Treatments and Therapies

Womens Health and Menopause Management

Dr Peers has a particular interest in counselling women in the menopause and HRT.

'I feel that women deserve to have clear, accurate information that will help them to make important choices whether it is about their contraception or about Hormone Replacement Therapy (HRT) Their choices now can impact positively or negatively on their quality of life and future health and happiness.'

The menopause and the peri-menopause can affect womens mood, sleep patterns, sex drive, energy levels and cause hot flushes, night sweats and various aches and pains including vaginal dryness. All of these symptoms can be treated by using the appropriate hormones which may also prevent ill health in the future. There is good evidence that HRT reduces the risk of dementia, osteoporosis, heart disease, depression and restores sexual function.

Dr Peers, a member of the British Menopause Society, regularly attends their meetings and is passionate that women should receive accurate, up-to-date information about the benefits of HRT, which improves their quality of life and long-term health. She is often asked to lecture on menopause management. She also gives menopause talks to national companies, schools and womens’ groups.

HRT post Breast Cancer

'This is an area of particular interest for me, as I have personal experience of this condition. When I became menopausal, following treatment for breast cancer, I was desperate to be able to go on HRT as I felt so ‘out-of-sorts’, so unlike myself, with no energy and no vitality. I researched the evidence and data on recurrence rates for women in my situation, spoke to key opinion leaders all over the world and sought as much expert opinion as I could. I went on HRT and immediately felt like I had ‘come back’. Thank goodness! I had so much work to do helping other women and so had to be firing on all cylinders! I care for many patients who, after full discussion and information on the data available for women on HRT post breast cancer, and after special consideration of their particular case, decide to go on HRT and improve the quality of their lives. As we now, thankfully, cure over 90% of early breast cancers, the vast majority of women survive this condition and then face the challenges of the menopause. I see many women at our clinic at Chelsea and Westminster, as well as in my private practice, who, like me, after considered thought, decide to take HRT.

For those interested in reading more about the evidence, Dr. Peers would recommend a recent publication: Oestrogen Matters by Dr. Avrum Bluming and Carol Tavris - a Platkus publication. Dr. Bluming was interviewed by Jenni Murray on Womans Hour on 31st October 2018 where he discusses the evidence and data that supports the safety of HRT use in women and in women post breast cancer. Listen to the programme here: https://www.bbc.co.uk/programmes/b007qlvb/broadcasts/2018/10

How long can a woman stay on HRT?

NICE guidelines in Menopause Management were published in November 2015. There is a section Called ‘information for the public.’ It states that women can ask their GP for HRT and if necessary ask to be referred to a menopause specialist. https://www.nice.org.uk/guidance/ng23/ifp/chapter/About-this-information

It also states that there is no arbitrary limit to the length of time a woman can stay on HRT. She should be supported in her decision to continue on the therapy if she so desires. (We know that women who stay on HRT have, on average, an increased life expectancy of 3.5 years. Good news indeed!)

Pharmacy services and HRT availability

We are constantly hearing that certain types of HRT are unavailable and difficult to obtain. We use an online pharmacy, The Independent Pharmacy, who can dispense private and NHS prescriptions.

From a patient...

'Six months ago I was at rock bottom with little quality of life, struggling to perform at work because of severe sleep deprivation, miserable, fatigued, and not a nice person to be around. I had been suffering with ever increasing menopause symptoms for 18 months. I used to ask myself regularly how could something supposed to be natural make me feel like I have a terminal illness?

My GP had said no to HRT because of a medical complaint that I believed to be questionable. My sheer persistence and non acceptance of the decision took me on an amazing journey. I met Dr. Tina Peers. I was listened to and made to feel that I was right to expect quality of life. I was thrown a lifeline - Dr. Peers gave me my life back.

I was started on HRT immediately, monitored and followed up with individual interest and concern. Within 3-4 weeks of treatment my symptoms had all but disappeared. 5 months down the line life is great, home life is back on track, I sleep normally, am happy and look forward to a long life. I belong to a gym again and have taken up rowing. I have Dr. Tina Peers to thank for her care and attention and giving me my life back.”

— Gill

No referral is necessary. Women can self refer and are able to book online. For further information please go to: www.drtinapeers.com

Prices
Initial Consultation - up to 45 minutes (including by telephone)
£250

Follow Up Session
£200

Queries

If you have any questions after your consultation, in the first instance please take a look at the FAQs section as you may well find an answer to your query there. If not please email your doctor. In the month following your consultation up to two follow-up emails will not be charged for. Subsequent emails will need to be charged at £40 each. Here at the Centre for Health 'we have time to listen to you and not only fully understand your symptoms and worries, but also have time to carefully explain all your options, answer all your questions and put together a treatment plan personalised for you. We are all individuals and each woman has a different story to tell.'

At your consultation

If you would like to bring your partner or a friend to the consultation please do - sometimes it's difficult to remember everything that is discussed. Also, if you have a disability and require wheelchair access, please do let us know at the time of booking and we will accomodate your needs.

At the consultation we will discuss the blood tests which maybe helpful and when these should be taken (also see FAQs below). If you GP is unable to organise these we can refer you to a local laboratory for the tests at a reasonable price for you (you pay the lab directly). A presciption will be supplied for the agreed hormone therapy and you can either take this to your loacal pharnacy, or we can arrange for it to be sent to you by post with free delivery from the online pharmacy service we use. This can be helpful as the supply of stocks are sometimes unreliable in local pharmacies. With your permission we will send either a letter to your GP copied to you, or to you directly and copied to the GP. Please let us know which you prefer. These are usually sent within 7-10 working days of your consultation.

Follow up consultations

You may be asked to schedule a follow up consultation for a few months after your first appointment. You can book this online or by telephone. It's advisable to book this as soon as you can as slots can get booked up far in advance.

Contact details

Tel: 01293 780442

Email: [email protected]


News

There are currently many stock issues with HRT products in the UK. See the latest news about HRT supply shortages from the British Menopause Society.

The following online pharmacies can dispense private and NHS prescriptions;

https://www.pharmacierge.com/


https://www.theindependentpharmacy.co.uk/


https://www.oxfordonlinepharmacy.co.uk/


Patients who have not been seen within the last 12 months:

Please book an initial consultation in order to allow sufficient time to take a full history and to fully understand your current needs. Please note that if we have not seen you for a review for over 12 months, then unfortunately we will be unable to comment on blood results or give email advice without a 45 minute consultation.

What our fees cover:

Your consultation fee covers the time spent with you during the consultation as well as writing and sending both your prescription and sending a letter to your GP.

It also covers up to two follow up emails for additional questions.

Other fees:

Additional email correspondence - £40

Private prescription (other than that at consultation) - £40

Additional letter fee - £50

On site payments should preferably be made by debit or credit card.

Telephone consultations should be paid for by bank transfer on the day of the consultation - you will receive an invoice on the day, with the details. Private Medical Insurance. We are not able to administer claims through private medical insurance - the fees must be paid by the patient at the time of the consultation. We can provide a receipt on request, which you may be able to use to claim the fees through your insurance policy if you are covered - please check with your health insurance provider.

Frequently Asked Questions

1. If my dose of oestrogen is changed, do I change the dose of progesterone (Utrogestan)?

The dose of the Utrogestan may stay the same. The standard doses are for 12 nights per month in cyclical HRT or 100mgUtrogestan at night, every night, for continuous combined HRT. If your oestradiol dose is over 1.5mg daily we may ask you to take 2 x 100mg Utrogestan every night.

2. If I get breast tenderness what should I do?

Many women can experience some breast tenderness when they initially start HRT. This usually lasts 2-4 weeks. If it is severe, or lasts longer, please take Super Starflower oil (Solgar make an excellent one) 300iu per day for 3-4 weeks. Eveneing Primrose oil 2000mg a day may also help.If you know that you are particularly prone to breast tenderness when taking Oestrogen, you could take the Super Starflower oil for 3-4 weeks prior to starting HRT to prime the breasts and reduce the reaction. If the breast tenderness does not respond to this and persists, please book in for further advice. We may change your dose or the preparation you are on.

3. What blood tests should I have before coming to my first consultation?

If you are not on HRT and over 45 years old, there is no need to have any bloods prior to your first appointmnet. I fyou are under 45 years old please ask your GP for:Oestradiol, progesterone, FSH, LH, testosterone, SHBG, TFTs (thyroid function tests) Please then bring the results with you. If you are on HRT already it is useful for us if you have an Oestradiol, testosterone and SHBG blood test. (Do not have the blood test on day 4 of a patch if you are using patches - the lkevekls can drop on day 4.) Please bring the results with you. You can either ask your GP to arrange the tests, or you can arrange them privately at The County Pathology Laboratory In Guildford Research Park:

County Pathology Ltd. 31 Frederick Sanger Road, The Surrey Research Park, Guildford, Surrey GU2 7YD

T: 01483 450388 Website:www.countypathology.co.uk Email:[email protected]


4.What should I do if I start bleeding heavily on continuous combined HRT and haven't had a period for over a year?

This is classed as postmenopausal bleeding and should be investigated as soon as possible. Please see your GP who will organise a trans-vaginal ultrasound scan to check the thickness of the linignofnyour womb and to see if there are any polyps or other causes of bleeding.

5. What if I start getting some 'old blood', or light spotting for a couple of days initially after starting the HRT? Keep a note of it and inform us at your 3 month follow-up.

This may happen initially and usually settles after 3-5 months.

6.What shall I do if the Vagifem pessaries irritate my vaginal or vulval skin?

Stop using them and try again once you have started to settle on the transdermal HRT. If it still irritates then contact us for another appointment, as we may need to examine you and prescribe a different preparation.

7. If I have a Mirena should I get it removed before starting HRT?

No. Many perimenopausal women need contraception as well as HRT. Contraception is recommended to the age of 55 years if you are still having periods or had them unitl you were 54 years old. The Mirena may have stopped all your bleeds and it may not be obvious to you that you are postmenopausal, so it's best to keep it if you are uncertain. The Mirena can also be used in HRT for the endometrial proytection. We acn discuss this with you at your consultation.

8. Testosterone preparations:

From 2018 some testosterone gels are no longer being manufactured. Testogel metered dispensers are NOT recommended for female use. The recommended alternative is Trostran gel 2%. 1 metered dose = 10mg and the usual daily female dose is 5mg per day, therefore Trostran can be used up to one metered dose on alternate days. Follow the instructions given to you at your consultation - the letter will remind you what these were. Another alternative is Testogel 50/5ml - each sachet being used sparingly over 7-14 days according to individual needs and side effects.

If you are on testosterone replacement, the International Menopause Society Guidelines recommend an annual blood test as a minimum, to monitor the levelsDo not apply the gel the day before or the day of the blood test. For further information please see the excellent website for the Menopause Clinic at Chelsea and Westminster Hospital in London, where we have put together information leaflets for women on all aspects of HRT and Menopause Management. www.chelwest.nhs.uk/services/womens-health-services/gynaecology-services/menopause-and-pms-clinics/special-notices


If you have any questions that are not answered above please email us.

Please also note that repeat prescriptions between appointments will be charged at £40 per prescription and additional letters written between appointments will be charged at £50 per letter.Please therefore book an appointment to be seen, in line with the GMC Good Medical Practice Guidelines. I foyu have not been seen for over 12 months your consultation will be charged as a new patient's consultation to allow sufficient time to take a full history and fuklkly understand your current needs.









Dr Tina Peers sees women privately for menopause counselling at The Centre for Health in Horley, Tillow Barn, Clare Park Hospital Farnham, North Downs Hospital Caterham, Gatwick Park Hospital, and at Hormone Health at 92 Harley Street London. If you have any questions after your consultation, in the first instance please take a look at the FAQs section on our website as you may well find an answer for your query there. If not, please email your doctor.

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