Your patient journey at Rowena Health Menopause specialist clinic

Rowena Health is here to help and support you at all stages through perimenopause, menopause and for life after menopause.

It could be the start of your perimenopause, you have very few symptoms but want to talk through all the options so you are prepared, or your hormones are changing and the symptoms you are experiencing are affecting the quality of your life at home and at work, or you may have gone through the menopause and are still having ongoing symptoms?

At Rowena Health you will have time to talk, to learn, to ask questions and to understand what is happening to your body, we will listen and there is no question that you cannot ask.

What can you expect from your patient journey at Rowena Health?

Step one

Please book a new patient appointment on the website, you can choose between an on-line appointment, from the comfort of your home, via video link, or an in-person appointment at my Guildford Clinic. Payment for the appointment is taken at the time of booking.

Step two

We will send you a booking confirmation, with a detailed questionnaire to complete before your consultation. This is time for you to reflect upon and summarise your symptoms, your lifestyle, your medical history, your family history and any medication you are taking. Please allow 20-30 minutes to sit and complete this, it is important and helps us understand how you are and for us to give much more useful information at your consultation. The more information we have, the more we can make the most of the time we have together.

The booking questionnaire will ask you for consent to hold your data on our secure system and to share your clinic letter with your GP so that we can care for you. Your data is held securely on our patient data base.

If you have any extra needs like need for an interpreter for your consultation, please email us on [email protected] and we will be in touch to help you.

If you have chosen an in person appointment, the details of where to go will be on your booking email and directions to the clinic rooms at The Surrey Cardiovascular Clinic, just off the A3, outside Guildford. There is easy parking straight outside, and a comfortable waiting room where you can enjoy a cup of tea or coffee. Please aim to arrive about 10-15 minutes early, and if there is a problem on your journey, please email: [email protected] to let us know you will be late. Please bring photo ID with you.

If you have chosen an appointment via video link, please make sure you have a private, quiet, place to talk and good WIFI. If there is a problem with the video link, I will call you on your phone number, so don’t worry. Click the link on the day and we will be able to see each other on the screen at the time of your appointment. Please have some photo ID ready.

For each new patient appointment please allow 45-50 minutes, and of course you are welcome to bring a list of any questions that you would like to ask. There can be a lot to discuss, you do not need to make notes, unless you wish to, as the patient report will contain a summary of our consultation. If you would like to bring someone to the appointment with you, you are welcome to do so.

Please see our FAQ’s on the website, for information on cancelling or rescheduling your appointment, if this is necessary. The FAQ’s contain lots of useful information to help support you.

Your consultation

Dr Sonnenberg is the only doctor at Rowena Health, all appointments are with her, both virtually and in person.

Your consultation is time for you. Dr Sonnenberg will have looked through your questionnaire in detail, and will want to listen, to you telling me how you feel, how things have been, what symptoms are the worst, how you really are, and it’s absolutely fine to need a tissue or two.

I will then need to ask questions and depending upon what you already know, will explain the reason for the symptoms you are experiencing and all the options for support and treatment and we can decide together what is best for you.

If you would like to find out about HRT, I have lots of different placebo products to show you: oestrogen, progesterone, testosterone, local vaginal oestrogen and moisturisers and lubricants. We can talk through the benefits, risks and side effects of HRT. We can talk about the lifestyle changes that might be helpful to support you now, and in the future. We can also discuss the complementary and alternative options to support you.

As we reach the end of the consultation I will ask if you have any questions. I will clearly explain what I recommend for you, and help you decide. My advice is guided by the British Menopause Society and NICE guidelines. There is no rush to decide on treatment, in fact I prefer that you take the time to think, and reflect upon the consultation before deciding, unless you are certain and have done some reading in advance.

If Hormone Replacement Therapy is recommended, I can privately prescribe regulated body identical HRT, or a regulated alternative which is best for you, or I can write to your GP to recommend they prescribe this for you. This type of HRT is backed by research and evidence and it can also be prescribed on the NHS, by your GP. If your GP prescribes your HRT you can apply for a pre-pay certificate for your NHS GP HRT prescription, which costs less than £20 a year. Sadly private HRT prescriptions are not covered by this certificate, and you would need to pay for the cost of each drug prescribed.

If you prefer to have a private HRT prescription from Rowena Health, a private prescription for your HRT can be done on that day of your appointment. This is sent electronically to an online pharmacy called CloudRx, which deliver medication to your home, (you may need to be in to sign for this), or to Signature Rx which can send you the prescription token for your HRT, to take to your own local pharmacy. CloudRx will contact you by text or email usually the same day to take payment for the medication. The cost of a private HRT varies, and is usually between £10 and £40 per product per month, with testosterone being more expensive depending what type is prescribed.

I will advise you of what happens next and when we should see each other again before I close the consultation.

There can be a lot to take in during our time together, so don’t worry, I will write a detailed letter, to summarise our discussion and this will be shared with you a few days after your consultation. It will come from [email protected]

After your consultation

I will send you a detailed report within 7 days, and will share this with your GP for your medical records. It is very important that your GP is informed of any treatment changes we make. Unless there are exceptional circumstances I do not prescribe any medication without informing your GP. If you notice any error in the letter please let me know and this can be easily corrected.

If you start taking HRT I will send you details on that day explaining clearly how to take your HRT. Please look at my Hormone Replacement Therapy article to remind you of any details.

We may have talked with you about having support from other specialists and will write to you to give personal details of who we recommend. We work with specialists in: Nutrition, Naturopathic nutrition, Cognitive Behavioural Therapy (CBT), Hypnotherapy, Pelvic physiotherapy, Psychosexual therapy, Personal trainers in fitness, Yoga, Pilates, Acupuncture, Reflexology, Herbal medicine, Homeopathy and support and rehabilitation after cancer.

Blood tests

Most women do not need to have blood tests. If you are aged 45 or above, no blood tests are not needed to diagnose the menopause, we do this on symptoms alone. If you are aged 40-45, blood tests are sometimes useful to exclude other causes of the symptoms and if you are aged 40 or under, we recommend blood tests are done to make a diagnosis of Premature Ovarian Insufficiency.

If we are concerned that your symptoms have another cause we will advise you to have a blood test to exclude anaemia, an under active thyroid gland, Vitamin D deficiency or Vitamin B12 deficiency, for example. The symptoms of these conditions can be similar to those of the perimenopause and menopause, they are treatable and are more common in midlife.

If blood tests are needed we will advise you how to arrange the appropriate blood venous (not finger prick) profiles using Medichecks or Nationwide Pathology. The test results will be sent to you and you can forward them to Rowena Health to be uploaded to your secure records and share them with your GP. If you need a discussion about the blood test results, then please book a mini check in appointment. If you are using HRT please do not use oestrogen or testosterone gel on the day of the blood test until after the blood has been taken.

Medichecks blood test

Please add the cost of the venous draw at clinic or the venous draw at home with a nurse. We will advise you of the tests we need you to arrange.

• Medichecks: Oestradiol only (this can be useful to see if you need an adjustment to your HRT)
• Medichecks: Female hormone blood test: FSH, LH, Oestradiol, Testosterone, SHBG, FAI, Prolactin, TSH, Free Thyroxine
• Medichecks: Advanced Well Woman blood test: this is more comprehensive (but does not include testosterone) – Cholesterol status, Hba1c (Diabetes), Uric acid (gout), FSH, LH, oestradiol (hormones), CRP (inflammation), Iron status, Kidney health, Liver health, Magnesium (minerals), FBC ( red and white cells), TSH, T3, free thyroxine (thyroid hormones), Vitamin D, Vitamin B12 and folate.
• Medichecks: Testosterone only (this is useful if you are taking testosterone as part of HRT, and want to monitor your testosterone level at 6-12 weeks on treatment and annually thereafter).

Follow-up appointments – 30 minutes – £150-£180

It is recommended that you have a follow up after 3 months after starting HRT, or changing the dose or regime. It can take 3 months to see the full beneficial effect of your HRT. This appointment is booked as before, online via the website booking page. The 30 minute follow-up appointment costs £150-180 and can be arranged in person, at the Surrey Cardiovascular Clinic, or by video-link. Video link appointments give more flexibility with appointment times and some are offered in the evening. This is a chance to assess how you have responded to your HRT, review your symptoms and to check for any HRT side effects. We may need to adjust the dose or type of your HRT, if necessary.

If everything is stable, an annual review is all that is needed if you remain on HRT. You may have had an opportunity to discuss your care with your GP and if your GP is happy to continue with prescribing your HRT, you can use your prepay certificate, and we can discharge your care back to your GP, who can continue to review your menopause and HRT annually.

If you prefer to be followed up by us at Rowena Health, or your GP is not able to prescribe your HRT, we are very happy to continue to prescribe your medication on an ongoing basis and see you for annual review, or at any time you need to make a follow-up appointment. In order to continue prescribing please can you ensure you have been seen once within a 12 month period, or we ask that you book a longer new patient appointment again, to give time to review your care in detail.

Mini check-in appointments – 15 minutes – £95

If you have any questions between appointments please can you book an on-line mini check-in appointment, these are shorter than a follow-up appointment and do not come accompanied by a detailed clinic letter.

We reserve emails purely for logistical issues and we are not able to provide personal or clinical information via email, due to our practice policy and patient safety.

Prescriptions and repeat prescription requests

Prescriptions issued at the time of the consultation are included in the cost of the consultation and will be sent to you via CloudRx (to your home address where you need to be in to sign for this) or via SignatureRx (a token is sent to you to take to your local pharmacy). You will need to pay for the cost of the drugs themselves which vary between £10 and £40 per month for HRT. Please be aware your GP can prescribe regulated HRT, but may not be able to prescribe Testosterone. Please enquire about a prepay HRT certificate to cover the cost of your HRT if your GP prescribes it. This certificate does not cover the cost of privately prescribed HRT from Rowena Health.

Please request all repeat medication required outside your consultations via the repeat prescription button on the website. There is a short safety questionnaire and a small administration fee of £35 to pay. We will, within 72 hours, issue your prescription to be delivered to your home (you may need to be in to sign for this) or for a token to be sent to you to take to a local pharmacy.

Contacting Rowena Health by email or telephone

If you have a simple query then an email is the best way to contact us. We do not charge for email correspondence but we are not able to discuss clinical issues by email, they are suitable for logistical or simple questions only. For anything more detailed we ask that you make a mini-online appointment. We do our best to reply to emails as soon as possible, but in the event of annual leave this can take over a week but we will ensure to get back to you as soon as we are able.

We do have a telephone messenger service but they are unable to provide advice, they can pass on a message to us. Please allow, as with emails, up to 72 hours for us to reply.

We do not provide emergency care so please contact your GP, 111 or 999 in case of an emergency.

Feedback

We will send you a form to complete after your consultation which helps us make sure that we are adhering the CQC standards of excellence. We would also be delighted if you might spend a moment giving us feedback on Google, and we will send you the link for this. Thank you so much.

Complaints

If you have any problems at all with your consultation, want to discuss something you are not happy with, or to find out how to make a complaint please email: [email protected] and we will contact you. Our terms and conditions and complaints policy are on our website. We will do our very best to talk through your concerns with you, but in some cases you may prefer to speak to another person and we can advise you how this is possible. We adhere to all CQC standards at Rowena Health.

Discharging care to your GP from Rowena Health

We will arrange for a reminder email to be sent to you to make a follow-up appointment, at the time we agreed at your consultation. Of course, we are aware that some people may only come to see us once, so we will not bother you with emails and if you do not book follow-up appointments with us at Rowena Health. If you have not been seen by us for more than 12 months, we will automatically discharge you from our care to the care of your GP. Please arrange your recommended follow-up with them ongoing.

You are welcome to see us at any time you like, we’d be delighted to see you. If it has been more than one year since your appointment, please book a new patient appointment.

Further information

These websites are full of information and should help to answer any further questions you have:

The Women’s Health Concern Fact Sheets and HRT risks and benefits

The Women’s Health Concern Wellness Hub

The British Menopause Society Videos

Menopause Matters

Rock My Menopause (the PCWHF)

Last updated May 2024 Dr Carys Sonnenberg

To book an appointment please visit the booking page of Rowena Health