Menopause and perimenopause
The perimenopause can begin a decade before periods stop, and its symptoms — disturbed sleep, altered mood, difficulty with concentration, hot flushes — are easily attributed to other causes. Diagnosis in this period is made on history, symptoms and pattern, because hormone levels fluctuate too widely for a single blood test to be conclusive. The department takes that history without time constraint, recognises the transition even where earlier results were within range, and plans treatment with you from the first consultation.
· Symptoms. Vasomotor symptoms, sleep disturbance, mood and cognitive change, assessed as a pattern rather than as separate complaints.
· Early and induced menopause. Premature ovarian insufficiency, and menopause following surgery or cancer treatment, which carry their own long-term risks and their own approach to treatment.
Hormone replacement therapy
Hormone replacement, begun at the right time and titrated to the individual, relieves symptoms and protects bone, and the evidence on its cardiovascular effect is now clear enough to be discussed plainly: benefit depends on when treatment is started. The department assesses suitability in every case, including where treatment was previously thought unsuitable, prescribes the form and dose that fit you, and monitors treatment for as long as it continues, adjusting it against your results rather than at a scheduled review.
· Assessment. Suitability assessed against your history, your risk and your priorities, with the timing of cardiovascular benefit discussed before treatment begins.
· Regimens. Regulated body-identical oestrogen and progesterone, chemically identical to your own hormones, in transdermal and oral forms, and testosterone where indicated, chosen for the individual.
· Monitoring. Titration, review and long-term monitoring at each attendance, through the same record that holds the rest of your care.
Genitourinary syndrome of menopause
Vaginal dryness, discomfort, recurrent urinary infection and changes to the pelvic floor affect most women after the menopause, are progressive without treatment, and respond well to it. They are also among the symptoms least often raised. The department asks, examines, and treats, with the same consultant over time, so that a condition that is highly treatable does not go untreated.
· Assessment. Examination and assessment by a consultant who treats these conditions routinely.
· Treatment. Topical vaginal oestrogen, vaginal dehydroepiandrosterone and ospemifene, chosen for you. Fractional CO₂ laser treatment on the Alma FemiLift, which stimulates collagen in the vaginal wall and is offered for laxity, mild stress incontinence and dryness where topical treatment is insufficient.
Bone health
Bone loss accelerates at the menopause and is entirely silent until fracture. Identified in the decade after the transition, its course can be changed; identified after a fracture, it cannot. The department measures bone density on the reference platform, assesses fracture risk, and treats bone loss with the combination of hormone therapy, bone agents and prescribed loading that the measurement warrants, repeating the measurement at the interval at which it could have changed.
· Measurement. Bone mineral density at spine and hip by dual-energy X-ray absorptiometry on the GE Lunar iDXA, with fracture risk assessed against your history.
· Treatment. Management of osteopenia and osteoporosis with hormone replacement therapy and bone agents, as the measurement warrants.
Reproductive endocrinology
Hormonal disorders across the reproductive years present through cycles, skin, hair, weight and mood, and are frequently investigated one symptom at a time. The department investigates them together, with hormones measured and pelvic ultrasound used, and interpreted by a consultant who sees the whole picture, and treats the cause rather than each symptom separately.
· Conditions. Polycystic ovary syndrome, premenstrual disorders, irregular menstruation, hirsutism and hormonal hair loss, and hyperprolactinaemia.
Fertility assessment
The department assesses fertility, investigates difficulty in conceiving, and counsels you on what the results mean and what follows from them. Treatment itself is referred to a named fertility specialist, with your assessment complete and your consultant remaining involved.
Egg freezing
Fertility preservation for women who wish to keep the option of a later pregnancy open. Following assessment of ovarian reserve, a course of ovarian stimulation is prescribed and monitored by ultrasound, eggs are collected under sedation in the Institute’s theatre, and they are frozen by vitrification and stored under licence. The Institute does not provide IVF; when you wish to use your eggs, they are transferred, with the paperwork handled by us, to the licensed clinic of your choice, in this country or abroad.
Preconception medicine
Fitness for pregnancy is best established before conception, when medication can be changed, deficiencies corrected and immunity confirmed without pressure of time. The department assesses each woman in the context of her existing conditions and prepares her for pregnancy as a planned event rather than a discovered one.
