Menopause treatments

North Devon menopause clinic

North Devon’s only menopause clinic

Dr Alka BhikhaIf you are aged between 40-55 years old and have not had a period for over 12 months you may be experiencing the menopause.

Some women have no symptoms throughout the menopause and others experience debilitating symptoms. At the Menopause clinic, you will have the opportunity to discuss any symptoms or concerns you may have regarding the Menopause.

Dr Alka Bhikha is a registered GP with a special interest in Women’s health who can help you understand the changes that are occurring to your body, and discuss with you the support and treatment options that are available to your individual case. Together you can make a plan regarding which options may suit you best.

What are the symptoms of the menopause?

  • Hot flushes
  • Memory problems
  • Difficulty concentrating
  • Change in mood: irritability, being tense, snappy or nervous
  • Vaginal dryness
  • Low sex drive
  • Lack of sleep
  • Headaches
  • Heart beating quickly or strongly
  • Muscle and joint pains
  • Feeling dizzy or faint

Menopause treatments


During the menopause, the ovaries cease to produce oestrogen. The oestrogen levels can fluctuate greatly in the months or even years prior to the menopause. This can lead to symptoms of the menopause.

HRT (Hormone Replacement Therapy) is the administration of hormones to replace those that the ovaries cease to produce following the onset of the menopause.  HRT assists in restoring the hormonal balance, treats symptoms and prevents disorders (e.g. osteoporosis) associated with the menopause.

Synonymous terms include menopausal hormone therapy (MHT) and oestrogen replacement therapy (ERT). While oestrogen and progesterone are the best known of the ovarian hormones, it is often not appreciated that the ovaries also produce the hormone testosterone, considered by many to be a “male” hormone, but in fact crucial and critical to normal bodily functions and good health in women too, albeit at a much lower level compared to the levels in men. Hormone replacement therapy therefore refers to the administration of any of these hormones, often in combination (see below).

Types of HRT

Oestrogen only (no progesterone) – when women have had a hysterectomy, they do not need progesterone to protect the lining of the womb. Oestrogen is then prescribed alone, or in combination with progesterone.

Combined HRT (oestrogen and progesterone) – this is necessary for women who have a womb (uterus). This can be given in two ways:

1. Continuous combined HRT – oestrogen and progesterone, taken together daily – this means that there will be no withdrawal bleeds/periods.

2. Sequential HRT – oestrogen only is given for the first 14 days, after which progesterone is added for the remaining 14 days of a 28 day treatment cycle. This results in monthly withdrawal bleeds, mimicking the natural menstrual cycle, but of course the periods are induced by the hormones.

north devon menopause clinic

Some clarification: Women who have had their womb removed (hysterectomy) can safely be given oestrogen alone (with or without testosterone – see below). However, in the presence of the womb, oestrogen given as HRT will stimulate the lining of the womb (the endometrium) to thicken. In the absence of progesterone, this thickening continues, and over the course of time this may lead initially to irregular bleeding due to haphazard shedding of the endometrium, but more importantly cancer may develop in the endometrium (endometrial or womb cancer).

In sequential HRT, the addition of progesterone results in the regular shedding of the endometrium, thereby preventing the development of endometrial cancer, and also irregular bleeding as the shedding of the endometrium is regulated. In the continuous combined formulation, the constant presence pf the progesterone prevents the thickening of the endometrium, and therefore again protects against the development of endometrial cancer.

Sequential HRT is often prescribed to women who are having menopausal symptoms but are still having periods or for those whose periods stopped less than a year ago. Continuous HRT (without bleeds) is more suitable for women who have not had menses for more than one year.  

The “hormone coil” or “hormone intrauterine device” (also known as the Mirena or the levonorgestrel intrauterine system) may also be used to protect the endometrium by preventing its thickening – in menopausal women there may be little to no bleeding associated with its use, and oestrogen can be given without additional progesterone. The coil lasts for 4 years, and an added advantage of this approach is that oestrogen given alone does not increase the risk of breast cancer.

Formulations of HRT – how HRT is given

HRT may be prescribed in the following formulations:

  • Tablets taken by mouth
  • Patches applied to the skin
  • Gels applied to the skin
  • Hormone-releasing rings inserted inside the vagina
  • Hormone-releasing coils inserted into the womb
  • Hormone creams or tablets applied into the vagina

Menopause examinationThe choice of formulation that will suit an individual can vary from woman to woman, and your preferred options will be discussed during your appointment. There are often good reasons why a particular formulation might be advised over another, and sometimes a formulation is prescribed, only to be changed later if it does not suit.

Transdermal patches are more frequently prescribed as first line, compared to the oral tablets, because the patches associated with fewer risks. This patch is also advantageous for women with diabetes, hypertension and other cardiovascular risk factors especially with advancing age.

Local preparations such vaginal oestrogen creams or pessaries do not carry the same risks associated with oral or transdermal HRT. In addition, as the dose of oestrogen is so low, they do not require the protective effect of progesterone.

They are highly effective for symptoms of vaginal dryness, painful sex and urinary frequency. Their use is safe and not linked to some of the major risks associated with systemic HRT. However, around 10-25% of women still have symptoms with local oestrogen so will require systemic HRT in addition.

Alternatives to HRT

If you are unable to have conventional HRT, other medications or treatments may be prescribed to help control your menopausal symptoms. For vaginal dryness and painful sex – vaginal lubricants and moisturisers are often effective. For hot flushes and night sweats – other oral medications such as antidepressants could be considered.

Booking an appointment

  • We will ensure you speak to our dedicated receptionist who will help you fill out the menopause questionnaire.
  • We will help you to choose the right package for your care.
  • You will be fully informed of consultation costs.
  • If you are unable to get to the clinic we can offer you an online consultation with Dr Bhikha.
  • Dr Bhikha provides a sensitive and highly confidential service


Menopause treatments

Age under 45
60 mins£275
Age over 45
45 mins£220
Consultation with internal examination for over 45s60 mins£275
Virtual consultation45 mins£200
Blood tests / investigations
Female hormone profile£410