Around half of all doctors in the UK are General Practitioners. GPs who have a special interest in menopause, are able to provide an overall head-to-toe evaluation of your general health and are trained, not just in general gynaecological health, but in your overall well-being. GPs are able to administer and interpret broad test results such as cholesterol, blood pressure and cardiac risk assessment to identify when specialist support is required before and during any menopause treatment. Approaching menopause as part of your overall health and well-being is paramount to ensure the best possible care and treatment.

Unfortunately, there is no definitive test that can be taken to determine if an individual has begun perimenopause. Oestrogen levels, slowly and over time, begin to deplete however, month to month the oestrogen levels continue to fluctuate depending on the stage of the menstrual cycle.

It’s these natural fluctuations that make it difficult to determine if perimenopause has begun in one stand-alone test. Instead, it is the symptoms that a patient is suffering from which is most important when assessing if the perimenopause has started.

A woman’s symptoms are the greatest clue to their hormone balance. Hormones are incredibly powerful and when the level of oestrogen drops down, symptoms in each individual can occur. Symptoms vary for each person and initially fluctuate.

When diagnosing menopause, GPs and specialists will want to understand in detail the types of symptoms a woman is experiencing, however small they may seem on the surface. These are all signposts to what hormonal change is taking place and will greatly assist the clinician in prescribing the most appropriate medicine to appease symptoms.

The most effective way to do this is to keep a symptoms diary. A symptoms diary is a daily record of how you are feeling in yourself as well as what emotional or physical symptoms may be occurring. From tingling skin to brain fog, or crying spells, all symptoms however unusual or slight, must be documented daily over a few months. This will then provide the GP with a full picture to help discuss what could be causing these changes as well as prescribe the most effective course of action.

You may have come across two different types of HRT when reading about menopause treatments, Body-Identical and Bio-Identical, but what is the difference, and which one is best?

Body-Identical Hormones (rBHRT)

Body-Identical Hormones is the HRT prescribed by the NHS and by the majority of British Menopause Society Members who are the doctors who specialise in menopause. The Revised Global consensus statement on Menopausal Hormone therapy states they are scientifically tested and proven to be a safe and effective treatment for perimenopause and menopause. This therapy works by replacing the hormones that menopause is causing to deplete. The dose and length of treatment is tailored to the individual.

Body-Identical Hormones can be prescribed as either a combination of oestrogen and progesterone for women who have their womb and oestrogen-only for women who no longer have their womb.

Sloane Menopause Clinic only prescribes Body-Identical HRT.

Bio-Identical Hormones (cBHRT)

Bio-Identical Hormones have not been scientifically proven to be safe or effective HRT treatment for the symptoms of perimenopause or menopause. Bio-identical hormones are not recommended or used by the NHS, nor are they a recommended course of treatment by the British Menopause Society.

Clinics who prescribe bio-identical hormones claim they can identify exact hormone replacements through unproven and highly complicated tests. However, these tests have never been scientifically substantiated nor are they supported by the British Menopause Society.

Bio-identical hormones are prescribed as creams, lozenges and vaginal preparations by ‘specialist pharmacies’ however the manufacturing of these products does not undergo the same meticulous testing and development process that Body-identical HRT has been through.

It is widely regarded in the scientific community that the efficacy and safety of bio-identical hormones are ‘unknown’.

Unfortunately, when it comes to menopause management there is no ‘one size fits all’ approach, it all comes down to a delicate balance.

It is important to remember it is your perimenopause/menopause and your choice.

Each individual will require their own tailored balance of treatments from medicines, diet, and exercise to psychological care.

A holistic approach to managing menopause symptoms is about reducing triggers and managing symptoms. There are a variety of ways to alleviate symptoms through therapies, and hormone replacement.

The goal is for the journey through menopause to be as calm and non-eventful as possible.

Getting the right balance is also about an evidence-based trial of treatment and learning what works for each patient. The aim is for the right treatment for each patient for the right length of time.

Starting treatments after careful consideration of the whole situation for each patient and adjusting therapies as and when is right for the individual to do so.

It is when a woman enters her mid-life that self-care becomes paramount to preventing disease and maintaining good health and wellbeing.

In perimenopause and menopause, it is important to start making a more conscious effort to eat well, maintain a healthy weight, exercise and reduce alcohol intake.

At Sloane Menopause Clinic we provide patients with holistic support based on their symptoms. Our expert team are on hand to alleviate the most severe of symptoms and work to prevent disease.

After an initial assessment with your GP, you may be asked to keep a symptoms diary.

Keeping a symptoms diary is paramount to providing the most informed and tailored care to manage symptoms of perimenopause and menopause.

It may sound like a tedious task, one you may think can be achieved through memory, however, the tracking of symptoms, when they occur within the menstrual cycle and their progressing severity, are integral for an accurate diagnosis. For even the most practised of memories, that is an awful lot of information to retain.

It doesn’t have to be a bore, there are plenty of apps on the market today that can help keep track of symptoms but simply writing it down in a traditional diary is a great way to start too.

The most important thing to keep in mind when completing your daily diary is to be honest and accurate. This will help with diagnosis and the overall management of symptoms.

At every consultation with your GP, you can take along your symptoms diary for discussion. Your GP will then be able to identify any continued changes in symptoms and make any necessary adjustments to your treatment plan.

The key things to note within the diary are:

· The date and the day of your menstrual cycle.

· Type of symptoms, however small or insignificant they may seem.

· Severity of each symptom (scale of 1 to 4) 1 = mild to 4 =severe.

· Overall mood for the day (scale 1 = low/not coping to 4 = happy/managing fine)

· Any notable differences in diet e.g. increased alcohol intake, increased caffeine intake.

Once you have kept your diary, bring it to your consultation for your doctor to review.

The early signs of menopause can be confusing and misunderstood. In a woman’s forties, she can begin to experience symptoms of perimenopause brought on by changes to the balance of hormones. There are many symptoms that can occur, the most common of these symptoms can include:

Difficulty sleeping

Low mood or anxiety

Mood swings

Reduced sex drive

Problems with memory or concentration

Irregular periods

Tingling in the hands and feet

Weight gain

Allergies including asthma-like symptoms

Headaches

Joint stiffness

Recurrent UTIs

Night sweats

Hot flushes

Vaginal dryness

Osteoporosis

Acne

Symptoms can occur slowly over time, some days and months perhaps feeling better than others. This slow onset is what prevents women from getting help early on in their perimenopause journey.

Also, women are used to adjusting to the changes in their hormone levels throughout the month. In perimenopause, new symptoms start to occur.

Keeping a symptoms diary can help track the frequency of symptoms and identify if they may be progressing in severity. It is then possible to manage these symptoms with the help of a GP, to prevent them from becoming problematic.

Today, the average woman presents up to seven pronounced symptoms at the time of diagnosis. By this stage in perimenopause, symptoms can be overwhelming for many patients. At the Sloane Menopause Clinic, our goal is to manage symptoms before they have a detrimental impact on an individual’s daily life including relationships and performance at work.

Body-identical HRT is a safe and effective treatment to ease symptoms of perimenopause and menopause. Each individual is different and therefore a tailored care plan is required.

During this assessment, a family medical history is conducted along with a comprehensive physical examination of the patient. If during this assessment an increased risk of common cancers such as breast, ovarian and bowel is identified, further investigation through genetic testing can be a useful tool to identify if a person is at an increased risk of developing cancer by starting HRT.

Through our Hereditary Health Screening program at Sloane Square Medical, we provide one of the most thorough genetic testing programs in the UK. Our Oncogentic Consultant, Dr George is one of only two consultants in the UK to specialise in both oncology and genetics.

If you are concerned about symptoms you may be experiencing or are considering HRT and are concerned about your cancer risk, book an appointment today with our highly experienced GP Dr Owen, who specialises in menopause management and is a member of the British Menopause Society. Dr Owen will be able to discuss with you an appropriate care plan to suit your symptoms and concerns.

Menopause screening is when we discuss with you the symptoms you are experiencing and decide which well-woman test may be appropriate.

From there we discuss treatment options and recommend the best course of treatment for symptoms.

“When I discovered that I was menopausal I was so grateful to be able to share my concerns with Dr Owen and to receive her expert advice, care and knowledge to enable me to find solutions. With conflicting media coverage, medical advice and a fair amount of taboo around the subject I had found it difficult to know what was best for me. Her understanding of HRT, supplements and lifestyle changes meant what was depleting and confusing is now manageable and positive.”

Sloane Menopause Clinic Patient

“I have been a patient of Dr Owen’s since 2018 and I could not recommend her enough. Dr Owen is knowledgeable, professional and very kind. I have received wonderful care and treatment from Dr Owen. She excels in the care that she provides to her patients.”

Sloane Menopause Clinic Patient