Frequently asked questions
I want to give you the best possible experience when we work together. Below, I've written some questions which patients often ask me. I hope it helps you.
About the consultation
I am currently doing all consultations via video call. You will receive a video call link after booking the appointment. You can have a partner or friend with you during the consultation.
If you feel you require an examination, please let me know.
I might need blood test results to discuss with you - please see below.
Do I need blood tests before the consultation?
If you are not on HRT and are over 45 years old, there is no need to have any blood tests prior to your first appointment.
If you are not on HRT and under 45 years old please ask your GP to test for the following: Oestradiol, Progesterone, FSH, LH, Testosterone, SHBG, TFTs (thyroid function tests).
If you are on HRT already and still experiencing symptoms such as low libido, please ask your GP to test for Oestradiol, Testosterone and SHBG. Please do not have the blood test on day 4 of a patch if you are using patches, because on this day levels can drop.
Please bring your blood test results with you to your consultation.
What does the consultation include?
- In-depth consultation and discussion with me, Dr Kharwadkar
- Preparing your treatment plan
- Writing your Consultation Letter which will be emailed to you, to take to your GP
- Reviewing your blood test results
- Reviewing other test results (client specific)
- Preparing your prescription if required (this does not include the cost of the medication should you decide to opt for a private prescription)
- Two follow up emails. These can be used to answer queries you may have after your consultation, but should be used within one month of your appointment (subsequent email advice carries a fee of £40)
Booking an appointment
Click here to book an appointment online.
After booking, you will receive a link to a health questionnaire. I will go through this before our consultation, so that you get the best treatment possible.
You can self-refer to me - you do not need a referral letter (see NICE guidelines).
Questions about prescriptions
A private prescription will be supplied for the agreed hormone therapy. You can either take this to your local pharmacy, or we can arrange for it to be sent to the online pharmacy service that we use, who will then contact you to arrange free delivery of your medication. This can be helpful as the supply of stocks are sometimes unreliable in local pharmacies.
Please take a photo of your prescription before giving it to the pharmacist. This will help you remember what you are taking and the correct dose as well as any instructions for administration. It will also mean you can check the pharmacist has written the correct instructions on the medication they have dispensed.
If you have any queries regarding your medication please refer to this and to your copy of the clinic letter, sent to your GP, where your medication will be clearly listed. We will send a letter addressed to your GP, to you directly. These are usually sent within 7-10 working days of your consultation.
How do I get my prescribed medication?
I use an online pharmacy, Pharmacierge, who dispense private prescriptions. Once the prescription is written, Pharmacierge will contact you for payment and then the medication will be couriered or posted to you. There is free same day delivery to London postcodes and next working day nationally within the UK. Same day deliveries outside London carry a fee. International deliveries are also available.
If you prefer, we can post or give your prescription to you so that you can obtain your medication from your local pharmacy.
Medical questions (new patients)
I have put together some answers to common medical questions that my new patients have. Please note that this is not specific medical advice, it is just for informational purposes.
How long can a woman stay on HRT?
National Institute for Health and Care Excellence (NICE) guidelines state that there is no arbitrary limit to the length of time a woman can stay on HRT. She should be supported in her decision to continue on the therapy if she so desires.
Studies show that women who stay on HRT have, on average, an increased life expectancy of 3.5 years.
If I have a Mirena should I have it removed before starting HRT?
No. Many peri-menopausal women need contraception as well as HRT. Contraception is recommended to the age of 55 years if you are still having periods or had them until you were 54 years old. The Mirena may have stopped all your bleeds and it may not be obvious to you that you are postmenopausal, or indeed still perimenopausal, so it is best to keep it if you are uncertain.
The Mirena can also be used in HRT for the endometrial protection. We can discuss this with you at your consultation.
Do you prescribe Testosterone preparations?
Yes we do! See details here.
Do I need contraception still?
Contraception is still required when women are in the perimenopause, even if they are on HRT. HRT is not a contraceptive. It is safe to be taking HRT and using the minipill as your contraception.
This will be discussed at your consultation, and you will be advised when it is safe to stop using contraception.
I've heard there is a shortage of HRT supplies?
This has been a particularly difficult time for women with regards shortages in HRT supplies.
We will endeavour to write on your prescription ‘or generic equivalent’ to ensure that the Pharmacist will provide you with an equivalent treatment for now.
Please refer to the British Menopause Society website for updates on the situation:
https://thebms.org.uk/news/british-menopause-society-update-on-hrt-supply/
Other information
Please note: If I have not seen you for a review for over 12 months, I unfortunately will be unable to comment on blood results or give email advice without a full initial consultation.
Private Medical Insurance: I am not able to administer claims through private medical insurance - the fees must be paid by the patient at the time of the consultation. I can provide a receipt on request, which you may be able to use to claim the fees through your insurance policy if you are covered. Please first check with your health insurance provider.
Medical questions (existing patients)
I have put together some answers to common medical questions that my patients have. Please note that this is not specific medical advice, it is just for informational purposes.
If my dose of oestrogen is changed, do I change the dose of progesterone (Utrogestan)?
In cyclical HRT:
The dose of the Utrogestan should be 2 x 100mg Utrogestan at night for 12 nights per month.
This should be taken regularly whether you bleed or not and per calendar month, irrespective of when your bleeding occurs.
In continuous combined HRT:
100mg Utrogestan at night every night.
We may increase your Utrogestan to 2 x 100mg at night, every night, if your dose of oestrogen is:
- 1.5mg (oral dose) or more
- 75mg patches or more
- Oestrogel 3 applications daily or more
If I get breast tenderness what should I do?
Many women can experience some breast tenderness when they initially start HRT. This usually lasts 2-4 weeks.
If it is severe, or lasts longer, please take Super Starflower oil (Solgar make an excellent one) 1,300 iu per day for 6 weeks
or Evening Primrose oil 2000 mg a day.
If you know that you are particularly prone to breast tenderness when taking oestrogen, you could take the Super Starflower oil for 3-4 weeks prior to starting HRT to prime the breasts and reduce this reaction. If the breast tenderness does not respond to this and persists, please book in for further advice. We may change your dose or the preparation you are on.
What should I do if I start bleeding heavily on continuous combined HRT and haven’t had a period for over a year?
This is classed as postmenopausal bleeding and should be investigated as soon as possible. Please see your GP who will organise a trans-vaginal ultrasound scan to check the thickness of the lining of your womb and to see if there are any polyps or other causes of bleeding.
What if I start getting some ‘old blood’, or light spotting for a couple of days initially after starting the HRT?
Please keep a note of it and inform us at your 3 month follow-up. This may happen initially and usually settles after 3-5 months.
What shall I do if the Vagifem pessaries irritate my vaginal or vulval skin?
Stop using them and try again once you have started to settle on the transdermal HRT. If it still irritates then please contact us for another appointment, as we may need to arrange an appointment to examine you and prescribe a different preparation. You may wish to see your GP to get the examination done.
Where is the best place to apply the oestrogen gel (Oestrogel or Sandrena)
Gel should be applied to the inner thigh, and rubbed with the inner lower arm, not with the hands. Do not get dressed for 10 minutes. The longer you give for the gel to dry the better the absorption. Rubbing it with your hands wastes it and puts it on the taps for other members of your household!
You can put it on every night, every morning, or split the dose between morning and night time-it is up to you and whatever suites your routine the best.
Some women find using it at night helps them sleep, others prefer to use it in the mornings or split the dose. It’s very individual.
For more information look at: www.womens-health-concern.org
What if my patch or gel irritates my skin?
When you first take the backing off the patch, please wave it in the air for 10 seconds before applying it to your skin. It should not be applied after applying body lotion.
Do not put the patch on the same area of skin, but move sites.
They should be placed below the naval on the anterior abdomen or hips or buttocks.
Do not have blood tests for Oestradiol on day 4 of a patch. When throwing them away, please wrap them in the foil wrapper they came in to protect the environment.
Existing patient with more questions?
If you are an existing patient, please email your doctor at womens-specialist@doctors.org.uk.
No charge is made for your first 2 emails if they are within the first month of your consultation. Additional email correspondence will be charged at £40 per email. Repeat prescriptions are charged at £40 per prescription.
I will endeavour to answer your email within 2 working days. It may take longer if I have to contact another healthcare professional in order to answer your enquiry (i.e. your GP or another consultant who is providing you with care.)
If you have not been seen for over 12 months, I am unable to comment on your treatment or blood results via email, in line with the GMC Good Medical Practice Guidelines. Please book an appointment.
If you have not been seen for over 2 years, your consultation will be charged as a new patients’ consultation to allow sufficient time to take a full history and fully understand your current needs.
Let me help you get relief from the menopause today.
I'm currently accepting new patients.
womens-specialist@doctors.org.uk
Disclaimer
All content and media on this website is created and published online for informational purposes only. It is not intended to be a substitute for professional medical advice and should not be relied on as health or personal advice. Always seek the guidance of your doctor or other qualified health professional with any questions you may have regarding your health or a medical condition. Never disregard the advice of a medical professional, or delay in seeking it because of something you have read on this website. If you think you may have a medical emergency, call 999. If you choose to rely on any information provided this website, you do so solely at your own risk. External (outbound) links to other websites or educational material (e.g. pdf’s etc…) that are not explicitly created by us are followed at your own risk. Under no circumstances is A1 Clinic or Dr Kharwadkar responsible for the claims of third party websites or educational providers.