Private menopause clinic London recommendation

[SamW4]

I'm in the early stages of menopause and have not reacted well to the HRT treatments suggested by my doctor so far. Frankly she seems a bit young and clueless. I wondered if anyone could recommend a menopause clinic in London, having had a trawl through past posts I couldn't find any very current suggestions. Thank you!

I'd not recommend a clinic as such but more along the lines of a gynaecologist with menopause as one of their specialties. I can PM you if you want with names.

The marion Gluck clinic. She specialises in Bioidentical hormones.

www.mariongluckclinic.com

If by 'bio identical' you mean made in a lab according to each woman's blood tests and saliva tests, these are not licensed in the UK. There is no real scientific basis for these tests.

If you mean 'body identical' - HRT the same molecular structure as our own hormones, - these are available on the NHS or from any consultant, private or NHS.

This explains it very well.
wwwmenopausematters.blogspot.co.uk/2017/01/bio-identicals.html

Compounding bio identical pharmacies have been practicing in USA for a number of years and have recently appeared in the UK. Investigations in the USA are being reported. In 2001 the Food and Drug Administration (FDA) collected and analysed 29 compounded drugs. Two of the compounded hormone drugs failed analytical tests because of contamination risks.
I think a lot of people are confusing 'compounded hormones' with body identical. There is no such thing as bio identical- it's a marketing term. The correct term used by drs is 'body identical' meaning the hormones made are the same as our own, not conjugated equine estrogen (CEE) or synthetic progestogens which are what Premarin and Prempak brands are.

Extract below from the blog link

"In 2012 “More” magazine commissioned laboratory tests of bio identical hormones produced by 12 compounding pharmacies. It was found that these hormones were of unreliable potency and would not meet the standards for the FDA requirements for commercially manufactured drugs and in fact because of the variable hormone levels, concern was expressed that endometrial cancer risk could be increased"

Sorry- cut and paste went a bit haywire in the above post.

Here is the correct version!

I think a lot of people are confusing 'compounded hormones' with body identical. There is no such thing as bio identical- it's a marketing term. The correct term used by drs is 'body identical' meaning the hormones made are the same as our own, not conjugated equine estrogen (CEE) or synthetic progestogens which are what Premarin and Prempak brands are.

This is from the blog link by Dr Currie
Compounding bio identical pharmacies have been practicing in USA for a number of years and have recently appeared in the UK. Investigations in the USA are being reported. In 2001 the Food and Drug Administration (FDA) collected and analysed 29 compounded drugs. Two of the compounded hormone drugs failed analytical tests because of contamination risks.

In 2012 “More” magazine commissioned laboratory tests of bio identical hormones produced by 12 compounding pharmacies. It was found that these hormones were of unreliable potency and would not meet the standards for the FDA requirements for commercially manufactured drugs and in fact because of the variable hormone levels, concern was expressed that endometrial cancer risk could be increased"

Thank you, now researching and deciding who to see

I know two people who have had an amazing turn around after seeing John Studd, although when I mentioned him before on MN people were a bit sneery. He will be my first port of call.

You can get the main hormones that John Studd prescribes on NHS ie estrogel and progesterone. Getting hold of testosterone on NHS can be problematic but not everyone needs this - but I wouldn't pay his exorbitant prices just to get this (testosterone) prescribed.

Lulu yes, my friends have then gone to their GP's who then prescribe what he suggested. They only needed the initial appointments with him to get the correct prescription after almost giving up with seeing the GP.

Dame They don't need to see Studd to get what he prescribes. Apart from testosterone, it's mainstream HRT available on the NHS.
He also supposedly diagnoses and prescribes by phone which, imo, is not ideal. There are several other excellent consultants who offer an even more individual approach rather than Studd's regime.

The only difference is if they are under supervision with a consultant for reduced progesterone (7 days a cycle instead of 12) and can access scans via a private consultant, quickly and sometimes as routine (annually or biannually), to check the uterine lining.

Dame They don't need to see Studd to get what he prescribes

But the GP's weren't prescribing.

why not? it's mainstream products- Oestrogel and Utrogestan. Did the GP refuse HRT per se or those items?

Just didn't have a clue generally. Were happy to prescribe once they knew what to prescribe.

That sounds a bit dire, really.

There is a huge amount online especially on Menopause Matters website where all HRT preps are listed. If women know what they want they can ask their GPs for it. ie 'I'd like to try Oestrogel and Urtogestan.'
The dose is easily found online.

I think it all works with your GP if you react well to what you are given. I was put on femoston which was great for a few months then I started getting violent mood swings and bloating. She then tried utrogestan with Evorel 25 patches. Fine for a month then the most violent nausea which stopped within 2 hours of taking the patch off. She didn’t know where to go from there and started muttering about menopause clinics. Hence I’m now looking at getting some help from elsewhere.

It's unusual to feel sick with that low dose of a patch. I felt nauseous with gel initially for a while but got round it by splitting the dose, morning and night. You aren't going to get anything privately that you can't try on the NHS, sadly, apart from a longer appt time and being able to talk through how you feel. Consultants can prescribe 'off licence' so can vary the regime a bit, but not beyond the limits of what is safe. My advice would be try Oestrogel instead of the patch, start with 1 pump (half the normal starting dose) and build up if it doesn't control your symptoms.

Utrogestan can cause nausea in some women when taken orally.

Maybe I just need a decent GP with a bit more understanding of how to prescribe! I’ve booked an appointment with another doctor in the practice, maybe she will have more idea.

I went down the John Studd route and after a few hideously expensive rounds of blood tests and a bone scan, asked my GP to prescribe the Oestragel and Provera which she did. I had high hopes about JS but found the process nowhere near as personalised as I would have liked.
I am more than happy to abandon the testosterone though it did smell nice. It has made my body hair grow like the rainforest. Still a problem 6 months after I stopped using it!

I hear Nick Pappas (?) comes very highly recommended and you can get an NHS referral (but you'll want to confirm that).

Can i ask about your symptoms? Im sure im suffering. Sore breasts mid cycle, just had a huge ott rant at my son then cried! Have not spoken to anyone yet. Also night sweats, but not all the time. Hot flushes after cups of tea. Not sure at what point hrt etc starts, thanks

I was night sweats, poor sleep and hot flashes that drove me to the docs. All back again so hope I can find a route that works.

Okay, body identical hormones, although they are called bioidentical in the media! If they have been proved not to meet proper standards, why were they featured on Womans Hour a few months ago, in very positive terms? Why am i reading lots of articles about them and they help they have given women who found HRT didn't suit them? The whole idea is to tailor make them to the individual woman, not just one size fits all. I also don't like the idea of using a hormone made from Mare's urine.

If they have been proved not to meet proper standards, why were they featured on Womans Hour a few months ago, in very positive terms?

Errr maybe it was someone from the Gluck clinic? Can you link to it please?

Don't believe everything you read or hear. There is plenty of evidence they are not safe - read the link from the former chair of the British Menopause Society.

What you may have seen or heard in the media is written by journalists and not always accurate. Unless they are directly quoting eminent gynaecologists (and Gluck is not a gynaecologist- she's a German GP who has jumped on the bio HRT bandwagon) then you shouldn't take any notice.

The point is, it's a waste of time trying to tailor HRT using blood or saliva samples. Levels of hormones change by the hour in peri. This point is made by many consultants.

HRT can still be individualised using licensed preparations. I'd say mine was that because I was advised to use anything from a tiny blob of estrogen gel up to the maximum dose and see how I felt. Same for progestogens- there are only 3 types plus the Mirena. It's trial and error. Even 'bio HRT' can't offer anything different. Some Bio HRT is progesterone cream but this is the main thing that there is concern over- it isn't enough to keep the endometrium thin.

There are only 2 types of HRT which are made from mares' urine - Premarin and Prempak. These are old fashioned types not often prescribed now. The rest is made from plants. Same applies to 'bio estrogen' - it's the same stuff.

Have a good read around- especially the link I left. It's clear that the Bio HRT message has confused lots of women.

There is so much incorrect information out there that it can be a bit of a minefield trying to find and navigate the route. The complication I find being in perimenopause is that my cycle is still present and causing all sorts of symptoms which are not predictable from day to day nevermind month to month.

The UK seems to prescribe on symptoms rather than blood results in the most case and to be honest my experience of both is that the symptoms are telling the story just as well as bloods.

So, oestrogen during perimenopause doesn't just "decline" as a lot of people believe, indeed it goes a bit mad and spikes and dips unpredictably.

Its for this reason that I fail to understand how the cream based versions from private clinics can be any better than the mainstream solutions, except of course that they cost a lot more and are not licensed for use, especially to protect the endometrium.

Given the perimenopause situation, the two main approaches I have seen are

1. Supplement the oestrogen with a low dose of 17beta estradiol which is the bio/body identical oestrogen (not a horse in sight!) to try and even out the spikes a bit. The really popular solution for this seems to be Oestrogel, a topical gel where you can tailor the dosage a bit to suit yourself. However it is not recommended to keep changing the dose too frequently as it simply serves to confuse the issue more.
2. Take high levels of oestrogen to override your normal cycle. This I have only read about and haven't tried myself (I did option 1) so perhaps someone with more experience on this could pop along and help out.

In both of these situations, if you still have a uterus, you must oppose the oestrogen with progesterone in order to prevent the endometrium proliferating too far and adding unnecessary risks. The NICE guidelines, as I recall, say something along the lines of 200mg progesterone for a minimum of 12 days. As with the oestrogen, micronised progesterone (Utrogestan) is a bio/body identical hormone and not as with progestins synthetic.

There is, I have found a lot of trial and error, frustration and exasperation in finding the right dose but I can also say that it is absolutely worth it because I have rediscovered the woman who seems to have vacated the premises when my hormones started going mad. Having been on the journey for about 3 years prior to HRT then taking HRT I would have taken HRT earlier.

Hope this helps.