fbpx

Support Centre

Home > Support Centre > Menopause

Menopause

Menopause symptoms and treatments.

Book a consultation.

If you have any questions or concerns about menopause, please book a consultation.

Don’t worry alone, we’re here to help.

Book Now
Are you experiencing menopause symptoms?

Take our free, online menopause assessment to help identify your symptoms and where you might be on your menopause journey.

Menopause Assessment

Systemic HRT

HRT is the umbrella term used for hormone replacement therapy, the most effective treatment available for symptoms of perimenopause and menopause. There are three hormones used in HRT medications, oestrogen, progesterone, and testosterone.

Below is a list of the different types and ways to take these hormones as part of HRT. These treatments all enter the bloodstream and are referred to as ‘systemic HRT’.

This is one of the most popular ways to take oestrogen and the gel is applied once a day to skin on the upper arm or inner thigh. It comes in a pump action bottle, and your prescriber will tell you how many pumps a day to use. The hormone in the gel is absorbed through the skin and enters the bloodstream. It’s easy to change the dose (if directed by your doctor), the gel takes a few minutes to dry before dressing, and there are no visible signs that you’re using HRT.
These are sticky patches that go on the skin a bit like a plaster. You apply them to your thigh or buttock (non-hairy places are best) and change it (usually) twice a week. The hormone is absorbed into the skin and enters the bloodstream, delivering a steady, continuous dose of oestrogen. Patches can sometimes leave a sticky residue when removed, and some people have a skin reaction to the adhesive used in some of the patches. The patch is visible but clear and usually worn discreetly.
Similar to the gel, the spray is applied once daily to the skin on the inner forearm, or inner thigh. You will be told how many pumps of spray to use. It is quick to dry and covers a smaller area than the gel.
Oestrogen in an oral tablet is used less nowadays as through-the-skin routes (transdermal) are safer like a patch or gel, and these are made from a more natural type of oestrogen than that in an oestrogen tablet. There is a very small risk of developing a blood clot with the oestrogen tablet.
These are similar to the oestrogen patches but they also contain the hormone progesterone. (If you still have a womb, you will need to take the hormone progesterone if you’re taking oestrogen, to prevent the womb lining getting too thick and to keep the cells healthy). Combination patches can be useful if you want only one HRT preparation, however it is harder to adjust the dose of oestrogen when using combination patches. Sometimes you need to alter your dose of oestrogen to get better symptom control, but you don’t necessarily need to change your progesterone dose. For this reason, many women take oestrogen and progesterone in separate ways.
There is a tablet that contains the more natural (body identical) type of oestrogen and progesterone in a single tablet (called Bijuve in the UK). If you still have a womb, you will need to take the hormone progesterone if you’re taking oestrogen, to prevent the womb lining getting too thick and to keep the cells healthy. Combination tablets can be useful if you want only one HRT preparation, however it is harder to adjust the dose of oestrogen when using combination tablets. Sometimes you need to alter your dose of oestrogen to get better symptom control, but you don’t necessarily need to change your progesterone dose. For this reason, many women take oestrogen and progesterone in separate ways.
If you have a womb, and you start taking oestrogen replacement, you also need to take a progesterone. Progesterone keeps the womb lining healthy and thin, as oestrogen taken on its own can thicken it. Micronised progesterone is a body identical type of progesterone and is available in a capsule that you swallow. In the UK, this medication is called Utrogestan. This type of progesterone is more body-friendly than the synthetic progesterone usually found in contraception and there are no known risks with micronised progesterone. It also has mild sedative properties so if taken in the evening, it can aid sleep and may help with anxiety too. Depending on when you last had a period, you will either be prescribed Utrogestan on a continuous basis, or in a pattern of 2 weeks on / 2 weeks off, which is called a sequential (or cyclical) combined HRT regime. If you take Utrogestan in this way, it’s common to have a withdrawal bleed in the weeks you’re not taking it, a bit like a period.
This is a device used for contraception and for treating heavy periods but it can also be used to provide the progesterone component of HRT. The Mirena is an intrauterine system, sometimes referred to as a coil, that releases a low and steady dose of a synthetic progesterone called levonorgestrel. It is a small, plastic T shaped device (around the size of a small matchstick) that is inserted into the womb and it lasts for 5 years. A Mirena coil has the added benefit of providing contraception (if needed), and if you’re troubled by your periods, they usually become a lot lighter or disappear altogether when fitted with a Mirena
Women produce testosterone too, and it declines sharply at menopause. Many women find it beneficial to take a low dose of testosterone in addition to oestrogen (and progesterone).  Menopause specialists and the women they support have observed testosterone replacement can help improve levels of energy and stamina, sex drive and level of pleasure, mental focus, quality of sleep, and mood stability. Although testosterone is only licensed for use in menopausal women suffering from very low sex drive, it can be prescribed ‘off-licence’ to help with these other symptoms, which many GPs and menopause specialists are now doing. There is a testosterone cream designed for women called Androfeme (not available on the NHS but available at Summerhill Health), or there are gel preparations that are produced for men but can be taken in lower doses by women. The gels are branded as Testogel or Testim, these are cheaper and available on the NHS if the prescriber is willing to do so.

Hormonal Treatments

Below is a list of hormonal treatments that are only for the vagina and vulva. These are called local or vaginal oestrogen treatments, and they are not the same as HRT as there is not the same absorption into the bloodstream.

These treatments are used for Genitourinary Syndrome of Menopause (GSM) which includes symptoms of vaginal dryness, soreness of the vagina and vulva, urinary urge, frequency and incontinence, and recurrent UTIs.

With the help of an applicator, a small tablet is inserted high into the vagina, initially every night for two weeks, and then twice weekly after this. It’s usually inserted at nighttime so it stays in place while asleep. The medication contains oestradiol (a type of oestrogen) and is branded as Vagifem or Vagirux.
The pessary is inserted into the vagina using your fingers, you insert one every night for 3 weeks, and twice weekly after this. It’s usually inserted at nighttime so it stays in place while asleep. There may be a waxy discharge with the pessary, and it also affects the effectiveness of condoms. The hormone in the pessary is estriol (a type of oestrogen), and it is branded as Imvaggis.
This comes with an applicator which you fill with the gel and insert into the vagina daily for 3 weeks and then twice weekly after this. The gel is absorbed quickly, but there may be some itching or irritation when first used. It contains the hormone estriol (a type of oestrogen) and is branded as Blissel.
An applicator full of cream is inserted into the vagina daily for 2 weeks and then twice weekly after this. It can be a bit messy, but you can also use the cream on your vulva if this is sore or dry too. It’s usually inserted at nighttime so it stays in place while asleep. The hormone is estriol (a type of oestrogen) and is branded as Ovestin.
This is a bit different to the other vaginal treatments listed. A soft silicon ring is inserted into the vagina either by yourself or by a healthcare professional and it can stay there for 90 days (or be removed and replaced for sex if preferred). It releases a steady dose of the hormone estradiol (a type of oestrogen) and is called an Estring. This method has the advantage of there being no daily or weekly application and it doesn’t have the residue or discharge issues that the other types sometimes do.

 

With all types of HRT and vaginal treatments, it can take 2-3 months before you start to feel the full benefits, so it’s always worth taking time with new medications to see if they’re going to work for you. And it’s common to need to alter the dose after an initial trial period.

You would usually have a review appointment after approximately 3 months to see how you’re getting on and adjust your dose if needed. After this, if you are well and happy with your regime, you can continue with a review of your HRT every 12 months.

Although HRT can seem complicated at first, Dr Natalie Summerhill will take the time to explain your options thoroughly and look to find a treatment regime that works for you. She will explain clearly when, how, and how often you need to take any medication prescribed for you.

Frequently asked questions and answers.

The list below contains some frequently asked questions and answers relating to menopause. If you would like to talk to a menopause expert about your own questions or concerns, please book a consultation so we can create a personalised care plan and discuss any recommendations for treatment.

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 […] Read more
For most women, HRT is safe and is the most effective way to treat menopause symptoms. If you’re under 51 years, there are no known associated risks with taking oestrogen through the skin (via a patch, gel or spray) and micronised progesterone (if you have a womb). These are the safest types of hormones and […] Read more
Perimenopause is the time before menopause when you still have periods (even if they’re very light or irregular). Menopause is not medically diagnosed until it has been 12 months with no periods. Perimenopause is caused by fluctuations in hormone levels before they steadily decline going into and after menopause. Perimenopause lasts on average between 4-10 […] Read more
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 […] Read more
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 […] Read more
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. […] Read more
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, […] Read more
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 […] Read more
There are no hard and fast rules to answer this question, as every person’s menopause is unique to them. On average, perimenopause lasts around 4-10 years and then after menopause (12 months with no periods), you may get symptoms for another 5 years or so. It is common for women to experience symptoms for a […] Read more
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 […] Read more
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 […] Read more
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 […] Read more
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 […] Read more
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 […] Read more
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 […] Read more
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 […] Read more
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 […] Read more

Useful Links

Information/support about menopause
https://www.menopausematters.co.uk/
https://thebms.org.uk/

https://menopausesupport.co.uk/

Information/support about PMS/PMDD
https://www.pms.org.uk/

Information/support about POI (menopause below the age of 40)
https://www.daisynetwork.org/

Information/support about subfertility:
https://fertilitynetworkuk.org/

Find a pelvic floor physiotherapist:
https://thepogp.co.uk/patients/physiotherapists

Support for endometriosis/pelvic pain:
https://www.endometriosis-uk.org/get-support

Plane

Newsletter Signup

Enter your email address to sign up to our newsletter to stay up-to-date with our latest news, plus helpful information on menopause and women’s health.
You can unsubscribe at any time.

Newsletter Signup