WELCOME TO THE WELLS MENOPAUSE CLINIC WEBSITE
Combe Grove metabolic health programme clients
Please email the clinic if you would like to book a one to one online session with Dr Juliet Balfour. These sessions are starting in April 2025.
Existing private patients
Please email the clinic if you are one of my current private patients and need to arrange a follow up appointment or a private prescription.
New private patients
At the moment I am concentrating on my NHS menopause work so am not taking on new patients (apart from Combe Grove clients, see above). You can find details of other British Menopause Society accredited menopause specialists on the British Menopause Society website in the ‘Find a Specialist’ section. This lists both the private and NHS clinics available. Lots of private clinics offer online consultations.
Many healthcare professionals have done extra menopause training in the last few years so it is worth approaching your GP surgery to see if they have a GP or nurse with a special interest or extra training in menopausal health. You can use this website and the suggested resources to educate yourself on your options. This will enable your overstretched GP or nurse to help you work what is the best course of treatment and/or lifestyle change for you. It is really helpful if you can provide an up to date blood pressure reading (some pharmacists offer this service) and your current height and weight.
Please note that this clinic does not offer an emergency service. Emails will usually be answered within 10 working days.
News
I closed my waiting list to NEW patients in March 2022 to concentrate on setting up a new NHS menopause service for Somerset. If you live in Somerset, you can check if you meet the criteria for the Somerset NHS Menopause Service via the Glastonbury Surgery website.
You can find alternative clinic options via the ‘Find a Specialist Service’ on the British Menopause Society website.
CURRENT patients can continue to email me as usual and I can either advise you or find a review appointment if needed. Please give at least 2 to 3 weeks notice if you are needing a new prescription, especially in view of the current HRT shortages.
Unfortunately there are lots of shortages of HRT at present.There is an HRT conversion chart on page 3 of the HRT factsheet on the Women’s Health Concern website – see link below. You can show this to your GP or pharmacist to help them work out equivalent doses if you have to change your HRT.
Click here for a factsheet on HRT: Types, doses and regimens
Updated BMS guidelines (May 2022) suggest blood tests are done before initiating testosterone. You can ask if your GP surgery is able to do these, if not you can contact the clinic about private options. The tests required are testosterone and sex hormone binding globulin levels.
If on oral oestrogen, please ask your GP to change you to transdermal oestrogen before these blood tests are done.
Please see page 42 of this new guideline for tables on estrogen doses and the corresponding recommended dose of micronised progesterone (MP) for adequate endometrial protection. Brand names include Utrogestan and Gepretix.
Summary of the guidance
If you are on the maximum licensed dose of estrogen i.e. the 100mcg estradiol patch or equivalent, you are advised to increase your micronised progesterone dose as follows:
– if on the sequential regime, you need to increase from 200mg to 300mg of MP for 12 to 14 days each month
– if on the continuous regime, you need to increase from 100mg to 200mg of MP daily at bedtime
Some women on lower doses of estrogen but with risk factors for endometrial cancer may also advised to increase their MP dose or change to a Mirena, after discussion with their doctor.
Those with the Mirena (or another 52mg levonorgestrel IUD) are covered for the 100mcg estradiol or equivalent dose. The combined patches contain the right amount of progestogen for the dose of estrogen so no changes needed.
Please email the clinic for a follow up appointment if you wish to discuss this. Alternatively you can discuss this with your GP at your next HRT review.
The guideline is published on the British Menopause Society website and the link is below. It is mainly about the management of unscheduled bleeding on HRT but also addresses suitable options and doses for endometrial protection to try to reduce the amount of unscheduled bleeding in the future. If you have been on HRT for at least 6 months but are still getting unscheduled bleeding or if this is a new symptom, please contact your GP to discuss this as soon as possible.
Clinic space will be reserved for Combe Grove metabolic health programme clients.
Welcome
The average age of the menopause (the last natural period) for women in the UK is 51 but any age from 45 – 55 is considered normal. Hormonal changes can often start in your 40s or even earlier, long before periods stop. This leads to many different physical, psychological and cognitive symptoms that can affect women to varying degrees. You (and your doctors) may worry that you are developing conditions such as dementia, a brain tumour, depression, heart disease, lymphoma, bladder disease, arthritis or fibromyalgia. You may be referred to lots of different specialists for investigations when in fact you may benefit most from a trial of HRT, also know now as MHT (menopause hormone therapy).
This symptom checker (click to download or open) may be useful to print off and fill in if you are having a GP consultation. If attending my clinic, we will go through these symptoms during the consultation.
Why go private?
Ideally all menopause care would be available on the NHS but sadly this is not the case for many women at present. GPs are under immense pressure with rising workloads and reduced staffing levels. Some GPs are not aware of the current evidence on the safety and benefits of HRT. Others are up to date on menopause management but trying to advise women during a short appointment can be challenging. A private consultation can give you plenty of time to discuss your symptoms and look at all your options for improving both how you are feeling now and improving your future health.
- My aim is to spend time working out the right HRT options for you and to then get you back to your GP for ongoing NHS prescriptions and follow up if possible. Everything I prescribe is available on the NHS apart from testosterone which is currently not an option in some areas.
- I can also look at your lifestyle and how this can be improved. However it can be so much easier to make lifestyle changes once HRT has improved any debilitating symptoms.
- Some women may request HRT from their GP but are told it is not safe for them to start or to continue it long-term due to underlying health conditions or their family history. In many cases certain types of HRT can be prescribed safely. Other women may have been told to stop HRT after 5 years or once they have reached 60 but would now like to restart it. If indicated I can write to your GP to advise them about the current evidence on the safety of HRT in your particular case. For most women under the age of 60, the benefits outweigh any risks and long-term HRT can significantly reduce the risks of cardiovascular disease and osteoporosis.
- It is very important for women whose last period is under the age of 45 to consider HRT unless there is a medical contraindication. This is because without HRT at least up until the average age of the menopause, they are at increased risk of cardiovascular disease, osteoporosis and cognitive issues.
- For those women in whom HRT is contraindicated, there are lots of other options that can be discussed to help with your symptoms and improve your long-term health.
