Do I need a blood test to diagnose the menopause?
Over 45, usually not — and this is worth knowing before you pay for one. Perimenopause is a clinical diagnosis made on symptoms. Hormone levels fluctuate so much from week to week that a single normal result excludes nothing at all.
Under 45 testing is worthwhile, and under 40 it is important — premature ovarian insufficiency is a different situation with different implications, and it needs identifying.
Can I start HRT at the first appointment?
Often yes, where the picture is clear and there is nothing that would make it unsuitable. The consultation covers your symptoms, your history, migraine, clot risk, blood pressure and family history, and then which preparation and route suits you.
Transdermal oestrogen — patch, gel or spray — does not carry the clot risk that oral oestrogen does, which means many women who have been told they cannot have HRT actually can.
Is HRT safe? I was told it causes breast cancer.
That belief traces to one 2002 study whose results were widely misapplied, and it is worth reading what that study actually found.
The short version: the increase reported was a relative figure, the absolute numbers were small, the participants averaged 63 and were mostly a decade past menopause, and the preparations used are not the ones typically prescribed in the UK now. The oestrogen-only arm showed no increase at all.
There is a real risk and it should be weighed — alongside genuine benefits including symptom control and fracture reduction. It should not be decided by a headline.
Can you do my smear test?
No — it is a physical procedure, and it is free on the NHS. If yours is due we will say so and encourage you to book it. Cervical screening prevents cancer rather than merely detecting it, and it is among the more valuable things available to you at no cost.
Can you fit or remove a coil or implant?
No — both need doing in person. We can discuss whether it is the right method, refer you for fitting, and manage problems and side effects afterwards. Many sexual health clinics fit them free.
I have been told before that it is just stress.
That is worth telling us, and it is a piece of clinical history rather than a grievance.
Stress and low mood are real explanations that deserve treatment in their own right — but they are usually a conclusion reached after excluding the physical causes, not instead of it. Thyroid disease, iron deficiency, coeliac disease, perimenopause and sleep apnoea all produce a picture that gets attributed to stress, and all are found with ordinary blood tests.
How heavy is too heavy for a period?
If your period dictates what you can do, it is too heavy. That is the practical definition and it is more useful than any measurement.
Concrete markers: soaking through protection in under two hours, needing double protection, passing clots larger than a 10p piece, or flooding onto clothes or bedding. Heavy periods are the leading cause of iron deficiency in women and are routinely normalised for years — ask for ferritin, not just a haemoglobin, and know that effective treatments exist.
Can you see me if I am pregnant?
For general health problems and prescribing questions in pregnancy, yes — and knowing what is safe to take is a common and reasonable reason to book.
We do not provide maternity care, and anyone pregnant should be under midwifery services. Bleeding, severe pain, reduced fetal movements or anything acute goes to your midwife or the early pregnancy unit, not to us.