Menopause and perimenopause
What is the menopause? Menopause is when your periods stop due to lower hormone levels, which usually happens between the ages of 45 and 55. It can sometimes happen earlier than 45 naturally or as a result of surgery to remove the ovaries (oophorectomy) or the uterus (hysterectomy) or cancer treatments. What is perimenopause? Perimenopause is when you have symptoms before your peri
What it is
Falling and fluctuating oestrogen, progesterone and (often overlooked) testosterone drive the symptoms. The picture is highly variable — from minimal symptoms to severe vasomotor, cognitive, mood, sleep, joint and genitourinary disturbance. Our consultants are British Menopause Society aligned and offer evidence-based HRT and lifestyle management.
Symptoms and signs
- Hot flushes, night sweats and disrupted sleep.
- Mood change, anxiety, brain fog, reduced concentration and memory complaints.
- Irregular periods that are heavier, lighter, closer together or further apart.
- Genitourinary symptoms — vaginal dryness, painful intercourse, urinary urgency or recurrent UTI.
- Joint and muscle aches, weight redistribution, hair thinning and reduced libido.
How we investigate
Diagnosis in women over 45 is clinical — no blood tests required. For women under 45, or where the picture is unclear, we arrange hormone profile (FSH, LH, oestradiol, TSH ± testosterone) and a baseline bone-health and cardiovascular-risk review. Bone density (DEXA) scan via our partner imaging centres where indicated.
Treatment options at The Vesey
- Body-identical HRT — transdermal oestradiol (patch or gel) with micronised progesterone for women with a uterus, prescribed in line with current British Menopause Society guidance.
- Testosterone replacement — for selected women with persistent low libido or fatigue despite optimised HRT, prescribed off-licence in line with BMS guidance.
- Vaginal oestrogen — local treatment for genitourinary symptoms; can be used long-term and alongside systemic HRT.
- Non-hormonal options — SSRI / SNRI, gabapentinoid, clonidine or CBT-based pathways for women who cannot or choose not to take HRT.
- Lifestyle, bone-health and cardiovascular planning — every plan includes weight-bearing exercise, alcohol and sleep guidance, and a long-term review schedule.
How do I know if my symptoms are menopause or something else? +
In women over 45, a clinical diagnosis of perimenopause can be made on symptoms alone — no blood tests are required. Below 45, or where symptoms are atypical (significant cognitive change, severe depression, thyroid symptoms), blood tests and specialist review help to distinguish menopause from other causes.
Is HRT safe? +
Body-identical HRT (transdermal oestradiol + micronised progesterone) carries a very low risk profile when prescribed correctly and is the preferred approach in our clinic. The slight increase in breast cancer risk applies mainly to combined oral HRT with synthetic progestogens, not to transdermal preparations.
How long will I need HRT? +
There is no fixed maximum duration. Current BMS guidance supports using HRT for as long as the benefits (symptom control, bone protection, cardiovascular benefit in early menopause) outweigh any risks, reviewed annually. Many women choose to continue into their 60s; others stop at 2–5 years when symptoms resolve.
What if I cannot take HRT? +
There are effective alternatives for women who cannot or choose not to take HRT: SSRIs/SNRIs (especially venlafaxine or escitalopram) for hot flushes, gabapentinoids for sleep and neuropathic symptoms, clonidine for vasomotor symptoms, and CBT-based programmes for menopause. Local (vaginal) oestrogen is extremely low-risk and can usually be used even when systemic HRT is contraindicated.
Pricing at a glance
Initial menopause consultation £260 (60 minutes). Follow-up reviews £180. Hormone profile from £180. HRT prescriptions issued same-day. Insurance accepted: BUPA, Vitality, AXA, WPA, Cigna, Aviva, Healix.
Book an appointment
When to see a specialist
See us if you are between 35 and 55 with new symptoms that are out of character — particularly sleep disturbance, anxiety, brain fog or unexplained physical symptoms — or if you have been on HRT but feel it is not working and want a structured review.
Cost and pathway
Initial menopause consultation £260 (60 minutes). Follow-up reviews £180. Hormone profile from £180. HRT prescriptions issued same-day. Self-pay and major insurers accepted.
- Open 7 days including Sundays — 8am to 8pm, no weekend surcharge
- No GP referral required — book directly with our consultant gynaecology team
- Sutton Coldfield location — serving Birmingham, Walsall, Tamworth, Lichfield and the West Midlands
- CQC-regulated — rated 4.87/5 on Doctify from 700+ verified reviews
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Sutton Coldfield · Birmingham · Walsall · Tamworth · Lichfield · West Midlands · Open 7 days 8am–8pm
Open 7 days · 8am–8pm · 0121 387 3727