For many women, the perimenopausal journey will start in the early to mid-forties, but is often not recognised. Perimenopausal symptoms are wide ranging and impact women in many ways. Women may still be having regular periods despite fluctuating hormone levels, which can make it harder to recognise as a cause of the symptoms. Symptoms such as anxiety, mood fluctuations, joint pains, fatigue, and palpitations often present earlier than the better known vasomotor symptoms of sweats and flushes, making it harder for women to identify what is happening to their bodies. The key is to have time to review symptoms with a trusted health care professional and discuss treatment options.
A spotlight is now being shone on this area of women’s health and at VHK Women’s Health Clinic we offer you the opportunity to have an in-depth discussion about your symptoms and what treatment options may be best suited to you. Finding a tailored approach to perimenopausal care is key to symptom control and improvement in quality of life. We each have over 20 years experience of medical menopause management and can use our in-depth knowledge to create a bespoke management plan for all our patients.
Menopause – known as the final period -typically happens around the age of 51 years, but symptoms frequently start many years before this. Some women will find that they are able to manage their symptoms initially, but they can become more intense and wide-ranging, including changes to mood, anxiety and confidence, alongside sweats, flushes, vaginal dryness and soreness.
Today we see an increase in the public’s awareness of how this life stage can affect women, and we encourage women to seek help. We give you the opportunity to have an open and honest discussion about how you are feeling and coping and offer both advice on lifestyle changes and managing these symptoms through an appropriate and safe medical management plan.
Women often report how a holistic approach, where they feel both informed and supported, can empower and enable them to take control of the symptoms affecting their changing body and improve quality of life. We at VHK Women’s Health Clinic are proud to offer this expert medical advice to menopausal women giving them choice.
If you would like the opportunity to discuss any concerns around menopause, please book an appointment with Dr Hobbs or Dr Kerr.
Hormone replacement therapy usually involves the prescribing of supplemented oestrogen and progesterone. The purpose of oestrogen is to replace the body’s fluctuating and naturally declining levels from the ovaries over time. Progesterone protects the lining of the womb (endometrium) from the stimulatory effect of the oestrogen replacement.
All women with a womb require both hormones, but the way these are given depends upon whether a woman is still having periods (perimenopausal) or if her periods have stopped for 12 months or longer (postmenopausal).
For women who have undergone a hysterectomy, progesterone is not usually required, and an oestrogen only regime is typically sufficient.
We recommend body identical 17B-oestradiol oestrogen, in patch, gel and spray form – this is called transdermal oestrogen. Oestrogen can also be given orally, but there is a small increased risk of blood clot and stroke when oestrogen is taken orally, so as per the NICE guidelines, we often recommend oestrogen transdermally in the first instance, particularly to women at higher risk of clot.
We prescribe a variety of progestogens including the body identical micronised progesterone called Utrogestan, along with other options such as the Mirena IUS and combination patches containing the synthetic progestogens, norethisterone or levonorgestrel. These options enable flexibility to find the best combination for each individual woman.
Prior to any medication recommendation, we take a detailed history and complete a risk assessment, along with a discussion about the risks and benefits using the most up to date research and published data. We want to ensure all women are fully informed when making treatment choices.
For most women who opt to start HRT the associated risks are very small, but additional risk of breast cancer is often the biggest fear for many women. The risk of breast cancer associated with starting HRT is not a high as many believe, with other lifestyle factors such as drinking a large glass of wine every evening, smoking or being obese carrying more risk. We discuss all risks and benefits of HRT in detail based on personal history, national guidelines and up to date published evidence.
We at VHK believe it is so important for women to properly understand their individual risk and how changes in lifestyle during this life transition will allow for better health in the future. We are happy to discuss this in detail at your appointment.
We recommend and prescribe body identical HRT regimes.
Body identical HRT is now widely recognised as the safest and most compatible HRT to the oestrogen and progesterone produced by a woman’s own body. These HRT products – 17B-oestradiol and micronised progesterone originate from the plant products, soya and yam. We usually recommend oestrogen via the skin (transdermal) in either patch, gel or spray products that can be tailored to your needs. This is because oestrogen given via the skin is absorbed directly into the blood stream and has less side effects and lower risks, specifically the reduced risk of blood clots and stroke compared to oestrogen replacement taken orally.
Body identical HRT is fully regulated and used across the NHS and is recommended in the NICE guidelines and The British Menopause Society.
We do not recommend or use compounded bio-identical hormone replacement products because these are unregulated and not licensed in the UK.
Menstrual health starts in early teenage life and for most women remains a monthly occurrence for the next four decades. This means that a woman could have just under 500 periods during her reproductive years. Many women endure complex, intolerable symptoms, reporting their bleeding as inconvenient, uncomfortable, and unpredictable which can impact on attendance at school, work and enjoyment of daily life. Symptoms include flooding leading to excessive leakage of blood, significant pain and anaemia. Half of all UK women believe this is just part of normality. There are many medical interventions that can be used to help alleviate and improve these symptoms. At VHK Women’s Health Clinic, we aim to support women, reduce the impact of symptoms through both hormonal and non-hormonal treatment options and thereby improve quality of life.
Endometriosis
Endometriosis is a chronic pelvic pain condition that affects up to 1 in 10 women and can take up to seven years to diagnose with teenagers and young women often having the worst symptoms; namely painful and heavy periods, chronic pelvic pain and difficulties with intimacy secondary to pain. The endometrial tissue that would be normally be confined to the lining of the womb, can be dotted around the rest of the pelvis, leading to disabling pain alongside urinary and bowel symptoms. This tissue bleeds with each period and this can lead to scar tissue developing which may lead to struggles with getting pregnant .
At VHK Women’s Health clinic, we want to ensure that women are supported in gaining a diagnosis, medical support and treatment alongside learning to understand and manage the condition holistically to reduce the impact on individual’s quality of life when other important life events are occurring such as school examinations, university life and careers.
Irregular periods and PCOS
A typical menstrual cycle is about 28 days but anything from 21 days to 35 days is classified as normal. For some women their menstrual cycle will be longer or more erratic and not fit into this typically normal regime. One of the commonest reasons for an irregular menstrual cycle is a condition called Polycystic Ovarian Syndrome (PCOS). Instead of a single egg developing and being released each month to then trigger a period about 14 days later, (if fertilization does not occur), the ovaries contain multiple immature follicles, and no single follicle develops to trigger ovulation. A slightly different hormone balance exists which not only affects a period cycle but also other body systems including acne, hair growth and increased body weight.
We are able to make the diagnosis, discuss treatment options, and help you to understand the short and long-term implications of this condition.
The use of contraception can enable women to have control and choice over when they plan to start their family. It can have additional uses such as control over their periods, There are many different choices available varying from the hormonal to non-hormonal methods. The contraceptive pill has been a method used commonly since the 1950s and has expanded in the number of available options allowing a more tailored regimen for each woman. Other methods include the subcutaneous implant, a choice of hormonal or non-hormonal coils or the Depo-Provera injection.
If you are struggling to find a suitable contraceptive option, we can help you find the right choice. At VHK Women’s Health Clinic we can have in-depth and non-judgemental discussions about your options and potential side effects. We are also able to fit coils and implants, so you are happy and feel in control of your contraceptive method.
Intrauterine systems and copper coils (IUC) have been a reliable form of contraception for many decades. Over the last 20 years IUCs have progressed significantly in their uses, allowing women more choice in safe treatment options. The Mirena intrauterine system (IUS) is one such choice, not only offering very effective contraception, but also being licensed as a treatment for heavy periods as recommended by the NICE guidelines. It can also be used as the progestogen component of HRT for up to 5 years.
Drs Hobbs and Kerr are both qualified coil fitters and trainers and both regularly fit coils and hold up-to-date qualifications with the Faculty of Sexual and Reproductive Health.
Premenstrual syndrome can be a debilitating condition that affects women during the luteal later phase of the menstrual cycle (from ovulation to the onset of a period). The cyclical hormonal changes can lead to many physical, behavioural, and psychological symptoms which are relieved when her period starts. Times when hormone levels change, for instance after having a baby, starting hormonal contraception or during the perimenopause, can mean symptoms becoming much worse.
A third of menstruating women can experience a moderate degree of PMS, with 5% having it severely, of which one type can be PMDD (Premenstrual Dysmorphic Disorder- this is a term used in America and describes a specific group of symptoms). Women who have this condition often tell of the distressing impact it has, leading to emotional and relationship difficulties.
At VHK Women’s Health Clinic, our doctors have a wealth of experience in managing ladies with this condition, in which there is no definitive cure but we can discuss the options that are available to lessen the severity of this syndrome.
The vulva is the term given to the female external genitalia which includes the vaginal entrance. Often this part of a woman’s body is seen as an area not to be openly discussed even with a trusted health professional because of embarrassment or shame. Many women at different stages of life can experience troublesome symptoms which can be successfully managed with the right support and advice.
Itching, prickling, soreness and dryness are common both internally and externally and often require a simple treatment plan. Vaginal pain or dryness known as vaginal atrophy or genitourinary syndrome of menopause (GSM), can first present in the perimenopause, and worsen with menopausal years due to reducing oestrogen levels. It can have a dramatic impact on a woman’s ability to enjoy an active sex life. The use of topical vaginal oestrogen and moisturisers along with many other simple treatments can successfully control symptoms for long term improvement.
It is important that women feel comfortable to be able to discuss their symptoms with a fully trained health care professional to ensure there is no other underlying cause requiring a more detailed review. The VHK team have a wealth of experience in managing these conditions in a sympathetic and sensitive manner.
Testosterone can be a valued element of a tailored HRT regime for certain women. Contrary to popular belief, this hormone in itself is not just for men, and is present in women’s blood streams through their reproductive years. Unlike oestrogen where this level drops significantly around the perimenopause, testosterone levels reduce more gradually from around age 30years.
It has been known for some time that women going through an early, premature or surgical (has had ovaries removed at operation) menopause will benefit from testosterone replacement, more recently its benefits for women going through the menopause at the natural age is better recognised. Towards a natural perimenopause, reduced or lack of sex drive is very common for a variety of reasons, and it may be appropriate for those women to have a trial of testosterone therapy. It is currently unlicensed for women in the UK, so many NHS doctors have a challenge to prescribe it, however, Androfeme is an Australian licensed testosterone product that is available from private clinics.
At VHK Women’s Health clinic, we are happy to discuss how testosterone could potentially help symptoms and supplement your oestrogen replacement. We can prescribe in a British Menopause Society recognised safe way which involves blood test monitoring and regular monitoring of your symptoms.