injection last? The injection provides 13 weeks of reliable contraception with a single treatment. It's particularly suitable if you want a very private method or struggle to remember regular contraception. Many women find their periods become lighter or stop completely while using the injection. You'll need to visit our clinic every 13 weeks for your next dose, and we'll help you keep track of when it's due. ### What makes the contraceptive patch a good choice? The patch works like a plaster that you change weekly for three weeks, followed by a patch-free week. It's ideal if you're likely to forget daily pills but want a method you can start and stop yourself. You can shower, swim and exercise as normal - most women forget they're wearing it. The patch is especially popular among busy women who want a simple but effective method. ### How does the vaginal ring work? The vaginal ring offers monthly contraception without daily pill-taking. You insert it yourself, leave it in place for three weeks, then remove it for a week. Most women and their partners don't notice it during sex, and you can use tampons as normal. It's particularly popular among women who want a lower-maintenance option but prefer to be in control of their contraception. ### What makes the mini pill different from the combined pill? The mini pill is an excellent option if you can't take oestrogen or are breastfeeding. Unlike the combined pill, you take it every day without breaks, ideally at the same time. While some women experience irregular bleeding initially, many find their periods become lighter or stop completely. It's just as effective as the combined pill when taken correctly. ### How does the combined pill work and what are its benefits? The combined pill offers more than just contraception. While being over 99% effective at preventing pregnancy, it can also help manage troublesome periods, reduce PMS symptoms, and improve acne. You'll typically take it for 21 days followed by a 7-day break, during which you'll have a withdrawal bleed. Many women appreciate the predictability this method offers, along with the flexibility to skip periods when desired. ### What should I know about emergency contraception? Emergency contraception is highly effective when taken promptly. The morning-after pill works best within 24 hours, though it remains effective for up to 72 hours. We offer same-day appointments whenever possible, as earlier treatment gives you the best chance of preventing pregnancy. We'll also discuss ongoing contraception options during your visit to help prevent future emergencies. ### What happens after implant fitting? A pressure bandage will be applied to reduce bruising and swelling, which should be kept on for 2-3 hours. The dressing can be removed after three days. ### How quickly can the implant be removed if it doesn't suit me? The implant can be removed at any time, though we recommend trying it for 3-6 months to allow your body to adjust. If you experience concerning bleeding patterns, please discuss this with us before deciding on removal. ### Can you remove a coil if I can't see the threads? Yes, we can usually remove coils even when threads aren't visible. If removal proves challenging, we'll refer you to a specialist clinic and may arrange an ultrasound scan. ### How are smear test results analysed and communicated? The lab will check the cells from your smear test to see if HPV (human papillomavirus) is present. If no HPV is detected, that's great news. It means your risk of developing cervical cancer is very low, and you can relax until your next recommended screening. If HPV is found in your sample, the lab will examine the cells more closely to check for any abnormal changes. Your results letter will explain everything they've found and let you know what the next best steps are. This might mean having another smear test in 12 months if no abnormal cells were spotted, or going for a colposcopy (a more detailed look at your cervix) if some cell changes are present. Whatever your results, please know that our dedicated team at Summerhill Health is here to guide you through it all with clear explanations, unwavering support, and the very best care at every stage. You've got this, and we're here for you. ### When will I receive my results? We know that waiting for results can be a bit nerve-wracking, so we make it a priority to get them to you as quickly as possible. Most of the time, you can expect your results within 7-10 working days. As soon as they arrive from the lab, we'll be in touch to talk you through everything and make sure you understand what it all means. If you have any questions or need some reassurance, Dr Summerhill is always happy to discuss the results with you in detail. ### What can I expect after the test? It's normal to have a bit of light bleeding, spotting, or mild cramps for a day or two after your smear test. This is just your body's natural response and should ease off within a couple of days. If you're at all worried or things don't seem to be settling down, please don't hesitate to give us a call. We're always here for advice and reassurance. ### What happens during the smear test? At Summerhill Health, Dr Summerhill performs all smear tests herself, so you can feel completely at ease in an understanding, supportive environment. Before getting started, Dr Summerhill will have a chat with you about any worries you might have or any specific needs she can help with. If smear tests are usually a bit uncomfortable for you, Dr Summerhill can discuss pain relief options or use a smaller speculum size to make things more comfortable. When you're ready, you'll be given some privacy to undress from the waist down and get settled on the examination couch. You'll be covered with a sheet to protect your modesty, and Dr Summerhill will walk you through each step of the process, making sure you're feeling good about everything before proceeding. Using some lubricant to make things more comfortable, Dr Summerhill will gently insert a speculum into your vagina. This allows her to properly visualise your cervix. Then, she'll use a small brush to collect some cells from your cervix. The entire procedure usually only takes 3-5 minutes, but you'll never be made to feel hurried. It's all about your comfort and wellbeing. Once the test is done, the cell sample will be sent off to the lab for thorough analysis. ### Do I need to prepare anything before my appointment? To ensure we get the most accurate results and keep you comfortable during the test, it's best to book your appointment for a day when you're not menstruating. If possible, try to avoid using tampons, lubricants, or any internal products for the 48 hours leading up to your test, just to prevent any interference with the sample. On the day itself, wear something comfortable that you can easily change out of for the procedure. And if there's anything specific you need or are concerned about, just let us know in advance so we can make sure everything is just right for you. ### How quickly can I get an appointment for a private smear test? We understand how important timely screening is, and we're here to make it happen for you. We offer flexible appointments and can often see you within the same week. You can give us a call, leave us a message or book an appointment directly through our website. We know that life can be busy, so whether you need an appointment on short notice or carefully planned around your schedule, we've got you covered. ### What if I feel anxious about smear tests? First of all, you're not alone! Many women feel a little apprehensive about cervical screening, whether it's their first time or they've had a less-than-comfortable experience in the past. At Summerhill Health, we completely understand, and we're here to support you every step of the way. Dr Summerhill is highly skilled at putting patients at ease, explaining everything clearly, and tailoring the process to ensure you're as comfortable as possible. Remember, you're in control throughout the appointment. If you need a moment or want us to adjust something, just let Dr Summerhill know. We're here to listen, support, and empower you throughout your screening journey. ### What is HPV and why do you test for it? HPV (Human Papillomavirus) is a common virus that most people will have at some point in their lives. We test for HPV during your smear test because nearly all cervical cancers are caused by persistent HPV infection. Don't worry though - your immune system usually clears HPV infections naturally within two years. Only persistent infections with certain high-risk types can lead to cervical cell changes. At Summerhill Health, HPV testing is included as standard in your cervical screening. This advanced screening method helps us identify potential risks earlier and more accurately than traditional methods alone. If you have any questions about HPV, Dr Summerhill will be happy to discuss them during your appointment. ### How effective is cervical screening at preventing cancer? Cervical screening is one of our most powerful tools for preventing cervical cancer. The numbers really show its value - since the UK screening programme began in the 1980s, cervical cancer rates have dropped by about 70% (Public Health England, 2017). Women who attend regular screening are 60-80% less likely to be diagnosed with cervical cancer compared to those who don't attend screening (Ronco et al., 2014). While no screening test is perfect, catching any changes early gives us the best chance to monitor or treat them before they become serious. That's why at Summerhill Health, we not only provide thorough screening but also take the time to discuss your results in detail. ### Do I need a smear test? The NHS recommends regular cervical screening for women aged 25-64, with tests every 3 years for those 25-49 and every 5 years for those 50-64. At Summerhill Health, we want to give you choices and flexibility. If you prefer a private smear test, you can have one at any age, as often as you like - just make sure it's been at least 12 months since your last one. Whether you're due for a routine check, missed your last NHS appointment, or simply want the extra peace of mind that comes with more frequent screenings, we're here to make it happen for you. ### What should I do if my child needs urgent medical attention outside clinic hours? For non-emergency concerns, we offer next-day appointments. For emergencies outside clinic hours, we advise visiting A&E. We provide all our registered patients with clear guidance on when to seek emergency care versus waiting for a clinic appointment. ### What immunisations do you offer and at what ages? We provide all standard childhood vaccinations following the UK schedule, plus additional recommended vaccines. We can create personalised catch-up programmes for missed vaccinations and offer travel vaccines for children going abroad. ### Do you provide development checks and growth monitoring? Yes, we offer comprehensive developmental assessments and growth monitoring, tracking your child's progress against standard milestones. This includes physical growth, motor skills, speech and language development, and social skills. ### What childhood illnesses and conditions do you treat? We manage a wide range of conditions including respiratory infections, allergies, asthma, eczema, growth concerns, developmental delays, behavioural issues, and digestive problems. We also provide support for chronic conditions requiring ongoing care. ### How quickly can my child be seen? We offer same-day appointments for urgent concerns, with flexible scheduling options including in-person, video consultations, and home visits. ### How long are appointments, and can I discuss multiple concerns? Initial consultations typically last 30 minutes, allowing time to thoroughly address your concerns. We understand children often have multiple health issues, and our unhurried approach ensures all matters can be discussed properly. ### What age groups do you treat? We provide healthcare services for children from birth through adolescence, with specialised care approaches for different developmental stages. ### What if I need specialist care? If specialist care is required, we can arrange referrals to trusted consultants and coordinate your ongoing care plan. We maintain strong relationships with specialist providers across Manchester and Cheshire. ### What medical services can be provided during a home visit? We provide comprehensive medical care including: Full physical examinations Blood pressure monitoring Blood tests and other diagnostic procedures Prescription services with local pharmacy coordination Chronic condition management and reviews Health screenings Vaccinations and immunisations We carry professional medical equipment to ensure thorough assessments in your home. ### Who can benefit from home visits? Our home visiting service is ideal for elderly patients, those with mobility challenges, individuals recovering from surgery, and anyone who finds it difficult to travel to our clinic. We also provide home visits for patients who require regular medical monitoring. ### How long does a home visit last? Consultations typically last 20-30 minutes, allowing time to thoroughly address your concerns. We never rush our visits, ensuring every aspect of your care is properly addressed. ### How quickly can I arrange a home visit? We offer flexible scheduling including same-day visits for urgent needs. Most regular appointments can be arranged within 24-48 hours, and we maintain slots for emergency cases each day. ### What areas do you cover for home visits? We provide home visits throughout Greater Manchester, focusing on Hale, Altrincham, Bowdon, Wilmslow, and surrounding areas. Our pricing is distance-based from our WA15 (Altrincham) location - please contact us for specific rates for your postcode. ### Do I need contraception during perimenopause? Yes, you still need effective contraception during perimenopause as pregnancy is still possible. While fertility naturally declines from your mid-30s, contraception should be continued until you reach menopause. Women aged 50 and above need to continue contraception until 12 months after their final menstrual period. Women under 50 should continue contraception for two years after your last period. Some contraceptive methods can mask menopause symptoms or affect your bleeding pattern, making it difficult to know when you've reached menopause. For suitable candidates under 50, combined hormonal contraception may help with perimenopause symptoms. The hormonal IUS offers dual benefits as both contraception and part of hormone replacement therapy. HRT alone is not a form of contraception, so additional contraceptive protection is needed if you're taking HRT during perimenopause. During your consultation, we can discuss suitable contraceptive options for your stage of life and help you plan when to safely stop contraception. ### Can I switch between different contraceptive methods? Yes, you can switch between methods with proper planning. We'll help you: Time the transition to maintain continuous protection Manage any temporary side effects Understand how the new method works Monitor how you adapt to the change The switching process varies depending on your current and chosen methods, and we'll create a personalised switching plan during your consultation. ### What should I expect during the recovery after coil fitting? Most women can return to normal activities immediately after coil fitting, though you may experience: Mild cramping for 24-48 hours Light spotting for a few days to weeks Period pattern changes, especially with hormonal coils You'll receive comprehensive recovery guidance, with ongoing support available if you have any questions or concerns. ### How long do different contraceptive methods last? Different contraceptive methods offer varying durations of protection: Long-term Options: Copper IUD (Copper Coil): 5-10 years depending on type Hormonal IUS (Hormonal Coil): 3-10 years depending on brand and age at insertion Contraceptive Implant: 3 years Injectable Contraception: 12 weeks Short-term Options: Combined Pill: Daily administration Progesterone-only Pill: Daily administration Barrier Methods: Single use ### What's involved in coil fitting? The coil fitting process involves several steps to ensure safety and comfort: Before the Procedure: Comprehensive consultation to discuss the procedure STI screening if required Pregnancy test if needed During the Fitting: Performed under sterile conditions by Dr Summerhill Takes approximately 15-20 minutes Local anaesthetic available if needed Step-by-step explanation throughout After Fitting: Post-procedure care instructions Guidance for post-procedure recovery and care Follow-up arrangements 24-hour contact details for any concerns   ### Which contraceptive method would suit me best? Finding the right contraception is a personal decision based on several factors. During your consultation, we'll have an in-depth discussion about: Your medical history and any existing health conditions Lifestyle factors including work patterns and daily routine Future pregnancy plans and fertility considerations Previous experiences with different contraceptive methods Personal preferences regarding hormonal vs non-hormonal options Potential side effects and benefits of each method Ease of use and reliability requirements ### What contraception options are available? We offer comprehensive guidance on all available contraceptive methods, each with unique benefits: Long-acting Reversible Contraception (LARC): Intrauterine Devices (IUD): Copper-based, non-hormonal protection Hormonal Coil (IUS): Progesterone-releasing system Contraceptive Implant: Tiny, soft plastic device inserted beneath the arm Injectable Contraception: Hormone injection every 12 weeks Short-acting Methods: Combined Oral Contraceptive Pill: Contains oestrogen and progesterone Contraceptive Patch: Small sticky patch worn on the skin, releasing oestrogen and progestogen, changed weekly for three weeks with one patch-free week Progesterone-only Pill: Suitable for those who can't take oestrogen Barrier Methods: Including condoms and diaphragms ### What about long-term health? Without appropriate treatment, post-menopausal women may face increased risks of: Osteoporosis Cardiovascular disease Type 2 diabetes Depression Dementia Clinical evidence indicates that when used appropriately for symptom control, HRT can offer additional health benefits. For women experiencing menopause symptoms, especially those under 60 or within 10 years of menopause onset, the benefits of HRT typically outweigh the risks. ### What follow-up care is provided? We provide comprehensive follow-up care including: Regular review consultations Blood test monitoring if needed Email support within 3 months of consultation Optional 15-minute video consultations for queries Annual reviews for long-term treatment ### What treatment options are available? We offer various options including: Hormone Replacement Therapy (HRT) in different forms (tablets, patches, gels) Lifestyle modifications Non-hormonal treatments We'll tailor your treatment plan to your personal needs and circumstances. ### When should I seek help for menopause symptoms? You can seek help at any stage - whether you're experiencing early perimenopause symptoms or are postmenopausal. Early intervention often leads to better management of symptoms and long-term health. ### What exactly is menopause? The menopause journey is marked by three distinct stages that affect women differently. During perimenopause, which usually begins in your mid-40s, periods become irregular as hormone levels fluctuate. This phase can last 4-10 years, with early symptoms including sleep changes, anxiety, and fatigue. For some women, it starts before age 40 (affecting 1 in 100 women), and in rare cases, before age 30 (affecting more than 1 in 1000 women). Many women choose to start HRT during this transitional phase. Menopause itself is officially diagnosed after 12 consecutive months without periods, typically occurring around age 51, though timing varies significantly. At this point, the ovaries stop producing key hormones - oestrogen, progesterone, and testosterone. Approximately 80% of women experience symptoms, with around 34 recognised symptoms that may last months or years. Without appropriate treatment, these symptoms can significantly impact quality of life. The post-menopausal phase continues for the rest of a woman's life. Currently, about 75% of women in the UK live with untreated low hormone levels, which can increase risks of several health conditions. These include osteoporosis (bone weakening), cardiovascular disease, type 2 diabetes, depression, and dementia. For optimal health during post-menopause, maintaining a balanced lifestyle is crucial. This includes regular exercise combining aerobic, weight-bearing and strength training, alongside maintaining good sleep patterns and a balanced diet. Managing stress levels and limiting smoking and alcohol are also important. When suitable, appropriate hormone therapy can help maintain quality of life and protect long-term health. Each woman's experience is unique, with symptoms varying in type and severity. Early recognition and appropriate management through personalised treatment plans can significantly improve quality of life during this natural transition. ### How often should I have routine blood tests? The frequency depends on your individual circumstances: Annual testing for general health monitoring Every 3-6 months for hormone therapy monitoring More frequent testing may be needed for specific conditions Athletes may need regular monitoring during training Dr Natalie Summerhill can advise on the optimal testing schedule for your specific needs. ### Do I need a GP referral? No referral is needed. You can book directly with us for any blood test. However, if you're currently under the care of another GP, it's helpful to inform them of any tests you're having done. ### Why choose venous blood tests over finger-prick tests? Venous blood tests provide more reliable results because: A larger sample volume allows for more accurate analysis Standardised laboratory processing Better quality control Ability to perform multiple tests from one sample Lower risk of sample contamination ### What's included in the price? The listed price includes: Blood sample collection by trained phlebotomists Laboratory analysis Written report of results Secure online access to your results Additional costs apply for follow-up consultations or result discussions with Dr Natalie Summerhill. ### Can I get a same-day appointment? We often accommodate same-day appointments, subject to availability. Priority is given to urgent cases. It's best to book in advance for specific time slots, especially for hormone testing which is often best done in the morning. ### Are your blood tests accurate? Yes, we use fully accredited laboratories with strict quality control measures. All our tests are processed using state-of-the-art equipment and are reviewed by qualified healthcare professionals. Multiple internal and external quality controls are performed regularly. ### Do I need to fast before my blood test? This depends on the specific test: Cholesterol tests typically require 10-12 hours of fasting Hormone tests are best done in the morning Glucose tests may require fasting or specific timing Vitamin and mineral tests generally don't require fasting We'll provide detailed instructions when you book your appointment. ### How long do blood test results take? Most routine blood test results are available within 24-48 hours. However, some specialised tests may take 3-5 working days. Hormone tests and more complex profiles can take up to 7 days. We'll inform you of the expected timeframe when you book your test. ### General Health Blood Tests (Individual) ⌄ Test Name Price Description Anti-Mullerian Hormone (AMH) £95 Specialised test measuring ovarian reserve to assess fertility potential and reproductive lifespan. Essential for fertility treatment planning. Apolipoprotein A1 (APO_A) £65 Advanced cardiovascular marker measuring 'good' cholesterol carrier protein. Important for assessing heart disease risk and monitoring treatment. Apolipoprotein B (APO_B) £65 Measures 'bad' cholesterol carrier protein, providing detailed insight into cardiovascular risk beyond standard cholesterol testing. Blood Urea Nitrogen (BUN) £50 Evaluates kidney function and protein metabolism. Important for monitoring kidney health and dehydration. Bone Health (RP18) £95 Evaluates bone health in terms of bone growth versus bone loss. Important for older people and those at menopause or with underlying health problems such as coeliac, IBD, malnutrition, eating disorders and vegans. C Reactive Protein (hsCRP) £35 Measures systemic inflammation levels. Useful for detecting infections and monitoring inflammatory conditions. Cholesterol (XLIPIDS) £40 Complete lipid profile including HDL, LDL, total cholesterol and triglycerides. Essential for cardiovascular health assessment. Cortisol (CORTISOL) £60 Analyses stress hormone levels throughout the day. Important for diagnosing adrenal issues and stress-related conditions. Diabetes Health (RP6) £55 Analyses glucose, HbA1C (which reflects glucose levels in the preceding 3 months), insulin and C-peptide which measure if you are still producing insulin to control your blood sugar. Full Blood Count (HSC1) £40 Comprehensive blood cell analysis including red cells, white cells, and platelets. Screens for anaemia, infections, and blood disorders. Vitamin B12 (VITB12) £39 Measures biologically active B12 (holotranscobalamin) for accurate assessment of B12 status and neurological health. Ferritin (FERRITIN) £39 Evaluates iron storage levels. Essential for diagnosing iron deficiency or overload conditions. Folate (RP9) £39 Measures vitamin B9 levels crucial for cell growth and DNA synthesis. Important during pregnancy. Follicle Stimulating Hormone (FSH) £35 Key reproductive hormone assessment for fertility and menopause diagnosis. Liver Function (RP14) £35 Comprehensive liver health assessment measuring multiple enzymes and proteins to evaluate liver function and damage. Luteinising Hormone (LH) £35 Key reproductive hormone that regulates ovulation in women and testosterone production in men. Essential for fertility assessment, monitoring menopause transition, and diagnosing hormonal imbalances. Oestradiol (EST) £30 Main oestrogen hormone crucial for female reproductive health, bone density, and cholesterol regulation. Important for monitoring fertility, menopause symptoms, and hormone replacement therapy effectiveness. Prolactin (PRL) £30 Hormone that stimulates breast development and milk production. Elevated levels can indicate pituitary disorders or affect fertility in both men and women. Essential for diagnosing causes of irregular periods or erectile dysfunction. Sex Hormone Binding Globulin (SHBG) £30 Protein that regulates the availability of sex hormones in the bloodstream. Important for assessing true hormone levels and diagnosing conditions like PCOS or monitoring hormone therapy effectiveness. Testosterone (TEST) £33 Primary male sex hormone important for muscle mass, bone density, and libido in both men and women. Used to diagnose low testosterone in men and excess testosterone in women. Testosterone (free) (FREE_TESTOSTERONE) £45 Measures the biologically active testosterone not bound to proteins. More accurate for assessing testosterone activity and diagnosing hormonal imbalances. Thyroid Function (RP4) £49 Comprehensive assessment of thyroid hormone levels (TSH, T3, T4) to evaluate thyroid gland function, including thyroid antibodies anti-thyroglobin and anti-thyroid peroxidase. Essential for diagnosing and monitoring thyroid disorders. Vitamin D (25OH_VITD) £48 Screens for low levels of vitamin D in your blood in order to treat it with supplements before it causes health problems. Kidney Health (RP20) £40 Essential test measuring kidney function and electrolyte balance. Important for monitoring overall health, medication effects, and kidney disease. ### Male Health Profiles ⌄ Test Name Price Description Well Person Check (WIN1M) £195 Comprehensive male health assessment including full blood count, cardiac markers, liver and kidney function, diabetes screening, prostate health (PSA), thyroid function and tumour markers. Essential for preventative healthcare and early detection. Sports Performance Men (HSC12) £299 Advanced athletic profile measuring nutritional status, hormone balance, and stress markers. Includes vitamin D, iron studies, testosterone levels, and cortisol to optimise training performance and recovery. Helps prevent overtraining and injury. Low Testosterone Screening (RDX_212) £160 Complete male hormone assessment including HBA1C, total testosterone, FSH, LH, prolactin, SHBG, PSA, LFT and full blood count. Helps identify testosterone deficiency and underlying causes, determining suitability for hormone replacement therapy. Male Testosterone Monitoring (RDX_213) £120 Male hormone assessment after 3-6 months of testosterone therapy including testosterone, free androgen index, FBC and oestradiol. Male Testosterone Annual Monitoring (RDX_214) £140 Male hormone assessment after 12 months of testosterone therapy including testosterone, SHBG, PSA and full blood count. TruCheck Intelli Multi-Cancer Screening (Including Pre and Post Test Consultation) £1,250 Revolutionary blood test capable of detecting over 70 types of solid organ cancers before symptoms appear. Uses advanced technology to identify circulating tumour cells (CTCs) in the bloodstream and can indicate the likely organ of origin. Includes comprehensive pre and post-test consultations with Dr Summerhill to discuss results and any necessary follow-up investigations. Essential for early cancer detection and improved treatment outcomes. ### Female Health Profiles ⌄ Test Name Price Description Well Person Check (WIN1F) £195 Comprehensive screening including full blood count, cardiac health markers, liver enzymes, kidney function tests, diabetes screening, urinalysis, bone health markers, iron studies, thyroid function panel and tumour markers. Essential for optimising overall health. Sports Performance Women (HSC12) £299 Specialised athletic profile measuring nutritional status, heart health, hormone balance, and stress markers. Includes tests for vitamin D, iron stores, testosterone, cholesterol and cortisol to optimise training and prevent overtraining syndrome. Health at Menopause MOT (HSC14) £225 Complete menopausal health assessment including hormone panels, thyroid function, liver health, cholesterol, bone health markers, and full blood count to guide treatment decisions and monitor overall wellbeing during menopause. Fertility Profile without AMH (HSC14) £225 Essential fertility markers including FSH, LH, oestradiol, and prolactin. Helps identify potential causes of fertility issues and optimise conception chances. Fertility Profile with AMH (HSC14) £250 Comprehensive fertility assessment including all basic fertility markers plus Anti-Müllerian Hormone to assess ovarian reserve and reproductive potential. Hormonal Health (RP7) £63 Appropriate for assessing perimenopause and HRT monitoring, including testosterone replacement TruCheck Intelli Multi-Cancer Screening (Including Pre and Post Test Consultation) £1,250 Revolutionary blood test capable of detecting over 70 types of solid organ cancers before symptoms appear. Uses advanced technology to identify circulating tumour cells (CTCs) in the bloodstream and can indicate the likely organ of origin. Includes comprehensive pre and post-test consultations with Dr Summerhill to discuss results and any necessary follow-up investigations. Essential for early cancer detection and improved treatment outcomes. Learn about our TruCheck cancer blood test. ### General Health Blood Tests (Panels) ⌄ Health Screen Panel Price Full Blood Count Heart Health Liver Health Kidney Health Bone Health Diabetes Iron Status Thyroid Health Nutritional Health Infection & Inflammation Allergy Evaluation Male Hormonal Health Pancreatic Health Muscle & Joint Health Blood Count Digestive Health Acute Med 1 (HSC3) £99 ✓ ✓ ✓ ✓ ✓ ✓ - - - - - - - - - - Acute Med 2 (HSC4) £125 ✓ ✓ ✓ ✓ ✓ ✓ ✓ - - ✓ - - - - - - Lifestyle Screen (HSC13) £125 ✓ ✓ ✓ ✓ ✓ ✓ ✓ - ✓ ✓ - - - - - - Basic Screen (HSC5) £75 ✓ ✓ ✓ ✓ - ✓ - - - - - - - - - - Standard Screen (HSC6) £130 ✓ ✓ ✓ ✓ ✓ ✓ ✓ - ✓ ✓ - - - - - - Standard Screen Plus (HSC7) £160 ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ - - - - - - Advanced GP2 (HSC8) £225 ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ - - - - - - Advanced GP3 (HSC9) £335 ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ - - - - Lipids & HbA1c (HSC2) £40 - ✓ - - - ✓ - - - - - - - - - - Tired All The Time (HSC10) £155 ✓ - ✓ ✓ - ✓ ✓ ✓ ✓ ✓ - - - - - - Long Covid (HSC11) £125 ✓ ✓ ✓ ✓ - ✓ ✓ - ✓ ✓ - - ✓ ✓ ✓ - Nutritional Health (HSC15) £250 ✓ ✓ ✓ - - ✓ ✓ ✓ ✓ - - - ✓ - - ✓ Anaemia Profile (RP21) £125 ✓ - - - - - ✓ - ✓ ✓ - - - - - - ### Can I get prescriptions? Yes, we can provide prescriptions when clinically appropriate. ### What if I need to cancel? We appreciate 24 hours' notice for cancellations where possible. ### Do you accept private health insurance? Please contact us directly to discuss payment options. We provide detailed receipts for all consultations and treatments. ### How much does an appointment cost? Please visit our Fees page for current consultation prices. ### Do you offer same-day appointments? Yes, we aim to provide same-day appointments whenever possible. ### Do I need to prepare anything before the examination? Some medical examinations may require fasting or specific preparations. We'll provide detailed instructions when you book your appointment. ### How far in advance should I book? We recommend booking your visa medical examination 3-4 months before your intended travel date. This allows adequate time for: Completion of all required medical tests Processing of documentation Meeting embassy submission deadlines Addressing any additional requirements Maintaining certificate validity (most visa medical certificates are valid for 6 months) ### How much does it cost? Fees vary depending on the type of certificate and examinations required. Please contact us for current pricing for your specific needs. ### Are your certificates internationally recognised? Yes, our medical certificates are recognised by embassies, government authorities, and professional bodies worldwide. ### What health checks are included? This varies by country and visa type. We'll inform you of the specific examinations needed for your destination when you book your appointment. ### Do you provide translation services? While our certificates are issued in English, we can advise on getting official translations if needed for specific countries. ### When will I receive my certificate? Many certificates can be provided on the same day. For those requiring laboratory tests or additional documentation, we aim to complete everything within 48-72 hours. ### How long does the examination take? Most medical examinations take 30-45 minutes, though this may vary depending on the type of certificate required. ### What documents do I need to bring? Please bring photo ID, any specific forms required by the requesting authority, and relevant medical history. For visa medicals, bring your passport and any documentation provided by the embassy. ### Where is the private GP surgery in Altrincham, Manchester located? Our private and discrete GP surgery is located to the south of the city in Hale Village, Altrincham. The surgery is a 20-minute drive or tram from central Manchester and provides excellent access to a range of specialist GP services for anyone living in the North West of England. The surgery is located at Summerhill Health on Broomfield Lane. It’s handily placed near Hale station, and on-street parking is available. You can get directions here.  ### Do you make private specialist referrals? Dr Summerhill can provide you with referral letters for private specialists if required. Most insurance companies will accept these. She can refer to a wide range of specialists and private hospitals. Additionally, we can recommend specialists and refer patients for private investigations, such as MRIs, mammograms and DEXA scans.  ### How much does a private GP in Altrincham cost? Service Cost Starting From (£) Appointment with Dr Summerhill £95 Home visits £225 Family appointments (4 max from same household) £200   The cost of a private doctor’s appointment in Cheshire covers the expert consultation as well as any necessary referral letters and a prescription if necessary. Depending on the particular requirements, there are varied rates for investigations, with blood tests starting from £30. ### What if something concerning is found? If we identify any health concerns, we'll discuss these with you in detail and either provide treatment directly or refer you to appropriate specialists. ### Is private health screening worth it? Regular health screening can detect potential issues before they become serious problems. Early detection often means more treatment options and better outcomes. ### When will I receive my results? Most blood test results are available within 48-72 hours. We'll arrange a follow-up consultation to discuss your results in detail and create a personalised health plan if needed. ### Do I need to prepare for my health screening? Some blood tests require fasting beforehand. We'll provide specific instructions when you book your appointment. ### How often should I have a health screening? We recommend annual health screenings for most people, though this may vary based on your age, health status, and risk factors. ### How long does a health screening take? Initial screenings usually take 45-60 minutes, allowing time for thorough examination and discussion of your health concerns. ### What does a health screening involve? Our screenings are tailored to your needs but typically include blood tests, physical examination, and specific health checks based on your age, gender, and risk factors. We'll discuss your lifestyle, family history, and any health concerns. ### Are evening or weekend appointments available? We offer flexible appointment times to accommodate working families and school schedules. Contact us to discuss availability. ### What about emergency care? While we provide same-day appointments for urgent matters, please note that emergency situations should be directed to A&E or emergency services. ### Do you provide vaccination services? Yes, we offer a range of vaccinations and immunisations for both children and adults, including travel vaccines. ### How quickly can we get a GP appointment? We offer same-day appointments where possible, with flexible options for in-person, video, or phone consultations. ### Do you offer home visits? Yes, we provide home visits for patients who are unable to attend the clinic, particularly beneficial for elderly family members or those with mobility issues. ### Can my whole family see the same doctor? Yes, Dr Summerhill provides care for all family members, ensuring consistency and comprehensive understanding of your family's health history. ### Will my consultation be confidential? Yes, all consultations are completely confidential and conducted in a professional, discrete environment. ### How often should I have a health check? We recommend annual health checks. However, this may vary based on your age, health status, and risk factors. Men with existing conditions or on treatments such as testosterone replacement may need more frequent monitoring. ### How long does an appointment take? Consultations typically last 15-20 minutes, giving you plenty of time to discuss your concerns in detail. More comprehensive health assessments may take longer, especially if blood tests are included. ### What does a men's health check include? Our health checks will take into consideration a variety of factors, including your age and specific concerns but typically include blood pressure measurement, BMI assessment, blood tests for key health markers, and prostate examination where appropriate. We'll discuss your lifestyle, family history, and any specific health concerns. ### How quickly can I get an appointment for women's health issues? We offer same-day appointments where possible, with flexible options for in-person, video, or phone consultations. Urgent concerns can usually be addressed quickly. ### Do you provide coil fitting and removal services? Yes, we offer both fitting and removal services for hormonal (IUS) and copper (IUD) coils. The procedure is done with appropriate pain management, and we'll discuss aftercare and what to expect during your consultation. ### What treatments are available for heavy periods? We offer various treatments including hormonal options (like contraception), medications to reduce flow, and pain management solutions. We can also investigate underlying causes and refer to specialists if needed. ### How do you diagnose and treat PCOS? PCOS diagnosis typically requires two or more symptoms from irregular periods, increased androgen hormones, or polycystic ovaries. Treatment is personalised and may include lifestyle changes, contraception, or specific medications depending on your symptoms and goals. ### What menstrual problems can you help with? While PMS involves common pre-menstrual symptoms, PMDD is a more severe condition affecting about 5% of women. PMDD significantly impacts emotional wellbeing and daily functioning, requiring specific diagnostic criteria and targeted treatment approaches. ### How do I know which contraception is right for me? The 'best' method often changes throughout your life. We'll discuss factors like your age, lifestyle, medical history, and whether you want hormone-based or non-hormonal options. We'll also consider if you need help with issues like heavy periods alongside contraception. ### What contraceptive options do you offer? We provide a comprehensive range of contraceptive options including combined and progestin-only pills, implants, and both hormonal (IUS) and copper (IUD) coils. Each method has different benefits and considerations, and we'll help you choose the most suitable option for your lifestyle and medical history. ### Where is the private GP surgery in Manchester located? Our private and discrete GP surgery is located to the south of the city in Hale village, Altrincham. The surgery is 20 minutes drive or tram from central Manchester and provides excellent access to a range of specialist GP services for anyone living in the North West of England. The surgery is located at Summerhill Health on Broomfield Lane. It’s handily placed near Hale station and there is on street parking available. The full address is: Summerhill Health 6 Broomfield Lane, Hale, WA15 9AQ ### Do you make private specialist referrals? Dr Summerhill can provide you with referral letters for private specialists if required. These will be accepted by most insurance companies.  She can refer to a wide range of specialists and private hospitals. ### How much does a private GP cost? An appointment with Dr Summerhill starts at £95. Home visits cost from £225. The cost of the private GP appointment covers the doctor's consultation as well as any necessary referral letters and a prescription if necessary. Depending on the particular requirements, there are varied rates for investigations, with blood tests starting from £30. ### What is a menopause specialist? A menopause specialist is not a protected term so in theory anyone could call themselves a menopause specialist, so it is good to be aware of the professionals usually involved and what qualifications are needed. Doctors that choose to specialise in menopause often have a background either as a GP, or as a gynaecologist, and they have usually done additional training in the subject of menopause and HRT prescribing. The most well recognised certification in the UK for additional training is from the British Menopause Society, or the Faculty of Sexual and Reproductive health, so you could look out for, or ask a professional if they are BMS/FSRH certified. Dr Summerhill is dual qualified.  Many, often female, GPs have an interest in women’s health which includes family planning and menopause, and although they may not have had the time to do the BMS training, they will still be experienced in looking after menopausal women and prescribing HRT. Some pharmacists, practice nurses or gynaecology nurse specialists have undertaken additional training to be able to prescribe HRT for menopausal women. If you have a complex medical history, including breast cancer, you may wish to see someone from a specialist menopause clinic either on the NHS or privately. There is great variability across the country in NHS menopause clinics however, and in their referral criteria and waiting times. ### WHAT NON-HORMONAL TREATMENTS ARE THERE? There are plenty of other ways to help your menopause apart from taking HRT. Lifestyle changes and talking therapies can be very beneficial and will be recommended by menopause specialists.  Lifestyle measures – for example healthy nutrition, exercise, improving sleep, reducing stress, and self-care measures, not just for managing your menopause, but staying healthy in the future too. Talking therapy – psychological therapies such as CBT have been shown to be beneficial in not only helping the psychological and emotional changes at perimenopause and menopause but even some of the physical symptoms too. Alternative or complementary measures – this would include herbal remedies like black cohosh, St John’s Wort, red clover and alternative therapies like aromatherapy, acupuncture, reiki, reflexology and so on. These measures may not have the scientific research or backing or be regulated in the same way as traditional medicine, but many people find some of these measures helpful. Just a little note of caution about herbal remedies – always do your research, buy from a reputable supplier, and check out whether it’s OK to take with other medications or remedies you may be on. Prescription medicines – non-hormonal medications are sometimes given for menopause symptoms, and these are most often antidepressants, which may help hot flushes but don’t always help the other range of symptoms including the mood and emotional changes due to hormone fluctuations. ### What is body identical hormones vs bioidentical hormones? It can be confusing to know what type of HRT is best as the words used to describe it sound similar and are sometimes used interchangeably. Body identical HRT is the safest and most regulated type, and the type that is provided on the NHS. This is because it’s regulated and has decades of research that demonstrate its safety and efficacy. The chemicals used in body identical oestrogen and progesterone are derived from the yam plant and mimic the same molecular structure as the natural hormones we produce in our bodies, hence the name body identical. This is also why they are better absorbed in the body, have fewer side effects and have the least risks. Bioidentical (sometimes called compounded) HRT does not have the same level of backing by science and is not quality controlled or regulated in the same way or prescribed on the NHS. The hormones are custom made to prescribe them in combination doses or preparations that are not routinely available. Combination doses of oestrogen and progesterone are problematic as you don’t have the flexibility to change the dose of one hormone but not the other, according to symptoms. It is important to research any menopause treatments before you commit to taking anything – you can check whether any treatment you’re considering is regulated and approved by NICE (National Institute for Health and Care Excellence). There is no evidence that compounded bioidentical hormones have fewer side effects or are more effective than body identical HRT, and bioidentical treatments have not passed the same rigorous checks that body identical types of HRT have. ### Can you take HRT if you have a migraine? Women are 3x more likely to have migraine than men and they can start at peri/menopause or get worse at this time if you’ve not had them for many years. Migraines may be triggered when oestrogen is low, or it can be caused when levels are too high or shifting. The good news is that, yes, you can take HRT and it can help reduce the severity, duration and frequency of migraine attacks. It’s important that you find the right type of HRT for you and the right dose. Oestrogen through the skin is best. The skin patch is often recommended as this releases a steady dose throughout the day, helping to reduce hormonal fluctuations that may be occurring. It helps to use the medication regularly as directed and not have breaks, as changes to hormone levels are likely to trigger an attack. You may want to start on a low dose and slowly build up if needed to help symptoms. The type of progesterone you take can also impact migraine, and you may want to try adding testosterone into your HRT regime as some women find this beneficial for migraine too. Give the HRT medication/s several months to take full effect before deciding on whether to continue with treatment or not.  You can read further information about migraine here. ### What diet and lifestyle changes help menopause? If you want to stay healthy and enjoying life to the full for as long as possible, a healthy diet and regular exercise is essential. Here are some healthy eating tips for any time of life: Eat 3 meals per day, at regular times and avoid skipping meals Eat a variety of foods at each meal covering the range of food groups (fruit, veg, protein, dairy, healthy fats, grains) Listen to your body. Eat when you’re hungry and stop when you’re feeling satisfied. It can take 20 minutes to feel full, so it helps to eat slowly Stay well hydrated by drinking plenty of water. Sometimes thirst is misinterpreted as hunger Have meat-free day/s every week, cut down on foods with high sugar or salt, and reduce the processed snacks, microwave meals and takeaways. Avoid trans and saturated fats as much as possible. Avoid ‘diet thinking’. There are no quick fixes to lose weight and no such thing as ‘good’ or ‘bad’ foods, it’s about balance and introducing small changes you can stick to for life.   Mediterranean style diet This type of diet consistently ranks top in terms of longevity, weight management, reducing future health risks and providing the best quality of life. It’s focussed around plant sources of food, so veg takes centre stage, with the supporting roles being wholegrains, seafood and fish, legumes, pulses and beans, nuts and seeds, herbs and spices, fermented dairy (yogurt and cheese) and extra virgin olive oil. Meat makes a rare appearance and there’s very few foods that are processed, or high in salt, sugar, trans and saturated fats. This type of eating is usually high in fibre, contains plenty of prebiotics which support a healthy gut, has anti-inflammatory effects and is high in Omega 3 fatty acids.   Nutrients to prioritise around menopause: Calcium: this is crucial for keeping your bones strong and healthy and for your mood and sleep. It works in partnership with magnesium and vitamin D. Found in dairy foods, leafy green vegetables, grains, tofu, summer squash, and many more.  Magnesium: this helps you absorb calcium from the blood into the bone to keep them strong but also helps balance glucose and may calm the nervous system, helping headaches. Good sources of magnesium include leafy green vegetables, summer squash, broccoli, cucumber, green beans, celery, and a variety of seeds.  Vitamin D: also crucial for proper uptake of calcium and your bone health. This sunshine vitamin helps your muscles and teeth stay strong too and may provide a boost for your mood and reduce the risk of type 2 diabetes. In the summer months, you’ll get most of what you need from sunlight if your skin is regularly exposed around midday (for around 10 mins twice a week if you’re light-skinned, extending to approximately 30 mins or longer if you’re dark-skinned), but if you don’t get enough sun at other times of the year, or you tend to stay indoors or covered up, you may want to take a vitamin D supplement, as it can be hard to get all that you need from diet alone.  B vitamins: these can help with energy, mental health, and the actions of our hormones, especially B6 and B12. Most plant-based foods have B vitamins and good sources of B12 are dairy, eggs, seafood, and chicken. Anti-inflammatory nutrients (polyphenols): you can get these as a supplement, but all plant sources of food contain polyphenols which are plant compounds good for your gut bacteria and have anti-inflammatory effects in the body. Apples and red onions for example contain quercertin. Phytoestrogens: some plant foods contain a type of oestrogen called phytoestrogen which is weaker than the oestrogen your ovaries produce, but plant sources may still help if you’re body’s suffering because of depleted oestrogen. Tofu/soy, chickpeas, ground flax or linseeds, chia seeds and raw almonds are great sources of phytoestrogens. Healthy fats like Omega 3 and Omega 6 (or vegan DHA equivalents): they act as anti-inflammatories and have multiple benefits in the body. Alcohol and nicotine (or other drugs), caffeine, and white flour products such as white bread, rice and pasta are best left alone or reduce them, as they can trigger or worsen menopause symptoms and may increase your risk of health conditions in the future.   What exercise should I be doing? Aim for a combination of the following: Balance activities: these are really beneficial and reduce the risk of having a trip or fall. Pursuits like yoga, Pilates and tai chi are great for this, but you can simply carry out some balance exercises at home like walking backwards, doing a few sit-to-stands, reaching up high on tiptoes, or standing on one leg to help your balance too. Aerobic exercise: anything to raise your heart and breathing rate (walking, swimming, dancing, climbing the stairs). Weight-bearing exercise: anything where you’re holding your own weight and it impacts through your joints, especially through changing direction of movement and having bursts of more intense movement in between lighter spells (think racquet sports, brisk walking/jogging, star jumps and squats). Muscle strengthening exercise: work your muscles harder than usual against resistance or your own body weight (resistance bands, press ups, sit ups, lift weights, lift anything!) Weight-bearing and strengthening exercises are crucial for your bone health. When your muscles pull on your bones it helps them renew and get stronger, making them much less likely to break. How much and how often? Any activity is better than none so if this seems out of reach for you, start small with realistic changes that you can build up slowly. Aim for 2 and a half hours a week (or around 30 minutes a day, 5 days a week) of moderate intensity aerobic exercise Or you can do 1 hour and 15 minutes a week (15 mins per day, 5 days a week) of more vigorous aerobic activity, such as jogging, or a workout class And muscle-strengthening activities on 2 or more days a week Aim to spread all your exercise evenly over 4 to 5 days a week, rather than one very long session.   ### Do I still need birth control/contraception? If you’re having penis-vagina sex, it is still possible to get pregnant even if you haven’t had a period for many months. If you want to avoid a pregnancy, here are the recommendations for when it is safe to stop contraception around the time of menopause: For under 50 year olds: Use contraception for at least two years after your last period. For over 50 year olds: use contraception for at least one year following your last period. If you are not sure when your last period has been due to use of hormonal contraception, or HRT, for instance we have to recommend contraception until the age of 55.  Taking HRT does not work as a form of contraception, unless you have a Mirena coil for the progestogen arm of your HRT. Also remember to use barrier methods for sexual health if you are in a new relationship or having sex with more than one person. This includes same-sex intimacy as it is still possible to pass on sexually transmitted infections. ### Benefits of whole-body cryotherapy (WBC) in the menopause Book a TRUE full body cryotherapy treatments with chillglow Relief from Hot Flashes: Hot flashes, which are sudden and intense feelings of heat, are a common symptom of menopause in women. WBC entails exposure to extremely cold, which could perhaps offer momentary relief from hot flashes by lowering heat-related symptoms and cooling the body. Reduced Pain and Inflammation: WBC is said to have anti-inflammatory properties, and some research indicate that it might aid in lowering inflammatory indicators in the body. WBC may be able to ease the symptoms of joint pain, muscle aches, and general discomfort that menopausal women may encounter. Better happiness and Well-Being: Cold exposure during WBC has been linked to endorphin production and elevated levels of specific neurotransmitters, such as norepinephrine, which are known to improve happiness and well-being. This might be helpful for controlling the mood swings, anxiety, or depression symptoms that could happen after menopause. Improved Sleep Quality: Sleep problems are frequent throughout the menopause. WBC may enhance sleep quality, maybe by encouraging relaxation and lowering stress levels, according to some anecdotal data. The management of menopausal symptoms and overall wellbeing can both benefit from better sleep. Energy and Vitality Levels May Increase: Cold exposure during WBC enhances the body's physiological responses, which may lead to higher energy and vitality levels. This might help to combat the frequent menopausal symptoms of weariness and poor energy. ### Is HRT safe? HRT is primarily prescribed to manage menopause symptoms, and improve quality of life. For most women experiencing symptoms, the benefits of HRT outweigh the risks when started at an appropriate time. During your consultation, we’ll discuss your personal risk factors, family history, and lifestyle to help you make an informed decision as to whether or not HRT is right for you. ### What are the benefits of HRT? HRT is the most effective way to relieve symptoms caused by perimenopause and menopause. Once you’ve taken HRT for 3 months or more, you will usually notice an improvement in many symptoms including, mood, anxiety, sleep, joint aches and pains, headache or migraine, hot flushes, and night sweats. HRT doesn’t only bring symptom relief, it can reduce the risks of some future health conditions. HRT helps slow down loss of bone tissue that can lead to weakened bones, osteoporosis and fractures. Taking oestrogen replacement keeps bones strong and healthy and reduces the risk of fracture. HRT also reduces the risk of cardiovascular disease, helping to keep the heart and blood vessels healthy. There is some evidence that HRT brings benefits to brain health, potentially reducing the risk of dementia and depression, and it may help reduce the risk of type 2 diabetes. Using vaginal oestrogen long term reduces the occurrence of vaginal dryness and soreness, itchiness, incontinence, UTIs, and can make sex more comfortable. ### Which type of HRT is right for me? If you’re thinking of starting HRT, it’s best to see a healthcare professional that is experienced in managing menopause and they can clearly explain the different options and types of HRT, as well as outlining the pros and cons of the medication regimes for you. They will also consider your personal history, lifestyle and preferences. Body identical HRT is the ‘gold standard’ of menopause treatments and it is closely regulated and evidence based. There are 3 hormones that make up HRT and you may only need 1, 2 or all 3 depending on your symptoms and history. These medications are absorbed into the bloodstream and circulate round the body, so are sometimes called systemic HRT. And then there is also local, vaginal oestrogen which is not the same as systemic HRT but is often needed to improve genital comfort and strength as well as urinary symptoms specifically. Oestrogen: this is the key hormone that causes many symptoms when no longer produced by the ovaries. You can take it through the skin as it is then absorbed into the bloodstream and travels round the body. It comes in the form of a skin patch, gel or spray and you will be recommended a certain number of pumps of gel or spray or a certain size patch as your dose. You use the gel or spray every day, or if patches are used, these are changed 2x a week. Oestrogen is available in tablet form, but this comes with a small risk of blood clot, so is less used these days.   Progesterone: if you still have a womb (haven’t had a hysterectomy), you will need to take progesterone when you start taking oestrogen. This is because oestrogen will thicken the lining of your womb and can sometimes cause the cells to change in an unhealthy way. Progesterone keeps the lining of your womb thin and the cells healthy. The safest type of progesterone is micronised progesterone, (called Utrogestan in the UK) and it comes in capsule form that you swallow. Depending on if you’re still having periods or not, you will be advised when to take the capsules. It may be in a 2 weeks on / 2 weeks off pattern, if you’re still having periods occasionally, or it will be continuously if it has been more than a year since your last period. The other way to have progesterone is from a Mirena coil that is inserted into the uterus and stays there for 5 years. This option has the added benefit of being a contraceptive if you need that, and it can help lighten heavy periods significantly. Testosterone: this hormone is particularly helpful for low sex drive, fatigue and brain fog, low mood, sleep, joint pains and muscle aches. Using this hormone as part of HRT is still relatively new and in fact, there are no licensed testosterone medications designed for menopausal women in the UK. All testosterone given to women at peri/menopause needs to be prescribed ‘off-licence’, but there are plenty of doctors (NHS and private) willing to do this. It can either be given via a cream (designed for women and called Androfeme) that is only available privately, or there are gels (called Testogel or Testim) that are designed for men but can be given in much smaller doses to women and these are available on the NHS. You rub the cream or gel into the outer thigh or lower tummy area daily. It’s important to have a blood test after you start testosterone replacement to ensure your levels stay well within the female range. Vaginal oestrogen: this treatment is not absorbed into the bloodstream, and just stays in the vaginal and vulval area. It’s to help with symptoms of dryness, itch, soreness, painful sex, needing to wee a lot, having leaks of wee, or recurrent UTIs or thrush. It comes in the form of a tablet, pessary, gel or cream that is inserted into the vagina, usually at bedtime to stay in place overnight. There is also a soft silicon ring called Estring that is inserted high up into the vagina and releases a steady of oestrogen for 90 days and is then replaced. Vaginal oestrogens are a very safe and effective treatments and need to be taken long term to provide benefits. It can be used alongside HRT. (If you are only using this type of oestrogen, you do not usually need to take progesterone).   ### DOES MENOPAUSE INCREASE RISK OF FUTURE HEALTH CONDITIONS? Yes, it does if no treatment is taken. The main two diseases that have an increased risk after menopause are the bone weakening condition; osteoporosis, and cardiovascular disease, which includes any disease of the heart and blood vessels such as heart attack and stroke. Taking HRT can reduce the risk of both developing in later life. There are other diseases that increase after menopause and relate to a lack of hormones such as type 2 diabetes, depression, and dementia and although evidence is still emerging, some studies suggest that HRT can have a beneficial effect on these risks too. ### I've had a blood clot, can I have HRT? The short answer is yes. Oestrogen in the form of the patch, gel or spray does not raise your risk of blood clot. (Don’t take oestrogen in tablet form as this does have a slight increased risk of clot). And micronised progesterone (Utrogestan) and testosterone are also safe to take if you’ve had a clot in the past. ### I've had breast cancer, what are my options? When you’ve been through the emotional and uncertain time of having breast cancer and treatments, it’s very important that your menopause is addressed and cared for in the best possible way. Some women feel they do not receive adequate information about their options for improving menopause symptoms and are simply told that HRT is not possible now or in the future. Some medications to treat breast cancer, such as aromatase inhibitors, profoundly suppress your own oestrogen and cause unwanted symptoms that can significantly affect your quality of life. Menopause can be triggered by such medications, or by chemotherapy or radiotherapy, and this may be permanent or temporary depending on your age and type of treatment you’ve had. You may suffer with more severe symptoms if you’ve had breast cancer, but at the time, your energies will be focussed on cancer treatments and surviving. It is often afterwards when you’re hoping to feel better that you realise there are enduring symptoms due to low oestrogen that are troubling you. So what are your options? Talk about how you feel with family, friends, and your breast cancer care team; you don’t need to feel that you can’t speak up about menopause symptoms. Your quality of life is very important. Document your symptoms, especially to show a healthcare professional when you go to seek help for your menopause. Take a look at our menopause symptom checker and use this, if helpful. Do your own research and seek out helpful resources. The charity, Breast Cancer Now, has a useful range of booklets and information. Try and lead a healthy lifestyle with regular physical activity, menopause-friendly nutrition, reduce your alcohol intake and stop smoking, do all you can to have good quality sleep and manage stress levels. Look after your genitourinary health see our information on caring for your vagina and vulva here and reducing infections here. ### What menopause symptoms might I experience? Common symptoms include: Hot flushes and night sweats Sleep disturbances Mood changes and anxiety Memory and concentration issues Vaginal dryness and bladder changes Joint pain Changes in skin and hair Loss of libido ### What is perimenopause and when does it start? Perimenopause is the transitional phase before your periods stop completely. During this time, your periods may become irregular in terms of frequency, duration, or flow as your hormone levels begin to fluctuate. While it typically begins in your mid-40s and lasts 4-10 years, every woman's experience is unique. For some women, perimenopause starts earlier - about 1 in 100 women experience it before age 40, and more than 1 in 1000 women before age 30. Early symptoms often include changes to sleep patterns, increased anxiety, mood swings, and unusual fatigue. These symptoms can come and go as hormone levels fluctuate throughout this transition. Many women choose to start Hormone Replacement Therapy (HRT) during perimenopause to manage symptoms - you don't need to wait until your periods have completely stopped. The symptoms experienced during perimenopause are essentially the same as menopause symptoms because they're all related to changing and declining hormone levels. For optimal health during this transition, maintaining a balanced lifestyle with regular exercise, good sleep patterns, and stress management can help manage symptoms. Regular monitoring with a healthcare provider can help determine if additional support, such as HRT, might be beneficial for your specific situation. ### How do I know if I am in menopause? The definition of menopause is when you haven’t had a period for 12 consecutive months (and there’s no other reason for this like weight loss, illness, the type of contraception used, or medical treatment or surgery). On average, a natural menopause happens around the age of 51 but it can happen earlier or later than this. You may or may not have any symptoms, but 80% of women do experience menopause symptoms at some point. If you are still having periods (even if only light or occasionally) and are noticing menopause symptoms, you may be in perimenopause. This is the transitional phase before periods completely stop, and it can last for several years. You may not know whether you’re in menopause because you don’t get periods due to the type of contraception you use, so pay attention to any symptoms you may be having that can suggest it might be menopause related. If you’re over 45 years and have one or more symptoms of menopause, you don’t usually have to have a blood test to diagnose peri/menopause as it is a diagnosis based on symptoms not blood results. If you’re under 45, and especially if you’re under 40, there are usually some blood tests that may be done to rule out other causes for your symptoms or to investigate things further. ### What is Primary Ovarian Insufficiency or POI? More than one in 100 women have menopause before they are 40 years old, one in 1000 before the age of 30, so it is not so rare. When your ovaries stop producing eggs and hormones at this earlier age, it is diagnosed as Premature Ovarian Insufficiency or POI. The process of menopause is different to a later ‘ordinary’ menopause in that it is an autoimmune condition in which the body may attack the eggs or the hormonal receptors to make them not function. You usually have 2 blood tests (a few weeks apart) to check your hormone levels to diagnose POI. POI can be caused by autoimmune conditions that mistakenly attack ovarian tissue treatments for cancer like chemo or radiotherapy some genetic conditions such as Fragile X or Turner Syndrome surgery that removes or impairs your ovaries Symptoms of POI are the same as menopause, as they all relate to the body reacting to a lack of oestrogen, progesterone and testosterone. Your fertility may be compromised as there will not be a monthly release of an egg. (There may be an occasional egg released though, so if you’re having penis-vagina sex, contraception is still advised if a pregnancy is not desired). The health risks associated with menopause become particularly important if you’re diagnosed with POI, as you will be living longer without these important hormones. The main two diseases of concern are the bone weakening disease osteoporosis and cardiovascular disease that may lead to circulation problems, heart attack or stroke. It is strongly recommended that HRT is taken to reduce these risks, at least until the average age of a typical menopause at 51 years. You will also be at risk of genitourinary syndrome of menopause (GSM) and may be advised to use vaginal oestrogen, which helps reduce any dryness, thinning and fragility of the genital tissue as well as minimising the risk of incontinence and infections. Some women choose to use contraception to provide the hormones – which can feel more age appropriate if you’re in your 20s or 30s. However, treating POI symptoms with birth control does not help reduce the risks to future health diseases mentioned as much as traditional HRT. You ought to have bone scans to check the strength of your bones at diagnosis and regular intervals. Living a clean lifestyle is also very beneficial to living with POI. Many women find it helpful to gain support from other women with POI. There is a charity called the Daisy Network that has information and support groups for this. ## Saswp ### Review ### Service ### Organization