HRT & menopause
Menopause care that listens first
Perimenopause and menopause are diagnosed from your symptoms and your history, not from a blood test. A proper conversation, a scored baseline, and a plan built around your risks and your preferences — including the option of no hormones at all.
Fully online. Video consultation with Dr Qurbain, medication dispensed to your door, and no need to travel anywhere.
Told your bloods are normal, and still not feeling right?
If any of these sound familiar, this consultation was built for you.
You have been offered an antidepressant for something that does not feel like depression.
You want time to explain it properly, not seven minutes.
You want the risks given to you straight, not softened or exaggerated.
You want a decision you made, not one made for you.
Your symptoms are the diagnosis. Your risk profile picks the treatment.
If you are 45 or over with menopausal symptoms, the diagnosis is clinical and blood tests are not routinely needed. Below 45, or after a hysterectomy, hormone tests help. Under 40 the bar is higher and deliberately so — premature ovarian insufficiency needs two blood samples four to six weeks apart, is never diagnosed on a single test, and warrants specialist referral if there is any doubt.
What then gets prescribed depends on your own history — clot risk, migraine with aura, liver and gallbladder history, whether you still have a uterus. That is why the first consultation is mostly listening and asking, and why two women with identical symptoms can correctly leave with different plans.
How it works
Four steps, all from home
Symptoms, scored
A structured symptom score at baseline across the vasomotor, psychological, physical and sexual domains — so that at three months we are comparing numbers, not impressions. Menstrual history, surgical history and cervical screening status recorded.
Your risk profile
Clot and cardiovascular history, breast and gynaecological history, liver and gallbladder, migraine with aura, thyroid, mental health, and family history. This is what decides route and preparation.
Blood tests where they help
Thyroid function and a full blood count at baseline, hormone levels where your age or history makes them useful, and others where indicated. Results are read by the doctor before anything is prescribed.
Your plan — including the non-hormonal one
Menopause-specific cognitive behavioural therapy is discussed with everyone, whether alongside hormones, instead of them, or because you would rather not take them. The discussion is recorded and a referral route given. Your GP is told what is prescribed.
Bleeding on HRT: when it is expected and when it is not
This is the thing most worth knowing in advance, because it saves both unnecessary alarm and dangerous reassurance.
What treatment involves
Route matters
- Through the skin first — patch, gel or spray — because it carries a lower clot and stroke risk than the tablet form
- Tablets where you prefer them and your risk profile allows it
- Local vaginal treatment for vaginal and urinary symptoms — very little is absorbed, and it does not need a progestogen alongside
If you still have a uterus
- A progestogen is always needed alongside systemic oestrogen, to protect the lining of the womb
- Body-identical micronised progesterone is the preferred option
- A monthly regimen while you are still having periods, or a continuous one once you are past them
- After a total hysterectomy, no progestogen is needed
Other options discussed
- Testosterone, off-label in women, where low sexual desire persists after hormone treatment is optimised and other causes are excluded
- A single-tablet alternative to combined treatment, for women past the menopause
- Menopause-specific CBT, discussed with everyone
- Compounded “bioidentical” preparations are not prescribed
Bleeding, and when to worry about it
Unexpected bleeding is a common side effect in two windows: during the first six months of treatment, and within three months of any change of dose or preparation. Inside those windows it is usually nothing, and you are asked about it at your three-month review. Outside those windows, unscheduled bleeding needs prompt assessment and investigation — and so does any unexpected bleeding after the menopause in a woman not taking HRT. We will not assume it is breakthrough bleeding without looking.
What is discussed before you decide
Side effects, and what to do about them
Read
Hormone treatment has benefits and risks, and both depend on your age, your history, the route and the preparation. Rather than print a number that may not be yours, the consultation goes through your individual risk and the discussion is recorded.
- The route changes the risk — which is why treatment through the skin is offered first, particularly with any clot history, migraine with aura, gallbladder disease, high triglycerides or liver impairment.
- Breast awareness and attending NHS breast screening are discussed at review, and where a strong family history or a known gene variant is present you are referred to a high-risk service.
- Clot symptoms — one-sided leg pain or swelling, chest pain on breathing, breathlessness — need urgent assessment, and you are told that explicitly.
- New migraine with aura starting on treatment — contact us; it changes what is appropriate.
- There is no automatic five-year limit. Duration is decided by benefit and risk at each annual review, not by the calendar.
- Where there is premature ovarian insufficiency, treatment normally continues to around the usual age of menopause.
When we will not prescribe
Who this service cannot treat, and why
Read
Some of these are absolute. Others mean a specialist should be involved, and you will be told which.
- Known or suspected breast cancer, or another hormone-sensitive cancer
- Undiagnosed vaginal or uterine bleeding — investigated first, always
- Active liver disease
- An active blood clot, or a known clotting disorder without haematology input
- A heart attack or stroke within the last three months
- Anyone under 18
- Where a coil is the right way to protect the womb lining, or any other procedure is needed — referred, because this service does not fit devices of any kind
A past clot, a BRCA variant, migraine with aura, fibroids or endometriosis do not rule treatment out — they change the route, the preparation and the monitoring, and sometimes mean a specialist opinion first.
Reviewed properly, then annually
The full review and monitoring schedule
Read
At three months: your symptom score repeated against baseline, side effects, how you are getting on with it, and your bleeding pattern specifically asked about. At six months: symptoms, bleeding, blood pressure, a breast awareness reminder, and the switch from a monthly to a continuous regimen where that is now right. Then a full annual review — history updated, new contraindications checked, blood pressure and BMI, screening status, and an explicit reassessment of whether continuing is still the right call.
How your treatment is reviewed
There is no automatic five-year limit on HRT. Duration is decided by benefit and risk at each annual review, not by the calendar.
Baseline
Scored, not guessed
A structured symptom score across four domains, your full risk profile, and blood tests where your age or history makes them useful.
Month 3
Compared against baseline
Symptom score repeated, side effects, and your bleeding pattern specifically asked about. Dose adjusted if symptoms persist.
Month 6
Settling
Symptoms, bleeding, blood pressure, a breast awareness reminder, and a switch from a monthly to a continuous regimen where that is now right.
Yearly
Full review
History updated, new contraindications checked, blood pressure and BMI, screening status, and an explicit reassessment of whether continuing is still right for you.
Our approach follows current national guidance. See the guidelines we work to.
Initial consultation
Your initial consultation is paid when you book, before the consultation, and is charged whether or not treatment is prescribed. A follow-up review is paid when it happens, and only if you or your doctor decide you need one.
Joining the waiting list is free. Medicine, if prescribed, is bought separately from the dispensing pharmacy and its cost is confirmed with you before you pay for each supply.
Video consultation with Dr Qurbain, structured symptom scoring, individual risk assessment, blood tests reviewed by the doctor where indicated, and a written plan. Medication, where prescribed, is dispensed separately by a registered pharmacy and priced before you pay.