Answering Your Questions
FAQs
Knowledge
Our FAQs are designed to help answer your questions about our service
Accessibility & Administration
Our clinic is based in Weston-super-Mare, at Cowan House. Our full address is:
Menopause Clinic WSM
Cowan House
21 Ellenborough Park North
Weston-super-Mare
BS23 1XQ
Our clinic at Cowan House is located close to the centre of Weston-Super-Mare, looking out upon the conservation area of Ellenborough Park. It is easily accessible via public transport, and is walking distance from the train station. Both the number 3 and 7 bus routes are located close by.
Our clinic at Cowan House is wheel chair friendly and currently provides a lift, ramp, disabled parking, and a large downstairs disabled WC. We strive to provide our patients with total accessibility, there is a comprehensive list of disabled access which can be viewed by following the link at Cowan House: https://www.cowanhouse.co.uk/accessibility.html.
The full accessibility guide can also be found via https://www.accessibilityguides.org/content/cowan-house
There is limited parking onsite however there is on street parking available with some meter payment in some areas near the clinic.
We provide both in-person and virtual clinics for both initial and follow up appointments.
We will request you submit photo ID from either your driver’s license or passport to confirm your identity prior to any appointment.
Your ID information will be stored on our secure clinical records.
The Menopause
We know that post-menopausal people have a 1 in 3 risk of osteoporosis, 45% risk of cardiovascular disease and an increased risk of type 2 diabetes and vascular dementia with the loss of circulating oestrogen when transitioning into the menopause. To help people stay healthy and reduce their long-term health risks, HRT alongside lifestyle modifications can support people living well and reduce these risks.
We have 3 key hormones: oestrogen, progesterone, and testosterone.
Oestrogen is an anti-inflammatory hormone. We have oestrogen receptors throughout our body Including vital oestrogen hormones transmitting to our brain to regulate temperature. We have vital oestrogen to help with our muscle and bone health, heart and brain health, gut and bowel health. Oestrogen helps to keep our genitourinary tracts lubricated and plump. It also helps to stabilise our natural PH and bacterial balance which in turn reduces vaginal dryness and urinary infections.
Progesterone influences the impact on menstrual regulation, mood, and sleep.
Testosterone, which is produced both in the adrenal glands and ovaries, helps with our sexual function and anecdotally supports muscle strength, cognitive function, and psychological well-being.
The short answer is no, you don’t need to use HRT if you feel it would pose no benefit, however, if you feel your quality of life could be improved, this is an entirely valid pathway to explore, and we would be delighted to support you.
Transitioning through menopause is a time to think about your health and well-being. It’s an opportunity to take time to refocus on what lifestyle changes you may wish to consider such as keeping active and healthy for your post menopause years to improve your overall long-term health.
Starting HRT within the first 10 years of menopause or before the age of 60 offers the best long term health outcomes with menopause. This does not mean you are excluded from a trial of HRT and having an appointment to discuss your symptoms will help determine the best evidenced based options for you. If you choose to commence HRT you will be offered transdermal body identical HRT. This means the oestrogen products will be provided to use through the skin reducing the risk of blood clots.
Preparing for Your Appointment
Yes, we ask you to complete one prior to confirming an appointment for an initial assessment and any follow ups so we can review your progress and identify any unresolved issues. This can really help with tracking progress. The link will be sent to you at the time of booking your appointment.
No this is not necessary. The times you will be asked to complete a MSQ is for initiating or reviewing systemic HRT product use for menopause management.
People over the age of 45 who would like to discuss menopause and HRT do not need to have blood tests to diagnose menopause. You may be advised to have bloods following your menopause consultation depending on the history you provide and the symptoms you are experiencing to identify any other health concerns discussed at your appointment.
People who are between 40-45 years may be offered a follicle stimulating hormone (FSH) blood test before their menopause consultation if you are having menopausal symptoms and changes to your menstrual cycle. FSH blood levels alone are not a reliable diagnosis in themselves, and we diagnose menopause using your clinical symptoms alongside other investigations.
People under the age of 40 years will be asked to have a set of blood tests prior to their initial consultation. One of the tests you will be asked to do is a follicle stimulating hormone (FSH). Ideally taken twice at 4–6-week intervals. FSH is found in higher levels in menopause. You should not be offered this test if you are taking the combined oral contraceptive pill or high dose progestogen such as the Depo Provera because the contraceptive changes your natural FSH levels. It is possible to measure your levels when you have a Mirena coil in place.
We use a laboratory called Nationwide Pathology. Once a form has been generated from the clinic you can contact them on 01858571322 to book an appointment with one of their phlebotomists. The costs of the blood tests will be discussed at your appointment and you will be advised of the phlebotomy charge when booking with them. They have over 150 centres across the UK and may also be able to send a phlebotomist to your home address. Blood test results will be discussed at your review appointments unless you opt to book a charged telephone call to discuss them sooner.
Using Hormone Replacement Therapy
When starting any new medication our bodies need time to adjust. This can feel frustrating and unsettling especially if you have heard other people feel fantastic as soon as they start their HRT. The oestrogen dose you start off on may not be sufficient initially to make you feel better. Often the first signs of improvements are reduction of night sweats and day time flushes. This means the oestrogen is absorbing and working. The goal is to find the right dose for you. One size does not fit all!
Fluid retention, breast tenderness, bloating, nausea, and headaches. Other less common symptoms may be experienced and should be discussed with your specialist nurse.
If symptoms do not settle these will be reviewed and discussed at your planned follow up. You may need to amend your product by changing the route, consider reducing your dose or change the product you are using. If no planned appointment is booked and you are struggling, please contact the team via .
When starting any new medication our bodies need to time adjust.
We typically suggest the first 3 months are the time for your new HRT to settle in. It is possible to feel worse before you feel better which can be very frustrating and leave you feeling uncertain.
The typical common side effects of progesterone are fluid retention, breast tenderness, bloating, headaches, mood changes and premenstrual like symptoms. Other less common symptoms may be experienced and should be discussed with your specialist nurse.
If symptoms do not settle these will be reviewed and discussed at your planned follow up. You may need to amend your product by changing the route, consider reducing your dose if possible or change the product you are using.
When starting HRT, increasing, or decreasing the dose of HRT, or when you have changed HRT products, there is a possibility of unscheduled and unexpected bleeding. Bleeding occurs when the lining of your uterus (endometrial lining) is stimulated by the Oestrogen products you are using. Your body needs time to adapt to the HRT you are prescribed.
If you are experiencing bleeding, please document the days you are bleeding and approximately how much blood loss i.e., light, spotting, only on wiping or heavy and painful. The more detail the better when letting the team know. Please write the dates of the blood loss, frequency of loss and duration of bleeding.
Generally, the bleeding will settle within the first 3-6 months of starting HRT. If the bleeding continues, we will want to investigate this. We may also need to adjust the dose or change the type of HRT you are using.
It is important to use the HRT medication according to the directions from your specialist nurse. We also ask you to arrange a 3 month follow up when a dose or product amendment has been made to your prescription.
For most people starflower capsules and topical ibuprofen gel can really help if breast tenderness becomes a problem when starting or increasing your dose of HRT. It is advisable to use Starflower capsules without additional vitamins so that you can increase the number of capsules daily without overuse of recommended other vitamins. When you attend your review, we will want to know if you have experienced any negative side effects from the HRT products you have been using.
HRT Practical Application and Use
Please follow the prescription instructions discussed at the time of your appointment.
Please apply the gel to clean dry skin on the outer arms, shoulders, or inner thighs, rubbing the gel in thoroughly. Once you increase beyond 2 pumps or sachets daily, split the dose between morning and evening. Ensure your skin is completely dry before you get dressed or have intimate contact.
Do not apply the gel to your breast tissue. Avoid applying other creams including sunscreen for a minimum of one hour after gel application. Do not go swimming within an hour of applying the gel. Please wash your hands after gel application.
There are a total of 64 pump doses per bottle.
2 pumps daily = one month
3 pumps daily =3 weeks
4 pumps daily = 2 weeks
The patches need to be applied to clean dry hair free skin below your waist on the lower abdomen, thigh, or buttock. Cup your hand over the applied patch so that the heat of your hand will seal the patch in place. The patch needs to be changed twice weekly and having a set day of the week helps with this routine. It is typical for the patch to leave marks on the skin. We suggest you use some oil such as almond or olive oil and a soft cloth to remove any residual glue from the patch. We advise you to rotate the patches to help with maintaining good skin health. If a patch comes off early, you can immediately just reapply another patch to replace it.
Please follow the prescription instructions discussed at the time of your appointment.
The container should be held upright and vertical for spraying. Before a new applicator is used for the first time, the pump should be primed by spraying three times into the cover.
Please apply the spray to clean dry skin on the forearm between the elbow and the wrist. Once you increase beyond 2 sprays daily, split the dose between morning and evening. Ensure your skin is completely dry before you get dressed or have intimate contact. Avoid overlapping spray sites if 2 or more spray doses are applied to the same arm.
Do not apply the spray to your breast tissue. Avoid applying other creams including sunscreen for a minimum of one hour after gel application. Do not go swimming within an hour of applying the spray. You should cover the application site with clothing if another person may come into contact with that area of skin after the spray dries. The site of application should not be washed for 60 minutes. Do not allow another person to touch the site of application within 60 minutes of application.
After delivery of 56 sprays, the container must be discarded even if there is some leftover solution in it. The number of sprays made should be marked using the table on the carton. As drug residue will remain in the used-up containers, they should not be disposed of via household waste. Empty containers should be returned to the pharmacy for disposal.
Utrogestan is a micronised progesterone, so it is “body identical”. This means that it has the same molecular structure as the progesterone we produce in our bodies. It is less likely to cause side effects than other types of progesterone. It has a mild sedative effect so is best to take at night. Some people experience some irregular bleeding when they start this progesterone, but this should settle within 3-6 months.
Some people experience side effects initially, which can include abdominal bloating, lower abdominal pain or discomfort, dip in mood and breast tenderness. If this is problematic for you, please get back in contact as we can look at ways to help.
Please note Utrogestan is made from plants including Yam. Utrogestan contains gelatine and soybean.
Utrogestan is taken either sequentially (cyclically) or continuously. You will have discussed with the specialist nurse which method is correct for you.
Oestrogen taken alone will cause thickening of the lining of the womb,
To prevent this, it is important that you use a progesterone medication.
Typical use would require you to take 1 capsule at bedtime each night on an empty stomach or if taken cyclically you are going to take 2 of the 100mg together at night for 2 out of 4 weeks starting on the 1stor 15th of the month according to the first day of your last period before commencing HRT.
You should stop eating 2 hours before taking the Utrogestan at bedtime.
Using Utrogestan by inserting into the vagina is an off-license approach and this needs to be discussed with the specialist menopause nurse. The regime is the same as per oral approach. This means either inserting a capsule every night before bed or 2 capsules taken for 2 weeks every month.
All medicines should be stored safely and out of reach from children and pets.
Do not refrigerate or freeze.
Do not store above 25°C.
If you have surplus stock of HRT you no longer wish to use, then it is recommended for you to return them to your local pharmacy for disposal. Please do not dispose these items via general household waste collections.
It is also recommended to return used oestrogen spray cannisters to your local pharmacy for disposal.
When removing used transdermal patches, it is recommended that you fold the adhesive sticky side in half to seal together and inserting into an empty pouch before discarding.
Yes, the Mirena coil is a fantastic progestogen hormone to help support the endometrial lining when using Oestrogen products. It is also a ‘gold standard’ for supporting heavy menstrual bleeding which can be particularly problematic in the perimenopause. It is used for both contraception and HRT. It can remain in place for a maximum of 5 years when used off-license before needing to be changed when using for HRT. The Mirena coil can be used alongside oestrogen gel, patch, spray, or tablet as part of combination HRT. You can request using a Mirena coil even if you have previously been sterilised or if you have never had a pregnancy.
Complex Health and HRT
Taking your oestrogen transdermally (through the skin) is not associated with an increased risk of clot. Taking it as a patch, gel or spray also results in a more reliable absorption into your body and the dose of the oestrogen can be changed more easily.
If you have a past medical history of blood clots it is important to inform your specialist nurse as part of your consultation history when requesting support with menopause and HRT.
Taking your oestrogen transdermally (through the skin) is not associated with an increased risk of migraine. Taking it as a patch, gel or spray also results in a more reliable absorption into your body and the dose of the oestrogen can be changed more easily. Sometimes when increasing the oestrogen dose, it is possible to experience some additional aura’s however these should settle once your dose stabilises. Often the first choice for people who suffer from migraines is the transdermal patch to enable consistent absorption over the 24 hours, but the main focus is on the individualised approach for each person.
Testosterone Therapy
Testosterone is an area of health in which more research is needed in the UK.
Testosterone can work to improve libido and it can also help to improve mood, energy, and concentration, as well as bone and muscle strength. There is not currently a testosterone product licensed in the UK for people assigned female at birth (AFAB). In our clinic we usually prescribe AndroFeme, a testosterone cream made especially for people assigned female at birth in Western Australia. This is a regulated product. Using testosterone does require annual blood test monitoring.
We also prescribe Testim and Testogel which are other products used off license. Not all people notice the impact of testosterone depletion and therefore may not want to use it. If you are thinking about testosterone as part of your HRT management, you will need to have a detailed consultation to understand the aims for adding this into your HRT management.
You need to consider risks and benefits of the treatment and agree to routine bloods which will be repeated 3 monthly and move to annually once stable. It takes up to 6 months to notice a difference with testosterone and if there are no significant improvements with testosterone therapy there would be no benefit continuing with this product. We have a detailed patient information leaflet if you are considering this as part of your management.
Further information can be found at https://www.womens-health-concern.org/help-and-advice/factsheets/testosterone-for-women/.
Genitourinary Health
Experiencing vaginal dryness and soreness and bladder irritation, frequency or urgency can be severely debilitating through our menopause transition. This is a time we naturally loose collagen and oestrogen from our genitourinary skin. This can affect our PH and bacterial balance in our genitourinary area.
We recommend some amendments to your intimate hygiene and suggest an emollient wash such as Aveeno, Zero-Base or Cetraben rather than soap-based products. Alternatively, you may wish to purchase Yes or Sylk foam wash which are safe to use and not soap-based. We suggest you try vaginal moisturisers such as YES and Sylk organic ranges to support any vaginal dryness and can be used on both external skin and internally twice daily. These products can be bought online.
Localised oestrogen pessaries, creams and rings will benefit both urinary symptoms and vulvovaginal dryness. Vaginal oestrogen products are very low dose and are safe to use alongside your current HRT. Primarily you are going to use pessaries and creams every night for 2 weeks and then reduce to twice weekly. It takes approximately 3 months to notice any significant improvements with genitourinary health. For some people it can take up to a year. If you experience no improvements after the first 3 months, please arrange an appointment for examination. The E-String (ring) is a soft, flexible ring used after menopause that continuously releases oestrogen over 3 months (before needing changing) to treat menopausal changes in and around the genitourinary area.
Localised topical products can be safely used alongside systemic HRT or as a stand-alone treatment.
Lifestyle and Non-Hormonal Approach to Menopause
Most people who are sexually active during the perimenopause and menopause need to consider their risk of pregnancy and methods of contraception. Although pregnancy is less likely during the perimenopause and menopause it is still an important consideration and there are a wide variety of contraception methods which can be safely used alongside HRT. Pregnancy testing will be offered as part of your investigations if you have prolonged bleeding when using HRT.
During your menopause transition you may have sexual intimacy with new partners. It is an important consideration to access sexual health screening for early detection of infections. Screening kits can be accessed via your GP service or online at:
https://www.unitysexualhealth.co.uk/request-postal-kit-using-online-account/
Sexual health screening will offer as part of your investigations if you have prolonged bleeding when using HRT.
Whilst there is no hard evidence, some people find magnesium with B vitamins helpful for general relaxation, sleep, aches and pains, migraine. We recommend you have a look at Emma’s nutrition at www.emmasnutrition.co.uk or the organic pharmacy www.theorganicpharmacy.com.
The NHS recommends 400 iu daily however we recommend a slightly higher dose of 800-1000 iu daily through taking either an oral tablet or oral spray. Oral Vitamin D3 is relatively inexpensive to buy over the counter at the local pharmacy. We recommend you take it throughout the year even in spring and summer to reduce a risk of deficiency. Vitamin D deficiency has very similar symptoms to the menopause.
We can absorb Vitamin D via food sources however it is often insufficient for our overall needs. The following website offers excellent information:
https://www.nhs.uk/conditions/vitamins-and-minerals/vitamin-d/
Sun exposure to the arms and face in the mid-day sunlight for 20-30 mins daily is a great boost to Vitamin D. Please be careful with sun exposure and burning.
NICE Guidelines state herbal remedies which are not regulated by a medicine authority should not be considered safer, as there is much variety in their effectiveness and potency and that there may be significant side effects. The same warning is given for bio-identical hormones which are compounded and again not regulated or subject to quality control. It is always important to check whether any ‘natural remedies’ negatively interact with prescription medications. Guidelines recommend that you look for the THR logo standing for traditional herbal medicines. Therapies such as acupuncture, hypnotherapy, and cognitive behaviour therapy (CBT) are recognised to have positive benefits in managing the symptoms of menopause independent of HRT.
In your consultation, the specialist nurse will discuss the importance of a healthy lifestyle and how what we call modifiable risk factors can influence the risk of breast cancer and overall health. The most important of these are aiming to stop smoking, maintain weight within the normal BMI range, eating a Mediterranean diet with reduced processed foods and sugars, keeping within the recommended alcohol limit of 14 units per week and moderate aerobic exercise for at least 150 minutes a week plus strength training which is beneficial for bone health and maintaining muscle mass.
Ideally, you want to find exercises which you enjoy and have fun with and will therefore feel inspired to continue. Walking, running, cycling, dancing, Yoga, Pilates, cold water swimming, tennis, badminton, and resistance training are all ideas of what you could try for both physical and mental well-being whilst transitioning into your menopause and beyond.
(Menopause Clinic WSM is not responsible for the content contained in any of the websites listed above).