Question 1

Will my medical insurance cover the cost of the consultation?

Accepted Answer

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.

Question 2

Vaginal oestrogen for menopause?

Accepted Answer

60% 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. It's called Genitourinary Syndrome of the Menopause. Young tissues are elastic, stretchy and strong, but as we age the tissues become thinner, weak and can easily break, leading to soreness and bleeding. What is vaginal oestrogen for menopause?



There are some fantastic local vaginal products which we, or your GP can prescribe which can be used long term safely in almost every woman. You can insert them into the vagina every night to start with, then twice a week long term. These can be used even if you do not take HRT or can be added to your HRT treatment, if you have troublesome symptoms. Vaginal oestrogen for menopause is not the same as your HRT. 



If you are buying a vaginal moisturiser or lubricant we recommend the YES brand or the SUTIL brand, as some of the others can irritate. Don't forget to do your pelvic floor exercises!



Please click on the link to read our article. It's really helpful and goes into much more detail telling you about all the products.



Please click on this link to listen to the BMS video on this topic.



Always invest in a good quality moisturiser and lubricant.



These are some of the local vaginal oestrogen products. Gina is available to buy over the counter. We can prescribe the other products, or your GP can do this.







This little plastic pessary can be fitted into the vagina and stays there for 12 weeks, then can be replaced by you or by your Dr. It is discrete and comfortable and does not have to be removed when you are having sex.

Question 3

Are you able to continue prescribing me medication after my initial consultation?

Accepted Answer

At your initial consultation we are happy to provide you with a prescription for the next 3 months. After this period, for us to carry on prescribing your medication we will need you to arrange a follow-up appointment to review your care with us to ensure your prescription is right for you. We are happy to prescribe your repeat prescriptions for 3 months at a time. You could choose to get further prescriptions from your own GP, who you would need to arrange a follow-up consultation with directly. If you do this, please ensure that you book in good time so that you do not run out of medication.

Question 4

What are the side effects of HRT?

Accepted Answer

Almost every medication can have side effects, and the same is true for HRT. The side effects can be due to the change in hormones, and to the way your body reacts to this change. 



The common side effects such as headaches, bloating or breast pain are usually transient and settle within 3 months. Sometimes it is necessary to change the HRT preparation, or dose, to minimise side effects.



Side effects of oestrogen are breast tenderness, legs cramps, skin irritation, bloating, indigestion, nausea and headaches.



Side effects of progesterone are PMS like symptoms, fluid retention, breast tenderness, low mood, bleeding and headaches.



When you start on HRT, or change the dose or preparation it is common to have some new unscheduled bleeding. If this bleeding is not settling after 3 months please speak with a Dr.

Question 5

Unexpected bleeding on HRT?

Accepted Answer

When should you worry about unexpected bleeding on HRT? It is very common for women to have irregular and even sometimes heavy bleeding when they start HRT or when they increase the dose of oestrogen in the HRT. This can take 3 to 6 months to settle.



If you are still having unscheduled bleeding more than 3 months after starting HRT or having your dose or regime changed then please speak to us or your Dr. We may need to consider changing your HRT dose or regime. 



We may advise that you arrange an appointment with a doctor to have an internal examination. You may need further investigations like an ultrasound scan or a hysteroscopy. These checks are needed to see where the bleeding might be coming from, to ensure that the vulva, vagina, cervix and endometrium are normal, and to rule out a serious cause for the bleeding. Please attend for your cervical screening appointments.



It is very important to take your HRT as it has been prescribed. Taking oestrogen HRT, without progesterone or progestogen, if you have a womb, puts you at risk of endometrial hyperplasia or endometrial cancer. 



Please click on this link to listen to the BMS video which gives you more information about bleeding and HRT.

Question 6

What do you treat?

Accepted Answer

Dr Carys Sonnenberg is a highly experienced Women's Health GP and Menopause Dr, she can help with:





 	

 	Symptoms of the perimenopause, menopause, and post menopause







 	

 	Menopause following pelvic surgery or cancer treatment induced symptoms, and is happy to see you before the surgery to discuss your post operative hormonal care







 	

 	Premature menopause







 	

 	Premature ovarian insufficiency – POI - but we are not able to give fertility care







 	

 	Vaginal/bladder and pelvic floor problems during menopause







 	

 	Women already on HRT who need a review of their treatment or experiencing complications with their medication







 	

 	Women with complex medical histories such as polycystic ovarian syndrome (PCOS), endometriosis, chronic diseases and women with co-morbidities, women with history of cancer, including breast cancer. We are happy to work with oncologists







 	

 	Women who choose not to, or are unable to have HRT, we can prescribe non-hormonal treatments







 	

 	Women who would like to consider Testosterone treatment, we are able to start, prescribe and monitor this







 	

 	PMS and PMDD







 	

 	She can support you with advice on all contraceptive choices







 	

 	She is experienced in dealing with a wide range of women's health problems so please email on info@rowenahealth.co.uk if you would like to discuss whether she can help you







 	

 	If you cannot find an appointment to suit you then please email info@rowenahealth.co.uk and we will do our best to be flexible to suit your needs

Question 7

symptoms of perimenopause and menopause?

Accepted Answer

Everyone is individual, some women feel very well through their menopause and have barely any symptoms, and for others their symptoms are severe and the whole experience is life a whirlwind affecting every part of their lives. The symptoms of perimenopause and menopause can affect every part of the body. 



Keeping a symptom chart is so helpful, especially as hormones fluctuate wildly and symptoms can come and go. There is one on our Rowena Health website that you can use, as often as you like. 



During Perimenopause, the time before the menopause, symptoms come and go. This can last for 4-7 years, on average.



The symptoms affect us physically as well as emotionally, hot flushes are commonly know but some symptoms are rare, like tinnitus and burning mouth syndrome. Have a look at the image below.



This image shows all the symptoms that may be found

Question 8

What happens after my initial consultation?

Accepted Answer

We will send you a securely encrypted email, summarising your menopause care plan and the details of our consultation within 7 days. If you have not received it please let us know, and please check your junk mail, just in case. It will come from info@rowenahealth.co.uk

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.

We aim to share your letter with your NHS GP, unless you ask us not to do this. We do not prescribe medication for anyone who is not happy for us to share this with their GP, unless there are extenuating circumstances. We feel this is safest for you and your Dr in case they prescribe anything which could interact with a medication which is prescribed by us.

If we are prescribing your medication we will send this to you at home or via a token you can take to the local pharmacy, and we will explain to you how to use this medication.

Question 9

I don’t live close to your Guildford practice, can I still get an appointment with you?

Accepted Answer

Yes, of course. We offer virtual and in-person appointments, so if you live too far away, or you prefer the convenience of an appointment from the comfort of your own home, then a virtual appointment would be ideal for you.

Question 10

How do I book a video consultation and how does this work?

Accepted Answer

Simply click the Book Appointment button on the top of our website to book a consultation at a time that is convenient to you.

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.

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.

Question 11

Caring for your bones in menopause?

Accepted Answer

How can we care for our bones in menopause? In women, the decline of general bone health speeds up once their regular menstrual periods stop with the menopause, due to the decline in the hormone oestrogen. Osteoporosis is the process that describes the thinning of the bones, causing them to become less dense and strong. As a result, the bones are more fragile and liable to break.





One in three women over 50 years will suffer from a fragility fracture. One in six women will fracture a hip and of these 20% will die within one month, 30% will die within one year and 50% will not be able to live independently. It is so important to be aware of your bone health.




How to keep your bones healthy using lifestyle?




Diet: Eating a balanced, healthy diet. This includes consuming calcium in food products such as milk, yogurt, cheddar cheese, brazil nuts, tinned salmon, tofu and leafy green vegetables. 1200mg calcium a day is required for post menopausal women and 700mg a day for pre-menopausal women. Are you eating enough calcium? Click this link to find out.





Topping up on Vitamin D levels: Vitamin D is absorbed through the skin when it’s exposed to sunlight, in combination with certain foods in the diet such as fish, eggs and fortified foods – for example cereal. It is also recommended to take a Vitamin D supplement, 1000iu a day.





Weight bearing exercise, these are activities that put weight through your feet and legs like brisk walking, running and aerobics. 30 minutes on most days, has been shown to help maintain bone mineral density. The benefits of lifting heavy weights are definitely seen in midlife to avoid muscle wasting and help with metabolism and bone strength.





Stopping smoking and reducing alcohol is important.





This link takes you to a website to explain more.





Any postmenopausal woman over the age of 50 years, who has a clinical risk factor for osteoporosis needs a FRAX score. We can do this for you at your appointment, if necessary.




What are the risk factors for osteoporosis?




This is the NICE guidance which shows what the risk factors are for osteoporosis and who should be assessed for fragility fracture risk.





If you have these risk factors please let us know. We will assess using a FRAX score.




A FRAX score?




The FRAX score gives us a 10 year risk of hip and major osteoporotic fracture, and links to the National Osteoporosis Guideline Group (NOGG) which advises further action. This could be with either life style advice, and reassessment in 5 years or sooner; to arrange a bone scan or to start treatment for osteoporosis, without the need for a bone scan.




Premature Ovarian Insufficiency or Early Surgical Menopause?




If you have had Premature Ovarian Insufficiency or an Early Surgical Menopause we recommend taking HRT to protect your bones and heart.

Question 12

Migraine and menopause?

Accepted Answer

We are experienced in helping you manage your migraine in perimenopause and menopause. We can guide you on the how to manage an acute migraine attack, what medications work best; how to look for your triggers and how to monitor your migraine attacks. We can guide you on preventer treatments, if you need them.

Migraine can become worse during perimenopause. It is safe for women who suffer from migraine to start transdermal oestrogen HRT, even if you have migraine with aura. Transdermal HRT does not increase the risk of blood clot or stroke in healthy women with normal doses.

If you suffer from migraine we will carefully manage your HRT, gradually and slowly changing doses. Some women find taking continuous combined HRT helps keep their hormones more stable (oestrogen and progesterone taken every day rather than cyclical progesterone). Do read this FAQ to explain this further. A patch of oestrogen may also be better than a gel or spray, so absorption is more controlled.

It is not safe to take the combined contraceptive pill if you have migraine with aura, due to increased risk of stroke.

Managing migraine is done in a number of ways, looking for triggers and keeping a simple diary; treating the acute attack with high dose NSAIDS like 900mg soluble aspirin with a small can or fizzy drink, an anti-sickness tablet and a 'triptan' taken as directed and regularly. If you are getting frequent attacks we can consider a preventer treatment like propranolol or an alternative and then review things to see how you are responding.

There is some evidence that taking supplements can help, we can guide you on the correct doses of Riboflavin B2 400mg daily and will turn your urine bright yellow; Magnesium Glycinate 400-600mg daily, co-enzyme Q10 150mg three times a day (can be expensive), Vitamin D and Omega 3. It is recommended to take these supplements for 3 months at least before you may see an improvement.

I have a live interview with Dr Katy Munro on my instagram account which is incredibly helpful, please contact me if you would like to watch this. It covers triggers, acute treatment, supplements and preventative treatment.

If you need a headache specialist assessment and you are in the UK, you can refer yourself to the National Migraine Centre, they ask for a voluntary donation to cover costs. This book, 'Managing your Migraine,' is written by Dr Katy Munro and can be very helpful, she also has a fabulous Heads up podcast.

NICE guidelines and the National Migraine Centre are very helpful.

Question 13

What is menopause?

Accepted Answer

All women go through the menopause, a natural menopause is said to have happened one year after your last natural period. The average age of women going through the menopause is 51-years old. By the age of 54, 80% of women have stopped having periods. Natural menopause usually happens gradually, with oestrogen levels fluctuating in perimenopause, periods may become irregular and then gradually stop.



Early menopause: this is when the menopause occurs younger than 45 years old.



Premature menopause, or premature ovarian insufficiency (POI): this is when the menopause occurs younger than 40, and affects 1 in 100 women. Menopause under the age of 30 affects one in 1000 women.



Surgical menopause: this is when menopause occurs following an operation to remove your ovaries. This procedure may occur as part of cancer or endometriosis treatment; in order to reduce the risk of developing cancer (in those who carry the BRCA gene mutations, for example; as a last resort in people who suffer with premenstrual dysmorphic disorder (PMDD), a severe form of premenstrual syndrome (PMS). This is different from natural menopause, as oestrogen production, which was being produced by the ovaries, is suddenly withdrawn.



Postmenopause is the time following one year after your last natural period.

Question 14

What is perimenopause?

Accepted Answer

The natural menopause is said to be the day one year after your last natural menstrual period. The average age is 51 years in the UK. The perimenopause is the time before that, starting usually in the early to mid 40's and lasting on average 4-7 years, but it can be longer. Your natural cycle changes, your ovaries start to produce less oestrogen and progesterone and this causes changes in your body. 



Oestrogen receptors are everywhere, so your symptoms can vary. It can be hard to put your finger on what is wrong when oestrogen falls, and some symptoms are quite unusual! You may be noticing things are changing in your body, but may be distracted juggling family, relationship, children, parents and work so it's not usual to wait some time before seeking help and before joining the dots between all the symptoms. Many women put their symptoms down to pressure of life, or to stress, or even to thinking that they are going mad, which of course is not true, but is something we hear often.



The ovaries do not come to a slow graceful stop as they run out of eggs, prepare to stop ovulating and stop producing hormones in a natural cyclical way. Some months they might ovulate and produce these hormones, and other months they may not, so periods could become closer together then further apart, maybe skipping a few months. Consequently periods can be light or can come as a surprise, after a long gap, with very heavy with flooding. If your bleeding is very heavy please click this link to read about how to help this.



Hormone levels can yoyo during perimenopause, so symptoms can come and go. Some women sail through it and feel well, and other women do not, they need help. Don't worry it you need help, there are lots of things we can do. The list of symptoms can be quite overwhelming, but please be assured that seeing a menopause specialist or your GP early, is the best thing to do, there is no need to wait and battle on through, without support and advice. 



This podcast is great to listen to if you'd like to know more information about perimenopause. This podcast covers lots of questions about menopause.



This is a guide to print off and take to your GP if you need help with that first appointment.

Question 15

What is the surgical menopause?

Accepted Answer

A surgical menopause is the menopause which occurs suddenly following an operation to remove your ovaries. 



This procedure may occur as part of cancer or endometriosis treatment; in order to reduce the risk of developing cancer (in those who carry the BRCA gene mutations, for example; as a last resort in people who suffer with premenstrual dysmorphic disorder (PMDD), a severe form of premenstrual syndrome (PMS)). This is different from natural menopause, as oestrogen production, which was being produced by the ovaries, is suddenly withdrawn.



The symptoms of surgical menopause are similar to those experienced in natural menopause, but they can be more extreme as they are sudden, and removal of the ovaries results in the sudden loss of oestrogen. Mood changes, hot flushes, night sweats, fatigue, palpitations and vaginal dryness.



Symptoms of testosterone deficiency may also be present, like low libido, headaches and a feeling of general malaise.



It is important to consider taking HRT, to protect the bones and cardiovascular health. 



Hormone treatment: for the majority of women who are able to take hormones after surgery, they will only need to replace oestrogen, unless you have had endometriosis, when we often use progesterone to protect the ectopic endometrial like tissues which may remain.



The Daisy network is a UK-based charity dedicated to supporting people who have gone through premature surgical menopause (under the age of 40) or have a diagnosis of premature ovarian insufficiency (POI). Surgical menopause can be very difficult emotionally, especially if it occurs at a young age, and you have not had children. It is important to let your family and friends know how you are feeling and we can support you with any treatment and talk you through all the options, working closely with you to support you through this time.

Question 16

Can I expect an HRT prescription after my initial consultation?

Accepted Answer

This depends on your individual case. If it is straightforward, we may be able to issue it there and then for you. In more complex cases we may need to investigate with blood tests or ask expert colleagues for advice. Each case is individual. We can issue a private prescription for you, through our private pharmacy, for which there will be a cost. Alternatively, you can arrange to see your GP to ask if they are able to prescribe your medication on the NHS.

Question 17

Do you prescribe regulated HRT or bio-identical compounded hormones?

Accepted Answer

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. It 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.

Question 18

Is HRT a contraception?

Accepted Answer

HRT is not a contraceptive, unless you are using the Mirena coil.



We can talk with you about contraception and which one might suit you best. All women can stop using contraception when they are 56 years old. You may need to use contraceptive hormones alongside your HRT and we can advise you about this.

Question 19

Progesterone in HRT?

Accepted Answer

Progesterone or progestogen is given as part of your HRT if you have a womb, and in some women after a hysterectomy. It's job is to keep the endometrium, lining of the womb, thin and to reduce the risk of endometrial cancer. It is very important to take your progestogen. If you take higher doses of oestrogen, we will increase your dose of progesterone or progestogen.



Progesterone is the hormone made by our own body. We commonly prescribe a micronised progesterone called Utrogestan, it is derived from the yam plant and is body identical, meaning it has same structure as your own progesterone. It is taken orally in the evening with food, as it can make you sleepy. It can either be taken continuously every night, or cyclically for 12-14 days of the month. We will advise you of the best way to take it for you. 



Other progestogens are synthetic and have a slightly different structure to progesterone. They protect the endometrium in the same way as progesterone. They can be taken orally, or as part of a combined HRT patch, or in a Mirena IUS, which can be fitted into the womb. Lots of women like using a Mirena IUS as it helps reduce heavy bleeding, it acts as a contraceptive and it can be used for 5 years.



Some women are intolerant of progesterone and progestogen and if that is the case please talk with us. We can try a different progestogen, or advise you how to take it differently.



Some women experience side effects when taking progesterone or progestogen, these can be felt as mood changes, bleeding, bloating, headaches and breast tenderness. These often settle with time but do speak with us if you are concerned.



These are some common ways to take the progestogen part of your HRT.

Question 20

Risks of taking HRT

Accepted Answer

NICE guidelines state that for the majority of women, the benefits of taking HRT outweigh the risks. For each individual woman this decision is based on your personal and medical history, any pre-existing medical conditions, your family history and whether or not you still have a womb (uterus).

Many women worry about breast cancer and blood clots.

Breast Cancer

Your personal breast cancer risk depends on many things including age, family history, age at puberty, number of pregnancies etc. Lifestyle factors play an important role in breast cancer risk with obesity, smoking and alcohol consumption of 2 or more units per day all increasing breast cancer risk while regular moderate exercise of 2 ½ hours per week reduces this.

Studies have shown that women who take estrogen-only HRT do not have an increased risk of breast cancer. Women who take combined HRT, containing estrogen and progestogen, may have a small increased risk of breast cancer. This risk can be minimised by using Body Identical HRT (estrogen through the skin in combination with micronised progesterone if required) as some studies have shown the risk of breast cancer with HRT is reduced if micronised progesterone is used.

Blood Clots

There are many risk factors for blood clots and the risk increases as you age. HRT taken orally as a tablet is associated with a small increased risk of blood clot, for this reason and should be avoided in anyone with an increased risk of blood clot such as a personal history of blood clot, liver disease or migraine. Evidence shows that HRT taken transdermally across the skin as an estrogen patch, gel or spray carries no increased risk of blood clot.

Ovarian cancer and gall bladder disease - small increased risk.

Question 21

Testosterone for Menopause?

Accepted Answer

Testosterone is an important hormone for many women. Yes, we are able to prescribe this for you on an individual basis, except if you are a competitive athlete or are planning to become one.

There is not currently a licensed preparation of testosterone available for women in the UK but if we prescribe it, we can explain about licensing, how to apply it, what monitoring will be needed and what possible side effects may occur.

Prescribing testosterone is endorsed by the National Institute of Clinical Excellence Guidelines Management of the Menopause NG23 2015. This leaflet gives you more information.

This picture shows the different types of testosterone than we can prescribe for women under NICE guidance.

Question 22

The benefits of HRT?

Accepted Answer

The benefits of HRT have been shown in many studies, it helps to improve quality of life. Some women find the transition through menopause easy, and for other women it is a life changing event. 



Nothing is as effective as HRT for the relief of menopausal symptoms. It will improve symptoms by about 70-80%: hot flushes, night sweats, vaginal and bladder symptoms, emotional symptoms, mood changes, skin changes, digestive problems, headaches and migraines, tiredness, joint and muscle pains, palpitations and many others.



Other proven benefits are maintenance of bone mineral density.



Additional potential benefits are the risk of coronary heart disease is reduced, if started early, within 10 years of menopause or under the age of 60; reduced risk of Type 2 Diabetes; reduced risk of colorectal cancer and reduced risk of Alzheimer's Disease, when started early.

Question 23

What can help symptoms of menopause?

Accepted Answer

There are many things that will help improve your symptoms of menopause. Menopause is individual, so we take care to understand exactly what symptoms are affecting you, and will support you, exploring what what is important to you when it comes to choosing the right way to help. We can help you build a menopause toolkit, it is so useful to 



For some women HRT (Hormone Replacement Therapy) is effective, but others cannot take this or choose not to take this. We can discuss how lifestyle is so important and guide you to try making some simple changes, which can really help improve your symptoms. You may prefer non-hormonal medical treatments. CBT (cognitive behavioural therapy) can be very helpful.  Some women explore complementary or alternative therapies like herbal remedies, acupuncture, reflexology, homeopathy, magnetism or yoga, for example. We can talk with you about all these options. 



We will support you as an individual and give you all the information you need when making choices about your individual treatment plan. You can ask us any question, no matter what it is, we understand some things are personal and can be difficult to talk about, but we are experienced and will take time to listen and understand.

Question 24

what if you HRT is not working effectively?

Accepted Answer

If you are currently taking HRT and feel like your current dose of HRT is not working then please don't suffer alone. Menopause regimes need regular reviews and adjustments, as your own hormones fluctuate. Some women do not absorb oestrogen well through the skin, or orally so need a different preparation.

Do have a look at my 'What is HRT'  FAQ as this will show you all the different preparations of HRT. We can make some suggestions to help change your treatment plan to help you feel greater benefits.

Question 25

What is HRT?

Accepted Answer

Hormone Replacement Therapy or HRT is a hormone treatment used to relieve the symptoms of menopause. It includes the hormones oestrogen, often progestogen and in some cases testosterone.



Using HRT is the most effective way to treat symptoms of the perimenopause and menopause, it tops up the hormones that your body is no longer producing. 



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.



Oestrogen - taken daily, trandermally, as a gel, patch, spray or taken as an oral tablet. Very few women use an oestrogen implant. We do not fit oestrogen implants at Rowena Health. The type of oestrogen mostly used is 17 beta-estradiol, which has the same molecular structure as the oestrogen you produce in your body, it is body identical. It is derived from the yam root vegetable.



Progesterone - if you have a uterus (womb), you will need to take a progestogen as well as oestrogen, ­this is known as combined HRT. Oestrogen taken on it's own can thicken the lining of the womb and increase the risk of uterine cancer; taking a progestogen keeps the lining thin and reverses this risk. The safest type of replacement progestogen is called micronised progesterone called Utrogestan. It is body identical. It comes as a capsule taken orally, at bedtime. Occasionally this progesterone can also be used vaginally, off license, only after discussion with a Dr. An alternative way to receive a progestogen is to have the Mirena coil inserted into your uterus. This is also a very effective contraceptive and it needs replacing every five years. There are other progestogens available as part of oral HRT combined tablets or patches, which we can discuss with you, if necessary.



Testosterone -­ many women during perimenopause and menopause suffer from a lack of sex drive. For some women, that does not cause them any concern, but for others it really upsets them and affects their relationship. If you are taking HRT for a few months and still have a low sex drive which is affecting you then NICE support us to prescribe Testosterone to women, even though it is not licensed to be used, but it can be safely used. Many women report that it helps with other symptoms such as fatigue, brain fog and lack of libido. Testosterone can be beneficial, in addition to the oestrogen in HRT, to bring about further improvements of these particular symptoms. 



Local vaginal oestrogen - vaginal oestrogen treatments can be added to your HRT to help if you suffer from vaginal and bladder symptoms. The vulva, vaginal tissues shrink and become dry as we age and can appear like a thinning, wisened prune. Adding oestrogen twice a week into the vagina, as a cream, a tablet, a gel or a little plastic ring keeps those tissues plump and strong and really helps and is very low dose and safe in almost every woman. We will discuss which products is right for you.



These are the oestrogen products that can be absorbed transdermally through the skin to help relieve your symptoms. This is the safest way to take your HRT, as evidence shows that in licensed doses in healthy women there is unlikely to be an increased risk of blood clot. Many women find this a great way to take oestrogen.



These are some different oestrogen patches which can be applied twice weekly, at doses individual to you.



Some women prefer to take the oestrogen part of their HRT as an oral tablet, we can discuss this with you when we look at risks and benefits of HRT. Taking HRT as an oral tablet slightly increases the risk of blood clot.



These are some ways to take the progestogen part of your HRT to protect the lining of the womb from the thickening effect that could occur if you took oestrogen alone. It is important to take progesterone, if it has been prescribed, as taking oestrogen HRT without a progestogen puts you at risk of endometrial cancer.



These are examples of patches which can be used so that both oestrogen and progestogen is absorbed through the skin through the same patch, some women find it easier to take both hormones in a patch. We will discuss if this is right for you.



There are also some oral tablets combining oestrogen and progestogen. 



We can discuss which preparation may suit you and your lifestyle best.

Question 26

CBT in Menopause?

Accepted Answer

We are trained in using cognitive behavioural therapy, CBT, in menopause, which can help manage to distress of hot flushes and night sweats. It can also be used to help if you are struggling to sleep, if you are anxious and if you are struggling with low mood. We have support of a number of psychologists, to whom we can guide you to provide this, or any other psychological support you may need.



The British Menopause Society have looked at the evidence for CBT in menopause, in helping reduce hot flushes and sweats and used a group therapy over a 6 weeks course, with 2 hours a week to really help women understand their bodies. 



Using a bio-psychosocial method helps to give an understanding of symptoms, a change in negative thought patterns, which consequently changes emotions and behaviours in a positive way. It looks at breathing techniques to reduce stress and at all forms of stress reduction. 



If you are interested in this then please do contact me, this can be run as a group or 1-1 and it is very helpful for all women, but particularly those women who are unable to take HRT, maybe after a breast cancer diagnosis, and are troubled by their symptoms.

Question 27

Healthy eating in menopause?

Accepted Answer

The first thing to say is don't worry, make eating a pleasure, enjoy tastes, textures, flavours and new things!



We understand that your weight and body shape can change at midlife. Usually this is caused by fluctuations in hormones, and many women find it confusing that they gain weight, even though their diet hasn't changed. They may try different diets or different ways of eating. There is a lot of confusion on social media now about this. Is low fat best, or low sugar? Is it ok to snack? Is a bedtime snack a good idea?



Midlife is a time to reflect on the here and now, and to focus on looking after your body, to consider your food choices and exercise and to think about changes you can make to protect your future health. I don't recommend any specific type of diet but do not support a low fat diet, and I do support a diet low in refined carbohydrates. Snacking can make up a fifth of your daily intake of food, so ensuring what you eat is healthy is important. From my reading, try and avoid a bedtime snack, as eating late can cause a rise in blood sugar, and the fluctuating blood sugar levels can consequently affect your sleep.



Healthy eating is not all about weight management, gut health is equally important. Do click on the link to read more about how to improve your gut health.



These are some things to consider when making choices on what you may enjoy to eat:




Find out about a Mediterranean- style diet ensuring you are eating enough protein with each meal. Many women do not eat enough protein, and protein is filling, and is broken down to amino acids which help with repair and is especially important for healthy muscles and bones.



Experiment with new foods, make it interesting and colourful trying a rainbow of fruits and vegetables, aim for 30 different types each week helps to feed our gut microbiome. You can pre-fill jars with different varieties of nuts and seeds, for example, to sprinkle on yogurt to get variety. 



Think about your gut health, this link takes you to some ideas.



Try and avoid white refined carbohydrates, as these cause a rapid increase in your blood glucose which make mood swings worse, and can make you feel tired, when the glucose level suddenly drops again. 



Aim for a diet low in ultra-processed foods, as these can be high in sugar. Ultra-processed foods typically have five or more ingredients and contain substances such as preservatives, emulsifiers, sweeteners, and artificial colours and flavours. Examples might be a flavoured yogurt or breakfast cereals.



Explore Vitamin D-rich foods, this is important to protect the bones and is the only supplement I recommend you invest in taking.



Enjoy iron rich foods, often women can become anaemic, or have a low ferritin if they have heavy bleeding in perimenopause.



Choose food rich in calcium, to protect your bones from osteoporosis. Click the link to see how much calcium you eat, it's best that this comes from your diet. After menopause we recommend 1200mg of calcium per day. A 800iu a day Vitamin D tablet is recommended daily.




We always talk about guiding you to try and keep your body mass index (BMI) within a healthy range between 19-25kg/m2, if you can. We gain weight as we age and menopause affects where our body fat is stored.

Question 28

Herbal therapy for Menopause?

Accepted Answer

For further reading, I recommend 'The New Natural Alternatives to HRT.' by Marilyn Glenville.

Reading as much as you can about the different products available on trusted sources is best.

These are links to trusted sources to give you more information about herbal therapy for menopause:

Patient info

Menopause matters

NICE guidance

Women's Health Concern Factsheet

Question 29

Monthly body check?

Accepted Answer

Yes please, this is really important. 



Examine your breasts, intimate area and skin once a month so you know what is normal for you. 



This article helps you recognise changes in your breasts.



If something changes then you know about it and can ask a Dr for advice.

Question 30

Pelvic floor exercises in menopause?

Accepted Answer

The pelvic floor is made of a bowl of muscles that all work together to give support to your bladder, bowel, womb and vagina.





If you have a weak pelvic floor, you might find that you have leakage from your bladder, leakage from your bowel or a heaviness or dragging sensation in the middle, sometimes with a bit of vaginal laxity.





Much like your arm, leg or abdominal muscles, the pelvic floor muscles can be trained and strengthened with daily exercises. To exercise them you need to practise both strong long holds, which we call 'slow exercises' and short squeezes, which we call 'quick exercises'. You should also try doing a strong 'squeeze and lift' just before any activity that causes a problem, like coughing or sneezing which might cause leaking.





Strengthening your pelvic floor muscles can help you to improve bladder control and reduce accidental leaks; reduce the risk of prolapse which in women, this may be felt as a bulge in the vagina or a feeling of heaviness, discomfort, pulling, dragging or dropping; improve recovery from childbirth and gynaecological surgery (in women) and increase sexual sensation and orgasmic potential.





If you are suffering from incontinence then it is really important to see your GP. They may need to refer you to a pelvic physiotherapist. Some women have an overactive pelvic floor and they need to be taught now to do pelvic relaxation exercises as well as training their pelvic floor.





If you need help with pelvic floor exercises please click on this link. Many women find the squeezy app helpful and these videos are all really useful.

Question 31

Phytoestrogens for menopause?

Accepted Answer

Phytoestrogens are plant substances that have similar effects to oestrogen. The most important groups are isoflavones and lignans. Can phytoestrogens for menopause be helpful?



Good sources of isoflavones are chickpeas, soyabeans, red clover, beans, peas and lentils.



Good sources of lignans and flax seed, sesame, legumes, whole cereals and fruit.



They are available as supplements, but NICE advises that although isoflavones may help with hot flushes and night sweats, the supplements are not standardised for quality or in content. Generally women who have had an oestrogen positive breast cancer are advised to avoid phytoestrogen supplements.



There are no consistent studies demonstrating how effective isoflavones are to help with flushes and sweats. Japanese women have a diet high in isoflavones and seem to have lower rates of menopausal symptoms and lower rates of breast cancer, ovarian cancer, heart disease and osteoporosis, but is soya the reason?



Is it safe to eat isoflavones if you have had breast cancer? The evidence we have didn't show a worse prognosis in women eating a soy rich diet, this is a helpful article if you would like more information.

Question 32

Sleep and menopause?

Accepted Answer

Sleep can be affected in menopause, please do speak with us about this. This website has some fantastic advice. Very simple tips that can help are:




Keep your bedroom cool and well-ventilated



Try having layers of bedding so that you can easily adjust the heat



Sleep in loose clothing — cotton and linen are usually best



Avoid spicy food, especially near bedtime



Cut back on nicotine, coffee and alcohol if possible. Avoid drinking caffeine after midday.



Limit screen-time in the evening



Establish and maintain a regular bedtime and getting up routine



Exercise regularly each day, but not too close to bedtime, and have some time with daylight on your skin



Look at ways to manage your stress and try to make time to relax




30-40% of women report chronic insomnia by the end of menopause and 40-60% of women experience sleep problems in menopause, and this can increase their risk of depression by 2-3 times. In menopause we see an increase in Restless leg syndrome, and also in Obstructive sleep apnoea, which can lead to morning headache, mood disturbance and nightmares.



Both lack of sleep and menopause can increase your risk of cardiovascular disease, affect your mental health, cognition, bone health, immune function and metabolic health. 



Prioritising sleep is so important, a regular bed time and wake time. Please talk with us if sleep is an issue as we are trained in CBT for hot flushes and night sweats and this training is very helpful in sleep management, too.

Question 33

Stress and menopause?

Accepted Answer

The symptoms of stress and menopause are similar and cortisol rises as we age. Psychological and emotional symptoms are common around the time of menopause and include anxiety, low mood, irritability, anger, inability to concentrate and mood swings. You may feel that you have los your self esteem, your body looks different and you cannot cope with the things you used to be able to do easily. Even normal day to day life and relationships can be a struggle.



Cognitive behavioural therapy (CBT), counselling or life coaching can help and work by teaching you coping skills for dealing with different problems. It focuses on your thoughts, beliefs and attitudes, and how they affect your feelings and actions. CBT can be a useful skill for managing stress and menopause.



Mindfulness is a technique used to help focus on the here and now, not to dwell on the past, or worry about the future. It uses meditation, yoga and breathing exercises, but actually it can be as simple as using your senses on a walk to be present in the moment, or watching a butterfly flutter, and only concentrating on that moment. It can be used to improve focus and concentration an, to decrease stress, increase self-awareness and increase wellbeing. It is recommended by NICE to help manage anxiety and depression.

Question 34

Yoga for menopause?

Accepted Answer

Yoga has been shown to help with the psychological effects of perimenopause and menopause.





If you would like to find out more I can happily recommend Anna Coates Yoga. Anna is based in Guildford and can be contacted via her website or by email anna@annacoatesyoga.com. She offers classes via Zoom and in-person in the Guildford area.

Question 35

Can I be seen if I live outside of the UK?

Accepted Answer

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.

Question 36

How do I book to see you in person or online?

Accepted Answer

To begin with, book a 45 minute new patient appointment, either on-line or in-person a our Guildford clinic.

The next appointment with us can be a 30 minute follow-up appointment, either on-line or in-person a our Guildford clinic, book on the booking page.

For a quick mini- consultation, a trouble shooting appointment, either on-line or in-person a our Guildford clinic, book on the booking page. This is only suitable for a quick question, not a follow-up review.

For a blood test, this is usually agreed during a consultation, please email us if you have any concerns. We will arrange the blood test for you either at our Guildford Clinic, or via Nationwide Pathology, which has clinics over the UK. We will send you an invoice to be settled that day please, to avoid us having to charge for extra administration time, or having to book another appointment to ensure the test is still needed.

You will be sent a booking confirmation after you book an appointment, and a detailed booking questionnaire asking for your medical history and other details like your NHS number and consent to us holding your data.

Question 37

We welcome everyone

Accepted Answer

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.

Question 38

Who do you treat?

Accepted Answer

We provide care to people 18 and older, going through perimenopause and menopause. We also provide consultations for PMS and PMDD.

We provide you with evidence-based information and advice to support you with your symptoms and treatment. We consult in-person or using online video consultation from the comfort of your own surroundings.

Your health and wellbeing are the the heart of our consultation. 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.

If you are not sure whether we can help you, or you cannot find an appointment time to suit you, please email us on info@rowenahealth.co.uk and we will do our best to be flexible and find a time to help.

Question 39

Do I need a referral from my GP to see you?

Accepted Answer

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.

Question 40

Do you have disabled access?

Accepted Answer

Yes there is parking at our Guildford clinic and access via a ramp to the clinic and the rooms are on the first floor.

Question 41

How do I book an in-person consultation and where will I be seen?

Accepted Answer

Simply click the option on the top of our main web page to book a consultation at a time convenient to you.

We offer in-person consultations at The Surrey Cardiovascular Clinic in Guildford which is located at 5 Huxley Rd, Guildford GU2 7RE. These usually take place on a Monday. Directions to us can be found here.

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 are working with another clinic in Guildford so hope to be able to offer more appointments in person in the coming months.

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.

Question 42

How long do consultations normally last?

Accepted Answer

Please allow up to 45 minutes for a new patient consultation (£250)

Please allow up to 30 minutes for a follow-up consultation (£150)

We offer short consultations of up to 15 minutes which are suitable to discuss a simple question or to review of a blood test (£95)

Question 43

What are your fees for consultations, blood tests and prescriptions?

Accepted Answer

Consultations:

A new patient to Rowena Health consultation is currently £250 - £280 for a 45 minute appointment. This does not include any prescription or investigation costs.

A follow-up patient consultation is currently £150 - £180 for a 30 minute appointment. This appointment can review your care and is usually booked after 6-12 weeks and annually. This does not include any prescription or investigation costs.

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, mini-online 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 6-12 week 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 a prescription for a medication is requested outside a consultation, 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.

Prescription dispensing fee outside of consultation £35.

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 short letter will be sent to your GP free of charge if we start medication or change your medication.

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.

Blood tests can either be taken at our Guildford Clinic or using our national blood letting service, which takes venous blood.

There are two fees for blood tests if we use the blood letting service, one for the blood test processing and one for the blood letting.

We have a contract with them and we will send a first invoice to you, to cover the processing cost of the blood (this cost varies depending upon which tests you require it can range from £75 to over £200, depending on the range of tests being ordered). This needs to be settled on that day, to avoid extra administration charges. Once it is settled the order is sent to the the blood letting service and a letter is sent to you with details of how to call them to arrange your blood test at a place near you.

The blood letting service, at the point of booking your blood test with you, will send a second invoice to you, to cover their blood letting fee at their clinic, which is usually between £35 and £70, depending upon which clinic you use in the UK.

We ask that you settle our blood test ordering invoice on the day that we sent it, to avoid us spending administration time chasing this up. If there is a period of time between you being sent the invoice and settling the invoice we may need to ask you to book another appointment to ensure the test is still right for you.

If you have your blood test done at our Guildford clinic there is one fee, and this includes both the blood test processing and the blood letting. Dr Sonnenberg lets the Surrey Cardiovascular clinic know which blood tests to arrange, and they organise with you the date and time of the blood test and they take payment and relay the results to Dr Sonnenberg, who will contact you when she receives them.

If your GP is happy to do the blood tests we are very happy to accept their results if you provide us with reports. We ask that you organise this yourself with your GP. Please email any results to info@rowenahealth.co.uk and we will upload them to your secure patient notes.

The national blood letting service provides the following blood panels to Rowena Health. The cost of processing these blood panels is stated but there as an extra cost, charged to you by the blood letting service for taking the blood test, called the blood letting fee, which is payable to them and varies between £35 and £70.

Profile 1 - Estradiol (£40 + extra blood letting fee)

Profile 2 - Total Testosterone, Sex Hormone Binding Globulin (SHBG) and Estradiol (£70 + extra blood letting fee)

Profile 3 - Follicle Stimulating Hormone (FSH), Luteinising Hormone (LH), Estradiol, Total Testosterone, Thyroid function Tests, SHBG, Prolactin (£95 + extra blood letting fee)

Profile 4 - Lipids, HbA1c (diabetes) (£55 + extra blood letting fee)

Profile 5 - Estradiol, LH, FSH, Total Testosterone, SHBG, Lipids (blood cholesterol), Liver function tests (LFT), Kidney function, Hba1c (Diabetes), Ferritin (iron), Thyroid function test, Full Blood Count, Vitamin D, Vitamin B12 and Folate (£150 + extra blood letting fee)

Profile 6 - Coeliac Screen (£80 + extra blood letting fee)

Profile 7 - Oestradiol, LH, FSH, Total Testosterone, SHBG, Lipids, LFT, U+E, Hba1c, Thyroid Function Test, Full Blood Count, Vitamin D, Vitamin B12, Folate, Coeliac screen, Magnesium, Zinc, Creatinine Kinase, Ferritin, Uric acid, Bone screen (£205 + extra blood letting fee)

Profile 8 - FSH, LH (£66 + extra blood letting fee)

Profile 9 - Total Testosterone and SHBG (£60 + extra blood letting fee)

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 info@rowenahealth.co.uk

Question 44

What happens at my consultation?

Accepted Answer

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. We can talk for 45-60 minutes so we will have plenty of time, and tissues if needed. Perimenopause and menopause can be an emotional time. Dr 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 she has already got key information that she will need, which allows her 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 she 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.

She 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, she 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. She may also recommend tests or further investigations that she feels are appropriate and she may need to ask for advice of specialist colleagues before starting treatment like HRT.

She will make a plan for your future care with us, or she can write in your care plan advice for your GP advising them of any further investigations or treatment she advises, and you can continue your care with them. She 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 info@rowenahealth.co.uk

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.

Question 45

What happens if I cannot get the video to work or the video is poor quality?

Accepted Answer

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.

Question 46

What happens if the Doctor needs to cancel an appointment?

Accepted Answer

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.

Question 47

What if I have questions between appointments?

Accepted Answer

We will issue a clinic letter with a comprehensive list of evidence based resources, at your first appointment and would encourage you to visit these first to see if you can answer your question. We are happy if you cannot find the answer that you email us, and we may be able to answer your question or we may ask that you book a 15 minute mini-consultation or a 30 minute follow-up consultation to help you. Please do not assume we will have seen your email if it is sent outside normal working hours.

We do not feel that consulting via email is safe and it also goes against our practice policy. Therefore we are only able to answer straightforward enquiries in this way.

If you have questions we will either advise that you book a short charged telephone call via the booking page called a mini-consultation at a cost of £95 for up to 15 minutes.

If you feel you need a longer discussion please book a follow-up appointment for £150 for up to 30 minutes. We are happy to see you as often as you need and to help and support you as much as we can so please do book appointments that are right length for you, to avoid us having to ask you to rebook so we can manage our schedule.

We will endeavour to answer your questions via email within 7 working days. This may be longer if your clinician is on annual leave so please do contact your GP, 111 or 999 in case of an emergency.

We are not able to answer emails outside normal working hours.

We do not provide emergency care and request that you contact your GP or the emergency services if you feel that you need this.

Question 48

What should I do if I am attending an in-person appointment?

Accepted Answer

Our in-person consultations are held at The Surrey Cardiovascular Clinic in Guildford, please click this link for directions. 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.

Our address is The Surrey Cardiovascular Clinic, 5 Huxley Rd, Guildford GU2 7RE.

If arriving by car, please park in one of the free designated slots, the receptionist will be expecting you, please let them know you have arrived.

There is a comfortable waiting room, with refreshments and facilities. We will be delighted to see you there for your consultation.

We advise that you arrive 15 minutes before your appointment, and if you are late we will may be able to see you for the remaining time of your appointment, but will not be able to offer you a refund for any time missed. We will need to see photo ID at the start of the consultation to verify your identity, your appointment cannot proceed without showing this proof. We will not save your ID.

We will ask you which pronouns you prefer and check you are safe at home, during your consultation. 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.

Question 49

What about emergency care?

Accepted Answer

We do not offer emergency care and ask that you contact your own GP or 111 in case of an emergency.

If you email us, we are very happy to answer logistical questions but due to practice policy we are not able to answer clinical questions and ask that you book an online mini check-in appointment to talk with us.

We do our very best be as available as we can, and to check emails during normal working ours, and respond as soon as we are able to do this. This may take up to 72 hours and could be longer, if we are on leave. Please do speak with your GP if you need to in the meantime.

Question 50

What ongoing care do you provide?

Accepted Answer

We are committed to providing your ongoing care.

After your initial consultation we may have started or changed your treatment and we are able to provide shorter follow-up consultations after 6-12 weeks, and as often as you require after this. At your appointments we will discuss your ongoing care and confirm how you prefer to receive your ongoing prescriptions. We ask that if you remain under our care and require us to provide your HRT prescriptions, that you are seen at least once by us in every 12 month period for a full follow-up review.

If we are both happy that your symptoms are stable on HRT or other treatments we are happy to keep providing you with your private prescriptions, as long as you let us know if there are any changes in your health, family history or medication.

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. Should you have a simple non-urgent query in between appointments then please submit this via email. We aim to respond within 72 hours. We realise that things may change and you may need advice sooner than your scheduled follow-up appointment. We are sorry that we unable to give any clinical advice over email. We would be delighted to speak with you to help you, whenever you need support.

Please see our booking page to book an appointment.

Question 51

Will you inform my GP?

Accepted Answer

On our first patient consultation questionnaire we ask that you consent for us to share your letter with your GP. I am a GP on he NHS, as well as running Rowena Health, and I understand the importance of a GP in managing the health of their patients, and how vital it is to be informed of any change in their medication and care.

For this reason we will not be able to prescribe medication for you at Rowena Health unless you consent with this information being shared with your GP.

Question 52

Can you issue a prescription without doing a review?

Accepted Answer

To issue a repeat prescription, and so that we can prescribe safely, it is very important that we carry out your regular reviews at 3 months and then annually. If your symptoms are stable and there is no change in your health, then we can issue repeat prescriptions, as long as you have had these reviews.

Question 53

How is my private prescription delivered?

Accepted Answer

Your private prescription is sent 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, but there is an administration prescription fee chargeable for all other prescription requests, of £35.

We work with two pharmacy providers, so it is possible to have your medication sent directly to your home, or, the prescription can be sent directly to you, and you can collect your medication from your own local pharmacy, to avoid inconvenience of having to be in, to sign for your medication when it is delivered.

The pharmacy will be in contact with you to arrange payment and delivery of your medication. Please allow at least a week for delivery. We issue prescriptions on the day of your consultation.

Question 54

How long does it take to get a private prescription?

Accepted Answer

We action repeat prescription requests within 72 hours, so please do make requests in advance of running out of medication, taking into account holiday periods.



A prescription will be generated and sent to our pharmacy service. 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. If you struggle to get your medication and have been sent a prescription then please do call pharmacies further afield, as this is often a good way to find stocks of what you need. 



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.

Question 55

How long will my prescription last?

Accepted Answer

We issue each prescription for a maximum of 3 months. We do not charge a prescription administration fee for any prescriptions issued during a consultation with you. We charge a £35 administration fee for prescriptions generated outside your consultation. If you need a repeat prescription please visit the repeat prescription page.

Question 56

Who provides me with my prescription?

Accepted Answer

This is your choice, and we are very happy to work with you to meet your needs.

You can choose to get your prescription issued on the NHS by your GP, and use your HRT Prepay certificate, or we happy to issue you with a private prescription for your medication, if this is easier for you. If we prescribe privately this is not covered by your HRT prepay certificate.

Private prescriptions issued by us can be delivered to your home or we can send the prescription to you via our prescribing service, so that you can collect it from a local pharmacy, if that is more convenient.

We only charge an administration cost for issuing a prescription outside a consultation. We are sorry that we are not able to issue NHS prescriptions, so there is a cost to you for the medications we prescribe of about

Question 57

Can I have my blood tests done by my own GP?

Accepted Answer

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.

Question 58

Can you arrange blood tests?

Accepted Answer

Yes, if we feel it is necessary, we can arrange private blood tests locally in at our Guildford clinic, or at locations over the UK using Nationwide Pathology. We have a range of hormonal blood profiles depending on your individual needs.

If you are over 45 years of age, have irregular periods and other symptoms of the menopause, you do not normally need any blood tests to diagnose the menopause. Talking through what symptoms you are experiencing is the basis for a diagnosis of the perimenopause or menopause. Tracking your symptoms is really helpful, using a symptom chart or app as symptoms come and go as hormones fluctuate wildly in perimenopause.

If you are younger than 45 years of age, we may want you to have some tests before making a diagnosis. The most common test is a blood test measuring a level of a hormone called follicle stimulating hormone (FSH). If this is high, then it is very likely that you are menopausal. The blood test is often repeated 4 to ­6 weeks later, to confirm. If you are under 40 years, then you may be advised to have further investigations to rule out other conditions that can affect your hormones, or cause your periods to stop, like genetic or autoimmune problems. Periods can stop due to other causes like stress, extreme exercise, weight changes or if you have polycystic ovarian syndrome (PCOS) so it is important to do tests in younger women.

Blood tests can be helpful to guide us if your symptoms are not improving on your HRT, despite dose changes and to monitor your absorption of the hormones.

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 test according to NICE guidelines.

We can arrange for blood tests for you, at a cost, at our Guildford clinic, or using our national blood service, or you can ask your GP to take them for you, and give the results to us.

Blood test profiles can include a range of tests including: oestradiol, testosterone, SHBG, FBC, U+E, LFT, Hba1c, Vitamin B12, folate, Vitamin D, Coeliac screening, TFT, FSH and LH. We can arrange bespoke tests, if necessary.

The national blood letting service provides the following blood panels. The cost of processing these blood panels is stated but there as an extra cost, charged to you by the blood letting service for taking the blood test, called the blood letting fee, which is payable to them and varies between £35 and £70.

Blood profile costs from national blood letting clinic

Profile 1 - Estradiol (£40 + extra blood letting fee)

Profile 2 - Total Testosterone, Sex Hormone Binding Globulin (SHBG) and Estradiol (£70 + extra blood letting fee)

Profile 3 - Follicle Stimulating Hormone (FSH), Luteinising Hormone (LH), Estradiol, Total Testosterone, Thyroid function Tests, SHBG, Prolactin (£95 + extra blood letting fee)

Profile 4 - Lipids, HbA1c (diabetes) (£55 + extra blood letting fee)

Profile 5 - Estradiol, LH, FSH, Total Testosterone, SHBG, Lipids (blood cholesterol), Liver function tests (LFT), Kidney function, Hba1c (Diabetes), Ferritin (iron), Thyroid function test, Full Blood Count, Vitamin D, Vitamin B12 and Folate (£150 + extra blood letting fee)

Profile 6 - Coeliac Screen (£80 + extra blood letting fee)

Profile 7 - Oestradiol, LH, FSH, Total Testosterone, SHBG, Lipids, LFT, U+E, Hba1c, Thyroid Function Test, Full Blood Count, Vitamin D, Vitamin B12, Folate, Coeliac screen, Magnesium, Zinc, Creatinine Kinase, Ferritin, Uric acid, Bone screen (£205 + extra blood letting fee)

Profile 8 - FSH, LH (£66 + extra blood letting fee)

Profile 9 - Total Testosterone and SHBG (£60 + extra blood letting fee)

Question 59

When should I use by oestrogel or tesosterone gels if i am having a blood test?

Accepted Answer

The blood test is best done before you apply the gel that day, as a test done after applying the gel can falsely elevate your hormone levels.



If you are using an estradiol patch, you can be apply this as normal.

Question 60

Do you offer a refund if I need to cancel or reschedule my appointment?

Accepted Answer

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.

Question 61

Is the cost of your service covered by the NHS?

Accepted Answer

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.

Question 62

When and how do you take payment?

Accepted Answer

We take payment online at the point of booking using all major credit and debit cards.

Question 63

How can I get my blood pressure reading?

Accepted Answer

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.

FAQs

Frequently Asked Questions

Top 10 Most Frequently Asked Questions

Menopause

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What are the risk factors for osteoporosis?

A FRAX score?

Premature Ovarian Insufficiency or Early Surgical Menopause?

HRT

Lifestyle

How to keep your bones healthy using lifestyle?

What are the risk factors for osteoporosis?

A FRAX score?

Premature Ovarian Insufficiency or Early Surgical Menopause?

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