Are menopause 'clinics' on private health only? Need to fine-tune my HRT.

[Pebbles574]

Am 49 (nearly 50). Have been on HRT (Elleste Duet 1 mg) for about a year. It's helped a lot by stopping hot flushes, aching legs and back and the general anxiety and brain fog, but there are still things which aren't quite 'right' like I get really bad bladder irritation about half of the month and constantly need to pee.
The problem with going to my GP is that it's all so rushed - 10 mins, quick chat and a prescription for something. It doesn't feel very 'tailored' to me, and I can't help wondering if there might not be a different drug/ better combination for me.
My mum had breast cancer and an aunt also had cancer, so I'm very worried about the GP just increasing my dose.
Are menopause clinics available on the NHS? I really want to be able to talk to a specialist and discuss all the options/risks.
I'm in the SE of England.

[PollyPerky]

Not all areas have meno clinics but if they do then they are NHS and I assume you need a GP referral.

What I've picked up from various forums is that most NHS meno clinics are staffed by 'ordinary' drs doing extra shifts and nurses and not necessarily gynaecologists.

For your bladder all you probably need is vaginal oestrogen (1:4 women need both) and your GP can give you this.

If you want to discuss HRT with a specialist then your best bet is a private gynae who specialises in menopause. Personally, I'd not use HRT in pill for as it's higher risk, and I'd not use anything with synthetic progestogens as the thinking now is they are linked to a higher risk of breast cancer.

[SofiaAmes]

I saw a menopause hormone specialist on the NHS in West London, Dr. Nick Panay back in 2004. He was fantastic. I was referred by my GP. I believe he still treats people on the NHS.

[PollyPerky]

He's at the Chelsea and Westminster- not sure about referrals from all over SE and assume it's for London boroughs only,but he does work privately of course too- understand he has a long waiting list.

[SofiaAmes]

I think I waited 6-9 months back in 2004. Wonder if it's longer now.

[HairyLittleCarrot]

Great advice to be had on the menopausematters forum from very knowledgeable women on every conceivable form and dosage of HRT.
No clinic in my area, but a little googling revealed a menopause expert in my region who ran a sexual health clinic. Bingo. Saw her under the banner of sexual health, no GP referral required, she was very helpful fine tuning my HRT and wrote a letter to my GP supporting my unconventional choices as being the gold standard which were well chosen and should not be discontinued.
At the time I was on oestrogel and utrogestan, now on estradot patches, but desperate to get the oestrogen implant which is only available at the chelsea and Westminster. Not much use when I live up north.

[PollyPerky]

The implant is only for certain types of meno as far as I know.My gynae says they are only suitable for women who have had a hysterectomy and not always advisable due to being hard to remove if they need to be.

Oestrogel and Utrogestan /or Mirena are considered the gold standard by most consultants.