BHRT and body-identical HRT, the regulated way.

NHS body-identical HRT is prescribable and effectively free with a prescription pre-payment certificate. Private care buys faster access, longer consultations and specialist input for complex or treatment-refractory cases.

1. 01

   Before

   You send us your symptoms and history

   A short confidential form. Perimenopausal or menopausal symptoms, prior HRT, breast, cardiac and clotting history, current medications.

2. 02

   Before

   We match you to a menopause specialist

   Within one working day. A BMS-certified consultant in London or by video, with indicative fees and a realistic first-appointment slot.

3. 03

   Before

   Baseline blood work if indicated

   FSH is not required over 45. Thyroid, ferritin, HbA1c, lipids and vitamin D help exclude alternative causes. Testosterone baseline if you want it.

4. 04

   Consultation

   Initial consultation, 45 to 60 minutes

   Symptom review, individualised risk-benefit discussion, blood pressure and BMI, and a written prescription for regulated body-identical HRT.

5. 05

   Consultation

   Prescription dispensed same day

   Estradot, Evorel, Oestrogel, Sandrena, Lenzetto or oral oestradiol, plus Utrogestan for endometrial protection if you have a uterus.

6. 06

   After

   Titration over 8 to 12 weeks

   Dose adjusted by symptoms, not by saliva or blood-spot levels. Most women settle on a steady regimen inside three months.

7. 07

   After

   Annual review, thereafter

   Blood pressure, weight, breast awareness, mammogram schedule and a symptom check every 12 months. Bone density if indicated.

• Vasomotor symptoms

  Hot flushes, night sweats and disrupted sleep. Transdermal oestradiol is the standard first-line regulated option.

• Genitourinary syndrome of menopause

  Vaginal dryness, urinary urgency and painful sex. Low-dose vaginal oestradiol (Vagifem, Ovestin, Estring) is highly effective and low-risk.

• Mood, brain fog and anxiety

  Perimenopausal mood change often responds to regulated HRT. Not a substitute for treatment of primary depression.

• Premature ovarian insufficiency (POI)

  Menopause before 40. Systemic HRT is recommended up to at least the natural menopause age to protect bone and cardiovascular health.

• Bone loss and fracture risk

  HRT preserves bone density. Considered where DEXA and clinical risk warrant, alongside vitamin D and weight-bearing exercise.

• Persistent HSDD after oestrogen replete

  Low libido that persists on adequate HRT. A trial of transdermal testosterone (off-label in women) may help, with a testosterone baseline first.

• Surgical menopause

  After bilateral oophorectomy. Regulated body-identical HRT started promptly, individualised to your breast and cardiovascular history.

• Red flag: unexplained bleeding

  Postmenopausal bleeding, or new breast lump, needs a two-week-wait pathway before any HRT is started or continued.

• Transdermal oestradiol and VTE

  Transdermal oestradiol carries no measurable increase in venous thromboembolism at standard doses. It is the preferred route in women with higher baseline clot risk.

• Breast cancer, the honest picture

  Combined HRT for over 5 years is associated with a small absolute increase in breast-cancer risk. Oestrogen-only HRT after hysterectomy carries little or none. Discussed individually before starting.

• Micronised progesterone versus synthetics

  E3N and WHI substudy data suggest micronised progesterone (Utrogestan) has a more favourable breast profile than older synthetic progestogens. This drives modern first-line choice.

• Endometrial protection is non-negotiable

  If you have a uterus and are on systemic oestrogen, you need adequate progestogen. Underdosing risks endometrial hyperplasia and cancer.

• Cardiovascular timing hypothesis

  Started within 10 years of menopause and under 60, HRT is broadly cardiovascular-neutral or beneficial. Started later, the balance shifts. Age of initiation matters.

• Why we do not use saliva or blood-spot

  Neither saliva nor blood-spot hormone testing is validated for HRT dosing. Regulated menopause care is symptom-led, with serum testing only where it changes a decision.

• Compounded cBHT, the safety concern

  BMS, NAMS and the Endocrine Society advise against compounded bioidentical pellets, troches and custom creams. Purity, potency and endometrial protection are not guaranteed.

• Annual review, always

  Blood pressure, weight, symptom score, medication review, mammogram schedule and breast awareness. Continued as long as benefits outweigh risks for you.

• Red flags on HRT

  New unilateral leg swelling, chest pain, breathlessness, unexplained vaginal bleeding, a new breast lump or severe headache with aura. Stop and seek urgent review.