FAQs
Frequently Asked Questions
Our FAQs are helpful if you have questions about HRT, lifestyle changes, or how to arrange an appointment with us. We have organised them into the following categories or you can use the search bar. If you cannot find an answer to your question, you can submit a new question at the bottom of this page, which we will endeavour to answer.
Top 10 Most Frequently Asked Questions
- How do I book a video or virtual consultation and how does this work?
Simply click the Book Appointment button on the top of our website and you will be taken to the booking page to select video or in-person appointments. Select the video consultation and you will be shown the available dates. It is easy to book a video consultation at a time that is convenient to you. These are so convenient and you can be in the comfort of your own home or work. You must be on UK soil at the time of your appointment.
Once your booking is confirmed, you will then receive a welcome email providing a secure questionnaire, which will need to be completed prior to your appointment, please allow 15 minutes to do this.
You will also receive a link in your email to use for the video appointment. The video link is provided through our secure patient platform.
At the time of the consultation please make sure you have a good WiFi connection and that you find a place where you are comfortable and can talk in private.
We recommend clicking on the video link a few minutes before the consultation to check it is all working and that you know how to mute and unmute and switch your camera on and off.
We will need to see Photo ID at the start of the consultation to verify your identity as your appointment cannot proceed without showing this proof. We will also ask who is present during our consultation and check you are in a safe place for us to talk. We will ask what your pronouns are and check if there is anything sensitive you would like us to be aware of before we start. If there is anything you would like to be made aware of please do not hesitate to let us know.
If there are any problems with video connection, we will call via the telephone number you have provided to continue our consultation.
We look forward to meeting you at Rowena Health.
Dr Carys Sonnenberg Rowena Health
- How long do consultations normally last?
When you book a private appointment we understand how important the time is to you. We take huge pride in providing holistic, care and to listen to you so that we can give you as much support as you need.
When we see you we will have reviewed your notes and booking questionnaire. We will introduce ourselves and confirm your ID. Do bring a list to your appointment if you would like to, as there is a lot to discuss and remember. You are welcome to bring someone to your appointment. You can show us details of investigations done, or you can email this information in advance, to [email protected]. We will upload everything to your secure patient records. It is helpful for us to have as much information as we can prior to your appointment.
We will send a detailed letter to you and your GP, with consent, after your appointment, within 7 days, so you do not need to make notes during our time together, but you can if you wish.
At the end of the appointment we will have a plan for you, and will discuss medication advice and timing of any recommended follow-up appointments.
To arrange your follow-up appointment, we can email you once, to remind you to book, or we can book your follow-up appointment just before you leave us.
Please allow up to 50 minutes for a new patient consultation
Please allow up to 30 minutes for a follow-up consultation
We offer short telephone consultations of up to 15 minutes which are suitable to discuss a simple question or to review of a blood test
We really look forward to meeting you. Dr Carys Sonnenberg Rowena Health
- How do I book an in-person consultation and where will I be seen?
Simply click the option on the top of our main web page to book a consultation at a time convenient to you.
Dr Carys Sonnenberg can offer in-person consultations, under practicing privileges, at The Surrey Cardiovascular Clinic in Guildford which is located at 5 Huxley Rd, Guildford GU2 7RE. It is conveniently located just off the A3, and Guildford railway station is the nearest stop and the hospital is less than a 10 minutes taxi ride away. These usually take place on a Monday. Directions to us can be found here. The booking for these appointments is via the Rowena Health website.
Both Dr Sonnenberg and Dr Chrystal offer virtual appointments, if you are in the UK, which can be booked via the website.
Once your booking is confirmed, you will then receive a welcome email providing a secure questionnaire, which will need to be completed prior to your appointment.
We will need to see Photo ID at the start of the consultation to verify your identity.
If arriving by car, please park in one of the free designated slots and ask reception for a parking token to display in your car, the receptionist will be expecting you, please let them know you have arrived.
There is a comfortable waiting room, with refreshments and facilities.
We advise that you arrive 15 minutes before your appointment, and if you are late we will will be able to see you for the remaining time of your appointment, but we may ask that you rebook another appointment to ensure we can safely advise and prescribe, if necessary.
Do not hesitate to tell us if there is anything sensitive you would like us to be aware of when we talk during your consultation.
We will be delighted to see you there for your consultation. Dr Carys Sonnenberg
- Can I be seen if I live outside of the UK?
Unfortunately, new patients who live outside the UK cannot be seen by us because our medical indemnity insurance only covers patients who are on UK soil at the time of the appointment. We will ask you to confirm this as part of our questionnaire.
- We welcome everyone
Throughout the Rowena Health website, we use the term women when describing the changes seen in perimenopause and menopause. We acknowledge that it is not only women who need access to menopause information. Some non-binary people, trans men, intersex people or people with variations in sex characteristics may also experience menopausal symptoms, PMS or PMDD. We warmly welcome everyone to Rowena Health who needs the support we can provide.
- Will you inform my GP?
On our first patient consultation questionnaire we ask that you consent for us to share your letter with your GP.
We also work as NHS GP's, and understand the importance of good communication in managing the health of patients.
For this reason we are not be able to prescribe medication for you at Rowena Health unless you consent with this information being shared with your GP.
- Hormone Replacement Therapy
Hormone replacement therapy (HRT) essentially replaces one or more of the hormones oestrogen, progesterone and testosterone and it is the most effective treatment for menopause and perimenopausal symptoms.
These hormones are produced by the ovaries, and changing levels of these hormones in perimenopause, and low levels after menopause, has wide-reaching effects from hot flushes and sweats to joints pains, loss of libido (sex drive) and vaginal dryness.When could I start taking HRT?
This is a personal choice. There is benefit for other long term health issues (heart disease/osteoporosis) if HRT is started early, certainly within 10 years of menopause.
I'm in perimenopause, can I take HRT?
You do not need to wait for your periods to stop, you can start taking HRT in perimenopause, when you are having symptoms and are still having periods, which may be changing in nature.
Another option which might be possible for some women is to take the combined contraceptive pill, patch or vaginal ring, if it is safe for you to take this. Some of the newer versions of this type of contraceptive contain oestrogen in the form of E2, Estradiol, or E4, Estetrol, instead of the ethinylestradiol, which many combined contraceptive pills contain. This method is usually stopped at 50 years.
If you take HRT there is no arbitrary time limit to using it, providing there is benefit, there is no specific cut-off and women are increasingly choosing to take HRT beyond the age of 60.
In women with Premature ovarian insufficiency, POI, HRT is advised to be taken, if not contraindicated, and continued until menopausal age, after this time it is an individual decision on continuing care.
I am older than 60 or more than 10 years from my menopause, can I take HRT?
This is an individual discussion about benefit and risk to you, and we are very happy to have that conversation with you. HRT may be appropriate and the benefits may outweigh the risks to you.
Certainly vaginal oestrogen is safe to take for almost every woman of any age, we can discuss if this is right for you.
How to take HRT?
Oestrogen
This can be replaced either through the skin as a patch, gel or spray, or in a tablet or implant. Most of these formulations contain oestrogen in a form identical to the oestrogen which women naturally produce called 17 B-estradiol, which is derived from the yam plant. Oestrogen is the key hormone that improves the majority of menopausal and perimenopausal symptoms.
Progestogen
This is needed alongside oestrogen if women have a uterus (womb) as taking oestrogen without progestogen can lead to thickening of the womb lining and an increased risk of womb lining (endometrial) cancer. Women with a uterus should therefore use combined HRT (oestrogen + progestogen). Progesterone, as a bioidentical / body identical hormone, is available in capsule form, as part of HRT, or a synthetic progestogen (similar to progesterone but not exactly the same) can be taken.
There are various ways in which you can take progestogen.
- A patch which contains oestrogen and a progestogen which is absorbed through the skin
- It is available combined with oestrogen in an oral tablet
- As a separate oral tablet or capsule to be used with oestrogen taken as a gel, patch, spray or oral tablet
- A hormone device containing progestogen (Mirena 52mg Levonorgestrel IUD) - up to 5 years at a time and also providing contraception and help to lighten heavy periods
One of the safest ways to take progestogen is as a capsule containing body identical micronised progesterone (Utrogestan or Gepretix), this is usually taken orally but some women use the same preparation and vaginally with advice from their Dr about dose and safety.
Testosterone
This is another key female hormone, although we produce much smaller amounts than men, it has important roles in libido, sexual arousal, metabolism, muscle and bone strength, mood and cognitive function. Some women find that, despite oestrogen being used, symptoms such as low libido, reduced orgasm, fatigue, low mood, brain fog and muscle fatigue are still an issue. In
these women, testosterone therapy (in addition to oestrogen) can be beneficial.Testosterone is available as a gel or cream which is rubbed into the skin. While there are no specific products licensed for female use in the UK, it is widely used and safe when prescribed by your menopause specialist who will carefully monitor the dose and blood levels during your treatment.
Low dose vaginal oestrogen
This treatment can be added to your HRT, or taken without HRT, to help if you suffer from vaginal and bladder symptoms.
For detail on benefit and risk please see our FAQ in the HRT section.
Bioidentical compounded HRT
The use of compounded bioidentical hormone replacement therapies is not recommended given the issues related to their purity, potency and safety.
There are different ways to take the different hormones in HRT and we will tailor make this for you, depending on your choice, your health conditions and your family history. We will recommend the safest preparation and dose for you. Please do talk with us about your preferences, some women love the gel and others don't. Some women remember to take a tablet every night for 2 weeks of the month and other's would never remember that, don't worry, we'll work together to find the right HRT for you.
We can discuss which preparation may suit you and your lifestyle best.
For an appointment at Rowena Health please click on the link, we will be delighted to see you.
Dr Carys Sonnenberg Rowena Health July 2024 - this article is written for patients of Rowena Health, to be used alongside a menopause consultation. Please regard this as guidance only, if you have not had a consultation with us.
- Do you offer a refund if I need to cancel or reschedule my appointment?We offer full refunds if there is a change or cancellation to your booking two full working days (48 hours, not including weekends) in advance of the appointment. Please see our Terms and Conditions. If you wish to reschedule an appointment within this 48 hour window this may be possible, there will be an administration charge to cover our costs, as we may not be able to fill an appointment at short notice. Should you cancel an appointment with less than two full working days (48 hours, not including weekends) of an appointment then we are unable to offer a refund. This is because it is unlikely, we will be able to rebook the missing slot. You can, however switch your appointment to an online one at no extra charge. Refunds are returned via your original payment method and can take up to 10 days to complete, this is governed by our payment system and cannot be expedited.
- When and how do you take payment?
We take payment online at the point of booking using all major credit and debit cards.
- Who do we treat and what do we do?
At Rowena Health we are a small online health clinic providing virtual consultations if you are in the UK, with an in person clinic in Guildford, Surrey.
Your health and wellbeing are the the heart of our consultations. We are proactive at giving you holistic care and advice so that you can improve your symptoms, your understanding of your hormones and how these can affect you, and to you help to improve your physical, mental, sexual and your future health.
We are are delighted to provide care to people 18 and older, who are having:
- Symptoms of perimenopause (at any age 18 years and over)
- Early menopause (40-45 years)
- Premature ovarian insufficiency, POI (menopause below the age of 40)
- Surgical menopause (menopause after an operation to remove the ovaries)
- Menopause (usually between the ages of 45-55)
- Premenstrual syndrome and Premenstrual Dysphoric Disorder at any age above 18 years
- We are experienced in supporting women who have complex medical histories
- Advice for those who experience menopause after cancer
- Advice about the holistic care options to manage perimenopause and menopause including hormonal treatments, non hormonal treatments, alternative and complementary treatments
- Advice about contraception
- We can work with your GP to help support you
We provide holistic care, listening to you and helping guide you using evidence-based information and advice, to support you with your symptoms and treatment, for as long as you need us.
We work with an extensive team of selected holistic experts in their field who work in alternative and complementary medicine as we believe education and choice is so important.
We can prescribe Hormone Replacement Therapy, hormonal contraception and non hormonal treatments to support your symptoms.
We can arrange blood tests and investigations like ultrasound scans if necessary.
We can refer on to specialist consultants for advice or further treatment if needed. We can see you once or see you ongoing for further care, let us know what you need.
We write to you and your GP, with your consent, so everyone is involved in your care.
We are delighted to see you in-person, or using online, via video consultation, from the comfort of your own surroundings.
If you are not sure whether we can help you, or you cannot find an appointment time to suit you, please email us on [email protected] and we will do our best to be flexible and find a time to help.
We are looking forward to meeting you. Dr Carys Sonnenberg Rowena Health
Menopause
- Complementary and Alternative therapy for menopause
There are many ways of managing your symptoms and support wellbeing that do not involve adding hormones.
- Healthy lifestyle choices can be used with complementary and alternative treatments
- See our lifestyle FAQ for helpful information about the lifestyle pillars on the Rowena Health website
- Cognitive behavioural therapy can help to improve anxiety, depression, sleep and hot flushes, this can be done in 1-1 therapy, in a group session or by using an online or book to support you
- Non-hormonal prescribable medications
- These include antidepressants, Gabapentin, Oxybutynin and Clonidine. These medications can be effective for relief of hot flushes, in low doses. It is important to discuss any side effects which might occur.
- Neurokinin B receptor antagonists
- These are available privately at the moment and are effective in the relief of hot flushes. Studies are ongoing in women who have a history of breast cancer. This link takes you to the BMS statement.
- Complementary treatments: evidence for relief of hot flushes is limited but these may improve wellbeing. It is important to see a qualified specialist who has undertaken the training to advise you safely:
- Hypnotherapy: a type of psychological therapy using hypnosis help treat some mental and physical health conditions and to change habits. Reduces vasomotor symptoms and self hypnosis can improve sleep. National hypnotherapy society
- Acupuncture: conflicting evidence for benefit. The British Medical Acupuncture Society
- Yoga: may have a broad impact on coping with menopausal changes and improving well-being rather than specifically controlling hot flushes. At the heart of yoga
- Ayurdeva - is the "Science of life" an Indian system of health care which deals with the physical, mental, spiritual and emotional aspects of health and illness. It views menopause as a transition period and treatments can include massage, baths and also enemas, laxatives, herbs, meditation and dietary advice.
- Reflexology: a gentle therapy stimulating, massaging and putting pressure on the feet and hands
- Aromatherapy: essential oils are produced from different parts of aromatic plants. They are then concentrated and their properties become more potent. They can be used blended in carrier oils before coming in contact with skin. The smell or inhalation of them also has an effect. The oils can be used in the bath, or for massage.
- Bergamot may reduce low mood
- Chamomile like the tea can aid a feeling of calm, lemon balm may also have this effect
- Clary sage may be useful for PMS
- Fennel helps alleviate water retention
- Geranium has a regulation effect, can help with anxiety and feelings of restlessness
- Jasmine can help with depression and anxiety
- Juniper can have a detoxifying effect.
- Lavender is useful in aiding sleep
- Rosemary helps prevent fluid retention when used regularly for massage. It also has an effect on GABA which may promote calm
- These are some examples, please see a therapist and check their qualifications and experience. Although little is known about the effect of aromatherapy on menopausal symptoms, it is a therapy which allows you time for yourself which may help you cope with the menopause better. Thank you Menopause Matters for this information
- Alternative treatments:
- Herbal medicine - we always recommend you see a specialist in order to get safe advice
- If traditional herbal medicines are purchased, guidelines recommend products with the THR logo. This shows that they have been approved, the product has the correct dosage and is of high quality and has suitable product information.
- NICE guidelines advise that many herbal medicines have unpredictable dosage and purity, and some have significant drug interactions so please seek advice from a herbal specialist
- Black cohosh: a North American traditional herb, may be effective in reducing hot flushes, but the quality and standardisation of products varies. Can interact with medications such as Tamoxifen. There are unknown risks about its safety and its safety in women with a history of breast cancer.
- St John’s Wort is extracted from leaves of Hypericum perforatum, a European plant. Its active ingredient hyperflorin has been shown to inhibit the reuptake of several neurotransmitters such as serotonin and dopamine. It has been used for the treatment of mild to moderate depression because of its SSRI effect. Some studies show benefits to improved menopause-related quality of life and sleep. It may improve hot flushes. It should be taken with caution as it interacts with other drugs such as anticonvulsants, anticoagulants and Tamoxifen.
- Oil of Evening Primrose is a flowering plant rich in linolenic acid, evidence suggests its effect on hot flushes is no better than placebo. It may be helpful for breast pain at a dose of 240mg per day for 2 months and then reduce the dose but side effects include headache, skin rashes and nausea.
- Other herbs: Dong Quai, Ginseng, Ginkgo biloba, Sage, Valerian roots, Agnus Castus, liquorice root, wild yam cream, Progesterone cream (not suitable for endometrial protection), Maca, are popular with women but there is no good evidence for support with menopausal symptoms.
- Please check with your Dr before taking any herbal medicine or homeopathic medicine and make any specialist you see in these fields aware of your medical history, medications and any supplements or other treatments you take.
- Homeopathy - consists of the use of minute doses of a medicine which has matching characteristics to the patient's symptoms, to stimulate healing processes and reduce or eliminate the symptoms and the disorder. We always recommend you see a specialist in order to get safe advice. Society of Homeopaths
- Herbal medicine - we always recommend you see a specialist in order to get safe advice
The British complementary medicine association
We can talk through the evidence we currently have for all of these methods and guide you to experts to support you in your choices.
- Women's health concern advice article on complementary and alternative treatment
- Cognitive behavioural therapy
- British Menopause Society short video: Complementary and alternative therapies
- International menopause society - non hormonal treatments
- European Menopause and Andropause Society article
This information is for guidance and for you to discuss with us at your appointment or your Dr to see if these might be suitable for you. Dr Carys Sonnenberg Rowena Health
- Healthy lifestyle choices can be used with complementary and alternative treatments
- Heavy periods?
Having heavy periods is common in perimenopause and this link takes you to an NHS information sheet which is really helpful at describing all the ways of managing this and telling you how effective these are.
NHS managing heavy periods information article
Dr Carys Sonnenberg June 2024
- Perimenopause and Menopause symptoms
These are individual, oestrogen receptors are everywhere so symptoms can be widespread and every woman is individual. Using our symptom tracker can be helpful, it will email your results to you.
These are some of the symptoms that can occur when hormones change in perimenopause and when oestrogen is low in menopause:
- Changes to periods in perimenopause - increased or decreased in frequency, heavier or lighter.
- Vasomotor symptoms - hot flushes, night sweats or chills
- Cognitive symptoms and mood disorders:.
- Low mood, mood swings, anxiety and worry, panic attacks, irritability, anger outbursts, loss of confidence, low self-esteem, loss of confidence and worsening of PMS and Premenstrual dysphoric disorder, PMDD.
- Memory, attention difficulties and brain fog
- Difficulty sleeping: affects 40-60% of women, causes include mood changes, night sweats, a need to pass urine in the night, restless legs syndrome (RLS), snoring and obstructive sleep apnoea, OSA.
- Fatigue, tiredness and low energy levels
- Musculoskeletal, joint and muscle pain
- Headaches and worsening migraine attacks
- Genitourinary Syndrome of the Menopause is a term used to describe the vaginal and bladder symptoms, affecting 80% of women. A low oestrogen environment causes changes in the bladder and genitals and can lead to:
- Bladder symptoms such as urinary frequency, urge to pee, need to wake at night to pee, urine infections, urge and stress incontinence, (leaking on the way, dashing to the loo, or when you cough or sneeze), urine infections and pelvic organ prolapse.
- The gential area can become dry, itchy, sore, irritated, prickly or burning, there may be shrinkage of the labia, clitoris and vagina which can affect sexual pleasure. Tissues can thin and bleed on contact and the vagina, which is usually acidic and healthy with lactobacillus, becomes less so. There can be a wetness or a dryness.
- Loss of libido or high libido
- Oestrogen receptors are all over the body so symptoms can be widespread and include dry itchy skin, dry ears, dry eyes, thinning, dry hair, brittle nails, unwanted hair growth, rosacea, acne, tinnitus, palpitations, dizziness or feeling faint, tender breasts, changes in oral health, weight gain, digestive issues and increasing allergies.
If you are experiencing these symptoms please make an appointment with us at Rowena Health, or with your GP, so we can support you. We would be delighted to meet you.
Dr Carys Sonnenberg Rowena Health
HRT
- Benefits and risks of taking HRT
The risk/benefit balance of HRT varies between women, and for each individual woman, from year to year, depending on presence or not of symptoms, other medical history and the number of years that HRT has been taken.
Generally, if you become menopausal early (before age 45) or prematurely, POI, (before age 40), the benefits of taking HRT up to at least age 50 far outweigh the risks. If you are under 60 and having menopausal symptoms, or have risk for osteoporosis, the benefits also outweigh the risks.
There are no arbitrary limits as to how long HRT can be taken, it is up to each woman to balance the risks against the benefits for her, at each annual review.
Some women may not need HRT at all, or may take it for a few years only, while others continue to take HRT for many years since it continues to provide significant benefits for them.
Every woman should be supported to make an informed choice about their use of HRT and for how long they take it.
Currently the evidence we have is:
Proven benefits of for all women HRT: (see the BMS HRT guide)
- It is the most effective treatment for the relief of menopausal symptoms
- Improved bone mineral density with reduced fracture risk while it is being taken
Additional potential benefits of HRT:
- Reduced risk of coronary heart disease when oestrogen is started early (within 10 years of menopause)
- Reduced risk of Alzheimers disease when oestrogen started early (more research is needed to confirm this)
- Reduced risk colorectal cancer
- Reduced risk Type 2 DM (diabetes mellitus)
Risks of HRT:
For the majority of women who use HRT under the age of 60, and for many beyond that age, the benefits of HRT outweigh any risks.
Risks associated with HRT include association with increased risks of breast cancer (with long duration HRT), blood clot and, if HRT is started many years after the menopause, possibly cardiovascular disease.
Cardiovascular disease:
- Studies show that when initiated below age 60 years or within 10 years of onset of menopause HRT reduces atherosclerosis progression and coronary events.
- This article from the BMS about HRT after myocardial infarction may be of interest in women with cardiovascular disease.
- Taking an oral tablet of oestrogen is associated with a small increase in risk of stroke. The risk of stroke in women under 60 years is very low, so the increased risk is small (1 extra woman per 1000 using HRT).
Blood clot / venous thromboembolism
- Taking an oral tablet of oestrogen causes a small increase in risk of blood clot.
- If there is a past or family history of blood clot or an inherited thrombophilia, appropriate investigations may be needed before prescribing HRT
- For some women, who are at risk of blood clot, including those with a body mass index above 30, the pros and cons of use of HRT should be discussed, and if using HRT, taking it as a transdermal oestrogen like a gel, spray or patch with a progestogen with low clot risk should be considered, since there is strong evidence that transdermal estrogen does not increase risk of blood clot in healthy women using moderate doses of oestrogen.
Type 2 Diabetes
- There is no increased risk of developing type 2 diabetes with any type of HRT.
Breast cancer
- The risk of breast cancer for women around menopausal age varies, and is affected by her family history and her lifestyle risk factors (weight, alcohol intake, smoking and exercise). Any woman in the UK has a 1 in 7 chance of developing breast cancer over the course of her lifetime, this is also known as the ‘baseline’ risk.
How does HRT affect risk? Evidence from studies varies.
NICE guidance states that:
- HRT with oestrogen alone is associated with little or no increase in the risk of breast cancer.
- HRT with oestrogen and progestogen can be associated with an increase in the risk of breast cancer; however, any increase in the risk of breast cancer is related to the length of time HRT is taken for, and it reduces after stopping HRT.
This is a summary of current evidence, if you would like more detail:
- Current opinion is that HRT taken for less than 5 years does not significantly increase the risk of breast cancer.
- Studies have shown that after 5 years of HRT use, there is an association with a small increased risk, but once HRT has been stopped, the risk returns back to baseline.
- It seems likely that different types of HRT are associated with different risk: oestrogen appears to increase the risk very little, while there appears to be a small increased risk of cancer promotion with long term use of oestrogen combined with progestogen (combined HRT).
- The progesterone component of HRT that is considered the most ‘breast-friendly’ according to the evidence, is micronised progesterone.
- Lifestyle factors play a role in cancer risk, this link takes you to a chart which is very helpful to show the comparison of lifestyle risk factors vs taking HRT
- If HRT is started at a young age because of premature ovarian insufficiency, POI, then the use of HRT up to the age of 50 is unlikely to increase breast cancer risk any more than in women who continue to have periods up to the age of 50. Additional risk from HRT only applies if it is then taken for more than 5 years after 50.
- This link can help you understand risk and benefit further, you can individualise it by adjusting the bars on the left: Wellsprings
- This pictogram of risk of HRT and lifestyle is helpful
- The studies to consider, if you would like more detailed information are NICE guidance, which was based upon a review of studies meeting grade criteria, (the largest RCT, randomised control study, in this group being the Women's health Initiative study, the WHI study); a meta-analysis of all available epidemiologic evidence on the association between HRT use and breast cancer risk was published in the Lancet in August 2019 and the E3N observational studies.
- WHI study: This study suggested that if 1000 women used HRT for 5 years, there would be 4 extra cases of breast cancer with combined HRT use, and 4 fewer cases with oestrogen-only use, on a baseline risk of 15 cases per 1000 women over 5 years. Women who had not used HRT prior to the study showed no increase in breast cancer with combined HRT for 5 years, but a higher risk than never users with over 5 years of treatment.
- The Lancet meta-analysis stated that: for women of average weight, 5 years of HRT use starting at age 50 years would increase their 20-year risk of breast cancer (between the ages of 50 and 69 years) by approximately:
- 1 in every 50 users of oestrogen plus daily progestogen.
- 1 in every 70 users of oestrogen plus intermittent progestogen.
- 1 in every 200 users of oestrogen-only regimens.
- E3N observational studies which found no increased risk of breast cancer over five years with the use of oestradiol and micronised progesterone.
- There is still no evidence of any increase in dying from breast cancer, in women taking HRT.
Ovarian cancer
- There continues to be uncertainty about the possibility of increased risk of ovarian cancer with use of HRT. With 5 years of HRT use, there could be 1 additional ovarian cancer per 1000 users and 1 additional death per 1700 women who use HRT.
Dementia
- More studies are needed in this area. Current evidence suggests that HRT is unlikely to increase the risk of dementia or to have a detrimental effect on cognitive function in women initiating HRT before the age of 65.
Endometrial cancer
- Oestrogen only therapy given to women with a uterus (womb) increases the risk of endometrial hyperplasia (thickening of the lining of the uterus) and eventually endometrial cancer.
- Daily oestrogen combined with progestogen given usually for 14 days per month, giving a monthly bleed is called sequential sHRT. Taking progestogen cyclically in sHRT reduces the risk of endometrial cancer but does not eliminate it. If you are taking sequential combined HRT at the age of 45 or above, within 5 years of taking it this way we would change the way you take HRT to a continuous combined ccHRT. This means you would take you progestogen daily, not cyclically. If you have a 52mg LNG IUD like a Mirena this is like continuous combined HRT. Sequential combined HRT, given for more than 5 years, does increase the risk of endometrial cancer by a small amount. No increased risk appears to apply to oestrogen combined with daily progestogen (continuous combined or period-free HRT).
- It is important to report any unscheduled bleeding on HRT to your Dr.
- It is important that your oestrogen and progestogen dose is balanced, you Dr will look at your risk factors for endometrial cancer and your dose of oestrogen in your HRT when deciding what dose of progestogen to prescribe.
- It is important to take your progestogen as prescribed.
There are medical conditions which can be affected by hormonal change and HRT such as migraine, epilepsy and thyroid disease. Please discuss this with your Dr when you are considering HRT so the safest and correct preparation is prescribed to you.
If you have any questions about benefit and risk please talk with us.
Dr Carys Sonnenberg Rowena Health - this information is provided to you, to the best of our knowledge using links to trusted sources to help you understand the current evidence. There is of course a great deal of information, and risk and benefit of any medication is individual to you, and must be discussed with your prescribing Dr, who has responsibility for your care and knows your medical history. For our patients we will individualise the advice given - July 2024
Other websites to refer to:
Women's health concern fact sheets
British Menopause Society tools for clinicians - at Rowena Health we support GP's in their learning, this link takes you to articles which will support the education of your GP
International Menopause Society advice for women
Dr Carys Sonnenberg ,written for patients at Rowena Health Menopause Clinic July 2024. This information should be discussed with your prescribing doctor to take into account your individual medical history and should only be regarded as guidance for discussion.
References:
- Do you prescribe regulated HRT or bio-identical compounded hormones?
All of the HRT we prescribe is regulated and the oestrogen and progesterone usually available on the NHS.
Bio-identical means having the same structure as a substance produced in the body.
Both estradiol, in the form of patches, gels and sprays, and the micronised progesterone, Utrogestan, are technically 'bio-identical' but these particular products are highly regulated bio-identical products. They are also called 'body-identical' as they are structurally identical to those found in the woman's own body, but they are actually made by pharmaceutical companies. Regulated bio-identical hormones like these, are derived from plants, and are available on a standard, regulated prescription. They can be prescribed by our clinic or your GP/specialist in the NHS.
We don’t prescribe compounded bio-identical HRT as this type of HRT is not recommended by NICE or the British Menopause Society. Compounded bio-identical hormones are made by private clinics in a process known as compounding. Compounded bio-identical hormones are not regulated and not available on the NHS. They are marketed as precise duplicates of the hormones from your ovaries after blood test analysis. The hormone combination is then made up by a private pharmacy. These combinations do not follow the same regulations as conventional HRT and haven’t been through the same strict testing processes for effectiveness and safety. The blood tests and hormones can also be very expensive – much more than the cost of private or NHS prescriptions. More expensive does not mean they are better.
Please listen to this link from the BMS, a video about this topic.
- Hormone Replacement Therapy
Hormone replacement therapy (HRT) essentially replaces one or more of the hormones oestrogen, progesterone and testosterone and it is the most effective treatment for menopause and perimenopausal symptoms.
These hormones are produced by the ovaries, and changing levels of these hormones in perimenopause, and low levels after menopause, has wide-reaching effects from hot flushes and sweats to joints pains, loss of libido (sex drive) and vaginal dryness.When could I start taking HRT?
This is a personal choice. There is benefit for other long term health issues (heart disease/osteoporosis) if HRT is started early, certainly within 10 years of menopause.
I'm in perimenopause, can I take HRT?
You do not need to wait for your periods to stop, you can start taking HRT in perimenopause, when you are having symptoms and are still having periods, which may be changing in nature.
Another option which might be possible for some women is to take the combined contraceptive pill, patch or vaginal ring, if it is safe for you to take this. Some of the newer versions of this type of contraceptive contain oestrogen in the form of E2, Estradiol, or E4, Estetrol, instead of the ethinylestradiol, which many combined contraceptive pills contain. This method is usually stopped at 50 years.
If you take HRT there is no arbitrary time limit to using it, providing there is benefit, there is no specific cut-off and women are increasingly choosing to take HRT beyond the age of 60.
In women with Premature ovarian insufficiency, POI, HRT is advised to be taken, if not contraindicated, and continued until menopausal age, after this time it is an individual decision on continuing care.
I am older than 60 or more than 10 years from my menopause, can I take HRT?
This is an individual discussion about benefit and risk to you, and we are very happy to have that conversation with you. HRT may be appropriate and the benefits may outweigh the risks to you.
Certainly vaginal oestrogen is safe to take for almost every woman of any age, we can discuss if this is right for you.
How to take HRT?
Oestrogen
This can be replaced either through the skin as a patch, gel or spray, or in a tablet or implant. Most of these formulations contain oestrogen in a form identical to the oestrogen which women naturally produce called 17 B-estradiol, which is derived from the yam plant. Oestrogen is the key hormone that improves the majority of menopausal and perimenopausal symptoms.
Progestogen
This is needed alongside oestrogen if women have a uterus (womb) as taking oestrogen without progestogen can lead to thickening of the womb lining and an increased risk of womb lining (endometrial) cancer. Women with a uterus should therefore use combined HRT (oestrogen + progestogen). Progesterone, as a bioidentical / body identical hormone, is available in capsule form, as part of HRT, or a synthetic progestogen (similar to progesterone but not exactly the same) can be taken.
There are various ways in which you can take progestogen.
- A patch which contains oestrogen and a progestogen which is absorbed through the skin
- It is available combined with oestrogen in an oral tablet
- As a separate oral tablet or capsule to be used with oestrogen taken as a gel, patch, spray or oral tablet
- A hormone device containing progestogen (Mirena 52mg Levonorgestrel IUD) - up to 5 years at a time and also providing contraception and help to lighten heavy periods
One of the safest ways to take progestogen is as a capsule containing body identical micronised progesterone (Utrogestan or Gepretix), this is usually taken orally but some women use the same preparation and vaginally with advice from their Dr about dose and safety.
Testosterone
This is another key female hormone, although we produce much smaller amounts than men, it has important roles in libido, sexual arousal, metabolism, muscle and bone strength, mood and cognitive function. Some women find that, despite oestrogen being used, symptoms such as low libido, reduced orgasm, fatigue, low mood, brain fog and muscle fatigue are still an issue. In
these women, testosterone therapy (in addition to oestrogen) can be beneficial.Testosterone is available as a gel or cream which is rubbed into the skin. While there are no specific products licensed for female use in the UK, it is widely used and safe when prescribed by your menopause specialist who will carefully monitor the dose and blood levels during your treatment.
Low dose vaginal oestrogen
This treatment can be added to your HRT, or taken without HRT, to help if you suffer from vaginal and bladder symptoms.
For detail on benefit and risk please see our FAQ in the HRT section.
Bioidentical compounded HRT
The use of compounded bioidentical hormone replacement therapies is not recommended given the issues related to their purity, potency and safety.
There are different ways to take the different hormones in HRT and we will tailor make this for you, depending on your choice, your health conditions and your family history. We will recommend the safest preparation and dose for you. Please do talk with us about your preferences, some women love the gel and others don't. Some women remember to take a tablet every night for 2 weeks of the month and other's would never remember that, don't worry, we'll work together to find the right HRT for you.
We can discuss which preparation may suit you and your lifestyle best.
For an appointment at Rowena Health please click on the link, we will be delighted to see you.
Dr Carys Sonnenberg Rowena Health July 2024 - this article is written for patients of Rowena Health, to be used alongside a menopause consultation. Please regard this as guidance only, if you have not had a consultation with us.
- Testosterone
Women naturally produce oestrogen, progesterone and testosterone. The ovaries produce most of the oestrogen during the years leading up to menopause and levels then fall. Progesterone is produced after ovulation and stops once menstruation ceases and at the menopause.
Testosterone blood levels peak at the age of 20 and slowly decline with time. Testosterone is involved in preservation of bone density, has a positive effect on libido, sexual arousal and response, cardiovascular health, cognition and maintains energy levels. Testosterone therapy is often given to women already taking hormone replacement therapy (HRT) who have hypoactive sexual desire disorder, this can include loss of libido, reduced arousal and difficulty achieving orgasm.
Women who have undergone a surgical menopause (ovaries removed) or those with premature ovarian insufficiency POI (menopause before age 40) are most likely to experience testosterone deficiency as the ovaries produce the majority of testosterone in the body.
Clinical symptoms of low libido, sexual arousal and enjoyment are the most indicative of testosterone deficiency and your doctor or menopause specialist will take a detailed history to explore these and look at other issues which may affect your symptoms (for example
psychological issues, other medical conditions such as diabetes, thyroid disease, vaginal dryness/ soreness, other medication, smoking, alcohol, exercise).If you would like to take testosterone therapy your GP or menopause specialist will arrange for a blood test to check the level of total testosterone. This is only done to check that the level is not at the high end of the female range, to be sure that if treatment is started your testosterone level is more likely to remain in the female range. Higher levels may associated with adverse side effects. Monitoring of your blood levels is advised within the first 3 months after starting testosterone and then every 6-12 months while treatment continues to ensure levels do remain in the female range.
Treatment
Testosterone is applied as a gel or cream which you rub into your skin so the hormone is absorbed directly into your bloodstream. You should apply a small amount of the gel/ cream as prescribed into the skin on your lower abdomen or outer thigh. You are advised to wash your hands thoroughly after using it. It can take 3-6 months for the full benefits of testosterone to work and for you to notice an
improvement.Products
There are no licensed Testosterone products for women so testosterone 1% cream or gel is prescribed, off license to be used as prescribed.
Side effects
Most women have no side effects of testosterone treatment as it is merely replacing the testosterone that you are not already producing. Occasionally women notice some increase in hair growth where the gel/ cream has been rubbed in, this can be avoided by changing the place where you rub the gel/ cream into regularly. Acne, unwanted hair growth and weight gain are common side effects. Hair loss, voice change (deepening) and enlargement of the clitoris are rare with testosterone treatment at the dose recommended in women but important to mention.
Duration of treatment
If women notice an improvement in the symptoms mentioned within 3-6 months, testosterone therapy can be continued with regular monitoring, your specialist will advise about the frequency of monitoring blood tests. If there is no clinical improvement at 6 months, therapy will be discontinued. Testosterone therapy can be reduced/ stopped without any significant issues.
Other information for you:
Womens Health concern leaflets Testosterone treatment
British menopause society leaflet on testosterone treatment
Books to read:
Mind the Gap by Dr Karen Gurney
Come as you are by Emily Nagroski
Podcasts:
- Vaginal oestrogen
80% of women suffer with vaginal and bladder symptoms in menopause if they do not take HRT, and 25% of women have these symptoms if they do take HRT. What is vaginal oestrogen and how is this different to HRT? Vaginal oestrogen products are
Genitourinary Syndrome of the Menopause is a term used to describe the vaginal and bladder symptoms, affecting 80% of women. A low oestrogen environment causes changes in the bladder and genitals and can lead to:
- Bladder symptoms such as urinary frequency, urge to pee, dysuria (stinging on passing urine), nocturia (need to pass urine at night), urine infections, urge and stress incontinence (leaking on the way rushing to the toilet, or leaking on cough, sneeze, jump or laugh, for example), urine infections and pelvic organ prolapse (a weakness in the pelvic floor muscles).
- The gential area, vulva and vagina can become dry, itchy, sore, irritated, prickly or burning, there may be shrinkage of the labia, clitoris and vagina which can affect sexual pleasure. Tissues can thin and bleed on contact and the vagina, which is usually acidic and healthy with lactobacillus, becomes less so. There can be a wetness or a dryness.
- A prolapse can give a sensation of a fullness or pressure in the vagina, it can affect bladder and bowel function, cause sexual difficulties or even present as a lump that protrudes from the vagina. Sometimes there are no symptoms and the prolapse is just noted at the time of a smear test or other examination. Treatment is not always necessary if there are no symptoms, but pelvic floor exercises can be helpful, as can weight loss, avoidance of constipation and vaginal oestrogen replacement (sometimes in addition to HRT). Please see your GP or a pelvic floor physiotherapist for an assessment.
These are some of the commonly prescribed local vaginal oestrogen products which can be taken alone or alongside your HRT, long term to help these symptoms. Gina is available to buy over the counter. They take 2-4 months to work, they may need dose adjustment, they only work whilst they are being taken.
Please discuss with your Dr to be sure they are appropriate for you to take. Please seek medical specialist advice before starting these if you are taking aromatase inhibitor medication.
At Rowena Health we can prescribe these products or your GP can prescribe them.
If the symptoms are not resolving please see a Dr to ensure the diagnosis is correct.
These links give you much more detail.
Womens Health concern Vaginal Dryness leaflet
Womens Health concern Urogenital symptoms leaflet (bladder and genital symptoms)
Please click on this link to listen to the BMS video on this topic.
Updated July 2024 Dr Carys Sonnenberg
Lifestyle
- Bone health in menopause?
An important long-term effect of reduced oestrogen involves the effects on the skeleton. With age and reduced oestrogen levels, particularly when the menopause occurs early, before the age of 45, there is an increased risk of progressive loss of bone strength leading to bone thinning and fragility (osteoporosis).
Osteoporosis is defined as: a systemic skeletal disease characterised by low bone mass and microarchitectural deterioraton of bone tissue, with a consequent increase in bone fragility and susceptibility to fracture.
If you have an early menopause, it is recommended that hormone therapy is taken at least until the average age of the menopause (early 50s) even if you are not having menopausal symptoms. Hormone therapy in this situation provides significant benefits for bone health, reducing the risk of osteoporosis and fracture.
Bone loss itself does not cause any symptoms until a fracture occurs, often as a result of a simple fall. Fractures commonly occur in the wrist, spine and hip. It has recently been estimated that by the age of 70, one in two of all women will have had a fracture related to osteoporosis.
The Royal Osteoporosis Society has information about osteoporosis, osteopenia and how to eat and exercise for bone health.
Updated July 2024 Dr Carys Sonnenberg
- Future health awareness
Being proactive about future health awareness can make a huge difference. It is never too late to make some simple changes which can help you enjoy good health in the future. We all have modifiable risk factors, these are things we may be able to change, like stopping smoking. Here are some things which we can bear in mind when making choices.
We all want to be able to look after ourselves when we are older and to make it upstairs to go to the loo without help. Simple changes now can support health in the future.
Heart and blood vessel health:
When hormones change at menopause, metabolic health can also change, affecting where we store body fat, blood pressure, blood lipids and blood sugar. Metabolic syndrome increases the risk of cardiovascular disease and diabetes.
- Blood pressure rises as we age - it is sensible to check it at least once a year
- Blood lipids rise - we recommend you have your NHS health check to check yours, or have this done using a private blood test
- There is natural gain weight through aging, which is accelerated around the time of menopause. The way we store body fat changes, encouraging more to store around the middle, which increases the risk of metabolic syndrome. Our lean muscle reduces. For health reasons it is important to try to keep a healthy waist to height ratio (<0.5 if possible) and keep our BMI in the healthy range. This varies according to ethnic group and age, and in those with high muscle mass. In general if you have a BMI > 35 then it is helpful to measure your waist -height ratio, with a tape measure, which should be less than 0.5. If it is more than this please speak with your Dr about how we can help.
- Insulin resistance increases. Insulin is a fat storage hormone that helps to regulate blood sugar. Insulin resistance can increase risk of developing Type 2 diabetes
Recommended books:
- The Full Diet by Dr Saira Hameed - really helpful advice about weight management
- A woman's heart by Dr Angela Maas
Bone health: the risk of osteoporosis increases after menopause.
- One in two women will suffer a fracture after the age of 50.
- HRT has a protective effect against osteoporosis, and related fragility fractures, while is is being taken.
Recommended website to find out more about bone health, look at the Royal osteoporosis Society for advice about nutrition and exercise for bone health, check you are taking enough calcium in your diet using this link. Supplementing with Vitamin D 1000iu daily long term may be beneficial
Cancer
- We cannot change our genetics but we can use healthy lifestyle choices to help protect us from cancer, for example it is widely known that smoking cigarettes is associated with lung cancer so stopping smoking is a modifiable risk factor
- Attending regular screening when invited: breast, cervix and bowel can pick up cancers early
- Other examples of modifiable risk factors are obesity, drinking alcohol above the recommended limit each week, and exercising.
Pelvic floor, vaginal and bladder health
- Keep the pelvic floor muscles strong to avoid weakness causing bladder and bowel problems or prolapse.
- Pelvic floor exercises need to be done about 4-5 x a day
- If you are struggling a pelvic floor physiotherapist may be able to help. Please try using the Squeezy app to remind you or look at this link: how to do your pelvic floor exercises
- Genitourinary Syndrome of the menopause: This is a term used to describe how low oestrogen levels affect the genitals and the bladder causing symptoms which affect almost 80% of women, but often they do not speak about them, due to embarrassment or thinking it is a normal part of aging. Vaginal dryness and bladder symptoms are common.
- Treatment using intimate care regimes, pH balanced non hormonal moisturisers and lubricants, and with addition of low dose vaginal oestrogen products are really effective, take time to work and need to be used regularly, long term to help manage the symptoms. This treatment can be used safely by most women, please seek advice from your Dr.
Recommended websites to get more information about bladder health: Pelvic floor muscles, a guide for women and POGP (Pelvic obstetric & gynaecological physiotherapy)
Dry skin and hair
- Simple advice of finding a moisturiser you enjoy using, vaseline is fine
- Wearing sunscreen daily even in the winter and even inside will help protect against sun damage
The book What every woman needs to know about skin and hair by Dr Mandy Leonhardt is an excellent resource
Brain health
- It is common for women to struggle with brain fog and memory problems
- Prioritising sleep, reducing stress, eating a mediterranean diet, drinking alcohol less than 14 units a week, socialising and learning a new skin can help with brain health; this video is helpful:
- International Menopause Society: Professor Maki: short video
- " target="_blank" rel="noreferrer noopener">How Menopause affects the brain with Lisa Mosconi: 15 minute TED talk
- We need more research about HRT and dementia, the evidence from four properly conducted studies in post menopausal women is currently reassuring. The British Menopause Society advises gives the following advice "Women should be reassured that HRT is unlikely to increase the risk of dementia or to have a detrimental effect on cognitive function in women initiating HRT before the age of 60."
Body checks
- Breasts: please do monthly body checks of your vulva, skin and breasts and attend regular mammograms.
- The British menopause Society advice about breast cancer and HRT is that "current evidence suggests that oestrogen alone HRT is associated with little or no change in the risk of breast cancer while combined HRT can be associated with an increased risk which appears dependent on how long HRT is taken for, and may vary with the type of progestogen used. However, this risk is low, particularly when it is compared to lifestyle risk factors such as obesity, alcohol intake and smoking, which can also increase the risk of breast cancer. For more information click this link.
- If you have questions about individual risk and benefit and require more information about this please make an appointment to talk about us about it.
Mental health
There are lots of ways we can positively support our mental health. Using nature and having a daily walk is the most simple and easy way to do this, evidence shows even just looking at greenery for less than a minute can improve mental health.
Reducing stress and finding things which bring you pleasure are simple starting points to support mental health.
You may need more help with mental health so please talk with us if this is the case.
Do speak with us if you have any questions about this advice, Dr Carys Sonnenberg Rowena Health
- Lifestyle advice
We love this lifestyle medicine screening questionnaire from the British Society of Lifestyle Medicine. This can help you focus on what matters most to you right now, and which areas of your lifestyle you might want to focus on.
What does matter to you?
The 12 pillars of good health, a healthy lifestyle should focus on appropriate levels of physical activity, eating real foods and undertaking activities that promote health, quality sleep, effective stress management, avoiding toxic overload, developing healthy relationships, and feeling a sense of purpose.
Genetics play a 20-30% role in our lifespan and our health span (the time where we enjoy good health without chronic illness) but 70-80% of our health span is due to factors in our environmental, like those above. Making even small changes, and starting slow can have a hugely positive effect.
Here are some of our tips, do share yours with us if you find something useful.
Activity:
How can you add physical activity into your daily life and spend less time sitting? Regular exercise can help us live longer, reduce periods of ill health in our lives and increase the all-important health span. Can you write down some ways to improve your aerobic exercise? Can you add 2-3 sessions to improve muscular strength each week? When do you practice balance? Do you remember your pelvic floor exercises?
Do you love being with nature? Might ecotherapy, connecting with nature, be something you would enjoy? Clear and abundant evidence demonstrates that interaction with nature affects not only our well-being but our health throughout life. A simple walk in nature can reduce anxiety, lift your spirits, and even improve memory. Do read more about the benefits of ecotherapy in this article if it interests you.
These are some examples you might enjoy, if you are exploring different ideas:
- Aerobic: 150 minutes a week, getting a bit hot and sweaty, building up and doing what you love, including running, skipping, jumping, dancing in the kitchen, something you love and that brings you joy. Do it in bite size chunks, make it easy for yourself. Outside is great if you can.
- Strength: these are just some options for you to explore if you like online classes:
- Carolines Circuits offers great online classes designed to improve strength and overall fitness
- Kate Oakley Your Future Fit
- Balance practice - help to protect yourself from falls: 10 minute"> balance exercise class
- Pelvic floor exercises: the muscles in the pelvic floor help prevent prolapse, bladder and bowel problems: pelvic floor exercises
- If you need help with this, a pelvic floor physiotherapist is the perfect place to get advice.
Sleep
Ensuring we get enough, good quality sleep is vital for our overall health and wellbeing, and so it is for good reason that sleep is one of the six pillars of Lifestyle Medicine. Sleep is essential for restoring our energy levels and giving our bodies a much-needed rest. We are becoming increasingly aware of its wider health benefits – as well as the harmful effects of poor sleep and sleep deprivation. There are benefits of getting between seven – nine hours of sleep every night. Do you need to explore this further?
For adults, getting between seven – nine hours of good quality sleep can help to build up our long-term disease immunity. The maintenance of healthy immune cells relies on us getting enough sleep if we are to effectively fight infections and even some cancer cells. The body’s microbiome, the trillions of microorganisms which perform a variety of important tasks for us, also needs sleep to perform its functions effectively.
Our body’s metabolism, which balances our insulin as well as our glucose intake, is in part dependent on sleep. Increased appetite and calorie intake is also associated with sleep deprivation, and may contribute to weight gain.
Cognitive function, memory and mental health are all dependent on good quality sleep. Studies show that when we sleep our brains are busy cementing new learning and processing new information. Lack of sleep reduces concentration, impairs memory, and evidence shows it can contribute to cognitive decline.
To help manage stress and support mental health, good quality sleep is essential. We know that high cortisol levels are associated with anxiety and stress, getting the right amount of sleep can help to manage these. Sleep can also reduce the risk of anxiety, depression, PTSD and the long-term effects of grief. Sleep helps us to process difficult emotions and experiences, giving us a better chance of staying resilient, positive and happy.
Tips for good sleep:
- Maintain the same wake and sleep time each day
- Ensure your bedroom is dark, cool and quiet
- Avoid caffeine after 2pm and limit alcohol consumption
- Try to spend some time each day outside in natural light to ensure your body gets a good dose of the melatonin it needs to sleep well. This also helps your hypothalamus to understand the difference between light and dark, triggering your natural body clock and helping you sleep better.
- Keep active: ensuring you are physically active can help you to enjoy better sleep
Mental wellbeing
None of the six pillars of lifestyle medicine exists in isolation, and mental health is no exception. There is a clear link between all of the other five pillars and mental health – what we eat, how active we are, harmful substance reduction, sleep and healthy relationships.
Tips to improve mental health:
- Disconnect to Connect- reduce screen time and limit social media use, increase meaningful social connection
- Practice Mindfulness, meditation, yoga or Tai Chi and spend time in nature to relax and reduce stress and anxiety
- Avoid unhealthy habits – we often mistakenly think smoking and drinking alcohol will reduce stress but in the long-term these toxic substances harm our mental and physical health
- Sleep well – getting good quality sleep for seven to nine hours each night can help to improve mental health
- Physical activity has been shown to reduce stress hormones such as cortisol and adrenaline while releasing positive “feel good” hormones such as endorphins, serotonin and dopamine. Regular physical activity also increases brain-derived neurotrophic factor (BDNF) which has generative effects in the brain, improving cognition and memory and reducing the risk of neurodegenerative disorders like Alzheimer’s Dementia and Parkinson’s Disease.
- Keep a gratitude journal to nurture positive psychology and focus on the good things in life, and maintain meaningful social connections and be kind to others to improve health, happiness and well-being
This FAQ is about how lifestyle can improve our pillars of health, but if you need support with your mental health please speak with your Dr.
Healthy eating
There is no one diet or way of eating which suits every one for good health. These are some tips and include advice from the BSLM:
- Explore how you can enjoy protein in every meal and snack
- Eat the rainbow, aiming for 30+ different plants each week and vary them: fruit, vegetables, nuts, seeds, beans and legumes
- If choosing meat or fish, choose unprocessed – and if you can choose food with high welfare credentials with less hormones and antibiotics in the processing the better.
- Advice is to eat ultra-processed food and drinks sparingly. These are foods which have been processed with the addition of additives and preservatives and are high in salt, fat and sugar.
- Choose wholegrain or wholemeal varieties of starchy foods such as rice, pasta and bread
- Ensuring you have adequate dietary calcium, about 1000mg a day
- Ensuring you have adequate Vitamin D levels from sunshine on your skin or consider taking a supplement
- Gut health is important: learn more about fermented foods, fibre, probiotics, prebiotics and polyphenols from the Zoe podcasts and this might be helpful: The Zoe gut guide
The Mediterranean diet pyramid
How to balance your plate to eat well
- Hydrate well with water
- Consider reducing caffeine, if necessary and think about when you are drinking caffeine and might it be having an effect upon your sleep?
Minimising harmful substances
The risks associated with harmful and toxic substances – such as alcohol, tobacco or recreational drugs – are well known. Smoking and heavy drinking in particular are key behavioural risk factors associated with many chronic physical and mental health conditions.
Achieving positive behaviour change is the difficult part – and this is perhaps most challenging when it comes to reducing or stopping harmful substances like smoking or drinking too much alcohol.
Lifestyle medicine can help to support with replacing harmful – and largely ineffective – ways to “feel good” and reduce stress with healthy alternatives such as physical activity, connecting with nature, sleeping well, eating healthy food, meditation, listening to music and improved social connections.
Listen to the BSLM podcast on creating healthy habits
Healthy relationships
Enjoying healthy and meaningful relationships and better social connection is essential for good mental and physical health.
As human beings we are hard wired to connect with each other; we are social beings and our family and community relationships give our lives purpose and meaning. Connecting with others not only helps us to survive but to thrive.
There is a growing evidence demonstrating a link between the quality of our social connections and the associated risk of conditions including obesity, heart disease and even some cancers. Our mental health too is closely linked to our relationships with others, and loneliness is a key risk factor for depression. High levels of loneliness can increase the risk of heart attack and strokes by 30 per cent.
How often do you see others?
Social connection and healthy relationships are critical to a lifestyle approach to healthy longevity alongside being active, a healthy diet, getting good quality sleep, avoiding harmful substances, and reducing stress.
Other recommendations
- Book: 'Get well stay well' by Dr. Gemma Newman
- Women's health concern wellness hub
- The ZOE podcasts
- Weight gain is common as we age and as we go through menopause, this book can be helpful: The Full Diet by Dr Saira Hameed
Lifestyle medicine calls for a move away from the traditional doctor-patient relationship where the clinician is the expert information provider. This is needed because we now know that giving simple lifestyle advice such as “eat less and move more” is often ineffective. At Rowena Health we want to work with you to improve your hormonal health and your general health, we feel lifestyle plays a vital part.
Dr Carys Sonnenberg Rowena Health
- What is Nutrigenomics?
Dr Carys Sonnenberg is trained in nutrigenomics and can work with a clinic and a nutritionist to offer you completely individual approach to your health. What is Nutrigenomnics?
Genomics is changing the future of health and medicine. Developments in genetic testing enables us to look in detail at our DNA – the chemical instructions present in every body cell that make us who we are and drive every body function.
This biological code tells the body how to do everything, including how well you absorb and use specific nutrients like vitamins, affecting your nutrient needs. It impacts production of sex hormones, reproduction and fertility, and neurotransmitters, influencing thinking and emotional wellbeing. It regulates how well your cells can grow and repair, even how efficiently they produce energy, or how readily you store excess energy as fat.
Common variations in our genetic code, called SNPs (Single Nucleotide Polymorphisms), result in small but important differences in function, affecting, for example, how much of a chemical in the body is made, how well it works or how our cells respond to it. These SNPs don’t create ill-health in themselves, but in combination they can affect our energy, mental wellbeing, detoxification and beyond, impacting health and contributing to development of specific health conditions. Looking at your genetic differences unlocks a personal health blueprint, offering a detailed insight into your unique biological strengths and weaknesses and a deeper understanding of your health.
The environment plays a big part too. What we do and what we are exposed to interacts with our body’s ability dynamically.
Nutrigenomics looks at how these nutrition and lifestyle factors impact our genetic potential. We can’t change our genes, but we can change what we do to make them less significant. Nutrigenomic testing gives us an understanding of how our life choices interact with what makes us tick, so we can make positive changes that align with our genetics and optimise our health and wellbeing.
There are thousands of potential genes and SNPs, this is complex. Dr Carys Sonnenberg has completed the training with LifecodeGX and she can advise you about this, referring you to a reputable clinic and nutritionist to give you a completely individual approach to your health. Common nutrigenomics testing questions.
These nutrigenomics reports give you an individual assessment of your body, your DNA:
- The Nutrient core report - this test analyses how gene variants can affect food tolerance (and intolerance), appetite control and blood sugar balance, vitamin and mineral needs, detoxification ability, and susceptibility to inflammation and infection
- The Metabolics report - This presents the genes that can powerfully influence key pathways driving human metabolism. It incorporates over 40 genes and 50 SNPs across 6 pathways, including appetite regulation, nutrient sensing, sugar and fat metabolism, cholesterol and bile, mitochondria and inflammation.
- The hormones report - this analyses genes involved in the regulation, synthesis, signalling, transport and metabolism of corticosteroids and sex steroids hormones. It looks at how gene variants affects hormones imbalance and details the nutrients and environmental factors that can influence and improve their balance.
- The Methylation report - Methylation is the process of adding methyl groups, consisting of one carbon and three hydrogen atoms, to other molecules. It is involved in almost every metabolic process in the body, occurring billions of times every second in our cells and contributing to numerous crucial functions. Imbalances in methylation - too little or too much - can increase susceptibility to chronic health conditions such as heart disease, circulatory problems, chronic fatigue, infertility, immune and autoimmune conditions, food and chemical sensitivities, and mood and psychiatric disorders, as well as cancer and premature ageing. The Methylation test examines genes involved in five sub-cycles - folate, methionine, neurotransmitter, transsulphuration and urea. Genetic results will inform whether someone is likely to be poor or overly efficient at processing cofactors - B6, B9 (folate) and B12 (cobalamin), methionine, betaine, choline, zinc and magnesium; and inhibitors - chemicals, moulds, drugs, hormones and heavy metals and provide guidance on how to support or bypass bottlenecks or weaknesses.
- Histamine intolerance report - This test analyses the genes and nutrients needed to breakdown and remove histamine, showing where disruptions occur and how to support optimal function.
- Oestrogen balance report - This test analyses genes involved in the oestrogen lifecycle. It looks at how gene variants affects production, activation and elimination of oestrogens as well as detailing the nutrients and environmental factors that can influence and improve their balance. The Oestrogen Balance report is recommended for women who suspect oestrogen-linked conditions.
- The Detoxification report - this report identifies personalised nutritional support required to optimise detoxification.
- The nervous system report - this analyses gene variants that impact serotonin (contentment) and melatonin (sleep), dopamine (motivation), noradrenaline and adrenaline (fight or flight); glutamate (the major excitatory neurotransmitter); GABA (the major inhibitory neurotransmitter) which is critical for relaxation; and endocannabinoids (AEA/ anandamide) which regulate other neurotransmitters. The report provides detailed recommendations for nutritional support to alleviate symptoms and to optimise mental health.
- APOE report - the Apolipoprotein E (APOE) gene is best known for its role in lipid (fat) metabolism by helping to remove cholesterol from the bloodstream. It can exist in three main forms known as E2, E3 and E4. The E4 form of the APOE gene has been associated with increased plasma cholesterol and triglycerides and susceptibility to cardiovascular disease - heart attacks or strokes due to atherosclerosis, insulin resistance and Alzheimer’s disease. However, having an E4 genotype is one of many risk factors and does not mean you will develop any of these conditions. In addition to APOE, this test examines genes involved in methylation, inflammation, toxicity and neuroprotection, to enable individuals to take preventative action by adopting personalised nutrition and lifestyle changes to optimise their future, long term health.
- Thyroid balance report - This report analyses the genes involved in the thyroid hormone lifecycle: synthesis - centrally (in the thyroid) and in activation in peripheral tissues, transport and metabolism, processing of cofactors (vitamins D and A) and inhibitors (stress and toxins). It also examines genes that confer susceptibility to inflammation and autoimmunity.
We highly recommend you watch some of the crowdcast videos from LifecodeGx as they are absolutely fascinating.
Do make an appointment if you would like to talk more about this.
Dr Carys Sonnenberg Rowena health
What we do
- We welcome everyone
Throughout the Rowena Health website, we use the term women when describing the changes seen in perimenopause and menopause. We acknowledge that it is not only women who need access to menopause information. Some non-binary people, trans men, intersex people or people with variations in sex characteristics may also experience menopausal symptoms, PMS or PMDD. We warmly welcome everyone to Rowena Health who needs the support we can provide.
- What is Nutrigenomics?
Dr Carys Sonnenberg is trained in nutrigenomics and can work with a clinic and a nutritionist to offer you completely individual approach to your health. What is Nutrigenomnics?
Genomics is changing the future of health and medicine. Developments in genetic testing enables us to look in detail at our DNA – the chemical instructions present in every body cell that make us who we are and drive every body function.
This biological code tells the body how to do everything, including how well you absorb and use specific nutrients like vitamins, affecting your nutrient needs. It impacts production of sex hormones, reproduction and fertility, and neurotransmitters, influencing thinking and emotional wellbeing. It regulates how well your cells can grow and repair, even how efficiently they produce energy, or how readily you store excess energy as fat.
Common variations in our genetic code, called SNPs (Single Nucleotide Polymorphisms), result in small but important differences in function, affecting, for example, how much of a chemical in the body is made, how well it works or how our cells respond to it. These SNPs don’t create ill-health in themselves, but in combination they can affect our energy, mental wellbeing, detoxification and beyond, impacting health and contributing to development of specific health conditions. Looking at your genetic differences unlocks a personal health blueprint, offering a detailed insight into your unique biological strengths and weaknesses and a deeper understanding of your health.
The environment plays a big part too. What we do and what we are exposed to interacts with our body’s ability dynamically.
Nutrigenomics looks at how these nutrition and lifestyle factors impact our genetic potential. We can’t change our genes, but we can change what we do to make them less significant. Nutrigenomic testing gives us an understanding of how our life choices interact with what makes us tick, so we can make positive changes that align with our genetics and optimise our health and wellbeing.
There are thousands of potential genes and SNPs, this is complex. Dr Carys Sonnenberg has completed the training with LifecodeGX and she can advise you about this, referring you to a reputable clinic and nutritionist to give you a completely individual approach to your health. Common nutrigenomics testing questions.
These nutrigenomics reports give you an individual assessment of your body, your DNA:
- The Nutrient core report - this test analyses how gene variants can affect food tolerance (and intolerance), appetite control and blood sugar balance, vitamin and mineral needs, detoxification ability, and susceptibility to inflammation and infection
- The Metabolics report - This presents the genes that can powerfully influence key pathways driving human metabolism. It incorporates over 40 genes and 50 SNPs across 6 pathways, including appetite regulation, nutrient sensing, sugar and fat metabolism, cholesterol and bile, mitochondria and inflammation.
- The hormones report - this analyses genes involved in the regulation, synthesis, signalling, transport and metabolism of corticosteroids and sex steroids hormones. It looks at how gene variants affects hormones imbalance and details the nutrients and environmental factors that can influence and improve their balance.
- The Methylation report - Methylation is the process of adding methyl groups, consisting of one carbon and three hydrogen atoms, to other molecules. It is involved in almost every metabolic process in the body, occurring billions of times every second in our cells and contributing to numerous crucial functions. Imbalances in methylation - too little or too much - can increase susceptibility to chronic health conditions such as heart disease, circulatory problems, chronic fatigue, infertility, immune and autoimmune conditions, food and chemical sensitivities, and mood and psychiatric disorders, as well as cancer and premature ageing. The Methylation test examines genes involved in five sub-cycles - folate, methionine, neurotransmitter, transsulphuration and urea. Genetic results will inform whether someone is likely to be poor or overly efficient at processing cofactors - B6, B9 (folate) and B12 (cobalamin), methionine, betaine, choline, zinc and magnesium; and inhibitors - chemicals, moulds, drugs, hormones and heavy metals and provide guidance on how to support or bypass bottlenecks or weaknesses.
- Histamine intolerance report - This test analyses the genes and nutrients needed to breakdown and remove histamine, showing where disruptions occur and how to support optimal function.
- Oestrogen balance report - This test analyses genes involved in the oestrogen lifecycle. It looks at how gene variants affects production, activation and elimination of oestrogens as well as detailing the nutrients and environmental factors that can influence and improve their balance. The Oestrogen Balance report is recommended for women who suspect oestrogen-linked conditions.
- The Detoxification report - this report identifies personalised nutritional support required to optimise detoxification.
- The nervous system report - this analyses gene variants that impact serotonin (contentment) and melatonin (sleep), dopamine (motivation), noradrenaline and adrenaline (fight or flight); glutamate (the major excitatory neurotransmitter); GABA (the major inhibitory neurotransmitter) which is critical for relaxation; and endocannabinoids (AEA/ anandamide) which regulate other neurotransmitters. The report provides detailed recommendations for nutritional support to alleviate symptoms and to optimise mental health.
- APOE report - the Apolipoprotein E (APOE) gene is best known for its role in lipid (fat) metabolism by helping to remove cholesterol from the bloodstream. It can exist in three main forms known as E2, E3 and E4. The E4 form of the APOE gene has been associated with increased plasma cholesterol and triglycerides and susceptibility to cardiovascular disease - heart attacks or strokes due to atherosclerosis, insulin resistance and Alzheimer’s disease. However, having an E4 genotype is one of many risk factors and does not mean you will develop any of these conditions. In addition to APOE, this test examines genes involved in methylation, inflammation, toxicity and neuroprotection, to enable individuals to take preventative action by adopting personalised nutrition and lifestyle changes to optimise their future, long term health.
- Thyroid balance report - This report analyses the genes involved in the thyroid hormone lifecycle: synthesis - centrally (in the thyroid) and in activation in peripheral tissues, transport and metabolism, processing of cofactors (vitamins D and A) and inhibitors (stress and toxins). It also examines genes that confer susceptibility to inflammation and autoimmunity.
We highly recommend you watch some of the crowdcast videos from LifecodeGx as they are absolutely fascinating.
Do make an appointment if you would like to talk more about this.
Dr Carys Sonnenberg Rowena health
- Who do we treat and what do we do?
At Rowena Health we are a small online health clinic providing virtual consultations if you are in the UK, with an in person clinic in Guildford, Surrey.
Your health and wellbeing are the the heart of our consultations. We are proactive at giving you holistic care and advice so that you can improve your symptoms, your understanding of your hormones and how these can affect you, and to you help to improve your physical, mental, sexual and your future health.
We are are delighted to provide care to people 18 and older, who are having:
- Symptoms of perimenopause (at any age 18 years and over)
- Early menopause (40-45 years)
- Premature ovarian insufficiency, POI (menopause below the age of 40)
- Surgical menopause (menopause after an operation to remove the ovaries)
- Menopause (usually between the ages of 45-55)
- Premenstrual syndrome and Premenstrual Dysphoric Disorder at any age above 18 years
- We are experienced in supporting women who have complex medical histories
- Advice for those who experience menopause after cancer
- Advice about the holistic care options to manage perimenopause and menopause including hormonal treatments, non hormonal treatments, alternative and complementary treatments
- Advice about contraception
- We can work with your GP to help support you
We provide holistic care, listening to you and helping guide you using evidence-based information and advice, to support you with your symptoms and treatment, for as long as you need us.
We work with an extensive team of selected holistic experts in their field who work in alternative and complementary medicine as we believe education and choice is so important.
We can prescribe Hormone Replacement Therapy, hormonal contraception and non hormonal treatments to support your symptoms.
We can arrange blood tests and investigations like ultrasound scans if necessary.
We can refer on to specialist consultants for advice or further treatment if needed. We can see you once or see you ongoing for further care, let us know what you need.
We write to you and your GP, with your consent, so everyone is involved in your care.
We are delighted to see you in-person, or using online, via video consultation, from the comfort of your own surroundings.
If you are not sure whether we can help you, or you cannot find an appointment time to suit you, please email us on [email protected] and we will do our best to be flexible and find a time to help.
We are looking forward to meeting you. Dr Carys Sonnenberg Rowena Health
Appointments
- Do I need a referral from my GP to see you?
You do not require a referral letter from your GP to see us at Rowena Health. We think it is important you inform you doctor of the advice we give and to help with this we ask that you share your treatment plan with your GP.
If you have any letters or blood test results from previous medical consultations that are relevant then please have them ready for your consultation.
- Do you have disabled access?
Dr Carys Sonnenberg can see you at the Surrey Cardiovascular Clinic in person under their practicing privileges.
Yes there is parking at this Guildford clinic and access via a ramp to the clinic and the rooms are on the first floor.
- How do I book a video or virtual consultation and how does this work?
Simply click the Book Appointment button on the top of our website and you will be taken to the booking page to select video or in-person appointments. Select the video consultation and you will be shown the available dates. It is easy to book a video consultation at a time that is convenient to you. These are so convenient and you can be in the comfort of your own home or work. You must be on UK soil at the time of your appointment.
Once your booking is confirmed, you will then receive a welcome email providing a secure questionnaire, which will need to be completed prior to your appointment, please allow 15 minutes to do this.
You will also receive a link in your email to use for the video appointment. The video link is provided through our secure patient platform.
At the time of the consultation please make sure you have a good WiFi connection and that you find a place where you are comfortable and can talk in private.
We recommend clicking on the video link a few minutes before the consultation to check it is all working and that you know how to mute and unmute and switch your camera on and off.
We will need to see Photo ID at the start of the consultation to verify your identity as your appointment cannot proceed without showing this proof. We will also ask who is present during our consultation and check you are in a safe place for us to talk. We will ask what your pronouns are and check if there is anything sensitive you would like us to be aware of before we start. If there is anything you would like to be made aware of please do not hesitate to let us know.
If there are any problems with video connection, we will call via the telephone number you have provided to continue our consultation.
We look forward to meeting you at Rowena Health.
Dr Carys Sonnenberg Rowena Health
- How do I book an in-person consultation and where will I be seen?
Simply click the option on the top of our main web page to book a consultation at a time convenient to you.
Dr Carys Sonnenberg can offer in-person consultations, under practicing privileges, at The Surrey Cardiovascular Clinic in Guildford which is located at 5 Huxley Rd, Guildford GU2 7RE. It is conveniently located just off the A3, and Guildford railway station is the nearest stop and the hospital is less than a 10 minutes taxi ride away. These usually take place on a Monday. Directions to us can be found here. The booking for these appointments is via the Rowena Health website.
Both Dr Sonnenberg and Dr Chrystal offer virtual appointments, if you are in the UK, which can be booked via the website.
Once your booking is confirmed, you will then receive a welcome email providing a secure questionnaire, which will need to be completed prior to your appointment.
We will need to see Photo ID at the start of the consultation to verify your identity.
If arriving by car, please park in one of the free designated slots and ask reception for a parking token to display in your car, the receptionist will be expecting you, please let them know you have arrived.
There is a comfortable waiting room, with refreshments and facilities.
We advise that you arrive 15 minutes before your appointment, and if you are late we will will be able to see you for the remaining time of your appointment, but we may ask that you rebook another appointment to ensure we can safely advise and prescribe, if necessary.
Do not hesitate to tell us if there is anything sensitive you would like us to be aware of when we talk during your consultation.
We will be delighted to see you there for your consultation. Dr Carys Sonnenberg
- How long do consultations normally last?
When you book a private appointment we understand how important the time is to you. We take huge pride in providing holistic, care and to listen to you so that we can give you as much support as you need.
When we see you we will have reviewed your notes and booking questionnaire. We will introduce ourselves and confirm your ID. Do bring a list to your appointment if you would like to, as there is a lot to discuss and remember. You are welcome to bring someone to your appointment. You can show us details of investigations done, or you can email this information in advance, to [email protected]. We will upload everything to your secure patient records. It is helpful for us to have as much information as we can prior to your appointment.
We will send a detailed letter to you and your GP, with consent, after your appointment, within 7 days, so you do not need to make notes during our time together, but you can if you wish.
At the end of the appointment we will have a plan for you, and will discuss medication advice and timing of any recommended follow-up appointments.
To arrange your follow-up appointment, we can email you once, to remind you to book, or we can book your follow-up appointment just before you leave us.
Please allow up to 50 minutes for a new patient consultation
Please allow up to 30 minutes for a follow-up consultation
We offer short telephone consultations of up to 15 minutes which are suitable to discuss a simple question or to review of a blood test
We really look forward to meeting you. Dr Carys Sonnenberg Rowena Health
- How to book to see us in person or online?
To begin with, book a 50 minute new patient appointment, which can be in-person or you can be seen virtually, by video link which is very popular with many of our patients.
If we see you in person you will be seen in Guildford, Surrey, where Dr Carys Sonnenberg has practicing privileges at the Surrey Cardiovascular Clinic.
If you prefer a virtual appointment, via our secure on-line patient system, and we would be delighted to see you from the comfort of home or work, as long as you are on UK soil at the time of your appointment. Many patients prefer this as we offer more availability (please email if you cannot find a time to suit on the booking page).
The next appointment with us can be a 30 minute follow-up appointment, either on-line or in-person in Guildford, book on the booking page.
For a simple query in between appointments, an online mini- consultation is perfect, a trouble shooting appointment, book on the booking page. This is only suitable for a quick question, not a follow-up review and is only possible for a virtual appointment.
Email is perfect for simple queries, we are sorry but we are not able to provide detailed clinical advice via email.
Please email [email protected] if you have any questions and we will be delighted to help you.
All appointments are easily booked via the website. Payment is taken at the time of booking and you will receive booking confirmation, details of your appointment and a booking questionnaire, please leave 15 minutes to complete this.
We really look forward to meeting you at Rowena Health.
Dr Carys Sonnenberg Rowena Health
- What are your fees for consultations, blood tests and prescriptions?
Consultations:
A new patient to Rowena Health consultation is currently £275 - £295 for a 50 minute appointment, either on line or in person. This does not include the cost of prescribed medication, or costs of recommended investigations.
A follow-up patient consultation is currently £175 - £180 for a 30 minute appointment. This appointment can review your care and is usually booked after 8-12 weeks and annually. This does not include the cost of prescribed medication or costs of recommended investigations.
If you have not been seen by the clinic for over a year, we will ask you to book a new patient appointment for a full review.
For a quick question, we are delighted to offer a trouble shooting, telephone appointment, lasting up to 15 minutes, which is perfect for in-between appointments, this costs £95. This is perfect to discuss a blood test result, or ask a quick question, but is not long enough for a follow-up or annual follow-up appointment.
Prescriptions:
We do not charge to issue a private prescription for a medication like HRT, during your consultation. If further prescriptions are requested by you, outside your consultations, then we charge a £35 administration cost. Please use the request a repeat prescription button on the website to do this.
Medication costs vary, the cost of the medication issued by us, like HRT, is not covered on the NHS, or by the HRT pre-pay certificate. The cost per month of each medication varies according to the product, and the dose you are taking, and it usually is between £10 and £40 per item. Prescriptions sent to your home incur a small extra postage charge. It is cheaper to get your HRT from your GP and we are very happy for you to do this if you prefer. You can apply for the HRT pre pay certificate for your NHS prescriptions which means many of your HRT products are covered for a cost to you of less than £20 per year at the moment. We are also happy to issue you with your medication privately if that is more convenient, but this is not covered by the NHS pre-pay HRT certificate. You can apply for the certificate at a pharmacy or online.
Emails:
We do not charge for emails but we are only able to deal with logistical issues by email. Any clinical concerns we ask that you book an appointment, as per our practice policy.
Additional letters requested for other specialists £30, we will send an invoice to you if you request this. A copy of your clinic letters will be sent to your GP free of charge so they are aware of our care and recommendations.
Private blood tests:
We offer a range of profiles for blood tests and only arrange ones which are necessary for you. Sometimes more investigations are needed we are ruling out some other causes for your symptoms. We can write and request blood tests are done at your GP, if they are happy to do so.
Blood tests can either be taken at a Guildford Clinic or using our national blood letting service, which takes venous blood, or you can select a range of blood tests using medichecks profiles, we can advise you which ones to use. Please see the FAQ on blood tests for further details.
Appointment cancellations:
These will be fully refunded if at least 48 hours notice during the working week is given. After this time it will be difficult for us to fill your appointment time so a refund will not be possible. It is possible to change your appointment from a face to face to a virtual appointment, please email us.
If you need to reschedule your booked appointment more than 48 hours before your appointment time please email us and we will call you to do this.
We reserve the right to change our pricing in future without prior notice.
We are sorry that we do not offer discounts, and believe our prices to be fair and competitive.
Please note that booking confirmation emails may go into your junk email box. You should receive an email on booking your appointment from [email protected]
We are delighted to see you at Rowena Health. Dr Carys Sonnenberg
- What happens at my consultation?
The most important thing about your consultation is that you feel comfortable and relaxed, and we will take time to listen to how you have been feeling and to talk through all of your symptoms.
Dr Carys Sonnenberg, has been a GP for over 20 years, she is a Mum of two teenagers, and has gone through the menopause herself. She started Rowena Health to give women the support she would have loved to have. So please take time for you, to sit with and cup of tea at her Guildford clinic, or in the comfort of your own home, and be honest together, with her, and talk through all the options to find a way to manage your symptoms that is best for you and your life.
Prior to your consultation you will have completed the patient questionnaire that was emailed to you, which ensures we have already got key information that we will need, which allows us to really focus on the areas that matter most to you. Please also ensure you have a full list of all your past medical history, family history and medications.
It is helpful to have copies of results or letters with you that may also be relevant. During your consultation we will discuss your symptoms, concerns and questions taking the time to listen. We will then guide you through the best options and address any questions that you may still have. With that in mind, it is often useful for you to write down any questions that you may have beforehand, that you may not have included in your questionnaire, to ensure she covers them.
We may discuss ways to adapt your lifestyle and she will decide together with you making, your personalised care plan, which she will ask that you share with your GP. If appropriate she will prescribe your medication, such as HRT, ensuring we properly cover any risks and benefits to treatment, based on the British Menopause Society recommendations. This is issued at the consultation but it may take a day or so to have the prescription delivered to you, so don't worry.
Prior to being able to provide you with a prescription, we will need to know your blood pressure, which we advise you have measured before our consultation. This can easily be done at most pharmacies or at your GP practice. We may also recommend tests or further investigations that we feel are appropriate and we may need to ask for advice of specialist colleagues before starting treatment like HRT.
We will make a plan for your future care with us, or we can write in your care plan advice for your GP advising them of any further investigations or treatment we advise, and you can continue your care with them. We will write to you within 7 days of your appointment to summarise your personal plan. If you do not receive this please let us know and check your junk mail, very occasionally things do end up there. It will come from [email protected]
If there is anything you need clarification on or you have concerns about please do not hesitate to ask, we would love to talk with you early and believe that good communication is the key to a supportive relationship for us both.
Rowena Health is a small clinic and Dr Sonnenberg is delighted to be part of a much bigger peer group supporting continued education in menopause, at the highest level, with other accredited British Menopause Society Menopause Specialists from all over the UK who run similar clinics, and are equally passionate and dedicated to women's health and menopause care. This group discuss cases regularly looking at latest evidence and best practice in order to provide the best care. Dr Sonnenberg also runs an NHS women's health clinic at her GP surgery so she is extremely experienced at dealing with all of your symptoms and at guiding you, if something doesn't seem like a menopause symptom.
- What happens if I cannot get the video to work or the video is poor quality?
If there are any problems with video connection, don't worry, we will call via the telephone number you have provided to continue our consultation.
If you have problems on the day email: [email protected]
- What happens if the Doctor needs to cancel an appointment?
In the event of the doctor being unable to provide an appointment, we will inform you as soon as possible and we will work with you to be as flexible as we are able to be to provide another appointment as soon as possible, or to refund your fee if this is not suitable for you.
- Who do we treat and what do we do?
At Rowena Health we are a small online health clinic providing virtual consultations if you are in the UK, with an in person clinic in Guildford, Surrey.
Your health and wellbeing are the the heart of our consultations. We are proactive at giving you holistic care and advice so that you can improve your symptoms, your understanding of your hormones and how these can affect you, and to you help to improve your physical, mental, sexual and your future health.
We are are delighted to provide care to people 18 and older, who are having:
- Symptoms of perimenopause (at any age 18 years and over)
- Early menopause (40-45 years)
- Premature ovarian insufficiency, POI (menopause below the age of 40)
- Surgical menopause (menopause after an operation to remove the ovaries)
- Menopause (usually between the ages of 45-55)
- Premenstrual syndrome and Premenstrual Dysphoric Disorder at any age above 18 years
- We are experienced in supporting women who have complex medical histories
- Advice for those who experience menopause after cancer
- Advice about the holistic care options to manage perimenopause and menopause including hormonal treatments, non hormonal treatments, alternative and complementary treatments
- Advice about contraception
- We can work with your GP to help support you
We provide holistic care, listening to you and helping guide you using evidence-based information and advice, to support you with your symptoms and treatment, for as long as you need us.
We work with an extensive team of selected holistic experts in their field who work in alternative and complementary medicine as we believe education and choice is so important.
We can prescribe Hormone Replacement Therapy, hormonal contraception and non hormonal treatments to support your symptoms.
We can arrange blood tests and investigations like ultrasound scans if necessary.
We can refer on to specialist consultants for advice or further treatment if needed. We can see you once or see you ongoing for further care, let us know what you need.
We write to you and your GP, with your consent, so everyone is involved in your care.
We are delighted to see you in-person, or using online, via video consultation, from the comfort of your own surroundings.
If you are not sure whether we can help you, or you cannot find an appointment time to suit you, please email us on [email protected] and we will do our best to be flexible and find a time to help.
We are looking forward to meeting you. Dr Carys Sonnenberg Rowena Health
- Will you inform my GP?
On our first patient consultation questionnaire we ask that you consent for us to share your letter with your GP.
We also work as NHS GP's, and understand the importance of good communication in managing the health of patients.
For this reason we are not be able to prescribe medication for you at Rowena Health unless you consent with this information being shared with your GP.
Ongoing care
- How do I book an in-person consultation and where will I be seen?
Simply click the option on the top of our main web page to book a consultation at a time convenient to you.
Dr Carys Sonnenberg can offer in-person consultations, under practicing privileges, at The Surrey Cardiovascular Clinic in Guildford which is located at 5 Huxley Rd, Guildford GU2 7RE. It is conveniently located just off the A3, and Guildford railway station is the nearest stop and the hospital is less than a 10 minutes taxi ride away. These usually take place on a Monday. Directions to us can be found here. The booking for these appointments is via the Rowena Health website.
Both Dr Sonnenberg and Dr Chrystal offer virtual appointments, if you are in the UK, which can be booked via the website.
Once your booking is confirmed, you will then receive a welcome email providing a secure questionnaire, which will need to be completed prior to your appointment.
We will need to see Photo ID at the start of the consultation to verify your identity.
If arriving by car, please park in one of the free designated slots and ask reception for a parking token to display in your car, the receptionist will be expecting you, please let them know you have arrived.
There is a comfortable waiting room, with refreshments and facilities.
We advise that you arrive 15 minutes before your appointment, and if you are late we will will be able to see you for the remaining time of your appointment, but we may ask that you rebook another appointment to ensure we can safely advise and prescribe, if necessary.
Do not hesitate to tell us if there is anything sensitive you would like us to be aware of when we talk during your consultation.
We will be delighted to see you there for your consultation. Dr Carys Sonnenberg
- Ongoing care and prescriptions after your appointment?
Thank you for attending your appointment with Rowena Health. We are delighted to help you, whenever you need support, and are committed to providing your ongoing care.
We hope that you have found your appointment beneficial and we would be delighted if you would support us by giving feedback, we will send you details of how to do this. How do we help you with ongoing care and prescriptions after your appointment?
Booking appointments
We offer an online booking system which is easy to use and which takes payment immediately for all appointments. You will then receive confirmation of your booking, please check your emails (and junk). If you need to change your appointment ,to avoid disappointment please also check the appointment cancellation policy.
At each appointment we will discuss your ongoing care, confirm how you prefer to receive your ongoing prescriptions and ask you how you would like to arrange your future care with us, or your GP. We do send one reminder by email, for our agreed follow-up plan. If you do not book that appointment we will assume that your GP is managing your care and we will not send subsequent emails.
Your clinic letter
You will receive a securely encrypted email, attaching a clinic letter following your appointment, outlining everything you discussed with the doctor and any medication suggested. This will be sent within 7 days from [email protected]. Please let us know if there is anything you would like to change about your letter, it will be detailed with links to other websites for your information and support.
This letter and all relevant correspondence will also be shared with your GP surgery to keep them informed of your care. If you do NOT wish for them to know, please tell us on your booking questionnaire and at your appointment.
At the appointment we will agree with you a future plan. You should leave having a clear understanding of what will happen next, how to obtain your medication, if appropriate, and when your next follow-up appointment is due.
Please let us know if there is anything you would like to change about your letter, it will be detailed with links to other websites for your information and support.
Prescribing private prescriptions at your appointment
There is no extra administration charge to you if we prescribe medication during your appointment, but you will have to pay for the cost of the medication, to the pharmacy. This is usually between £10-40 per month per product.
If we are prescribing your medication we will share your prescription with your consent, which is given in your booking questionnaire, with CloudRx or SignatureRx, our online pharmacies.
CloudRX will contact you to arrange for payment of your medication, and arrange for it to be delivered to your home address, where you may need to be in to sign for it.
SignatureRX will give you the flexibility to collect your medication from a local pharmacy, a prescription token will be sent to you. Please ensure the medication you collect from the pharmacy is correct.
This prescription is not a repeat, if you need more medication please see repeat prescriptions, below.
We are only able to prescribe medication for you if you are happy for us to share this information with your GP, unless there are extenuating circumstances. We feel this is safest for you and your GP in case they prescribe anything which could interact with a medication which is prescribed by us.
Repeat medications
If you need us to prescribe your ongoing medication outside the time of an appointment please let us know 7 days in advance.
Repeat prescriptions can be obtained by clicking the repeat prescription button on the website. An administration fee of £35 will be requested, and a questionnaire sent to you, to complete. Once this has been received by us and checked, we are happy to prescribe your medication. It is important to write exactly what medication and what dose you require on the questionnaire when you complete it, to avoid any errors.
For safe menopause prescribing practices, medication can only be issued to women who are actively under the care of Rowena Health.
If you haven’t had a consultation in the past year, or if you haven’t had a three-month review following the start of your treatment or any changes to your treatment, a follow-up appointment will be necessary before issuing a menopause prescription.
Please allow 5 working days for prescriptions to be processed.
We prescribe up to 3 months of medication at a time.
Your GP can prescribe your medication ongoing, if you wish, please discuss this with them.
Please tell us of any side effects to your HRT, or change in your medical or family history so we are sure we are safely prescribing.
NHS prescription
If you have told us that you prefer to obtain your medication on an NHS prescription, using your HRT pre pay certificate, then this request will be included in our clinic letter and emailed to you and your GP surgery, after your appointment.
You will need to contact your surgery to ensure that they are happy to prescribe and have actioned your prescription request.
Blood tests
Please see our FAQ on blood test prices.
If you have had a blood test, we generally receive the results within five working days. Results are reviewed by your doctor and a letter of
explanation, along with your results, will be emailed to you directly and shared with your GP surgery.Private blood tests: we can use Nationwide pathology to arrange your blood tests, or we can advise you which female hormone profile to arrange using a venous blood sample at Medichecks. The medichecks profiles are not suitable for everyone so please discuss with us first. You can send us the results when you receive them.
If you have been asked to arrange a blood test we will send you one reminder to do this, via email, and will not send subsequent reminders. We will only be able to prescribe medication if all advised tests and information are up to date.
Follow-up appointments
At your initial appointment, we will discuss when your follow-up appointment is due. This can be booked for you then, or we can send an email reminder for you to book this yourself via the website.
Emails
Email communication is limited to the clarification of appointments or the reinforcement/clarification of prescribing advice.
We are not able to provide emergency care
We do not have an emergency service or a telephone service, so in the event of an emergency please contact your GP, 111 or 999.
Contacting your Doctor
We offer a 15 minute telephone appointment to help support you with questions between follow-up appointments, which can be booked via the website.
How did we do?
We strive to offer the highest quality of care and service to our patients and your feedback really matters. All feedback is welcomed so please let us know how we did at your appointment. We have a feedback questionnaire which is returned to us, and is available at the bottom of your clinic letter, and we have a google feedback, which we would be delighted if you would complete.
Tell a friend
Talking about the menopause is important. If you've benefited from our care, you can help your friends and family by spreading the
word. As well as high quality individual care we also offer corporate support and training for businesses and public sector organisations so do get in touch if you would like further information.Rowena Health Ltd is a company registered with company number 14277302
Rowena Health Ltd is regulated by the Care Quality Commission (CQC)Please see our booking page to book an appointment.
- Questions and emails between appointments?
Within 7 days of your new patient or follow-up appointment, we will send a detailed clinic letter, with a comprehensive list of evidence based resources and we encourage you to visit this first, if you have questions.
We reserve email communication to clarifying appointments, or reinforcing prescribing advice. We are not able to conduct consultations, or give detailed clinical advice via email and, as we feel it is important to have a consultation to safely and effectively manage your care.
We offer telephone consultations, lasting up to 15 minutes, which can be booked via the website to manage questions between follow-up appointments.
If you do send an email to [email protected], we will endeavour to reply, within 7 working days, it may be quicker but please allow this as both Dr Sonnenberg and Dr Chrystal may be away from the office. We are not able to answer emails outside normal working hours and please do not assume we will have seen your email if it is sent outside normal working hours.
Please do contact your GP, 111 or 999 in case of an emergency. We do not provide emergency care and request that you contact your GP or the emergency services if you feel that you need this.
Thank you for working with us so that we can best help you and our other patients.
Dr Carys Sonnenberg Rowena Health
- What about emergency care?
We are a small bespoke clinic and due to this we are not able offer emergency care, and ask that you contact your own GP or 111, or call 999 in case of an emergency.
If you email us, we are happy to answer simple logistical questions, but due to practice policy we are not able to answer detailed clinical questions via email, and ask that you book a telephone appointment to talk with us.
We are not able to check emails out of working hours. We do our very best be as available as we can via email, but it may take up to 7 days for you to receive a response, if we are away from the office. Please do speak with your GP if you need to in the meantime.
If you need repeat medication, please allow 7 working days for your prescription to be processed.
Thank you for working with us to help us support you and our other patients.
- What are your fees for consultations, blood tests and prescriptions?
Consultations:
A new patient to Rowena Health consultation is currently £275 - £295 for a 50 minute appointment, either on line or in person. This does not include the cost of prescribed medication, or costs of recommended investigations.
A follow-up patient consultation is currently £175 - £180 for a 30 minute appointment. This appointment can review your care and is usually booked after 8-12 weeks and annually. This does not include the cost of prescribed medication or costs of recommended investigations.
If you have not been seen by the clinic for over a year, we will ask you to book a new patient appointment for a full review.
For a quick question, we are delighted to offer a trouble shooting, telephone appointment, lasting up to 15 minutes, which is perfect for in-between appointments, this costs £95. This is perfect to discuss a blood test result, or ask a quick question, but is not long enough for a follow-up or annual follow-up appointment.
Prescriptions:
We do not charge to issue a private prescription for a medication like HRT, during your consultation. If further prescriptions are requested by you, outside your consultations, then we charge a £35 administration cost. Please use the request a repeat prescription button on the website to do this.
Medication costs vary, the cost of the medication issued by us, like HRT, is not covered on the NHS, or by the HRT pre-pay certificate. The cost per month of each medication varies according to the product, and the dose you are taking, and it usually is between £10 and £40 per item. Prescriptions sent to your home incur a small extra postage charge. It is cheaper to get your HRT from your GP and we are very happy for you to do this if you prefer. You can apply for the HRT pre pay certificate for your NHS prescriptions which means many of your HRT products are covered for a cost to you of less than £20 per year at the moment. We are also happy to issue you with your medication privately if that is more convenient, but this is not covered by the NHS pre-pay HRT certificate. You can apply for the certificate at a pharmacy or online.
Emails:
We do not charge for emails but we are only able to deal with logistical issues by email. Any clinical concerns we ask that you book an appointment, as per our practice policy.
Additional letters requested for other specialists £30, we will send an invoice to you if you request this. A copy of your clinic letters will be sent to your GP free of charge so they are aware of our care and recommendations.
Private blood tests:
We offer a range of profiles for blood tests and only arrange ones which are necessary for you. Sometimes more investigations are needed we are ruling out some other causes for your symptoms. We can write and request blood tests are done at your GP, if they are happy to do so.
Blood tests can either be taken at a Guildford Clinic or using our national blood letting service, which takes venous blood, or you can select a range of blood tests using medichecks profiles, we can advise you which ones to use. Please see the FAQ on blood tests for further details.
Appointment cancellations:
These will be fully refunded if at least 48 hours notice during the working week is given. After this time it will be difficult for us to fill your appointment time so a refund will not be possible. It is possible to change your appointment from a face to face to a virtual appointment, please email us.
If you need to reschedule your booked appointment more than 48 hours before your appointment time please email us and we will call you to do this.
We reserve the right to change our pricing in future without prior notice.
We are sorry that we do not offer discounts, and believe our prices to be fair and competitive.
Please note that booking confirmation emails may go into your junk email box. You should receive an email on booking your appointment from [email protected]
We are delighted to see you at Rowena Health. Dr Carys Sonnenberg
Prescriptions
- Can I expect My HRT prescription at my initial consultation?
If together we decide to prescribe medication at your appointment then we will send the prescription to one of our on line pharmacies that day. CloudRx will contact you to arrange for delivery to your home address, where you will need to be in to sign for the delivery, or SignatureRx will contact you with details of how to bring your prescription to your local pharmacy. This is very easy, but do contact us via email: [email protected] if you have any problems and please check the medication is what you are expecting.
In more complex cases we may need to investigate with blood tests or ask expert colleagues for advice.
If we issue a private prescription for you, through on of our private pharmacies, you will need to pay for the cost of the drugs, which are usually £10 - £40 per item per month.
Alternatively, you can arrange to see your GP to ask if they are able to prescribe your medication on the NHS, and don't forget you can use your HRT pre-pay certificate.
Thank you for supporting us at Rowena Health to support you. Dr Carys Sonnenberg
- Ongoing care and prescriptions after your appointment?
Thank you for attending your appointment with Rowena Health. We are delighted to help you, whenever you need support, and are committed to providing your ongoing care.
We hope that you have found your appointment beneficial and we would be delighted if you would support us by giving feedback, we will send you details of how to do this. How do we help you with ongoing care and prescriptions after your appointment?
Booking appointments
We offer an online booking system which is easy to use and which takes payment immediately for all appointments. You will then receive confirmation of your booking, please check your emails (and junk). If you need to change your appointment ,to avoid disappointment please also check the appointment cancellation policy.
At each appointment we will discuss your ongoing care, confirm how you prefer to receive your ongoing prescriptions and ask you how you would like to arrange your future care with us, or your GP. We do send one reminder by email, for our agreed follow-up plan. If you do not book that appointment we will assume that your GP is managing your care and we will not send subsequent emails.
Your clinic letter
You will receive a securely encrypted email, attaching a clinic letter following your appointment, outlining everything you discussed with the doctor and any medication suggested. This will be sent within 7 days from [email protected]. Please let us know if there is anything you would like to change about your letter, it will be detailed with links to other websites for your information and support.
This letter and all relevant correspondence will also be shared with your GP surgery to keep them informed of your care. If you do NOT wish for them to know, please tell us on your booking questionnaire and at your appointment.
At the appointment we will agree with you a future plan. You should leave having a clear understanding of what will happen next, how to obtain your medication, if appropriate, and when your next follow-up appointment is due.
Please let us know if there is anything you would like to change about your letter, it will be detailed with links to other websites for your information and support.
Prescribing private prescriptions at your appointment
There is no extra administration charge to you if we prescribe medication during your appointment, but you will have to pay for the cost of the medication, to the pharmacy. This is usually between £10-40 per month per product.
If we are prescribing your medication we will share your prescription with your consent, which is given in your booking questionnaire, with CloudRx or SignatureRx, our online pharmacies.
CloudRX will contact you to arrange for payment of your medication, and arrange for it to be delivered to your home address, where you may need to be in to sign for it.
SignatureRX will give you the flexibility to collect your medication from a local pharmacy, a prescription token will be sent to you. Please ensure the medication you collect from the pharmacy is correct.
This prescription is not a repeat, if you need more medication please see repeat prescriptions, below.
We are only able to prescribe medication for you if you are happy for us to share this information with your GP, unless there are extenuating circumstances. We feel this is safest for you and your GP in case they prescribe anything which could interact with a medication which is prescribed by us.
Repeat medications
If you need us to prescribe your ongoing medication outside the time of an appointment please let us know 7 days in advance.
Repeat prescriptions can be obtained by clicking the repeat prescription button on the website. An administration fee of £35 will be requested, and a questionnaire sent to you, to complete. Once this has been received by us and checked, we are happy to prescribe your medication. It is important to write exactly what medication and what dose you require on the questionnaire when you complete it, to avoid any errors.
For safe menopause prescribing practices, medication can only be issued to women who are actively under the care of Rowena Health.
If you haven’t had a consultation in the past year, or if you haven’t had a three-month review following the start of your treatment or any changes to your treatment, a follow-up appointment will be necessary before issuing a menopause prescription.
Please allow 5 working days for prescriptions to be processed.
We prescribe up to 3 months of medication at a time.
Your GP can prescribe your medication ongoing, if you wish, please discuss this with them.
Please tell us of any side effects to your HRT, or change in your medical or family history so we are sure we are safely prescribing.
NHS prescription
If you have told us that you prefer to obtain your medication on an NHS prescription, using your HRT pre pay certificate, then this request will be included in our clinic letter and emailed to you and your GP surgery, after your appointment.
You will need to contact your surgery to ensure that they are happy to prescribe and have actioned your prescription request.
Blood tests
Please see our FAQ on blood test prices.
If you have had a blood test, we generally receive the results within five working days. Results are reviewed by your doctor and a letter of
explanation, along with your results, will be emailed to you directly and shared with your GP surgery.Private blood tests: we can use Nationwide pathology to arrange your blood tests, or we can advise you which female hormone profile to arrange using a venous blood sample at Medichecks. The medichecks profiles are not suitable for everyone so please discuss with us first. You can send us the results when you receive them.
If you have been asked to arrange a blood test we will send you one reminder to do this, via email, and will not send subsequent reminders. We will only be able to prescribe medication if all advised tests and information are up to date.
Follow-up appointments
At your initial appointment, we will discuss when your follow-up appointment is due. This can be booked for you then, or we can send an email reminder for you to book this yourself via the website.
Emails
Email communication is limited to the clarification of appointments or the reinforcement/clarification of prescribing advice.
We are not able to provide emergency care
We do not have an emergency service or a telephone service, so in the event of an emergency please contact your GP, 111 or 999.
Contacting your Doctor
We offer a 15 minute telephone appointment to help support you with questions between follow-up appointments, which can be booked via the website.
How did we do?
We strive to offer the highest quality of care and service to our patients and your feedback really matters. All feedback is welcomed so please let us know how we did at your appointment. We have a feedback questionnaire which is returned to us, and is available at the bottom of your clinic letter, and we have a google feedback, which we would be delighted if you would complete.
Tell a friend
Talking about the menopause is important. If you've benefited from our care, you can help your friends and family by spreading the
word. As well as high quality individual care we also offer corporate support and training for businesses and public sector organisations so do get in touch if you would like further information.Rowena Health Ltd is a company registered with company number 14277302
Rowena Health Ltd is regulated by the Care Quality Commission (CQC)Please see our booking page to book an appointment.
- Prescriptions and repeat prescriptions
Information about prescriptions and repeat prescriptions at Rowena Health. We prescribe medication according to guidance from the British Menopause Society and The Royal Society of Obstetrics and Gynaecology.
If we decide together to prescribe a medication you have two options:
You can choose to get your prescription issued on the NHS by your GP, and use your HRT Prepay certificate, if you take HRT. You will need to arrange for this, with your GP surgery, using the letter sent to you, and them, after our consultation. Your clinic letter will be sent to you within 7 days of your consultation.
or
We are happy to issue you with a private prescription for your medication. If we prescribe medication privately you will need to pay the cost of the medications, as this is not covered by your HRT prepay certificate. This payment is made to the pharmacy or online pharmacy.
Your private prescription will be sent by us, to one of our pharmacy providers after your consultation with us. We do not charge a prescription administration fee for any prescriptions issued during a consultation with you. If you request medication and outside of your consultation, there is an extra administration prescription fee chargeable, of £35.
We use CloudRx and SignatureRx, our online prescription services, where, with your consent, which is given on your initial booking form, we share your private prescription. Our private prescriptions can be delivered to your home via CloudRX, or we can send the prescription to you via SignatureRX, so that you can collect it from a local pharmacy, if that is more convenient.
We will discuss with you if we are prescribing medications out of license.
Repeat prescriptions
Repeat prescriptions can be requested using the repeat prescription button on our website. This takes an administration payment and sends you a questionnaire to complete, once we have checked this and are sure it is safe to prescribe we will issue your medication.
For safe menopause prescribing practices, medication can only be issued to women who are actively under the care of Rowena Health and are up to date with their reviews.
If you haven’t had a consultation in the past year, or if you haven’t had a three-month review following the start of your treatment or any changes to your treatment, a follow-up appointment will be necessary before issuing a menopause prescription.
Please allow 5 working days for prescriptions to be processed, please do make requests in advance of running out of medication, taking into account holiday periods. Our advice is to request when you have 2 weeks of medication left and put a reminder on your phone or diary.
A prescription will be generated and sent to our pharmacy services, above. They will need administration time to issue your medication and send it to you, or send you the prescription to take to your own local pharmacy.
We are afraid that we are not in control of any medication supply shortages, and will do our best to provide an alternative medication, if you are unable to get yours.
We prescribe up to 3 months of HRT medication on each prescription.
We prescribe up to 2 months of antidepressants on each prescription once you are stable on treatment, until then we prescribe one month of medication, in order to practice safe prescribing.
Thank you for supporting us to care for you and our other patients by giving us time to issue your medication. If you think you are running out in an emergency then please email us on [email protected]. We check emails during working hours only.
Dr Carys Sonnenberg Rowena Health booking page
Links to: out of license prescribing & HRT prepay certificate.
- What are your fees for consultations, blood tests and prescriptions?
Consultations:
A new patient to Rowena Health consultation is currently £275 - £295 for a 50 minute appointment, either on line or in person. This does not include the cost of prescribed medication, or costs of recommended investigations.
A follow-up patient consultation is currently £175 - £180 for a 30 minute appointment. This appointment can review your care and is usually booked after 8-12 weeks and annually. This does not include the cost of prescribed medication or costs of recommended investigations.
If you have not been seen by the clinic for over a year, we will ask you to book a new patient appointment for a full review.
For a quick question, we are delighted to offer a trouble shooting, telephone appointment, lasting up to 15 minutes, which is perfect for in-between appointments, this costs £95. This is perfect to discuss a blood test result, or ask a quick question, but is not long enough for a follow-up or annual follow-up appointment.
Prescriptions:
We do not charge to issue a private prescription for a medication like HRT, during your consultation. If further prescriptions are requested by you, outside your consultations, then we charge a £35 administration cost. Please use the request a repeat prescription button on the website to do this.
Medication costs vary, the cost of the medication issued by us, like HRT, is not covered on the NHS, or by the HRT pre-pay certificate. The cost per month of each medication varies according to the product, and the dose you are taking, and it usually is between £10 and £40 per item. Prescriptions sent to your home incur a small extra postage charge. It is cheaper to get your HRT from your GP and we are very happy for you to do this if you prefer. You can apply for the HRT pre pay certificate for your NHS prescriptions which means many of your HRT products are covered for a cost to you of less than £20 per year at the moment. We are also happy to issue you with your medication privately if that is more convenient, but this is not covered by the NHS pre-pay HRT certificate. You can apply for the certificate at a pharmacy or online.
Emails:
We do not charge for emails but we are only able to deal with logistical issues by email. Any clinical concerns we ask that you book an appointment, as per our practice policy.
Additional letters requested for other specialists £30, we will send an invoice to you if you request this. A copy of your clinic letters will be sent to your GP free of charge so they are aware of our care and recommendations.
Private blood tests:
We offer a range of profiles for blood tests and only arrange ones which are necessary for you. Sometimes more investigations are needed we are ruling out some other causes for your symptoms. We can write and request blood tests are done at your GP, if they are happy to do so.
Blood tests can either be taken at a Guildford Clinic or using our national blood letting service, which takes venous blood, or you can select a range of blood tests using medichecks profiles, we can advise you which ones to use. Please see the FAQ on blood tests for further details.
Appointment cancellations:
These will be fully refunded if at least 48 hours notice during the working week is given. After this time it will be difficult for us to fill your appointment time so a refund will not be possible. It is possible to change your appointment from a face to face to a virtual appointment, please email us.
If you need to reschedule your booked appointment more than 48 hours before your appointment time please email us and we will call you to do this.
We reserve the right to change our pricing in future without prior notice.
We are sorry that we do not offer discounts, and believe our prices to be fair and competitive.
Please note that booking confirmation emails may go into your junk email box. You should receive an email on booking your appointment from [email protected]
We are delighted to see you at Rowena Health. Dr Carys Sonnenberg
Blood tests
- Blood tests pricing
If we feel it is clinically necessary, and will be helpful to guide our management, we can arrange private blood tests
This can be done locally in at a Guildford clinic, or at locations over the UK using Nationwide Pathology, or you can arrange a venous blood sample through Medichecks. If you choose to use medichecks we will advise you which profile to order.
Blood tests can be useful at times, but are often not necessary. They are required in younger women, and can be useful to exclude other diagnoses, and may be helpful in guiding oestrogen dosing with HRT, but bear in mind that in perimenopause the hormones fluctuate wildly and we cannot be sure the tests will be helpful.
It is important to consider oestradiol blood tests carefully. There is a wide variation in absorption of oestrogen through the skin ( for example using patches, gels or sprays) from person to person, and this can vary in the same individual if there is a difference in temperature or hydration. There is no actual level we are aiming for, usually it will be in the female physiological range and in order to bring relief of symptoms and give protection to bone.
There is in some people benefit to taking a blood test, but in others the results are not helpful. It is not possible to compare results from different labs which may use different assays.
It is also important to consider oestrogen receptors in the body, how sensitive they are, for example, and to consider how effective the processing and elimination is oestrogen. Lots of factors can affect this like genetics, nutrition (including supplements) , stress, thyroid and insulin resistance, inefficient breathing, trauma and exercise for example.
We do monitor blood tests when we prescribe testosterone, to make sure your level of testosterone is kept in the female range. We test before starting testosterone, to make sure you do not already have high levels and then we repeat tests at 3 months and annually according to recommendations.
Blood tests at Guildford clinic
It is possible to have a blood test taken at the Surrey Cardiovascular clinic, you book this with them and we can give you the required form in order to do this. Payment is taken by them and they send the results to us so we can inform you.
Blood tests arranged by us using Nationwide pathology
We have a range of hormonal blood profiles at Nationwide pathology, depending on your individual needs. We will advise you at your appointment. The cost of processing these blood panels is stated and payable to us in advance of us informing Nationwide about your test.
There is an extra cost, charged to you by the individual blood letting clinic, for taking your blood test, called the blood letting fee, which is payable to them and varies between £35 and £70.
Rowena Health blood profiles from Nationwide Pathology which we can arrange for you:
Profile 1: FBC, U+E, LFT, Lipids, Ferritin, Thyroid function, Hba1c, oestradiol, testosterone, Vitamin B12, folate and Vitamin D
Profile 2: Oestradiol, SHBG, testosterone, thyroid function ( similar to Female hormone blood test - Medichecks profile below)
Profile 3: Oestradiol, SHBG and testosterone (similar to Testosterone, free testosterone and oestradiol blood test - Medichecks profile below - note - we consider the total testosterone only)
Profile 4: Thyroid function, including Free T4 and free T3 (or see Thyroid function test - Medichecks profile below)
Profile 5: FBC, Thyroid function, testosterone and SHBG
Profile 6: SHBG and testosterone (similar to free and total testosterone profile below, note we only consider the total testosterone)
Please add the blood letting fee to the test costs
Blood tests arranged by you with advice from us using Medichecks
This is an online provider who can help you by offering set profiles, and you can visit one of their clinics to have your blood profile taken. You pay them for the profile and for taking the blood test and the results are sent to you, which you can share with us.
We will advise you in your clinic letter which profile to book, and discuss cost for you. Examples are:
Female hormone blood test: £79 - 9 biomarkers including: oestradiol, testosterone, FSH, LH, SHBG, prolactin, thyroid function (TSH and free thyroxine)
Thyroid function test: £45 - 3 biomarkers - TSH, T4 and T3
Testosterone, free testosterone and oestradiol blood test: note this is in the male blood test section - £69 - 5 biomarkers but we want to see total testosterone, oestradiol and SHBG
Free and total testosterone blood test: £55 - note this is in the male blood test section - total testosterone, free testosterone, albumin and SHBG
Menopause blood test: £69 5 biomarkers - FSH, LH, oestradiol, TSH, free thyroxine
Blood tests are often not necessary and certainly are not very helpful in perimenopause, due to your own hormonal fluctuations, we can advise you of this.
Thank you for your support to help us care for you at Rowena Health. Dr Carys Sonnenberg
- Can I have my blood tests done by my own GP?
Yes, if your GP is happy to take your bloods, we support any care that your GP can provide. However, if you are seeing a doctor privately, your NHS GP is under no obligation to arrange tests or provide prescriptions.
If you do choose to have your tests done by your GP, you need to take responsibility for having them done in time for your appointment and to ensure that the results are sent to us at least 7 days before your appointment.
We send all details of any required bloods in your clinic letter, so your GP knows which ones to arrange. I'm afraid we cannot take responsibility for accessing blood test results done by your GP.
- What are your fees for consultations, blood tests and prescriptions?
Consultations:
A new patient to Rowena Health consultation is currently £275 - £295 for a 50 minute appointment, either on line or in person. This does not include the cost of prescribed medication, or costs of recommended investigations.
A follow-up patient consultation is currently £175 - £180 for a 30 minute appointment. This appointment can review your care and is usually booked after 8-12 weeks and annually. This does not include the cost of prescribed medication or costs of recommended investigations.
If you have not been seen by the clinic for over a year, we will ask you to book a new patient appointment for a full review.
For a quick question, we are delighted to offer a trouble shooting, telephone appointment, lasting up to 15 minutes, which is perfect for in-between appointments, this costs £95. This is perfect to discuss a blood test result, or ask a quick question, but is not long enough for a follow-up or annual follow-up appointment.
Prescriptions:
We do not charge to issue a private prescription for a medication like HRT, during your consultation. If further prescriptions are requested by you, outside your consultations, then we charge a £35 administration cost. Please use the request a repeat prescription button on the website to do this.
Medication costs vary, the cost of the medication issued by us, like HRT, is not covered on the NHS, or by the HRT pre-pay certificate. The cost per month of each medication varies according to the product, and the dose you are taking, and it usually is between £10 and £40 per item. Prescriptions sent to your home incur a small extra postage charge. It is cheaper to get your HRT from your GP and we are very happy for you to do this if you prefer. You can apply for the HRT pre pay certificate for your NHS prescriptions which means many of your HRT products are covered for a cost to you of less than £20 per year at the moment. We are also happy to issue you with your medication privately if that is more convenient, but this is not covered by the NHS pre-pay HRT certificate. You can apply for the certificate at a pharmacy or online.
Emails:
We do not charge for emails but we are only able to deal with logistical issues by email. Any clinical concerns we ask that you book an appointment, as per our practice policy.
Additional letters requested for other specialists £30, we will send an invoice to you if you request this. A copy of your clinic letters will be sent to your GP free of charge so they are aware of our care and recommendations.
Private blood tests:
We offer a range of profiles for blood tests and only arrange ones which are necessary for you. Sometimes more investigations are needed we are ruling out some other causes for your symptoms. We can write and request blood tests are done at your GP, if they are happy to do so.
Blood tests can either be taken at a Guildford Clinic or using our national blood letting service, which takes venous blood, or you can select a range of blood tests using medichecks profiles, we can advise you which ones to use. Please see the FAQ on blood tests for further details.
Appointment cancellations:
These will be fully refunded if at least 48 hours notice during the working week is given. After this time it will be difficult for us to fill your appointment time so a refund will not be possible. It is possible to change your appointment from a face to face to a virtual appointment, please email us.
If you need to reschedule your booked appointment more than 48 hours before your appointment time please email us and we will call you to do this.
We reserve the right to change our pricing in future without prior notice.
We are sorry that we do not offer discounts, and believe our prices to be fair and competitive.
Please note that booking confirmation emails may go into your junk email box. You should receive an email on booking your appointment from [email protected]
We are delighted to see you at Rowena Health. Dr Carys Sonnenberg
Costs & payment
- Do you offer a refund if I need to cancel or reschedule my appointment?We offer full refunds if there is a change or cancellation to your booking two full working days (48 hours, not including weekends) in advance of the appointment. Please see our Terms and Conditions. If you wish to reschedule an appointment within this 48 hour window this may be possible, there will be an administration charge to cover our costs, as we may not be able to fill an appointment at short notice. Should you cancel an appointment with less than two full working days (48 hours, not including weekends) of an appointment then we are unable to offer a refund. This is because it is unlikely, we will be able to rebook the missing slot. You can, however switch your appointment to an online one at no extra charge. Refunds are returned via your original payment method and can take up to 10 days to complete, this is governed by our payment system and cannot be expedited.
- Is the cost of your service covered by the NHS?
We are a private menopause clinic, so our costs are not funded by the NHS and all of our appointments, prescriptions and blood tests are chargeable.
- What are your fees for consultations, blood tests and prescriptions?
Consultations:
A new patient to Rowena Health consultation is currently £275 - £295 for a 50 minute appointment, either on line or in person. This does not include the cost of prescribed medication, or costs of recommended investigations.
A follow-up patient consultation is currently £175 - £180 for a 30 minute appointment. This appointment can review your care and is usually booked after 8-12 weeks and annually. This does not include the cost of prescribed medication or costs of recommended investigations.
If you have not been seen by the clinic for over a year, we will ask you to book a new patient appointment for a full review.
For a quick question, we are delighted to offer a trouble shooting, telephone appointment, lasting up to 15 minutes, which is perfect for in-between appointments, this costs £95. This is perfect to discuss a blood test result, or ask a quick question, but is not long enough for a follow-up or annual follow-up appointment.
Prescriptions:
We do not charge to issue a private prescription for a medication like HRT, during your consultation. If further prescriptions are requested by you, outside your consultations, then we charge a £35 administration cost. Please use the request a repeat prescription button on the website to do this.
Medication costs vary, the cost of the medication issued by us, like HRT, is not covered on the NHS, or by the HRT pre-pay certificate. The cost per month of each medication varies according to the product, and the dose you are taking, and it usually is between £10 and £40 per item. Prescriptions sent to your home incur a small extra postage charge. It is cheaper to get your HRT from your GP and we are very happy for you to do this if you prefer. You can apply for the HRT pre pay certificate for your NHS prescriptions which means many of your HRT products are covered for a cost to you of less than £20 per year at the moment. We are also happy to issue you with your medication privately if that is more convenient, but this is not covered by the NHS pre-pay HRT certificate. You can apply for the certificate at a pharmacy or online.
Emails:
We do not charge for emails but we are only able to deal with logistical issues by email. Any clinical concerns we ask that you book an appointment, as per our practice policy.
Additional letters requested for other specialists £30, we will send an invoice to you if you request this. A copy of your clinic letters will be sent to your GP free of charge so they are aware of our care and recommendations.
Private blood tests:
We offer a range of profiles for blood tests and only arrange ones which are necessary for you. Sometimes more investigations are needed we are ruling out some other causes for your symptoms. We can write and request blood tests are done at your GP, if they are happy to do so.
Blood tests can either be taken at a Guildford Clinic or using our national blood letting service, which takes venous blood, or you can select a range of blood tests using medichecks profiles, we can advise you which ones to use. Please see the FAQ on blood tests for further details.
Appointment cancellations:
These will be fully refunded if at least 48 hours notice during the working week is given. After this time it will be difficult for us to fill your appointment time so a refund will not be possible. It is possible to change your appointment from a face to face to a virtual appointment, please email us.
If you need to reschedule your booked appointment more than 48 hours before your appointment time please email us and we will call you to do this.
We reserve the right to change our pricing in future without prior notice.
We are sorry that we do not offer discounts, and believe our prices to be fair and competitive.
Please note that booking confirmation emails may go into your junk email box. You should receive an email on booking your appointment from [email protected]
We are delighted to see you at Rowena Health. Dr Carys Sonnenberg
- When and how do you take payment?
We take payment online at the point of booking using all major credit and debit cards.
- Will my medical insurance cover the cost of the consultation?
Some health insurance policies do not, unfortunately, cover menopause. Please check with your provider, that they cover menopause and that they cover you to be seen by a British Menopause Society accredited Menopause Specialist who sits on the GP register with the GMC, before booking the appointment. We are able to provide you with an invoice to claim back from your insurer.
We are delighted to see that more policies are recognising the importance of menopause and offering cover - in particular WPA and Aviva both cover this service.
If your provider suggests an alternative clinician please check that they hold the BMS Menopause Specialist qualification to ensure you get the best quality holistic care.
Other
- Can I be seen if I live outside of the UK?
Unfortunately, new patients who live outside the UK cannot be seen by us because our medical indemnity insurance only covers patients who are on UK soil at the time of the appointment. We will ask you to confirm this as part of our questionnaire.
- How can I get my blood pressure reading?
If you are considering an online consultation, you may have been asked to provide your blood pressure reading. This is often needed in order for us to issue you with a prescription for any medication, such as HRT.
Getting your blood pressure reading can be done easily at home using a simple home blood pressure monitor, such as these, or can often be provided as a quick service to you by visiting your local pharmacy or GP.
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