Individualised and evidence-based advice to support you through the menopause and beyond

Welcome to Wells Menopause Clinic

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. At the moment I am concentrating on my NHS menopause work so am not taking on new patients. 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.


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.

For those already on my waiting list, I will be contacting you as appointments become available but please also look at 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.

Autumn 2021 Some patients are finding their menopausal symptoms have returned when changed to the new pump-packs of Oestrogel (same shape but slightly different labels). Please see my Instagram posts and video for more details. If you are a current patient and feel this is relevant to you, please email the clinic to arrange a follow up appointment or ask your GP to change you to a different form of transdermal oestrogen.

Autumn 2022 You may be given cylindrical Oestrogel bottles as the company has reintroduced the use of an older style container to increase production and reduce supply issues.

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.


The average age of the menopause for women in the UK is 51 but hormonal changes often start in your 40s or even earlier, long before periods stop. This leads to many different physical and psychological 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 just need to replace your reducing oestrogen levels.

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 in a relaxed setting 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. Hopefully this will change soon. I have recently managed to get testosterone for women on the Somerset GP Prescribing Formulary and menopause doctors are working on this in other areas of the UK.
  • 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 your 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
Dr Juliet Balfour
Advanced Certificate in Menopause Care
BMS Menopause Specialist