Over 45 the menopause is diagnosed from symptoms and not from a blood test. Hormone treatment is effective for flushes, sleep and mood, and a GP with women’s health training can prescribe it at the first appointment. A 30 minute consultation is £150 and the review is £59.
Message the clinic and a doctor replies within 24 hours.
Any of these needs to be seen the same day. If you are severely unwell, go to your nearest emergency department or call 999.
Menopause is the point 12 months after your last period, and in the UK it happens on average at 51. The years before it, the perimenopause, are when most symptoms arrive and they can start in your early forties while periods are still regular.NICE NG23, 2024
Hot flushes, broken sleep, low mood, anxiety, difficulty concentrating, joint aches, changes in periods and vaginal dryness are the common ones. Many women are told it is stress or age. Both explanations are cheap and neither is treatable.NICE NG23, 2024
The cause is falling and fluctuating oestrogen as the ovaries stop releasing eggs. Fluctuation is why symptoms come and go and why a hormone level taken on one day says little about the month.NICE NG23, 2024
An underactive thyroid produces tiredness, low mood, cold intolerance and heavy periods, and it is the mimic most often missed in this age group. A TSH is the single test worth doing where the picture is not typical.NICE NG145, 2019
Periods often become heavier and less predictable during the perimenopause. Heavy bleeding at this stage is treated on its own terms, with iron checked and a treatment chosen for the bleeding, rather than folded into a hormone prescription and left.NICE NG88, 2021
Send us what you are seeing and we will tell you what it is likely to be.
Over 45 the diagnosis is made on symptoms alone and no blood test is needed. The appointment is a history, your periods, what has changed, your own risk profile and what matters most to you, then a decision about treatment.NICE NG23, 2024
Under 45, or where the picture is unclear, hormones and thyroid are checked, because premature ovarian insufficiency is treated differently and for longer. Blood pressure and weight are recorded, because they change which preparation suits you.NICE NG23, 2024
Bleeding that starts again after 12 months without a period is not menopause and is not treated as such. It needs a gynaecology opinion on the urgent pathway, which we arrange rather than describe.NICE NG12, 2015
Doing nothing
A reasonable choice. Symptoms settle for many women within a few years, and treatment is for how you feel now rather than a disease that must be treated.NICE NG23, 2024
Cognitive behavioural therapy
Has evidence for flushes, sleep and low mood, and suits women who cannot take hormones or would rather not.NICE NG23, 2024
Non hormonal medication
Several prescription options reduce flushes without oestrogen. They work less well than hormone treatment and are the right answer where hormones are not an option.NICE NG23, 2024
Vaginal oestrogen
Treats dryness, discomfort and recurrent urinary symptoms. It acts locally, can be used long term, and can be used alongside systemic treatment or on its own.NICE NG23, 2024
Systemic hormone treatment
Oestrogen through the skin with progesterone where you still have a womb, and testosterone where libido has not responded. Through the skin rather than by tablet does not carry the clot risk that oral oestrogen does. The benefit and the breast cancer number are set out together before you decide.General Medical Council GMC guidance, 2020
Flushes and sleep usually improve within 4 to 8 weeks of starting treatment. Mood and concentration take longer and are reviewed at 3 months, which is when the dose is adjusted rather than abandoned.NICE NG23, 2024
The inconvenient number. Combined oestrogen and progestogen taken for 5 years from age 50 is associated with roughly one extra breast cancer per 50 users over 20 years, and oestrogen alone with roughly one per 200. The risk is dose and duration related and it falls after stopping. It is discussed as a number rather than as a reassurance.The Lancet Beral, 2019
Started under 60, or within 10 years of the menopause, hormone treatment does not raise cardiovascular mortality, and oestrogen through the skin does not carry the clot risk tablets do. Cardiovascular risk is assessed at the same appointment because it changes at this age for reasons that have nothing to do with treatment.NICE NG238, 2023
Keep a 4 week diary before the appointment. Date, flushes per day, hours slept, mood out of 10, and the dates of any bleeding. It takes a minute a day and it turns a vague history into something a doctor can treat and then measure against.
Bring three numbers if you have them. Your blood pressure, your weight and the date of your last period. Blood pressure and weight change which preparation is suitable, and the last period date is what decides whether a blood test is needed at all.NICE NG23, 2024
Ask yourself one question before you come. What would you most like back, sleep, mood, energy, sex, or concentration. Treatment is judged against that answer at 3 months rather than against a hormone level.
Do not buy a private hormone panel if you are over 45 with typical symptoms. Levels swing week to week, a single reading changes nothing about the decision, and the money is better spent on the appointment that makes it.NICE NG23, 2024
Do not buy compounded bioidentical hormones from a clinic that mixes its own. They are unregulated, the dose is not guaranteed and the progesterone component may not protect the womb lining. Regulated body identical preparations do the same job and are prescribed here.British Menopause Society BMS consensus statement, 2024
Do not buy a supplement for flushes before you have had a ferritin and a thyroid check. Low iron and an underactive thyroid produce the same tiredness and are corrected rather than masked.Gut Snook, 2021
Step 1
30 minutes with a GP trained in women’s health. Symptoms, periods, history and what matters most to you.
Step 2
Whether hormone treatment is right for you, which form, and what the numbers mean for you rather than for the average woman. Blood tests only where they change the decision.
Step 3
A prescription the same day where it is appropriate. A telephone review adjusts the dose against the diary you kept, and the record follows you.
Ask before you book if you are not sure this is the right appointment.
For most women under 60, or within 10 years of menopause, the benefits outweigh the risks. Oestrogen through the skin does not raise clot risk the way tablets do. Combined treatment carries a small increase in breast cancer risk that rises with duration, around one extra case per 50 women using it for 5 years from age 50.
Over 45, no. The diagnosis is made on your symptoms and your periods, because hormone levels swing from day to day and a single reading does not change the decision. Under 45, or where something else may be going on, hormones and thyroid are checked and the Advanced panel is £650.
Yes, where it is appropriate for you. The consultation covers your history, your blood pressure, your own risk profile and the form that suits you, and you leave with a prescription and a date for the review rather than a leaflet and a second appointment.
It can help libido where oestrogen alone has not, and in the UK it is prescribed off licence for women, which means outside the terms the product was authorised for. The doctor will say whether it is worth trying in your case and what monitoring goes with it.
There are non hormonal prescriptions that reduce flushes, cognitive behavioural therapy with evidence behind it for flushes and sleep, and vaginal oestrogen for dryness which acts locally. Nobody is turned away because systemic treatment is not right for them.
The first appointment is £150 for 30 minutes in person. The 3 month review by telephone is £59. Where a blood panel is needed the Advanced Health panel is £650 and the Core panel is £350. Prescriptions are dispensed separately and priced by the pharmacy.
There is no arbitrary stopping date. The decision is reviewed at least once a year against your symptoms and your risk profile, and the risk from combined treatment rises with duration, so the conversation is about whether it is still earning its place rather than about a limit.
Some policies cover menopause consultations and many exclude them as a chronic condition. You receive an itemised receipt suitable for a claim, so ask your insurer what is covered before you book rather than afterwards.
This page is general information about a condition and it is not a diagnosis. Treatment depends on what a doctor finds when they examine you, and no outcome is guaranteed. If you are severely unwell, or if any of the warnings at the top of this page apply to you, go to your nearest emergency department or call 999.
British Menopause Society
Tools for clinicians, hormone replacement therapy and the risk of breast cancerBMS consensus statement, 2024
General Medical Council
Decision making and consentGMC guidance, 2020
Gut, British Society of Gastroenterology
Guidelines for the management of iron deficiency anaemia in adultsSnook, 2021
NICE
NICE
Thyroid disease, assessment and managementNG145, 2019
NICE
Heavy menstrual bleeding, assessment and managementNG88, 2021
NICE
Cardiovascular disease, risk assessment and reduction, including lipid modificationNG238, 2023
NICE
Menopause, identification and managementNG23, 2024
The Lancet
Written and reviewed by the clinical team at The Wellness. Last reviewed 8 September 2026.
Tell us what is going on and a doctor will say what to book, or whether you need to be seen today.