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Can I still get pregnant during my perimeopause? The simple answer is YES! Take a look at this fact sheet which explains more about contraception and the menopause.

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HRT is not the only way of managing symptoms of the menopause and perimenopause. And for some women, HRT will not be a suitable or safe option. This link has further information about other options for managing symptoms

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Alternatives to hormone replacement therapy (HRT)

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Find out about HRT alternatives such as lifestyle changes, other medicines or herbal remedies for menopause symptoms.

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This NHS article explains what HRT is and what forms of HRT are currently available. It also helps to explain the regimes of HRT and which might be suitable depending on whether you are still having periods or not.

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Types of hormone replacement therapy (HRT)

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Find out about the different hormones used in hormone replacement therapy (HRT), the different types of HRT and how you can take it.

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There are many different forms of contraception out there and it is important to find a method that works for you. This website has information on all forms of contraception available and can help you to decide what might be best for you.

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There are many types of contraception available and none are perfect. The Contraception Choices website provides honest information to help weigh up the pros and cons.

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This summary sheet explains simply, what alternative options there are to HRT.

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GP Dr Sophie explains what menopause is and also what HRT is and which options might be recommended and why. This video is only 10 mins long but explains all the key points you need to know if you are considering HRT as an option.

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Veoza (fezolinetant) is a new NON-HORMONAL medication that has just received NICE approval for use in the NHS. It has been approved for use for the treatment of moderate to severe vasomotor symptoms - put simply hot flushes and night sweats - in those in whom HRT is not suitable. It works by blocking receptors in the brain responsible for body temperature regulation. It is not suitable for all women and so a discussion will be required with your GP about this medication if you are considering it. It has only recently been approved by NICE and so it will take some time before it is available to be prescribed by your GP locally in Nottingham.

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NICE supports NHS prescribing of fezolinetant

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NICE supports NHS prescribing of fezolinetant

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This podcast will guide you through the risks and benefits of HRT, allowing you to make an informed choice about what is right for you.

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HRT Risks and Benefits - Dr Clare Spencer Ep 29

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Listen to this episode from Henpicked Menopause Podcast on Spotify. Do you know enough about HRT to make an informed choice about whether it's right for you? In this episode we'll discuss the benefits and risks of HRT. Henpicked's Deborah Garlick talks to Dr Clare Spencer of My Menopause Centre.

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The menopause occurs when your periods stop due to changes in hormone levels. It usually affects women between the ages of 45 and 55, but it can happen earlier.

Early menopause is when periods stop between the ages of 40 and 45 and premature menopause occurs when periods stop before the age of 40.

Many women experience symptoms before their periods stop completely and this time is known as the perimenopause. Symptoms can start up to 10 years before periods stop!

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Menopause is when your periods stop due to lower hormone levels. It usually affects women between the ages of 45 and 55, but it can happen earlier.

It affects anyone who has periods.

Menopause can happen naturally, or for reasons such as surgery to remove the ovaries (oophorectomy) or the uterus (hysterectomy), cancer treatments like chemotherapy, or a genetic reason. Sometimes the reason is unknown.

Perimenopause is when you have symptoms of menopause but your periods have not stopped. Perimenopause ends and you reach menopause when you have not had a period for 12 months.

Menopause and perimenopause can cause symptoms like anxiety, mood swings, brain fog, hot flushes and irregular periods. These symptoms can start years before your periods stop and carry on afterwards.

Menopause and perimenopause symptoms can have a big impact on your life, including relationships and work.

There are things you can do to help with symptoms. There are also medicines that can replace the missing hormones and help relieve your symptoms.

Page last reviewed: 17 May 2022
Next review due: 17 May 2025

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Find out about menopause symptoms, causes and treatments, and things you can do to help.

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This animated video explains, in the words of women, what perimenopause is and the symptoms they have experienced. It also talks about different treatments women have found helpful.

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Cycle of Change; Understanding Menopause - an animated film

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The perimenopause is the whole duration of time from when you first start having menopausal symptoms and – for most people – periods start to change, right up to the ‘menopause’ point in time. It might just be months but for the majority, perimenopause lasts for many years.

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What is the perimenopause? A quick guide - Balance Menopause & Hormones

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An explanation covering what is the perimenopause, why does it happen and what symptoms you can expect due to hormone changes.

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This picture explains how female hormones change throughout the course of life. As you can see, hormones fluctuate greatly in the peri-menopausal period. This is the cause of many of the symptoms experienced.

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Peri-menopause, menopause and post-menopause put simply 

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Peri-menopause, menopause and post-menopause put simply 

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If your periods stop prior to you turning 40 you will be considered to have had a premature menopause. This is also called premature ovarian insufficiency (POI). Follow the link to see support available via the Daisy Network

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Charity for Women with POI | The Daisy Network

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More than 1% of women under 40 go through early menopause. Daisy Network is a charity offering information, advice and support. Make contact with other members, chat to specialist doctors online and receive news, videos and fact sheets.

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Print your answers and take to your GP appointment!

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Menopause Symptoms: Scoresheet

The Greene Climateric Scale. Reproduced with kind permission from Dr Greene.

The Greene Scale provides a brief measure of menopause symptoms.
It can be used to assess changes in different symptoms, before and after menopause treatment.
Three main areas are measured:

1. Psychological.
2. Physical.
3. Vasomotor.

SEVERITY OF PROBLEM IS SCORED AS FOLLOWS:

Download a checklist of vaginal atrophy symptoms you can print out and take to your GP or nurse to help you start a discussion: PDF (47K) or Word (47k)

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Menopause Matters: The Menopause Handbook

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The Greene Climateric Scale. Reproduced with kind permission from Dr Greene. The Greene Scale provides a brief measure of menopause symptoms. It can be used to assess changes in different symptoms, before and after menopause treatment. Three main areas are measured: 1. Psychological. 2. Physical. 3. Vasomotor.

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These interventions can help improve symptoms of the menopause without medication.

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The menopause and per-menopause can be an emotionally challenging time and can affect those around you too. It is important to think about supporting your emotional wellbeing and this fact sheet explains more about how you can do this.

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Oestrogen is an important part of bone health. As the menopause approaches, the levels of oestrogen in the body fall and this can lead to loss of bone density and in some cases, osteoporosis. This leaflet explains how you can keep your bones healthy (with and without HRT).

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Changes in hormone levels can trigger weight changes around the time of the menopause. This can can have huge effects on self-confidence and self-esteem. This video explains why weight is gained and how you can adapt your lifestyle and nutrition to help maintain a healthy weight.

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Menopause: Weight gain, nutrition and lifestyle - a British Menopause Society video

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The menopause is the time when periods stop. It is defined as occurring 12 months after the last menstrual period and usually happens between the ages of 45-55.
The period leading up to the menopause is called the perimenopause, this is usually what women mean what they talk about 'going through' the menopause.

What happens during the menopause?

During the perimenopause your body can change in different ways. As oestrogen levels fall, your periods may become irregular and/or heavy and you may lose your fertility. You may notice other physical changes including higher blood pressure, changes in cholesterol levels (increasing risk of heart disease), and losing calcium from your bones (raising the risk of osteoporosis). Other symptoms of the perimenopause can include weight gain, hot flushes, night sweats, irritability, poor concentration, more frequent headaches, and joint pains. These symptoms are mainly due to falling oestrogen levels, and can last for just a few months or for several years. The range of symptoms and how severe they are, is different for each woman.

What can I do?

A range of lifestyle changes can make symptoms more tolerable. Hormone replacement therapy (HRT) can be used by many women to help control these symptoms, however some women cannot take HRT due to other health problems, whilst others choose not to. The decision to take HRT or not should be discussed with your doctor. For all women, diet and lifestyle changes can help with symptoms. This can include taking dietary supplement products.

Weight gain

During the menopause, muscle mass reduces which means you may needing that fewer calories may be needed. Over time this can lead to weight gain. Being careful about how many calories you consume, your portion sizes and doing more physical activity can help prevent weight gain. Resistance activities, such as using weights, are especially important to both preserve and build muscle mass. Thirty minutes of fast walking a day could lead to around 7kg (15lb) weight loss in a year, and also reduce the risk of heart disease. The BDA Food Fact on Weight Loss has tips on safe effective weight control.

Bone health

From the age of about 35, we slowly lose calcium from our bones. Losing oestrogen during menopause increases the rate of loss, which can increase the risk of osteoporosis.

Taking HRT helps to maintain oestrogen levels and protect bone health. There are also lots of nutrients that help to keep bones healthy, so it's important to have a balanced diet. Choose a variety of foods and consume plenty of fruit, vegetables and dairy foods as these are a source of calcium.

Aim for two to three portions of calcium-rich foods every day which can include:

a third of a pint/200ml semi skimmed milk,

a matchbox size piece of cheese,

a small yoghurt or

a milk-based pudding like custard or rice pudding.

Vitamin D is also very important for bone health. Your skin makes it in response to sunlight, but in the UK this can only happen between April to September. During this time, it's recommended you expose your skin to direct sunlight for around ten minutes, once or twice per day, but avoid burning. All adults should consider taking a daily supplement containing ten micrograms of vitamin D, especially during autumn and winter. Women over the age of 65, those with dark skin, from African, African-Caribbean and South Asian backgrounds or who have low sunlight exposure should also consider taking a vitamin D supplement of ten mcg per day all year round. There are not many foods that are good sources of vitamin D. Find out more in our Vitamin D Food Fact Sheet.

Foods that contain vitamin D include:

oily fish, some mushrooms (Vit D marked on packaging, red meat, fortified plant beverages (e.g. soya or oat drinks), fortified breakfast cereals and eggs.

Heart health

Menopause can increase your risk of developing heart disease. Eating a heart healthy diet can help to lower cholesterol levels and blood pressure, here are some very simple lifestyle changes you can make to reduce the risk:

Switch from saturated to unsaturated fats by cutting down on fatty meats, switching to low saturate oils and spreads, choosing lower fat dairy and grilling rather than frying your food.

Include meals based on fish, nuts, beans or pulses at least once or twice each week.

Eat at least four to five portions of unsalted nuts, seeds and legumes per week.

Reduce your intake of refined sugars like sweets, cakes and soft drinks.

Reduce salt by avoiding processed foods like ready meals, soups and cooking sauces, and limiting salted snacks. Cooking from scratch means you can use different ingredients for flavour such as herbs and spices.

Aim for at least two portions of fish per week, one which should be oily as these are rich in omega-3 fats. Oily fish includes canned sardines, mackerel, salmon, trout and herrings.

Fruit and vegetables provide vitamins, minerals, fibre and other plant nutrients such as antioxidants that help protect your heart. Aim to get your 5-a-day from a range of different coloured fruits and vegetables every day. ALL types can count (fresh, frozen, canned, dried or juiced).

Swap to higher fibre foods, such as wholegrain breads, high fibre breakfast cereals and brown rice whenever you can. Oats, wholegrain cereals and breads as well as pulses like lentils, chickpeas and beans are all excellent sources of fibre and heart friendly.

What about plant oestrogens?

Plant oestrogens (also called phytoestrogens) are very similar to human oestrogen. If eaten regularly, and in sufficient quantities, they can start to have mild oestrogen-like effects - which is useful as oestrogen levels decline.

For some women these effects could be sufficient to help relieve menopausal symptoms, particularly hot flushes. It is worth knowing that:

it can take two to three months for benefits of plant oestrogens to be seen

they seem to work better for some women than others which might be down to differences in gut bacteria

consuming plant oestrogens several times a day appears to be more effective compared to one larger dose

foods containing plant oestrogens (such as soya and linseeds) are also heart friendly so it's worth trying to include calcium-enriched soya products like milk, yoghurts, soya and linseed bread or edamame beans two to three times each day before opting for supplements.

Caffeine and alcohol

Both caffeine and alcohol can make hot flushes worse so try to moderate intake of caffeine from drinks like coffee, tea and colas or choose decaffeinated drinks if you are sensitive to its stimulatory effects. Keep to sensible alcohol limits - no more than two to three units per day, avoid altogether if you feel it makes symptoms worse.

Summary
A lifestyle approach to the menopause

Changing lifestyle may help to reduce menopausal symptoms, keep bone density and reduce risk of heart disease

Eat a heart healthy diet, including at least five portions of different coloured fruit and vegetables, plenty of fibre rich cereal foods, and more fish, nuts (unsalted), peas and beans

Aim for two to three portions of calcium-rich foods every day

Reduce caffeine and alcohol intakes to help manage hot flushes

Maintain or take steps to achieve a healthy body weight

Take regular moderate exercise, especially weight bearing activity and include some muscle strengthening exercises on two or more days each week

If you think you might want to take nutritional supplements, get some advice from your dietitian, doctor or pharmacist, especially if you are taking regular medications

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The menopause is the time when periods stop. It is defined as occurring 12 months after the last menstrual period and usually happens between the ages of 45-55. This Food Fact Sheet explains what happens during the menopause and provides dietary advice to help aid symptoms.

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Many women struggle to manage their weight in the peri-menopause and menopause. This Fact Sheet provides information on how you can adapt your diet to help ensure you are still getting all the nutrients you need.

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Menopause and peri-menopause does not mean the end of your sex life! You can still have an active, enjoyable and fulfilling sex life, this video explains how!

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Does menopause spell the end of your sex life?

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This webpage has lots of other useful links that can help you to manage your menopause while working.

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Menopause at Work

Magazine Article

Download A4 Poster
Menopause in the workplace - let's talk about it Coping with menopausal symptoms at work can be tough and some women are, understandably, reluctant or even afraid to talk to their employer about it.
With around 3.5 million women aged between 15 and 65 years currently in employment in the UK, women now represent nearly a half of the UK labour force. That surely makes menopause mainstream and as important as any other occupational health issue.
Working through the menopause

Many women find they are little prepared for the onset of the menopause and are even less equipped to manage its symptoms at work. They tend not to disclose their symptoms to their manager

The majority of women feel they need further advice and support

Workplaces and working practices are not designed with menopausal women in mind

Heavy and painful periods, hot flushes, mood swings, fatigue and poor concentration can pose significant and embarrassing problems for some women, resulting in lowered confidence

Women are often uncomfortable disclosing their symptoms and problems to managers, particularly if they are young or male.

Where women have to take time off work to deal with their symptoms many do not disclose the real reasons for their absence

Some women say they have to work extremely hard to overcome their perceived shortcomings due to their menopause

Others consider working part-time, despite the concern about the impact on their career. Some even think about leaving employment altogether.

Source: UNISON's Health and Safety guide to the menopause Wouldn't it be great to see employers providing...

Greater awareness among managers of the menopause as a real occupational health issue

Provision of a culture where women feel comfortable about discussing their symptoms and what impact that has on their working lives

Options around flexible working hours and working arrangements to help manage symptoms

Improved access to support -formal or informal

Options to improve your work environment temperature and ventilation

You might find it helpful to...

Find out more about menopause in general

Talk to your GP about treatment choices

Talk with a manager / HR department you feel comfortable with

Use technology where it can help you - setting up reminders on your phone or taking more notes

If you have supportive work colleagues talk about your experiences with them, you may find you're not alone. Humour can help deflect embarrassment and increase your confidence

Look into mindfulness techniques you can practice at work and home

Consider lifestyle changes - could you exercise more? Stop smoking or set a revised weight goal?

This article is an extract from an article published in the Spring 2017 issue of Menopause Matters magazine.
" Download the article as a PDF (314Kb)"Menopause at work"
" Download an A4 Poster here. PDF (300Kb)
" Subscribe or buy the latest issue of Menopause Matters magazine here.

Menopause in the Workplace - Links
" UK Parliament, House of Commons Committee report (28 July 2022)" Womens Health Concern: Menopause in the workplace (19 Oct 2021" Global consensus recommendations on menopause in the workplace: A European Menopause and Andropause Society (EMAS) position statement. (8 Sept 2021)" Response to the BMA report 'Challenging the culture on menopause for doctors'. (14 Aug 2020)" Challenging the culture on menopause for doctors (Aug 2020)
" The menopause nearly killed me (6 June 2021)
" New menopause and the workplace guidance and model workplace policy (Oct 2019)" Why companies should be supporting employees going through the menopause (18 Oct 2019)
" Protecting staff and preventing ill health - taking a targeted approach: menopause in the workplace (10 Oct 2019)
" Menopausal women 'should get flexible work hours' - BBC News (21 Sep 2019)" Menopause and the workplace - PDF (British menopause Society publication - Feb 2019)
" Information for employers - dealing with health problems in the workplace: advice on the menopause (2016)
" Union leader calls for bosses to act on menopause
" Financial sector takes part in survey about impact of menopause

" MPs to examine lack of support for working menopausal women
" Menopause training for men
" We need to stop the menopause hijacking careers

" Northern Ireland MPs and journalists call for stigma to end

" Jooble - Job vacancies all over the United Kingdom

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Menopause in the workplace: Menopause Matters

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Menopause and treatment options. An independent, clinician-led site aiming to provide accurate information about the menopause.

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Getting the most from your GP appointment 

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Getting the most from your GP appointment 

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Tips to help you get the most out of that first appointment!

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Getting The Most From Your GP Appointment

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This picture puts the risks and benefits of HRT in simple terms. Many women worry about the risks of HRT. It is important to discuss your risk with your GP as every person is different and the risks of taking HRT will be different for each individual.

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This picture demonstrates the risk of breast cancer in women in a number of different scenarios. HRT can increase the risk of breast cancer for some women but so can other lifestyle choices. It is important to discuss your individual risk with your GP as other factors, such as family history, also need to be taken into account.

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The type of HRT you may be offered depends on a few factors including if you have had a hysterectomy and if you are still having periods. This simple flow chart will help you understand the type of HRT you might be offered if HRT is a suitable option for you.

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If you still have your womb and have not had a hysterectomy, then progesterone is a key part of your HRT and MUST be used alongside oestrogen. This article helps explain why!

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Oestrogen is commonly talked about as being the most important sex hormone for women, but the ovaries make another hormone - progesterone - and many women need this to form part of their hormone replacement therapy (HRT) also.

Before we look at what progesterone does, it's helpful to understand the different terminology used, which can be confusing:

Progesterone is the name of the hormone made by cells in the ovaries. Utrogestan oral capsules contain the 'body identical' progesterone.

Progestogens (or sometimes the term progestins is used) are versions of progesterone. They are synthetic hormone drugs that mimic the body's own progesterone. Many types of HRT (and the combined oral contraceptive pill) contain a synthetic progestogen (for example norethisterone, dydrogesterone, medroxyprogesterone acetate or levonorgestrel in the Mirena or Levosert coils). They all do a similar job, but the side effects can vary.

Through this article, we will refer to progestogens to include synthetic and body-identical hormones.

What does progesterone do?

During reproductive life, from puberty to the menopause transition, the most important activity of progesterone is to prepare the womb lining for pregnancy during the second half of the menstrual cycle (called the luteal phase).

If there is a pregnancy - if the egg released is fertilised by a sperm - the progesterone is important for maintaining that pregnancy. Amongst other actions, it allows the womb lining to 'mature' so it is ready to allow the fertilised egg to implant and develop.

Look at the diagram below to see how the progesterone levels (shown in green) change during the monthly cycle - if a pregnancy does not happen, the progesterone level drops and the womb lining is shed.

In addition, progestogens can have an impact on mood and behaviour and they also have a role to play in maintaining bone density- helping to keep the bones strong and less likely to fracture as a result.

Why is a progestogen needed in HRT?

Oestrogen is needed to manage most menopause symptoms. If you still have a womb (you have not had a hysterectomy) and take oestrogen by itself, this can thicken the lining of your womb, increasing your risk of womb cancer. The progestogen hormone is there to protect the lining of the womb, keeping it stable and preventing it from over thickening. If you had a subtotal hysterectomy or if you had a hysterectomy for endometriosis, you may also need a progestogen alongside oestrogen. This will be discussed with you.

It is so important, therefore, to speak to a doctor or other healthcare professional if you are not tolerating the progestogen in your HRT or if you cannot get access to your usual prescription due to shortages through your pharmacy.

You can read more about how progestogens fit into HRT here.

Are blood tests helpful to check progesterone levels?

Blood tests for progesterone do not have a role in menopause management. We use set doses of progestogen and progesterone that have been shown to keep the womb lining thin.

A blood test won't help predict side effects and won't tell us if your side effects are progestogen related.

The only use of blood tests for progesterone is to check to see if you have ovulated - that is to find out if you have released an egg during the menstrual cycle that can then become fertilised by sperm. This blood test should be timed to be taken 7 days before your period.

Side effects of progestogens

How do progestogens effect mood?

For some women, progestogens and progesterone can significantly impact mood. For example, the rise in progesterone and, for some, the drop before a period, can be the cause of premenstrual syndrome (PMS)-like symptoms.

Some women experience symptoms when they take progestogens in HRT and contraception pills with varying degrees of severity - some feel irritable and low, while others can feel very depressed.

We don't know exactly why some women are more sensitive to progestogens than others.

It's likely that the impact on mood occurs as progestogens can have an effect on the chemicals in our brain that are responsible for controlling levels of mood and anxiety, for example serotonin and GABA (gamma aminobutyric acid - thought to play a role in controlling anxiety, stress and fear).

Mood related side effects include tension and irritability, fatigue, feelings of aggression or anger, mood swings, anxiety and loss of confidence.

When you give a progestogen in HRT, some women feel great. The micronized progesterone in oral Utrogestan TM capsules can help get you into a deeper state of sleep and can take the edge off anxiety.

However, other women may have side effects such as a lower mood or irritability. Side effects can improve over time. Some tolerate one type of progestogen and not others. A small percentage of women do not tolerate the progestogen or their own progesterone at all. They feel very low, as if a dark cloud is hanging over them, and feel depressed. Some even feel suicidal (and see below for a link to support if this is happening to you). These symptoms usually lift when the progestogen is stopped - and this is how you can tell the difference between progestogen sensitivity and clinical depression. Unfortunately, we don't yet have a test to find out who will be sensitive to progestogens and who won't. It is so important that you talk to your doctor if you are experiencing these symptoms so you can discuss alternatives, to find a progestogen that does suit you, or a way of taking it that can be tolerated. A menopause specialist is the ideal person to talk to about this (if you would like to book an appointment with one of the menopause specialists in our clinic, head here).

It is important to understand that the fewer than recommended number of days that a progestogen is taken each month, the greater the risk of womb lining thickening, and a way of monitoring this may need to be discussed if you are not able to tolerate taking the progestogen as recommended.

What are the physical side effects of progestogens?

Physical side effects include breast tenderness, bloating, headaches/migraine, acne/greasy skin, constipation, nausea and fluid retention - all very similar to premenstrual symptoms for some women.

Progestogens and breast cancer risk

The risk of breast cancer as a result of taking HRT has been shown to vary with the type of progestogen used, though the differences are very small, and the absolute level of risk is very small. [1] [2] [3]

In general, the risk of breast cancer with body-identical progesterone or dydrogesterone (biochemical very similar to body-identical progesterone) seems to be lower than with synthetic alternatives such as medroxyprogesterone acetate and norethisterone. However, the risk is still very low with the synthetic alternatives.

If you've looked at the National Institute of Clinical Excellence guidelines on menopause ( here), you will see that oestrogen-only HRT has little or no change in the risk of breast cancer and HRT with oestrogen and progestogen can be associated with an increase in the risk of breast cancer. The risk is small and is balanced against the greater increase in the risk of cancer of the womb if the progestogen is not taken.

The National Institute of Clinical Excellence (NICE) state in their guidance on the menopause that:

the baseline risk of breast cancer for women around menopausal age varies from one woman to another according to the presence of underlying risk factors

HRT with oestrogen alone is associated with little or no change in the risk of breast cancer

HRT with oestrogen and progestogen can be associated with an increase in the risk of breast cancer

any increase in the risk of breast cancer is related to treatment duration and reduces after stopping HRT

However, the risk of cancer of the womb lining is greater if the progestogen is not taken.

Commonly used progestogens in HRT

The progestogens discussed below are available to take alongside your oestrogen. Some women will tolerate one but not the other, other are better for controlling bleeding than others - there is variability in both tolerance and effect.

Micronised progesterone

Micronised progesterone is biochemically matched to your own progesterone - so it's bioidentical - and is available on prescription as a small capsule that is usually swallowed, called Utrogestan TM, in addition to oestrogen.

Compared to synthetic progestogens (which are versions of the same hormone), micronised progesterone has several advantages:

it is often better tolerated

it can help with sleep

there is evidence that the risk of breast cancer is lower when compared with synthetic alternatives

Unlike synthetic progestogens, micronised progesterone should not affect your risk of heart disease or blood clotting.

The case of the capsule contains soy and gelatin. If you have a severe nut allergy, some women are allergic to soy may not be suitable for you. The gelatin is usually of bovine origin and therefore not suitable for vegans/vegetarians or some religious groups.

You can read more about Utrogestan TM here.
Using micronised progesterone vaginally
Micronised progesterone can be used vaginally, off license. A pessary (or the oral capsule as a last resort) of progesterone is inserted into the vagina where it is absorbed by the blood vessels that surround the vagina. There is evidence, albeit limited, that it is effective in keeping the womb lining thin and stable when taken this way. Some women tolerate progesterone better when it is absorbed vaginally. This is because the breakdown products of progesterone are the ones usually impacting on mood, and there are more of the breakdown products when progesterone is swallowed compared with when it is used vaginally.
BijuveTM
is a combined oral capsule containing 1mg oestradiol and 100mg micronized progesterone and is an option for women who want to take body-identical progesterone plus oestrogen in 1 oral capsule. The shell contains gelatine.

Medroxyprogesterone acetate

Medroxyprogesterone acetate (MPA) is the progestogen found in Provera TM. This is a synthetic progestogen and comes in the form of a small tablet that can be swallowed separately from the oestrogen which would then be taken as gel, patch spray or tablet. There is one combined oral HRT called Indivina TM which contains both oestrogen and MPA, though at the time of writing, there are stock issues with this.

While Provera TM is not licensed to take separately as part of HRT, it is used frequently for this purpose. It is licensed to use as a treatment for endometriosis and abnormal bleeding.

Levonorgestrel

Levonorgestrel is the synthetic progestogen found in the Mirena™ intrauterine system or 'coil', the Levosert™ coil and Femseven™ patches - Femseven Conti and Femseven Sequi.

The Mirena is a small T-shaped device that sits in the cavity of the womb and releases a tiny amount of levonorgestrel into the womb lining and blood stream.

Once a Mirena™ has been fitted, it lasts for 5 years (this use is outside its product license - but is used in line with guidance from the Faculty of Sexual and Reproductive Healthcare). The advantage of having a Mirena fit is that it provides contraception for those who need it, for most women it will stop bleeding if you are still having periods when it is fit, and it is a good way of managing the unpredictable, heavy bleeding than some women suffer in the perimenopause.

A Mirena does not suit everyone, but if it does suit you, it is a very convenient way of delivering the progestogen and, for HRT, all you need is to use the oestrogen alongside in patch, gel, spray or tablet. The other advantage of the Mirena is that the amount of progestogen absorbed is tiny, so it may be better tolerated than progestogens that are swallowed or absorbed through the skin.

The Levosert™ coil contains the same amount of levonorgestrel as the Mirena™. It has a license for contraception and treatment of heavy menstrual bleeding but does not have a license for use in HRT. Although Mirena™ is currently the only LNG-IUD that is licensed for this indication, the FSRH supports the use of any 52 mg Intrauterine contraception for endometrial protection as part of HRT for up to 5 years. This recommendation is supported by the Royal College of Obstetricians and Gynaecologists and the British Menopause Society[2].

Femseven patches are patches that you change weekly rather than twice weekly. The levonorgestrel is absorbed through the skin in the combined patches. At the time of writing, there are supply issues with Femseven Sequi patches but Fenseven Conti should be available.

The risk of breast cancer as a result of taking levonorgestrel in the Mirena is not zero, but it is low [3].

Dydrogesterone

Dydrogesterone is very similar in biochemical structure to micronized progesterone. In the UK it is only possible to take it mixed with oestradiol in the Femoston™ products - it is not available separately.

Dydrogesterone may be better tolerated than other synthetic alternatives as it is so close to progesterone. Like micronized progesterone, there is evidence from observation studies that the risk of breast cancer is lower than more synthetic alternatives (such as MPA and norethisterone.)

There is lactose in the combined HRT Femoston tablets.

Norethisterone

Norethisterone is a synthetic progestogen that is biochemically similar to testosterone - more so than other progestogens. It is found in Evorel Conti and Evorel Sequi twice-weekly patches plus some brands of combined oral HRT which it is taken with oestradiol - e.g. Elleste Duet and Ellest Duet Conti, Kliofem and Kliovance. In addition, it can be taken separately to protect the womb lining. It is also found in some progesterone-only contraceptive pills - e.g. Noriday.

Some women do not tolerate norethisterone so well, experiencing irritability headaches and fluid retention.

Norethisterone taken orally may increase the risk of blood clots by a small amount. It is an effective way of managing heavy or unscheduled bleeding. On its own (i.e., not in a combined tablet) it is not licensed for use as part of HRT, but it can be, and is, used in this way. It is not recommended to take it as part of HRT if your body mass index is 30 or above because of the risk of blood clots.

Like other tablets, lactose is found in norethisterone tablets. There is a marginally higher risk of breast cancer compared with micronised progesterone and dydrogesterone, but it is effective in managing troublesome bleeding and it is convenient to use the combined pills.

Desogestrel

Desogestrel is a synthetic progestogen found in Cerazette™ and Cerelle™ progesterone-only pills (POP). It is not licensed to use as part of HRT. There are studies to show that desogestrel 150 micrograms may be effective as the progestogen component of HRT for some women (i.e., 2 x Cerazette/Cerelle 75mcg POP). There is a lack of evidence to show that desogestrel 75 micrograms on its own is adequate and if you are using this for contraception, an additional progestogen would need to be added[4].

Desogestrel is well tolerated by some women and not by others. There is lactose in the tablet ingredients. Off license, therefore, and accepting the lack of large studies, a double dose of desogestrel - 15mcg - can be used for continuous combined HRT and contraception.

Livial™ is tibolone - a synthetic form of HRT that mimics the activity of oestrogen and progestogens - and may also have some androgen (male hormone) activity. It can be an option if you do not tolerate progesterone or other progestogens and is usually taken as a form of HRT when your periods have stopped. For more info, head here.

What are your options if you cannot get your usual prescription of oral UtrogestanTM capsules?

You should discuss the following options with your doctor:

1. Have a Mirena or Levosert coil fit. Although having a coil fit may not be the most pleasant of experiences once it is in, it can stay in for 5 years and they are usually much easier to remove if you really do not tolerate it.

2. Switch to a combined patch - Evorel Conti or Evorel Sequi, or Femseven Conti or Femseven Sequi (if available).

3. Use Provera (medroxyprogesterone acetate) tablets or norethisterone tablets separately to the oestrogen.

4. Speak to your doctor or other healthcare professional about whether using a micronized progesterone pessary would be a suitable method for you.

5. Again, speak to your doctor or other healthcare professional about whether a double dose of desogestrel containing POP would be suitable for you.

6. If you are perimenopausal and under the age of 50, the combined oral contraceptive pill could be an alternative. Not everyone can take this - for example, if you smoke the risks would be deemed to be high in relation to the benefits. It may be an option for some, however, and be useful if you need contraception also (you can read more here).

What can you do if you have progesterone and progestogen sensitivity?

If you are sensitive to taking progesterone/progestogen, please don't despair. It's really important that you speak to a healthcare professional or o ne of the menopause specialists in our clinic to discuss your options.

You are not alone

Remember, if you are having dark thoughts or feel suicidal please call your GP practice, the Samaritans, 111 or 999 straight away.

Further reading
Hormone Replacement Therapy explained What to expect when you first start HRT Storing HRT Menopause Treatment Options
Authored by:

Dr Clare Spencer
Registered menopause specialist, GP and co-founder; see Dr Clare in person at The Spire Hospital, Leeds or online

Join the pause. community

We've created pause. as a space for women to come together and share stories about their menopause experience, ask questions, and to find support and inspiration. We'll also share the latest news and updates on the menopause from our experts.

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The key things you need to know about progestogens and progesterone

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Dr Clare Spencer explains what progesterone is, why it's important as part of your HRT regime, and alternatives to it

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A handy diary sheet you can use to record your symptoms before and during treatment with HRT.

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Patches, tablets, coils, sprays... Where do I start?

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Patches, tablets, coils, sprays... Where do I start?

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There are many options to choose from when deciding to take HRT to manage perimenopause/menopausal symptoms and this can seem overwhelming. It is important to find something that works for YOU. It can be a trial and error approach and you may find that you need to try a few different methods or products before you find what works best. Below is some information about some of the products available. There are many different brands and types available and these are only a few.

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There are many ways of taking oestrogen as part of HRT, these include; gels, patches, sprays and tablets. This information leaflet explains how to use Oestrogel, which is a body identical oestrogen.

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This information leaflet explains more about Lenzetto; an oestrogen containing spray which is applied to the skin. If you still have a womb, you will also need progesterone to help protect the lining of the womb. This can be given as a tablet or by having a Mirena coil fitted.

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Lenzetto Patient Leaflet (Digital) - October 2022

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Evorel patches are available as a combined preparation with oestrogen and progesterone (evorel conti or Evorel Sequi) and also in different strengths containing only oestrogen. There are also other brands available containing oestrogen only and these include Estradot and FemSeven. If you still have a womb and decide to use oestrogen only patches, you will also need to protect the lining of your womb by taking a progesterone tablet or by having a Mirena coil fitted.

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Evorel® Conti information for Patients | Consilient Health Ltd.

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Frequently asked questions for Patients who have been prescribed a Consilient Health medicine - Evorel® Conti. Evorel ®

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Progesterone is an important part of HRT for people who have a womb. It is available as patches or tablets. Utrogestan is a body identical progesterone tablet containing micronised progesterone. There are other progesterone products available. Different products contain different types of progesterone.

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The Mirena Coil can be used to protect the lining of the womb as part of HRT. Once in place, it can be used for up to 5 years as part of HRT. It is also licenced for use as contraception and to help with heavy periods too. This website explains more about the Mirena coil, how it is inserted and how it works. If inserted and used as part of HRT, oestrogen (patch, tablet, gel or spray) can then be prescribed to be used alongside the Mirena coil.

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This website is here to support you on your journey from being prescribed Mirena (52mg levonorgestrel), through to fitting and onto re-fit/removal. This website is intended for Mirena patients in the United Kingdom.

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Vaginal dryness and irritation can affect many women during their peri-menopause and menopause. Topical treatment can help relieve these symptoms. This link will explain more about treatment with vaginal oestrogen and when it might be used.

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Vaginal oestrogen: medicine for vaginal dryness and irritation

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NHS medicines information on vaginal oestrogen - what it's used for, side effects, dosage and who can use it.

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You might have heard about the use of testosterone replacement for women in the menopause and peri-menopause. In the UK, testosterone may be prescribed 'off licence' as part of HRT for women who have Hypoactive Sexual Desire Disorder (HSDD) and in whom a trial of conventional HRT (oestrogen +/- progesterone) has not improved the symptoms of HSDD. This factsheet provides more information about testosterone therapy for women.

In some parts of the country, testosterone cannot be prescribed in primary care (e.g. in the GP setting) and as it is an 'off licence' treatment, you may need to be referred to a specialist menopause clinic if this is a treatment being considered for you. There are some GP's with a specialist interest in menopause and with more experience in prescribing testosterone that may prescribe this in the GP setting.

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'If you're looking for a good website with lots of written information then this website is a good starting point.

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Doctor to doctor
Dr Ben Sinclair, with nearly two decades' experience as a British GP and Founder of Dr Finlay's Private Practice, interviews a range of extraordinary people from all walks of life and recently he spoke with our very own Dr Heather Currie MBE about menopause, her career and life.
" Listen here

Have you experienced memory issues in menopause?
Lexi is a PhD researcher at University College London (UCL). She is looking for research participants who have experienced memory issues during menopause for a focus group study. If you have experienced memory or concentration problems during your menopause, she would like to hear from you! Please contact her by email if you are interested.
" Email Lexi here

Episode 4 of our Let's Talk Podcast: The psychological & emotional symptoms
Thankfully there has been increased awareness about these symptoms in relation to the menopause in recent years. They are incredibly common and can be some of the most debilitating symptoms that people will experience...but don't forget, not everyone will experience these symptoms. It can be challenging for some people to identify the cause of these symptoms, as it's not always related to hormones - there can be many contributory factors. We discuss the range of options which can help to manage these symptoms. Is it right to take antidepressants, should you take HRT, is a combination acceptable? We go through alternative options for you to consider, either on their own or in combination with the above, but remember taking an individualised approach is always important. We also continue the conversation about HRT.

A new weekly podcast will be available from 6pm every Tuesday or you can listen now via the link below and catch up with those you may have missed.

Menopause Matters information is available via Amazon Alexa
Menopause Matters will be providing answers to some of the most commonly asked questions around menopause via Amazon's cloud-based voice service, Alexa.
" Read more

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Menopause Matters, menopausal symptoms, remedies, advice

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Menopause and treatment options. An independent, clinician-led site aiming to provide accurate information about the menopause.

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This webpage discusses some of the myths associated with the menopause and explains why they are not the case!

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‘I’ll grow a beard’ - and other HRT myths busted

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Separating the HRT myths from the facts - everything you need to know from the menopause experts about hormone replacement therapy

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Nutrition: The Happy Menopause Podcast Series 

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Nutrition: The Happy Menopause Podcast Series 

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This series of Podcasts discusses many issues around the menopause and peri-menopause and how diet and nutrition can play a part in alleviating symptoms.

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Imagine if over half the UK population was to experience the same life-changing health condition, which if disregarded would contribute to an increase in disease and illness, an increase in mental health issues, and the likelihood of losing jobs and marriages. Wouldn't we want to do something about that?

This is the current situation for the 33 million women in the UK who, at some stage in their life, will experience menopause. But, due to a lack of awareness among the public, a lack of training among some medical professionals and social stigma, their needs during this critical life change are frequently ignored, belittled or overlooked.

No two menopause stories are the same. This contributes to the lack of understanding. Some women transition smoothly, without any major effects. Others will suffer the most extreme symptoms and endure the massive negative impact these have on their lives.

We're working towards a more holistic view of an individual's overall health state. So that multiple symptoms become correctly recognised as perimenopause or menopause. This doesn't just immediately improve current health. Educated decisions protect against long-term medical issues, caused by menopause, that affect quality and longevity of life.

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The Menopause Charity - Menopause Facts, Advice and Support

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The Menopause Charity works to education everyone so that perimenopause and menopause are properly understood. We deliver trusted information and support for those experiencing or treating menopausal symptoms, as well as family, friends, co-workers and employers.

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This short booklet explains the menopause and how your partner or loved ones can recognise and support you through this part of your life.

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The Eve Appeal is a charity supporting women who have had one of the 5 gynaecological cancers; ovarian, endometrial, cervical, vaginal and vulval cancers. This article discusses how women who have had these cancers can manage their menopause and ease symtpoms.

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The Maggie's website provides information on menopause and cancer, including what treatment options might be suitable depending on the type of cancer.

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Information from Maggie’s on how cancer can induce an early menopause, its side effects, and ways to manage it.

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This article from Cancer Research explains why HRT might not be suitable for patients after breast cancer and what other options are available.

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Some cancer treatments cause low levels of sex hormones that lead to early menopause or menopausal symptoms.

Breast cancer treatments that cause an early menopause include:

drugs that block or lower the amount of hormones in the body (hormone therapy)

chemotherapy

Your menopause might be temporary or permanent. It is more likely to be permanent if you are closer to the natural age of menopause. Your doctor might be able to suggest what will happen in your situation. But this will be difficult to know for sure.

Some women have already been through the menopause. But their treatment can cause symptoms similar to the menopause.

Common menopausal symptoms

Symptoms you may have that are related to low sex hormone levels include:

hot flushes and sweats

night sweats

anxiety, low mood and mood change

feeling very tired (fatigue) and poor sleep

loss of interest in sex

problems with thinking, concentration and memory - sometimes called brain fog

joint pains and muscle aches and you may have thinning and weakening of the bones (osteoporosis) over time

headaches and worsening migraines

itching, irritation or dryness of your vulva or vagina

vaginal pain or discomfort during sex

vaginal bleeding after sex

urinary problems such as needing to wee urgently, infection or incontinence

Fertility

Your fertility might also be affected and you may no longer be able to have children naturally. This loss of fertility can be upsetting even if you have a family or did not intend to have children. Whether this happens to you depends on different factors. For example, your age and the cancer treatment you have had. Speak to your doctor if this is a concern for you. They can explain how likely this is in your situation.

Some women who have experienced an early menopause can still get pregnant. So you may still need to use contraception.

Who can I talk to about my menopausal symptoms?

It can be hard to know whether your symptoms are due to your cancer and its treatment. Or whether they relate to the menopause. It might help to keep a diary or make a list of your symptoms. You can discuss these with your cancer doctor, clinical nurse specialist GP or general practice nurse.

You can ask your GP surgery if there is a GP that specialises in the menopause. In some situations, your GP may refer you to a specialist menopause clinic or a gynaecologist.

Hormone Replacement Therapy (HRT) after breast cancer

Many women in the UK take hormone replacement therapy (HRT) to reduce menopausal symptoms. But doctors don't routinely recommend taking HRT after breast cancer.

The concern is that HRT could increase the risk of your breast cancer coming back (recurrence). The risk for women who have had breast cancer is uncertain because research so far has not drawn any firm conclusions. This might depend on the type of HRT and how long you have it.

The risk is thought to be greater in women:

whose breast cancer has receptors for the female hormones - hormone receptor positive breast cancer

who take HRT that contains oestrogen and progestogen (combined HRT)

It's important that you talk to a health professional if you are finding menopausal symptoms difficult to cope with. Ideally you should speak to your cancer doctor as well as a doctor that specialises in the menopause.

Your doctor might suggest that you try other things first, such as non hormonal medicines. But they may offer HRT if your symptoms are severe. For example, if hot flushes or low mood, or a combination of symptoms are affecting your quality of life. Your doctor should discuss the risks and benefits of HRT with you.

Things that might help

For some women, HRT is the only way to completely get rid of menopausal symptoms. But there are other ways of reducing symptoms if you can't take HRT, or choose not to take HRT.

There are a range of other treatments and things you can do to help cope with the effects of menopause. You may need to try different things before you find something that works for you. And you might find that a combination of things is better than one.

We have information about ways to cope with symptoms such as:

hot flushes and sweats

vaginal dryness and loss of interest in sex

problems sleeping

bone loss

Talking, time for yourself and getting support

It can be hard to come to terms with your diagnosis at the same time as having menopausal symptoms. It might help to talk to family and friends and share how your symptoms are making you feel with your family and friends.

Try to make some time for yourself. Some people practice breathing or relaxation techniques, or mindfulness. And some people find counselling and support groups helpful.

Work and menopausal symptoms

It might help to let someone in your workplace know if you are finding menopausal symptoms difficult. It makes sense to talk to your manager first, it might be useful if some of your colleagues know as well. This all depends on how comfortable you feel about sharing what you are going through. If possible, small adaptions to your work could help. For example, flexibility of your hours, positioning your desk near a window or nearer to the toilet.

Information is available about menopause in the workplace. You can find resources on government, union and charity websites.

Sharon's story

Sharon was diagnosed with breast cancer in 2016.
'I'm still on medication... this causes early menopause that's not been fun but coping well now.'

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Some cancer treatments cause low levels of sex hormones that lead to early menopause or menopausal symptoms. Breast cancer treatments that cause an early menopause include: drugs that block or lower the amount of hormones in the body (hormone therapy) chemotherapy Your menopause might be temporary or permanent.

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A handy guide that provides information and tips on managing menopause at work. This also has tips and information for managers and employers on how they can and should support you.

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Premature Menopause, also known as Premature Ovarian Insufficiency (POI), is when the menopause occurs in someone under the age of 40. This article explains why this can happen, how it is diagnosed and what treatment is available.

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Premature ovarian insufficiency (POI) occurs when you are under 40 years and your ovaries stop working. It’s sometimes called premature ovarian failure.

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Too many women are suffering in silence

To significantly improve menopause education amongst GP's - far too many women are suffering as GP's receive very little, if any menopause education during their training leaving them poorly-equipped to recognise and manage a phase of life that will directly affect at least 50% of the population.

To raise awareness within the workplace and for all employers to have menopause guidelines in place to be able to support women experiencing symptoms. Too many women feel unsupported at work and currently 1 in 10 leave the workplace due to menopause symptoms.

Already achieved: To introduce menopause education in to the PSHE curriculum for all teenage boys and girls. Everybody deserves to understand this phase of life. Far too many individuals and relationships suffer as a result of a lack of understanding of menopause.

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menopausesupport.co.uk - Supporting You Through Change

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Too many women are suffering in silence To significantly improve menopause education amongst GP's - far too many women are suffering as GP's receive very little, if any menopause education during their training leaving them poorly-equipped to recognise and manage a phase of life that will directly affect at least 50% of the population.

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This article from the British Heart Foundation explains how the menopause can affect your heart health and also provides some information about taking HRT if you have a heart condition.

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Before the menopause, women in general have a lower risk of being affected by coronary heart disease. But after the menopause, your risk increases.

Why does the menopause affect your heart?

Oestrogen is a hormone naturally produced in a woman's body which forms a vital part of regulating her menstrual cycle. It can offer some protection against coronary artery disease therefore reducing the risk of a heart attack. It helps to control your cholesterol levels and so reduces the risk of fatty plaques building up inside the artery walls.

As we get older the blood vessels can become stiffer, caused by high blood pressure. This is a risk factor associated with heart attacks and stroke

During and after the menopause, a woman's body gradually produces less oestrogen than it used to. This increases the risk of the coronary arteries narrowing whereas it previously protected the lining of the artery walls reducing the build-up of plaque. This increases your risk of developing coronary heart disease, or a circulatory condition such as stroke.

Does hormone replacement therapy (HRT) affect your risk of heart and circulatory disease?

Women going through the menopause can suffer from unpleasant symptoms, such as hot flushes, night sweats and mood swings. If you experience these, you may be prescribed hormone replacement therapy (HRT) to help relieve the symptoms.

HRT can be very effective for relieving some symptoms of the menopause. But some women avoid taking it because they worry that it may increase their risk of certain health conditions such as blood clots.

Taking HRT in tablet form can increase the risk of a blood clot, which such as deep vein thrombosis (DVT) in the lower leg or pulmonary embolus in the lung. But this risk can be reduced by having HRT through the skin, as a patch or gel. You should discuss your individual needs with your GP.

Recent evidence shows that menopausal women taking HRT have no higher risk of dying from a heart attack than women who don't take HRT.

Early menopause and the heart

If you have early menopause (before the age of 40) you are at higher risk of premature coronary heart disease, so treatment is very important. Common treatments include HRT and the combined contraceptive pill - you can speak to your GP about whether these are suitable for you.

Menopause and heart palpitations

Some women who are going through the menopause may be more aware of their heart beating, or might feel as though their heart is racing. These are called palpitations. If you experience them, see your GP. For most women the palpitations are harmless and don't mean anything is wrong with the heart, but your GP may wish to give you a check-up to be sure.

Help and information

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Before the menopause, women in general have a lower risk of being affected by coronary heart disease. But after the menopause, your risk increases. Oestrogen is a hormone naturally produced in a woman's body which forms a vital part of regulating her menstrual cycle.

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Perimenopause Information – Perimenopause Information UK. Signs, Symptoms and Help with Premenopausal Symptoms

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Perimenopausal Information & SymptomsWelcome and if you have found our site, the chances are you think you might be experiencing premenopausal (perimenopause) symptoms or you know someone who is going through it. This is the stage before you reach menopause. It can last from a few months to 8+ years. It can start at any age but typically it starts in your mid 40’s. When you haven’t had a period for a full year you have hit menopause.

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The menopause and peri-menopause can cause mental as well as physical health changes. It can also have an impact on pre-existing mental health conditions. Mental Health UK provides more information about this.

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Menopause and mental health - Mental Health UK

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The menopause is something all women will experience, yet the symptoms of the change and how it affects our mental health is still not widely spoken about. Find out more about what the menopause is, how it can affect your physical and mental health, and what steps you can take to look after your wellbeing during this period in your life.

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This is another fantastic website with loads of information and resources that can help with understanding your peri-menopuase/menopause.

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Rock My Menopause - Menopause Information

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Our menopause campaign will empower you with the information you need to become menopause aware to talk to your GP and loved ones with confidence.

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You can now get a prescription prepayment certificate if you are taking HRT. This costs £19.80 for 12 months and will cover all of your HRT prescriptions within that 12 month period. You can buy a prescription prepayment for HRT by following this link.

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If you pay for NHS prescribed HRT medicine 3 or more times in 12 months, an HRT PPC could save you money.

Each item on an NHS prescription usually costs £9.65. You can buy an HRT PPC for a one-off payment of £19.30 (the cost of two single items).

The HRT PPC covers an unlimited number of certain HRT medicines for 12 months, regardless of why they are prescribed.

The HRT PPC does not cover all HRT medicines. Check if it covers your HRT medicine.

If your HRT medicine is not covered, or you also get prescriptions for items other than HRT medicine, you may save more with a 3 or 12 month PPC that covers all NHS prescriptions.

Before buying an HRT PPC, check if you're entitled to free NHS prescriptions and other help with health costs using our eligibility checker.
Buy an HRT PPC
We can send your HRT PPC by email and you can also print and download it.

Contact us

Contact us if you need help with your application or your certificate details.

Online: using our online contact form

Telephone: 0300 330 2089
Monday to Friday, 8am to 6pm and Saturday, 9am to 3pm.
> Find out about call charges

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NHS Hormone Replacement Therapy Prescription Prepayment Certificate (HRT PPC)

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If you pay for NHS prescribed HRT medicine 3 or more times in 12 months, an HRT PPC could save you money. Each item on an NHS prescription usually costs £9.65. You can buy an HRT PPC for a one-off payment of £19.30 (the cost of two single items).

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Hello and welcome! My name is Dr Lorna Filby and I am a GP working in Mapperley, Nottingham. I have created this Padlet page as a 'one stop shop' for information relating to the menopause and perimenopause. After speaking to many women during my day to day work as a GP, I know how many questions there are about all aspects of the menopause and peri-menopause. I wanted to be able to direct women to good quality information without them needing to search the web for hours. I also appreciate that not everyone likes to read articles, with some people preferring to listen to podcasts or watch videos. Here, I have put together a selection of the most useful resources I have found and also some that have been recommended to me by my colleagues and patients. I hope you find this Padlet useful and that it empowers you to make the choices that are right for you!

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Looking after your pelvic floor muscles is important at all stages of life but the perimenopause and menopause can be a time where there is weakening of these muscles. This can lead to bladder leaking. This leaflet explains how you can strengthen your pelvic floor with exercises. The 'Squeezy' App can be downloaded to your smartphone for a small one off fee and this also offers support (and reminders) with pelvic floor exercises.

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A Brief guide to pelvic floor exercises - Feb 2024