Your patient journey at Rowena Health Menopause specialist clinic

I have set up Rowena Health to help and support you at all stages through perimenopause, menopause and for life after menopause. It can be a hard decision to decide to book a private menopause appointment, this could be the start of your perimenopause, or you may have gone through the menopause and are still having symptoms? You may have tried treatments already, seen countless doctors, or this could be the first time you have talked to anyone? 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 for us and for you, to reflect upon your lifestyle and to summarise your symptoms, your medical history, your family history and any medication you are taking. Take 20-30 minutes to sit and complete this, it helps us understand where we are at the start of your journey with us. The more information we have, the more we can make the most of the time we have together. It 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. 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 15 minutes early, and if there is a problem on your journey, please email: [email protected] to let us know you will be late.

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.

For each new patient appointment please allow 45-50 minutes and have your photo ID ready and list of any questions that you would like to ask.

Your consultation

This is the time for you. I know you may have filled out forms and may have had tests and could be anywhere in perimenopause or menopause, but this is the time to breathe and ask any thing you like. I will have looked through your questionnaire in detail and then 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 role of oestrogen, the reason for the symptoms you are experiencing and we can decide together how best to manage them. If you would like to find out about HRT, I have lots of different placebo products to show you: estrogen, progesterone, testosterone, local vaginal oestrogen and moisturisers and lubricants.

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, I will usually prescribe regulated body identical HRT, or a regulated alternative which is best for you. This is backed by research and evidence and it can be prescribed on the NHS, by your GP.

Don’t forget you can apply for a pre-pay certificate for your NHS GP prescribed HRT costing less than £20 a year. Sadly private HRT prescriptions are not covered by this certificate, so you may prefer to ask your GP to prescribe your HRT. If you prefer me to prescribe and agree with my recommended menopause care plan, I can do a private prescription for your HRT that day, and this is sent electronically to an online pharmacy called CloudRx, which deliver medication to your home, or Signature Rx which can send you the prescription 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 record. It is very important that your GP is informed of any treatment changes we make.

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

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.

Blood test profiles range from £70 to £250 plus the phlebotomy fee and are not included in the consultation fee. A further appointment may be required to discuss the results.

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, or you would like to have a health check, these can be done at Surrey Cardiovascular Clinic, arranged through them. Alternatively, I will request these through Nationwide Pathology. I will send you an invoice and once this is settled I will send you details and you will be asked to call Nationwide Pathology to book a convenient appointment at a location near you in the UK. The cost of the blood test is in addition to the consultation fee. You will be told the cost of the blood test before this is booked.  A fee is also payable to the phlebotomist who takes the blood, you will be advised by Nationwide Pathology what this cost will be at the time of booking. Payment for the blood test is taken at the time of booking your blood test.

The results of blood tests are usually received and processed within 7-10 days. I will share these results with you when I receive them along with an explanation of what they mean. It may be necessary for you to make an on-line mini check-in appointment to discuss the result of the blood test, if we are considering changing treatment and discussing options.

Follow-up

It is recommended that you have a follow up after 3 months, to ensure patient safety, this is part of national guidelines. 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 Follow Up can be in person at Surrey Cardiovascular Clinic, or by video-link using the same video link. 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.

We can discuss sexual wellbeing and the role of testosterone in normal female sexual function at this appointment, once you are taking HRT. Please note that if you are, or are considering becoming a competitive athlete we will not be able to prescribe you Testosterone therapy.

If we have not made a change to your HRT, you will usually be asked to make a follow up appointment in 6 months. At this point, if everything is stable, an annual review is all that is needed. 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.

If you request a prescription between appointments this carries an administration fee of £35.

If a change to the HRT regime has been made at your follow up appointments, please can you book a follow-up appointment after 3 months.

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. We do have a telephone messenger service but they are unable to provide advice, they can take a message and we may call or email you to advise you of the best action and what appointment would be best for you to book to help with your query.

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

If you are discharged to the care of your GP, you are welcome to see us at any time you like, we’d be delighted to see you.

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 June 2023 Dr Carys Sonnenberg

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