What We Treat
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What We Treat
From perimenopause to premature ovarian inadequacy, we provide expert, compassionate care for every stage of your hormone journey. Our specialists understand the complexities of hormonal health and are here to help you feel like yourself again.
Perimenopause
The term perimenopause refers to the years leading up to the menopause during which hormone levels begin to change. For many women, this time can feel like a physical and emotional rollercoaster and for some women it can start in their 30's and over 10 years, so it's impact cannot be underestimated.
In its earliest stages, a decline in the hormone progesterone is to blame, followed later by wide fluctuations in oestrogen levels. It is very common to feel emotional, irritable, anxious and sleep deprived.
Periods become increasingly erratic, may be more frequent or heavier and more prolonged. Many women also experience flushes and sweats, brain fog, joint pains along with changes to their skin and hair.
A tailored regimen of body identical Hormone Replacement Therapy (HRT) can replenish and balance depleted hormone levels, leading to control of these distressing symptoms.
Menopause
The term menopause is used when a woman has stopped having periods for 12 months. The average age to reach menopause is 51 years but around 5% of women will go through an early menopause, between the age of 40-45years, and 1% under the age of 40. This is known as Primary Ovarian Insufficiency (POI).
Menopausal symptoms are caused by the significant decline in hormone production, primarily oestrogen and progesterone, although a decline in Testosterone, DHEA and Pregnenolone may also be involved.
80% of women will experience symptoms in the menopause but they will vary significantly in type and intensity between individuals with 25% experiencing severe symptoms.
The symptoms include hot flushes and sweats, concentration and memory difficulties, brain fog, mood changes, insomnia and fatigue. There is often weight gain around the middle and many women report a loss of confidence and just don't feel like themselves.
Replacing these lost hormones with body identical Hormone Replacement Therapy (HRT) can resolve many of these symptoms, as well as reducing the risk of heart disease and osteoporosis.
Premenstrual Syndrome (PMS)
Premenstrual Syndrome is the name given to a set of physical and emotional symptoms that occur cyclically, in the lead up to your period. You may have noticed that you feel low in mood, anxious, irritable or overly emotional during this time. You may also crave sweet things, feel bloated, experience insomnia and feel exhausted. It usually occurs during the week before your period but some people can suffer for 10 days or more. PMS can start with your first period, or may be something that you develop later in your reproductive life. In fact, the onset of PMS, or PMS that becomes more intense or prolonged can be the first sign of perimenopause.
PMS can be extremely debilitating both physically and mentally.
Whether you have been a lifelong sufferer or whether this is a new experience for you, it is important to note that there are hormonal and non-hormonal treatments that can help you take back control.
Premenstrual Dysphoric Disorder (PMDD)
Premenstrual Dysphoric Disorder is a severe form of premenstrual syndrome. Just like in PMS, patients experience cyclical mood changes which begin in the second half of their menstrual cycle. However, in PMDD the symptoms are severe enough to have a significant impact on their mental health. Patients describe symptoms including intensely volatile moods, feelings of despair or suicidal thoughts, anxiety, panic attacks and feeling out of control. There can also be physical symptoms such as breast tenderness, bloating, food cravings and headaches. These symptoms not only significantly impact the woman but also those around her, affecting personal relationships and her ability to work.
There are times when the management of PMDD requires shared care with other professionals such as a Mental Health Practitioner but the right hormonal treatments can be very beneficial.
Hormonal Migraine
A migraine is more than just a headache, it is an inherited neurological condition which causes a wide range of symptoms including nausea, vomiting, visual disturbance and sensory changes. Women are three times more likely to experience migraine than men and unfortunately, many migraine sufferers find that their symptoms get worse in perimenopause as hormone levels start to fluctuate. Attacks can become more frequent, more intense and longer lasting. Some women report feeling as if they are on the brink of a migraine for much of the time.
Other women find that they only every suffer an attack during the day or two before their period begins, a scenario called a menstrual migraine.
The good news is that for many women their migraines will significantly improve after menopause. In the meantime, where changes in hormone levels are triggering attacks, balancing out hormone levels and creating stability can be an effective way of reducing the frequency of attacks.
Premature Ovarian Insufficiency
Premature Ovarian Insufficiency (POI) affects 1% of women and is a condition where the ovaries stop working at a younger than average age – under 40 years. Periods become very infrequent or stop alongside other symptoms from the low hormones. There are implications for fertility as well long-term health consequences resulting from low levels of hormones, in particular oestrogen.
In the majority of cases, there is no cause found for POI although it can be related to gene abnormalities, autoimmune conditions, or medical treatments such as chemotherapy which damage the ovaries.
POI is diagnosed using a combination of blood tests and patient history. It is important to know that some women with POI may still have some ovarian function and so may have a sudden period or experience symptoms of premenstrual syndrome (PMS). Between 5-10% of women with
POI may conceive naturally and so it is still important to consider contraception if this is not desirable.
Hormone Replacement Therapy (HRT) is vital in women diagnosed with POI as the extended period with no oestrogen leads to an increased risk of heart disease, osteoporosis and a reduced life expectancy. It should be taken at least until 51, the average age of menopause and is not associated with any increased risks when used up until the average or menopause since we are replacing hormones that the body should naturally be making.
Surgical Menopause
If a woman has her ovaries removed (oophorectomy) she will enter a surgical menopause. Hormone levels plummet, and she will experience a sudden onset menopause. This is in contrast to the more gradual decline in hormone levels that occurs in a natural menopause.
As well as dealing with an abrupt onset of menopausal symptoms due to the sudden loss of oestrogen and progesterone, women who have their ovaries removed appear to be at greater risk of suffering from symptoms of testosterone deficiency than those who enter menopause naturally.
When a woman knows she will be having her ovaries removed it can be very helpful to make a plan regarding Hormone Replacement Therapy (HRT) to start immediately following the operation to reduce the impact of these sudden changes, as long as the condition for which she is having her ovaries removed is not a contra-indication to hormone treatment.
Vulval, Vaginal and Urinary Symptoms
Low oestrogen levels which occur during the perimenopause and menopause cause the tissues of the vulva and vagina to become thinner, drier and less flexible. Low oestrogen can also affect the bladder leading to urine frequency and incontinence. This is known as genitourinary syndrome of the menopause. These changes to the tissues mean there is a greater chance of developing vaginal infections and urinary tract infections.
Women also often find that sexual intercourse is painful and can be less satisfying due to changes in the tissue of the clitoris. Other women may notice that they are uncomfortable wearing trousers or even underwear.
Many of these issues can be solved easily and safely with vaginal moisturisers and topical vaginal oestrogens in the form of cream, pessary or vaginal ring. These treatments use low doses and generally safe for all women including after hormone dependent cancer.
Testosterone Deficiency and Low Libido
Testosterone is a hormone that is made by the ovaries and adrenal glands. Many people think of it as a "male" hormone because men have much higher levels of it than women do, but it is just as important in women.
Testosterone influences a woman's level of interest in sex (libido) as well as how pleasurable it is. It is also thought to be important in maintaining muscle mass and bones, energy levels, alertness and mood.
Levels of testosterone gradually decrease as we age but drop more sharply at menopause and very abruptly in women who have their ovaries surgically removed. When testosterone levels fall a woman may notice that her interest in sex reduces and that when they do have sex, it is less pleasurable than it used to be.
The main reason for replacing testosterone is to improve libido in women who are troubled by this change. However, many women who use testosterone supplementation also report improvements in their mood, energy levels and general well-being although there is currently no scientific data to confirm this so more studies are needed. The important thing to note is that we replace testosterone with the aim of making a woman feel better in herself.
No testosterone preparations for women are licensed in the UK but The Women's Hormone Clinic can prescribe medicines that are not licensed if they are commonly used and supported by evidence and experience, usually a male preparation that's used at a very low dose. Alternatively, The Women's Hormone Clinic can prescribe a bioidentical testosterone cream that is made in a dose specifically tailored to a woman's needs.
Osteoporosis
Osteoporosis and osteopenia are conditions that affect bone strength and increase the risk of fractures. Osteopenia is the early stage of bone loss, where bone mineral density is lower than normal but not low enough to be classified as osteoporosis. Osteoporosis is a more advanced condition where bones become fragile and more likely to break, especially in the hips, spine, and wrists. These conditions are more common in postmenopausal women due to the natural drop in oestrogen levels, which plays a key role in maintaining bone density. Hormone Replacement Therapy (HRT) can help treat and prevent osteoporosis and osteopenia by restoring oestrogen levels, slowing bone loss, and even improving bone density in some cases. HRT is most effective when started around the time of menopause, and your doctor will help weigh the benefits and risks to determine if it's a suitable option for you
Menopause After Cancer Treatment
Some women suffer an early menopause as a result of their cancer treatment and other women reach the natural age of menopause but due to a history of cancer earlier in their life are worried about taking HRT. Every woman's case is different and our highly trained specialists can talk you through the risks versus benefits of treating your symptoms with hormone replacement therapy, and for those in which it is not advisable, discuss the alternatives that are available
