If you are a menopausal or perimenopausal woman seeking treatment from an NHS doctor, you might be waiting a while. Not only can one in four not get a GP appointment at all, i recently revealed that many women seeking specialist menopause treatment typically wait for more than a year.
Doctors report that campaigns by celebrities such as Davina McCall and Mariella Frostrup have led to a surge in demand for menopause care, while in the five years up to 2022, the number of HRT prescriptions – prescribed to help with symptoms such as hot flushes and mood changes – doubled in the UK, resulting in intermittent shortages.
This heightened awareness of menopause and its potential treatments, coupled with a stretched NHS and HRT shortages, means women are increasingly looking elsewhere – to expensive private menopause clinics, non-medical lifestyle gurus, and pricey over-the-counter products – for help and guidance. A recent report by the Global Wellness Summit revealed that menopause merchandise is projected to turn over £492bn by 2025.
The menopause is big business – but are menopausal women, often desperate for help and feeling let down by the NHS – getting value for money? And even more importantly, could they be endangering their health by seeking help outside the NHS?
There are now 155 NHS clinics, and 228 private clinics in the UK, according to the British Menopause Society, the specialist authority for menopause and post reproductive health in the UK, which was established in 1989.
Typically, private appointments cost between £100 and £350 and might involve a detailed discussion of symptoms, such as anxiety and lack of sex drive – all the nitty-gritty a GP might not have the time to explore, given the pressure on appointments and time. Next comes a treatment plan, which might involve HRT.
Elise Hurcombe, 42, an arts development director from Bristol, sought private treatment in 2021, after she began suffering from a wide range of perimenopausal symptoms, including sore joints, heavy and erratic periods, rage, fatigue and hot flushes.
She says: “My GP could only offer 15-minute appointments, so told me I could only talk about two symptoms at a time. They offered help but only after a year of struggling and, even then, it was limited. They also thought I was depressed when I knew I wasn’t.” Eventually – after frequently ringing at 8am to get a GP appointment and finding there were none available – Elise felt she had reached “breaking point”.
She says: “I felt I was going mad and everything was falling apart.” After calling several private menopause practices, she booked an appointment with one of the GPs at Newson Health, which had been recommended to her. She says: “I had an hour-long video appointment and felt completely understood. They took a detailed history and prescribed 50, rising to 100mcg of oestrogen, with my progesterone coming from a coil. I’m now on 150mcg of oestrogen and use a testosterone gel, plus vitamins and magnesium.”
In general, the standard NHS dose of oestrogen patches – following clinical guidelines – is 50mcg, though each patient is individually assessed. In some private clinics, patients are regularly prescribed higher “unlicensed” or “off-label” doses – a practice that is allowed if a doctor feels it may help the condition and if a patient has given “informed consent,” so is aware of the risks and benefits.
Hurcombe says her consultant made her aware that her dosing was something an NHS GP would not prescribe. She adds: “My prescription helps with about 75 per cent of my symptoms. I have much better sleep and I feel like myself again. I know I am on a high dose of oestrogen, but it makes a big difference. I also know testosterone helps as I went a period of time without it. Even if it only helps with low libido, this is really important. Men wouldn’t put up with a low libido.”
“I understand the pressures the NHS is under, but it shouldn’t be the case that just women who can afford it get this help. This is one of the most important transitions in a woman’s life and I felt completely alone.”
Hurcombe is adamant about the positive effects of a high dose of HRT, but some experts, including Paula Briggs of The British Menopause Society – the UK’s specialist authority for menopause healthcare professionals – have voiced concern: saying: “Some private clinics believe HRT is the only answer so they priotise this over other treatments.”
Joyce Harper, professor of reproductive science at the Institute for Women’s Health at University College London, says: “The whole situation is a mess. It used to be that women were wary of HRT. Now the message coming out of some private clinics is that HRT can sort everything – the menopause, depression, osteoporosis, cardiovascular issues, suicidal thoughts, insomnia – but where is the evidence to support this?
“Obviously, HRT has its place but I know many private clinics are prescribing different levels of HRT and also testosterone without clinical evidence to back this up.
When the i put these concerns to the Newsom clinic, Dr Magnus Harrison, chief medical officer of Newson Health, responded with this comment: “Consistent with national recommendations, Newson Health approaches the decision to prescribe HRT with each patient on an individualised basis after discussing the relevant benefits and risks.
“There is no reliable clinical evidence available that indicates proof of harm caused by different doses of HRT prescribed, and a huge amount of data from clinical experience as the UK’s largest menopause clinic supports the benefits of different doses.”
Last December, the British Menopause Society published a statement saying it was “aware that high doses of oestrogen are being provided routinely to women in some clinics”.
The charity has also seen a rise in cases of abnormal bleeding and considers there might be a link
s between the two. Its chair, consultant in sexual and reproductive health, Dr Paula Briggs, “We have definitely seen an increase in the number of women with abnormal bleeding, requiring investigation. This is having an impact on the number of women who need referral to rapid access services in secondary care to ensure timely investigation.
“We need more clinicians in NHS General Practice, but because this is such a challenging job, younger doctors, most often women, are sometimes leaving to join private clinics. As far as I’m concerned, though, the menopause is not a specialty in its own right but part of broader reproductive health.”
Other medics – even those working in the private field – have also voiced concerns. Dr Nina Fuller-Shavel, a consultant gynaecologist at Synthesis Clinic in Stockbridge, Hampshire, sees women who have typically given up on the NHS. She says, “We do prescribe HRT but in very conservative doses. Often, I think private clinics can put everything down to the menopause without considering other factors such as thyroid issues or metabolic disorders.”
In one instance, a woman came to her clinic who had previously had a rare form of endometrial cancer and was bleeding heavily after being prescribed a high dose of HRT. Dr Fuller-Shavel adds, “It’s utterly irresponsible. Personally, I don’t think private clinics should be able to treat women who have a history of cancer without speaking to an oncologist.”
Another GP has also voiced concerns about the increasing demand for testosterone. Dr Punam Krishan, based in Glasgow, told the i that menopause is now one of the most common conditions seen in her GP practice, taking up a third of daily consultations. While she is encouraged by growing awareness of menopause and treatment options, she is also “frustrated” by “menopause experts online and in the media whose advice, at times, can be confusing.”
She says: “I have had some patients shouting at me if I don’t offer them testosterone as a first-line treatment. They threaten to go private, which they are entitled to do, of course.
“There is no evidence to say testosterone for menopausal symptoms other than libido is safe and effective to take in the long term. And testosterone comes with several potential side effects, including acne and excess hair growth at the site of application.”
Dr Jane Wilkinson, from Liverpool, left the NHS to set up a private menopause clinic in 2017, so she could spend more time with women. But she felt uncomfortable with the “two-tier system”, so closed it in 2020 and returned to work in the NHS.
She says: “There are many dedicated doctors and nurses in the NHS and we want to give patients our time. Women want to be listened to and many of us want to help and are trained to do so. But there needs to be funding for longer appointments and we need more innovative ways of working. At the moment, there is no funding for longer appointments. This two-tier system is leading to an ever-increasing widening in the inclusion agenda, with a Caucasian majority seeking help.”
The i spoke to Meera Bhogal, of London, who began offering advice in the South Asian community three years ago after suffering from menopause symptoms herself. With a background in exercise, she cannot offer advice on prescriptions, but instead provides general guidance, which she feels is often not dispensed by doctors.
“The NHS is getting better but it is still hit and miss,” she says. “Even at private clinics, women are often not told why they are being prescribed certain things. Women are depressed because they don’t have the knowledge. It’s not just about HRT. Women also need to look at their lifestyles. They might need to slow their pace down, cut out alcohol, focus more on moving and strength training.”
Her view on the need for knowledge is supported by Katie Taylor, 53, of north London, who runs The Latte Lounge (lattelounge.co.uk), an online platform for midlife and menopause. She says: “I’m certainly not blaming GPs, as they often have very little menopause training, which means that too many women get misdiagnosed with depression. Many leave their jobs and marriages due to their symptoms. There are thousands of women who are just not coping or receiving the right information and support via the NHS.”
MENOPAUSE PRODUCTS RATED
From Gwyneth Paltrow’s £74 ‘Madame Ovary’ £74 supplements to Naomi Watt’s £32 ‘play oil’, there are hundreds of products on the market aimed at menopausal womem.
Here, GP and menopause expert Dr Philippa Kaye, author of The M Word: Everything You Need to Know About the Menopause, reveals what we should be spending our money on.
Naomi Watt’s The Cool Factor Ectoine Cooling & Calming Face Mist
This cooling mist spray is designed to help women cope with hot flushes. The ‘refreshing mist’ contains hyaluronic acid, skin-balancing Edelweiss flower extract, and an antioxidant mineral blend, which reportedly delivers cooling hydration.
Expert verdict: While the spray may feel cooling, a hot flush is actually caused by the brain. Typically, the thermoregulatory centre in the brain tries to keep us within a certain temperature range. But during the perimenopause, it reacts to even tiny temperature changes, leading to a hot flush. This spray may feel nice but won’t solve the problem.
The Emsella Chair
£200 per session
The Emsella Chair is available in some private clinics and is designed to be used by women hoping to improve their pelvic floor. The menopause, troublingly, can lead to incontinence, caused by a drop in oestrogen. During each 30-minute session on this chair, the muscles of the pelvic floor contract over 11,000 times. Most people need six sessions – costing roughly £1,200.
Expert verdict: There are studies to support the use of this chair but the research does not look at the long-term benefits. Other treatments include vaginal oestrogen or physiotherapy.
Rating: Expensive, needs more research 7/10
Wylerahair Sonic Growth Stimulator
This sonic growth stimulator is designed to stimulate hair growth during the perimenopausal years. Lack of oestrogen can cause hair loss, but this stimulator promotes blood flow to the scalp, using red light therapy to re-energise hair cell growth, strengthening hair at its roots and preventing breakage.
Expert verdict: Hair loss can be down to many factors, including changing hormone levels and low iron levels. Red light therapy has been shown to improve hair loss in some trials but more research is needed into the specific wavelengths, length of treatment etc.
No 7 Menopause Skincare Instant Radiance Serum
This top beauty brand has created a serum designed specifically for menopausal skin. Not only does it reportedly target the accelerated appearance of ageing skin with collagen, it also cools the skin.
Expert verdict: Lower oestrogen results in lower collagen in the skin which can lead to fine lines, or dry or itchy skin. This product contains ingredients to hydrate the skin and potentially treat the signs of skin ageing.
Goop’s Madame Ovary vitamins
These supplements contain herbs, phytonutrients from plants, and vitamins designed to support thyroid health and provide nutritional support for women who may experience mild hot flushes, mood shifts, and stress-related fatigue.
Expert verdict: Most people do not need a regular vitamin supplement aside from vitamin D during the winter months. This supplement contains black cohosh, but there is no evidence this helps for hot flushes. The other vitamins can be obtained through a balanced diet.
Rating: An expensive 2/10