The symptoms associated with menopause arise from the withdrawal of oestrogen, progesterone, and testosterone, hormones that regulate far more than reproductive function. Their absence is felt across the body in ways that are frequently underestimated in standard clinical settings.
Menopause
Menopause is defined as the point at which a woman has not had a menstrual period for twelve consecutive months, marking the end of ovarian reproductive function.
Overview
What Is Menopause?
Menopause is defined as the point at which a woman has not had a menstrual period for twelve consecutive months, marking the end of ovarian reproductive function. It is a natural biological transition, not a disease, but its hormonal consequences, particularly the sustained decline in oestrogen, progesterone, and testosterone, affect virtually every system in the body and can have profound and long-lasting implications for quality of life, cardiovascular health, bone density, cognitive function, and metabolic resilience.
The average age of natural menopause in the United Kingdom is 51, though it can occur earlier as a result of surgery, chemotherapy, or primary ovarian insufficiency, and later in some women. What follows menopause, sometimes referred to as the postmenopausal phase, is a period during which the hormonal environment has fundamentally changed and the biological risks associated with that change, including osteoporosis, cardiovascular disease, cognitive decline, and metabolic dysfunction, begin to accumulate if they are not actively addressed.
At The Schoeman Clinic, we treat menopause not as an ending but as a pivotal clinical opportunity. The decisions made at this stage of life, about hormones, nutrition, metabolic health, and long-term protective strategies, have a measurable impact on how well a woman ages over the decades that follow.
Symptoms
Symptoms of Menopause
Vasomotor symptoms, including hot flushes and night sweats, affect the majority of menopausal women and can persist for many years. They range in frequency and severity from occasional mild discomfort to multiple episodes per hour that severely disrupt daily functioning and sleep.
Genitourinary symptoms include vaginal dryness, atrophy, discomfort during intercourse, urinary urgency, and recurrent urinary tract infections. These symptoms tend to worsen progressively over time without treatment and are among the most undertreated aspects of menopausal care.
Psychological and cognitive symptoms are common and clinically significant. Low mood, anxiety, loss of confidence, poor concentration, memory lapses, and a marked change in emotional resilience are frequently reported by menopausal women and are directly linked to declining oestrogen levels, which play a fundamental role in neurotransmitter regulation and brain function.
Musculoskeletal symptoms include joint pain, muscle aches, and reduced physical stamina. Bone density begins to decline rapidly in the years immediately following menopause, increasing fracture risk significantly over the longer term.
Metabolic and cardiovascular changes are among the most clinically consequential consequences of menopause. The loss of oestrogen's protective effect on the cardiovascular system, combined with shifts in fat distribution, insulin sensitivity, and lipid profiles, substantially increases cardiovascular risk in postmenopausal women.
Diagnosis
How We Diagnose and Assess Menopause
For most women over the age of 45 presenting with characteristic symptoms, menopause can be identified clinically. For younger women, or those with an atypical presentation, or where the clinical picture is complicated by overlapping conditions, more detailed investigation is warranted.
At The Schoeman Clinic, every patient presenting with menopausal symptoms receives a comprehensive clinical consultation with your doctor, covering full symptom history, menstrual history, medical and family history, and current medications or previous treatments.
Blood panel assessment may include oestradiol, FSH, LH, testosterone, SHBG, progesterone, thyroid function (TSH, free T3, free T4, and thyroid antibodies where indicated), DHEA-S, cortisol, fasting insulin, HbA1c, lipid profile, bone markers, vitamin D, B12, ferritin, and inflammatory markers. Testing is conducted through The Doctors Laboratory (TDL) and interpreted within the full context of your clinical presentation.
Where additional investigations are indicated, including pelvic ultrasound to monitor endometrial health during HRT, or cardiovascular risk assessment through our cardiology partner One Heart Clinic, these are arranged and coordinated as part of your care.
Treatment
Our Approach to Menopause Treatment
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Body-Identical and Bioidentical Hormone Replacement Therapy
The evidence base for hormone replacement therapy in menopause is substantial and continues to grow. NICE guidelines and the British Menopause Society are clear that HRT is effective, appropriate, and, for the majority of women without specific contraindications, beneficial not only for symptom relief but for long-term protection of bone, cardiovascular, and cognitive health.
At The Schoeman Clinic, your doctor uses body-identical hormones, which are molecularly identical to those produced by the human body, across the full range of available preparations. Clinicians at the clinic have completed advanced BHRT training through WorldLink Medical and the Marion Gluck Training Academy and prescribe oestrogen, progesterone, testosterone, and DHEA in the forms and doses most appropriate to each individual patient's clinical profile.
Treatment is not standardised. The preparation selected, the dose, the route of administration, and the monitoring schedule are all determined by your clinical presentation, your test results, your medical history, and your personal preferences.
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Testosterone for Women
The role of testosterone in female health is significantly underappreciated in mainstream clinical practice. Testosterone decline in menopause contributes to reduced libido, fatigue, low mood, muscle loss, poor concentration, and diminished sense of wellbeing. At The Schoeman Clinic, testosterone is assessed and, where indicated, prescribed as part of a comprehensive menopausal treatment plan.
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Metabolic and Cardiovascular Protection
Menopause is a significant inflection point in a woman's cardiovascular and metabolic risk trajectory. We assess and actively address insulin resistance, lipid profiles, inflammatory load, blood pressure, and weight as components of menopausal management, not as separate concerns. Our cardiology partnership with One Heart Clinic allows us to arrange advanced cardiovascular investigations where the clinical picture warrants it.
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Bone Health
Rapid bone density loss in the years immediately following menopause significantly increases long-term fracture risk. We assess bone health markers and, where indicated, incorporate bone protective strategies into your treatment plan, including hormonal optimisation, nutritional prescribing, and targeted supplementation.
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Nutritional, Lifestyle, and Functional Medicine Support
Menopause is a metabolic transition as much as a hormonal one. The quality of a woman's nutrition, her gut health, her sleep, her stress physiology, and her physical activity patterns all influence how she experiences menopause and how she ages through the postmenopausal years. We address these factors directly, using your clinical data to guide personalised recommendations.
Why us
Why Choose The Schoeman Clinic for Menopause Care?
Women seeking specialist menopause care at The Schoeman Clinic benefit from a level of clinical thoroughness that is rarely available in a standard GP or general private medicine setting. Schoeman combines the diagnostic breadth of a GP with advanced specialist training in hormonal medicine, bioidentical hormone therapy, and functional medicine, and she approaches every consultation with the time and attention that genuine personalisation requires.
We do not offer a single standard menopause prescription. We offer a clinically rigorous, individually tailored programme that addresses the full breadth of menopausal impact, from immediate symptoms to long-term health protection, and that evolves with you as your biology changes.
The Schoeman Clinic is CQC-registered and adheres to NICE guidelines (NG23), British Menopause Society standards, IFM frameworks, WorldLink Medical protocols, and GMC guidance in the delivery of all patient care.
Continue
Where to go next.
Related conditions
Condition
Perimenopause
ConditionThyroid Conditions: Hypothyroidism and Hashimoto's Thyroiditis
ConditionNeurophysiology and Hormonal Brain Health
ConditionInsulin Resistance, Weight Gain and Difficulty Losing Weight
ConditionSleep Disturbance and Insomnia
ConditionLongevity and Healthy Ageing
ConditionChronic Fatigue and Burnout
Questions
Frequently asked questions
If your question is not answered here, our patient office will take it personally.
Book a consultationMany women begin to notice improvements in vasomotor symptoms and sleep within four to six weeks of starting HRT. Mood, cognitive function, and energy levels may take somewhat longer to respond. The full effect of HRT is typically assessed at a follow-up appointment two to three months after treatment commences, at which point dose and preparation adjustments are made if required.
Body-identical hormones are molecularly identical to those produced by the human body. Many are available on NHS prescription and are the form recommended by current NICE and BMS guidance. Synthetic progestogens, which differ structurally from the body's own progesterone, were associated with the elevated breast cancer risk identified in some older HRT studies. Body-identical micronised progesterone carries a more favourable risk profile and is the form your doctor uses in their prescribing practice.
There are a small number of women for whom HRT is contraindicated. For these patients, your doctor will discuss alternative approaches, which may include non-hormonal pharmacological options, targeted nutritional and lifestyle interventions, and functional medicine support to address the underlying drivers of their symptoms as effectively as possible.
Yes. Oestrogen plays a protective role in cardiovascular health, and its sustained decline following menopause contributes to increased cardiovascular risk. This is one of the reasons that appropriate menopausal management, including consideration of HRT where indicated, is important not just for symptom relief but for long-term health protection. We assess cardiovascular risk as part of our menopausal management programme and can arrange advanced cardiovascular investigations through our cardiology partnership with One Heart Clinic where indicated.
No referral is required to book a consultation at The Schoeman Clinic. We recommend informing your GP that you are receiving specialist private menopause care, as this supports continuity across your healthcare team.
Next step
Begin Your Menopause
Consultation
If you are experiencing menopausal symptoms and want specialist, personalised care from a clinician with advanced training in hormonal medicine, we would welcome the opportunity to support you.
Clinics
96 Harley Street
London W1G 7HY
4 St Marks Place
Wimbledon, London SW19 7NP
Patient office
The Schoeman Clinic is a CQC-registered private medical clinic. All clinical content on this page has been written or reviewed by Dr Gina Schoeman MB ChB, MBA, Dip Derm, MRCGP, MBCAM, AFMCP. This page is intended for informational purposes and does not constitute individual medical advice. Please book a consultation to receive advice tailored to your specific circumstances.
