Menopause care on the NHS

On the NHS, menopause care starts at your GP practice. There is no separate front door. The NHS website says to contact your GP if you think you have symptoms of perimenopause or menopause and want to know your options, and its treatment page says a doctor, nurse or pharmacist can talk you through HRT and the alternatives.

The guideline behind that care is NICE NG23, prepared for the NHS in England. It sets out how a GP should identify perimenopause, what to offer, when to review and when to refer. Most of the Getting Help pages on Roshara quote it, so you can walk in knowing what your doctor is working from.

What the NHS lists as treatment

The NHS website's treatment page lists HRT as the main treatment for those who need it. Estrogen comes as tablets, patches, spray or gel, and anyone with a womb who takes it also needs a progestogen to protect it. The page says testosterone for low sex drive may be prescribed by a menopause specialist. For women who cannot take HRT or do not want to, it lists CBT for hot flushes and night sweats, and other medicines a GP can talk through. It also says there is very little evidence on how well or how safely herbal remedies work.

Reviews and referral

NICE NG23 recommends a review of each treatment at three months, then yearly, sooner if it is not working or causing problems (1.9.2). It suggests referral to a healthcare professional with expertise in menopause when HRT may not suit you, when the best option is unclear (1.5.26), or when treatment is not helping or side effects carry on (1.9.3). In England that referral usually comes through your GP. The British Menopause Society keeps a register of its recognised specialists, searchable by postcode. Seeing a menopause specialist explains what they do.

Paying for HRT

If you pay for prescriptions, the NHS Business Services Authority sells an HRT prescription prepayment certificate, known as the HRT PPC. One payment covers certain HRT medicines for 12 months, however many prescriptions you need. It does not cover every HRT medicine, so the NHSBSA asks you to check yours is on its list first, and to check whether you already get free prescriptions. You can buy it online or at some pharmacies. The price changes, so we link to the NHSBSA page rather than print it.

Support beyond the surgery

The NHS website's help and support page points to three organisations for information and support, among them Women's Health Concern, which it describes as the British Menopause Society's website. NHS inform, Scotland's health website, offers several of its menopause pages in Urdu.

The NHS website lists reasons to contact your GP: symptoms you want help with, a fast heartbeat, periods that have become heavier rather than lighter, and any bleeding after 12 months without a period. It says postmenopausal bleeding should be checked even if it happened once, was only spotting or came with no other symptoms. If you are on HRT and still have irregular or heavier bleeding after six months, the NHS says to talk to your GP.

If you fast in Ramadan, medicine timing is a question for your GP or pharmacist, who can tell you whether a tablet can move to suhoor or iftar. Questions about the fast itself belong with a qualified scholar. And if you are booking for your mother, who would rather speak Urdu, ask the practice what language support it offers.