All women should have access to individualised and up to date advice for the Perimenopause and the Menopause, but this is not always the case.
Dr. Trish Davis provides patient centred care with menopause at the heart of the discussion.
At the Rebalance Your Life clinic we aim to support and guide women individually, with particular reference to the role of hormone replacement therapy (HRT) in line with guidance from the British Menopause Society as well as discussion of diet modification and lifestyle advice.
In addition, men can have testosterone management in accordance with guidance from the British Society for Sexual Medicine.
Dr. Davis is a member of and holds the Certificate in Menopause Care from the British Menopause Society.
Hormone Replacement Therapy
As recommended by the British Menopause Society we use regulated Body Identical hormone therapy which is the safest kind of HRT.
Non-regulated Bioidentical HRT otherwise called Compounded Bio-HRT, uses synthetic manufactured hormones that are precise duplicates of hormones.
There is absence of medical evidence to support the way that these are used. For example, the dose of bioidentical progesterone used has not been proven to be sufficient to protect the endometrium in the presence of estrogen against cancer.
The same regulatory pathway of evaluation of the MHRA are not followed by manufacturers of bioidentical hormones. And so, the safety of these medications is simply unknown. Further data from large studies is required and this will be available we hope in the near future. However Dr Davis has completed training in bioidentical hormone therapy also and is able to advise if this might be the right type of HRT for you.
The decision whether to take HRT together with the dose and duration is made on an individualised basis after discussing the benefits and risks with each patient.
We can advise women who are experiencing
- Premature menopause (40-45y)
- Premature Ovarian Insufficiency (Under age 40y)
- Surgical menopause
- Peri-menopause
- Symptoms that persist
- Ongoing symptom management whilst taking HRT
- Testosterone service for women already on HRT
We provide HRT guidance to those who may have
- Migraine
- A family history or personal history of breast cancer
- A history of blood clots
- Cardiovascular medical problems
- Osteoporosis
What are Hormones?
Hormones control cell growth, development, protein synthesis & metabolic rate. Optimum levels are essential for quality of life, good health and disease prevention.
HRT (Hormone replacement therapy) follows individualised diagnosis of sex hormone imbalance from a detailed discussion.
The objective of HRT treatment is to optimize hormone levels in the blood, help reduce symptoms associated with low levels of hormone and improve general wellbeing. The hormones are prescribed and tailored for each patient to ensure optimum effectiveness.
Interpretation of hormone deficiency is based on symptom evaluation, medical history, lifestyle, blood analysis and widespread understanding of the data and research available on HRT and extensive clinical experience.
Sex hormones include
- Oestrogen
- Progesterone
- Testosterone
Sex hormones control our
- Nervous System
- Cardiovascular System
- Immune System
- Gastrointestinal System
- Skeletal & Muscular Systems
- Endocrine System
”Perimenopause and Menopause can be the cause of mood disorders and memory symptoms in the menopause transition whether a woman has pre-existing depression / anxiety or not.
Menopause Practice StandardsBritish Menopause Society
What symptoms might I notice?
Perimenopause / Menopause
Oestrogen deficiency causes many symptoms which include
-
hot flushes and/or sweats
-
period problems / heavy periods
-
irritability, depression, mood swings, anxiety
-
insomnia
-
aches and pains including joint ache
-
vulval changes, urinary symptoms and urinary tract infections
-
memory problems
-
worsening of premenstrual stress disorders
-
osteoporosis
-
skin and hair changes, itchy skin
-
palpitations
-
gastrointestinal symptoms such as indigestion
-
headaches, new or increased frequency of migraine
How can treatment help me?
By correcting hormonal imbalance caused by menopause you can have
-
reduced blood pressure and reduced incidence of heart disease
-
‘good cholesterol’ balance correction, (reducing the ‘bad’ LDL type)
-
prevention of fat in the organs reducing cardiovascular risk
-
improved sensitivity to insulin and reduced incidence of diabetes
-
immune system response improvement
-
improved skin, hair and muscles
-
improved mood, brain function and health
-
improved pain management
-
reduced loss of bone in spine and hip, increased BMD
-
improved sexual function, reduction in urine infections
-
reduction in risk of dementia
Patients Journey
Consultation Duration
45mins
Management Planning
Decision on whether testing initial hormone levels is appropriate and what steps are needed.
Review Appointment
3 months after the initial consultation.
Ongoing Review
Review at 3 months post initial HRT prescription and then annually.
Frequently Asked Questions
How much will the HRT medication cost?
If deemed appropriate, a prescription for HRT will be issued privately at a cost of £35 and this can either be issued by our remote pharmacy (who will contact you to take payment for the medication and organise delivery) or it can be taken to any local pharmacy.
We don’t stock any items. It is your choice how you do this. Some women decide to ask their GP to issue the prescription, and the decision to do so is up to the individual GP.
£35 will be charged for each private prescription, regardless of the number of items on the prescription.
Do you prescribe Bioidentical HRT?
We do not prescribe Bioidentical HRT. This is a ‘non NHS’ kind of HRT that uses a synthetic ‘chemically identical formula’ to human hormones, made in private laboratories.
We believe in the British Menopause Society stance on HRT, that ‘Body Identical HRT’ is safer than ‘Bio identical HRT’.
Can I have a Mirena coil inserted in the clinic / implant?
If this is needed then the practicalities of this will be discussed -including the option of fitting in the clinic if available. Alternatively we may refer you to another service for this to be done or your GP.
Do you prescribe female testosterone?
Yes, if it’s appropriate, we prescribe testosterone on a private prescription.
What is the review process?
Please ensure that you have made your follow-up appointment approximately three months after the initial appointment and we will advise when to have any further follow-ups. To obtain a prescription from us you will need to be seen at least annually.
If you have not been seen by us for over 2 years a new INITIAL consultation will be needed.
What correspondence will I receive from the clinic after my appointment?
The clinician will email you a summary, outlining what was said during the consultation, usually within 7-10 days.
Your GP can also be sent a copy of this letter if you would like this, or you may have said you prefer for your GP not to be contacted.
Usually, we ask you to give a copy of your summary letter to your GP.
How do I receive the results of any blood tests I have?
Blood tests are taken in clinic, close to your home or by a nurse at your home for an additional charge.
We use an alternative lab if you choose to go to a centre close to where you live. Once you have been invoiced by us for your tests then you will be able to proceed with a centre visit or a kit will be sent to your home. As soon as your results are available, they will be reviewed and commented on by us.
You will then receive an email with your results / comments / treatment plan / prescription.
What is checked in the blood tests and other investigations?
We may recommend a blood test to assess hormone levels or to simply check for good health. This will depend on what happens in your consultation. Blood tests are also sometimes recommended as part of a well woman check or to assess other systems, for example thyroid function tests.
It is not usually necessary to do a blood test to diagnose the menopause. It is always necessary to have a blood test for men who are attending for testosterone advice.
We cannot access your NHS doctor’s lab system. Recommended investigations for some women, such as a bone mineral density scan, mammogram or pelvic ultrasound scans can be arranged if needed.
At what age might I need HRT?
Patients most commonly experience menopause symptoms from the age of about 45. Some women experience an early menopause (40-45y) or Premature Ovarian Insufficiency (under 40y).
Was are the possible side effects of oestrogen?
Adverse reaction may include bloating, breakthrough bleeding, breast swelling and tenderness, fluid retention, nausea, headaches, leg cramps, dyspepsia.
Was are the possible side effects of progestogens?
May cause sedation, in view of this it is recommended to coordinate dosing with sleep cycle. Adverse reactions may include bloating, migraine, breakthrough bleeding, missed menstruation, breast swelling and tenderness, fluid retention, sedation and depression.
Was are the possible side effects of testosterone therapy?
Side effects can include acne, hair growth on face and body but reduced on the scalp, change in libido, clitoris enlargement, voice changes and water retention. If using gels or creams then irritation to the skin where it is applied can occur.
What happens during the consultation?
The 45 minute consultation process includes assessment regarding the risks and benefits of hormone replacement for you as an individual in relation to your medical history as a whole. The decision to use HRT has to be made on a person to person basis, taking into account any baseline risk factors that may include non-modifiable genetic predispositions and modifiable lifestyle factors.Further onward referral can be made if the decision to use HRT is more complex, for example in those who have a history of breast cancer and who have decided that they would like to go ahead with HRT will also be seen by a Consultant Gynaecologist Dr Davis is able to provide counselling and support regarding the options available for your unique experience of the menopause transition, including HRT.
Can you recommend any resources?
Website Links
Menopause Matters
Manage my Menopause
The British Menopause Society
Womens Health Concern
Bladder Matters
Sexual Advice Association
www.sexualadviceassociation.co.uk/factsheets
FPA Sexual Health
www.fpa.org.uk/download/people-over-50-relationships-and-sexual-health-pdf
Polycystic Ovarian Syndrome
Endometriosis
Pelvic Pain
Premature Ovarian Insufficiency
Calcium Intake calculator
Recommended Books
Mating in Captivity
Esther Perel
Intimacy & Desire
David Schnarch
Enhancing Couple Sexuality
B McCarthy
Mind the Gap
Karen Gurney
Moisturisers
May be helpful for genito-urinary symptoms.
These hold moisture on the vaginal wall, use 2-3 times per week.
- Replens
- Regelle
- Hyalofemme
Lubricants
Check the label as some contain petroleum and this can damage condoms and cause infections.
- Sylk
- Yes
- Astroglide
- Durex Play
- Pjur
Treatment Pricing
Consultations
Female hormone consultations can be in person or online.
£295
£225
£115
£35
Investigations
Blood Tests
Blood test prices vary depending on what is required plus the option to have it taken by a nurse at your home, near your home or in the clinic. Additional charges if applicable are listed below. Finger prick samples are unreliable and are therefore not ever used by this clinic.
Advanced Well Woman
Blood count, Liver, Kidneys, Urate, Cholesterol, Iron, Diabetes, Thyroid, FSH, LH, Estradiol, SHBG, Vitamin B12, Folate, Vitamin D, Magnesium.
£285
£345
Female Hormone
SHBG, Thyroid, Testosterone, FHS, LH, Estradiol, FAI, PRL
£145
£205
SHBG, Testosterone Estradiol
£120
£180
Estradiol
£80
£140
To book an appointment please use the online Booking Form
Or call us on
0800 464 7220
Consultations can be in person in Newcastle upon Tyne or online if you do not live locally or would prefer a video consultation.
If you are unsure whether this service is right for you then a free discovery call can be arranged. Please request this using the Booking Form.
To book a consultation, please use the Booking Form and select which service you would like.
If you live outside the North East we can organise a prescription to be sent to you or it can be requested from your GP. If you require blood tests, they can be taken at or close to home.