Menopause is a natural transition that every woman experiences, yet for decades it was dismissed, minimised, or treated as something to simply "get through." Times are changing. Today, we understand that the perimenopausal and menopausal years deserve proper medical attention, and that effective treatments exist to manage symptoms and protect long-term health.
At Lambert Medical Practice in Surbiton, we provide comprehensive menopause care for women across Surrey, Kingston upon Thames, and South-West London. Our approach combines thorough assessment, evidence-based treatment options including hormone replacement therapy (HRT), and ongoing support tailored to your individual needs and preferences.
This guide covers everything you need to know about perimenopause and menopause: recognising symptoms, understanding your options, the truth about HRT safety, and how to access expert support when you need it.
Understanding Perimenopause and Menopause
Before discussing treatment, it's important to understand what's happening in your body during these transitions.
What Is Perimenopause?
Perimenopause literally means "around menopause" and refers to the transitional years leading up to your final period. During this time, your ovaries gradually produce less oestrogen and progesterone, but not in a smooth, linear decline—levels fluctuate unpredictably, which is why perimenopausal symptoms can be so variable.
Key facts about perimenopause:
- Typically begins in your mid-40s, though can start earlier or later
- Can last 4-10 years before your final period
- Hormone levels fluctuate rather than steadily decline
- You can still become pregnant during perimenopause
- Symptoms may be more intense than during menopause itself due to fluctuations
- Periods become irregular—longer, shorter, heavier, lighter, or skipped
What Is Menopause?
Menopause is defined as the point when you've had no periods for 12 consecutive months (in the absence of other causes). It marks the end of your reproductive years and typically occurs between ages 45-55, with the average age in the UK being 51.
After menopause, you enter "postmenopause"—the years following your final period. Oestrogen levels stabilise at a lower level, and while some symptoms may ease, others can persist or emerge.
Early Menopause and Premature Ovarian Insufficiency
Early menopause (before age 45) and premature ovarian insufficiency (before age 40) affect approximately 1 in 100 women. These conditions require particularly careful management due to the longer duration of oestrogen deficiency and its implications for bone and cardiovascular health.
If you've experienced early menopause—whether naturally, due to surgery, or following cancer treatment—specialist support and typically HRT (at least until the average age of menopause) is especially important.
Recognising Perimenopause and Menopause Symptoms
Symptoms vary enormously between women. Some sail through with minimal disruption; others find their lives significantly impacted. There's no "typical" experience, and your symptoms may differ from friends, sisters, or your mother's experience.
Vasomotor Symptoms
- Hot flushes (sudden waves of heat, often with sweating)
- Night sweats (hot flushes during sleep, often drenching)
- Palpitations accompanying flushes
- Sleep disruption from night sweats
Psychological Symptoms
- Low mood, irritability, or depression
- Anxiety or panic attacks
- Difficulty concentrating ("brain fog")
- Memory problems
- Reduced confidence
- Mood swings
Genitourinary Symptoms
- Vaginal dryness and discomfort
- Pain during intercourse
- Recurrent urinary tract infections
- Urinary urgency or frequency
- Incontinence
Physical Symptoms
- Fatigue and reduced energy
- Joint and muscle aches
- Headaches or migraines
- Breast tenderness
- Weight gain, especially around the waist
- Skin and hair changes
Sexual Symptoms
- Reduced libido
- Difficulty with arousal
- Changes in orgasm
Sleep Disturbance
- Difficulty falling asleep
- Waking during the night
- Early morning waking
- Unrefreshing sleep
Long-Term Health Considerations
Beyond immediate symptoms, oestrogen decline affects long-term health:
- Bone health: Accelerated bone loss increases osteoporosis and fracture risk
- Cardiovascular health: Loss of oestrogen's protective effect on blood vessels and cholesterol
- Metabolic health: Increased risk of metabolic syndrome and type 2 diabetes
- Cognitive health: Ongoing research into oestrogen's role in brain function and dementia risk
These considerations are important when weighing treatment options, as HRT can provide protection in some of these areas.
Diagnosis: Do You Need Blood Tests?
A common question women have is whether they need blood tests to confirm perimenopause or menopause. The answer depends on your age and circumstances.
Women Over 45
For women over 45 with typical symptoms, diagnosis is usually clinical—based on your symptoms and menstrual pattern. Blood tests are not routinely needed because:
- Hormone levels fluctuate significantly during perimenopause
- A single blood test may catch levels at any point in the fluctuation
- "Normal" results don't exclude perimenopause
- Symptoms themselves indicate the diagnosis
NICE guidelines support this approach: in women over 45 with menopausal symptoms, FSH testing is not required to diagnose perimenopause or menopause.
When Blood Tests Are Helpful
Blood testing is valuable in certain situations:
- Women under 45: To investigate possible early menopause or premature ovarian insufficiency
- Unusual or severe symptoms: To exclude other conditions (thyroid disorders, anaemia)
- Diagnostic uncertainty: When symptoms are atypical or other causes need exclusion
- Monitoring HRT: Baseline and follow-up testing can guide treatment
- Contraception decisions: Determining if contraception is still needed
- Comprehensive health assessment: As part of a broader health MOT
What We Test at Lambert Medical Practice
When blood testing is appropriate, our comprehensive female hormone panel includes:
- FSH and LH (pituitary hormones indicating ovarian function)
- Oestradiol (main form of oestrogen)
- Testosterone (important for libido, energy, and wellbeing)
- Thyroid function (TSH, T4) to exclude thyroid problems
- Full blood count (checking for anaemia)
- Vitamin D (commonly deficient; important for bones)
- HbA1c and glucose (metabolic health)
- Lipid profile (cardiovascular risk assessment)
Hormone Replacement Therapy: The Evidence-Based Approach
HRT remains the most effective treatment for menopausal symptoms, yet it's surrounded by confusion and outdated concerns. Let's address what modern evidence actually shows.
What Is HRT?
HRT replaces the hormones your ovaries no longer produce adequately. The main component is oestrogen, which relieves most menopausal symptoms. Women with a uterus also need progesterone to protect the womb lining from the effects of oestrogen.
Types of HRT
Oestrogen-only HRT: For women who have had a hysterectomy. Oestrogen can be given alone as there's no womb lining to protect.
Combined HRT: Oestrogen plus progesterone for women with a uterus. Can be taken as:
- Sequential/cyclical: Oestrogen daily with progesterone added for part of each month (causes a monthly bleed)
- Continuous combined: Both hormones daily (no bleeds)—usually started 1+ years after last period
Delivery Methods
Transdermal oestrogen (patches, gels, sprays) is generally preferred because:
- Absorbed through skin, bypassing the liver
- No increased blood clot risk (unlike oral oestrogen)
- Suitable for women with migraine, obesity, or clot risk factors
- Steady hormone levels
Oral oestrogen (tablets) is still effective but carries small increased clot risk as it passes through the liver.
Progesterone options:
- Micronised progesterone (Utrogestan): Body-identical, usually preferred. Can be taken orally or vaginally
- Mirena IUS: Progestogen-releasing coil, protects womb lining and provides contraception
- Synthetic progestogens: Older options, still used in some combined preparations
Testosterone may be added for persistent low libido not responding to oestrogen alone. Available as cream or gel.
Body-Identical vs Bioidentical: Clearing Up Confusion
Body-identical hormones are molecularly identical to hormones your body produces and are available on NHS/private prescription. Examples include oestradiol (in patches, gels, sprays) and micronised progesterone (Utrogestan).
"Bioidentical" hormones is a term often used by compounding pharmacies for custom-made preparations. These are not regulated like licensed medicines, lack standardised quality control, and are not recommended by menopause specialists.
At Lambert Medical Practice, we prescribe regulated body-identical HRT—giving you hormones identical to your body's own in preparations that are properly tested, regulated, and proven effective.
HRT Safety: What the Evidence Actually Shows
Much of the fear around HRT stems from the 2002 Women's Health Initiative (WHI) study, which was widely misinterpreted. Two decades of subsequent research has clarified the picture considerably.
The Benefits of HRT
Symptom relief:
- Hot flushes and night sweats reduced by 75-90% for most women
- Significant improvements in sleep quality
- Mood stabilisation and reduced anxiety/depression
- Improved concentration and cognitive function
- Relief of vaginal dryness and urinary symptoms
- Improved libido (especially with testosterone addition if needed)
- Better quality of life across multiple domains
Long-term health benefits:
- Prevents bone loss and reduces fracture risk by approximately 30-40%
- When started within 10 years of menopause, may reduce cardiovascular disease
- Possible reduction in type 2 diabetes risk
- Colorectal cancer risk reduction
Understanding the Risks
Breast cancer:
- Oestrogen-only HRT: No increased risk (possibly decreased risk in some studies)
- Combined HRT: Small increased risk with long-term use (more than 5 years)
- The increased risk is small: approximately 4 extra cases per 1,000 women over 5 years of use
- Risk returns to baseline within a few years of stopping
- For perspective: obesity, alcohol consumption, and lack of exercise each carry similar or greater breast cancer risks
Blood clots:
- Oral oestrogen: small increased risk of venous thromboembolism
- Transdermal oestrogen: NO increased clot risk
- This is why transdermal preparations are generally preferred
Stroke:
- Small increased risk with oral oestrogen in older women
- No increased risk with transdermal oestrogen in women starting before age 60
The "Timing Hypothesis"
Research consistently shows that HRT is safest and most beneficial when started within 10 years of menopause or before age 60. This "window of opportunity" means that for most symptomatic women in their 40s and 50s, the benefits of HRT substantially outweigh the risks. This is why early assessment matters.
Individual Risk Assessment
At Lambert Medical Practice, we conduct thorough individual risk assessment before prescribing HRT, considering:
- Personal medical history (previous clots, breast cancer, heart disease, stroke)
- Family history (breast cancer, blood clots, cardiovascular disease)
- Current health status (BMI, blood pressure, smoking)
- Symptom severity and impact on quality of life
- Your preferences and priorities
For most symptomatic women, HRT is appropriate and safe. For some women, certain types or routes of HRT are preferable. For a small number, alternative treatments may be recommended.
Non-Hormonal Options and Lifestyle Approaches
While HRT is the most effective treatment for menopausal symptoms, it's not the only option. Some women prefer non-hormonal approaches, and some have contraindications to HRT.
Lifestyle Modifications
Exercise: Regular physical activity helps with weight management, mood, sleep, and bone health. Aim for a combination of cardiovascular exercise and resistance training.
Diet: A Mediterranean-style diet rich in plant foods, healthy fats, and lean protein supports overall health. Some women find reducing caffeine and alcohol helps with hot flushes and sleep.
Weight management: Excess weight can worsen hot flushes and increases health risks. Our medical weight loss programme can provide structured support.
Stress management: Techniques like mindfulness, yoga, and cognitive behavioural therapy can help with mood and hot flush management.
Sleep hygiene: Consistent sleep schedule, cool bedroom, limiting screen time before bed.
Non-Hormonal Medications
For women who cannot or choose not to take HRT:
- Fezolinetant: Newly approved medication specifically for hot flushes, works on brain pathways involved in temperature regulation
- SSRIs/SNRIs: Certain antidepressants (paroxetine, venlafaxine) can reduce hot flushes by 40-60%
- Gabapentin: Can help with hot flushes and sleep
- Clonidine: Older option with moderate effectiveness for hot flushes
- Vaginal moisturisers and lubricants: For genitourinary symptoms when systemic HRT is not appropriate
Cognitive Behavioural Therapy (CBT)
CBT specifically adapted for menopause can help with:
- Reducing the impact of hot flushes (doesn't reduce frequency but helps cope with them)
- Managing mood symptoms
- Improving sleep
- Building coping strategies
Supplements and Complementary Therapies
Many women try supplements such as black cohosh, red clover, evening primrose oil, or phytoestrogens. Evidence for effectiveness is limited and variable. If you choose to try these, ensure you use reputable products and inform your doctor, as some can interact with medications.
What to Expect: Your Menopause Consultation at Lambert Medical Practice
If you're experiencing perimenopausal or menopausal symptoms, here's what happens when you book with us in Surbiton:
Initial Consultation (30 minutes) - £150
A thorough assessment covering:
- Detailed discussion of your symptoms, their impact, and your concerns
- Menstrual history and pattern changes
- Medical history, including contraindications to HRT
- Family history relevant to menopause, breast cancer, cardiovascular disease, osteoporosis
- Current medications and supplements
- Lifestyle factors
- Your treatment preferences and priorities
- Blood pressure and BMI measurement
- Discussion of treatment options with balanced information about benefits and risks
Blood Tests (if appropriate)
Comprehensive hormone panel from £200 if testing is indicated based on your age or circumstances.
Treatment Initiation
If HRT is appropriate and you wish to proceed:
- Prescription for body-identical HRT tailored to your needs
- Clear instructions on how to use your medication
- Information about what to expect and when
- Guidance on managing any initial side effects
Follow-Up Review (3 months) - £100
Review appointment to assess:
- Symptom response
- Any side effects
- Adjustment of treatment if needed
- Blood pressure check
- Questions and concerns
Ongoing Care
Annual reviews to monitor treatment effectiveness, adjust as needed, and address any new symptoms or concerns. We also coordinate with your NHS GP if you prefer to transfer prescriptions to the NHS once stabilised.
Appointments often available within days | Serving Surrey, Kingston upon Thames & South-West London
Why Choose Lambert Medical Practice for Menopause Care?
Many women struggle to access quality menopause care. NHS appointments are often short, GPs may have limited menopause training, and specialist menopause clinics have long waits. Here's what we offer:
- Prompt appointments: Often available within days, not weeks or months
- Time to listen: 30-minute initial consultations allow thorough discussion
- Menopause expertise: Up-to-date knowledge of current evidence and treatment options
- Individualised approach: Treatment tailored to your symptoms, preferences, and circumstances
- Comprehensive care: Access to blood testing, related services (weight management, general health), and ongoing support
- Continuity: See the same doctor for ongoing care
- Accessible location: Easy to reach from Kingston upon Thames, Surbiton, and across Surrey