Welcome to the Birmingham Women’s Hospital Menopause Service. This service is one of the largest in the country, managing complex patients, premature menopause and a Hormone implant service. It is led by a dedicated team of experts in their field who have achieved a national reputation for excellence.
Birmingham Women’s Hospital Menopause Clinic
The service provides holistic support and advice to women in the menopause from both natural and surgical causes, women with premature ovarian insufficiency, and endometriosis patients in an induced chemical menopause. The management of hormone-related disorders is based on a balanced and rounded approach and provides advice on lifestyle and consequences of hormone deficiency, alternative and complementary therapies and licensed hormonal therapies. The service takes referrals for patients with complex medical histories as well as treatment-resistant patients, those with a history of breast and other cancers or HIV. It is one of the only centres in the country to offer a hormone implant service.
Birmingham Women’s Hospital
The service is located on the ground floor to the right of the main entrance, within the Gynaecology department.
Birmingham Women’s and Children’s NHS Foundation Trust
To reschedule an appointment:
0121 335 8102
To leave a message at the menopause helpline answerphone:
0121 335 8107
Advice to GPs prior to referral
Clinical advice on treatment of menopause.
We apologise for the current disruption to the Menopause Service. As you will be aware, this is due to the current COVID-19 pandemic. We have had to concentrate all our resources on emergency and urgent care and therefore had to cancel all non-urgent out-patient appointments. We have tried to continue with these on a virtual basis but it is possible that we will not be able to continue with this service either due to staffing issues.
We are proud of the service that we provide and we also reluctantly are having to withdraw our nurse helpline at this time due to staffing pressures.
To try and help with your queries, our team have designed some frequently asked questions with responses for you which we hope will be of help at this time.
Q. My appointment has been cancelled in the menopause clinic. When will I be sent another appointment?
A. We will recommence clinics as soon as we are able to provide staffing and resources. These are likely to be virtual clinics in the first instance.
Q. I am concerned regarding availability of certain HRT preparations. My GP cannot obtain my usual preparation.
A. We are aware that many HRT preparations are still in short supply. We have been reassured by manufacturers that they are resolving this issue. The company producing oestrogel and utrogestan have recently contacted us and reassured us that they have no supply issues. We would advise you or your GP to check the British Menopause Society (BMS) website which is regularly updated and also has a useful advice for you and your GP on equivalent HRTs: https://thebms.org.uk/wp-content/uploads/2019/11/HRT-alternatives-04.11.2019.pdf
I have had some bleeding while on HRT – what should I do?
- You should be reassured that unscheduled bleeding on HRT is very common and a serious cause for this is very unusual. The risk of endometrial cancer in women with postmenopausal bleeding on HRT is much lower than women not on HRT.
If you are on a sequential HRT then we expect you to have regular bleeds so do not be concerned.
If you have been commenced on a sequential HRT or continuous combined (no bleed) HRT for less than 6 months and are having erratic bleeding then this is very common and no action is required. This is likely to settle with time.
You should contact your GP if:
- You have been on the HRT for more than 6 months and you are still having erratic bleeding
- You have been on HRT for more than 6 months and just started bleeding
- You are not on HRT but are postmenopausal (more than 12 months since last period) and have started bleeding
It is likely your GP will arrange for you to be referred to the Birmingham Women’s Hospital outpatients for a pelvic ultrasound scan with or without a biopsy from the womb lining to rule out any problem.
For women on HRT for less than 6 months, modifying progestogen intake will often control the bleeding
Progestogen intake could be modified / increased as follows:
- For continuous combined HRT regimens the dose of progestogen can be increased (e.g. go up from utrogestan 100 mg daily to 200 mg daily on continuous basis). Women on continuous combined HRT regimens containing a progestogen in a combined preparation or have the Mirena IUS, can have utrogestan / medroxyprogesterone acetate or norethisterone added to the HRT regimen. If you continue to experience ongoing unscheduled bleeding, the HRT regimen could be changed to a cyclical intake of progestogen.
- For cyclical HRT regimens: Increase progestogen dose (e.g. Utrogestan 300 mg for 12 days a month instead of 200 mg) or increase duration of progestogen intake (can take progestogen for 14 days a month or for 21 days out of a 28-day HRT intake cycle).
Q. I am bleeding and my last period was more than 12 months ago and I am not using HRT?
A.The advice for women not using HRT is different from the above and you should contact you GP regarding these symptoms. Your GP can refer to national guidance regarding management.
Q. I am having unpleasant side effects from my HRT – what should I do?
- Most side effects from HRT are transient ( eg,. mild headaches, nausea, bloating, breast tenderness) and while unpleasant they aren’t serious and therefore you can continue with the HRT and they will usually subside. If you find them unbearable then you can stop the HRT and we can reassess when we start clinics again.
Serious symptoms which may need you to stop the HRT are:
- New onset migraine or increase in frequency of migraine
- Leg/calf pain or swelling
If you notice migraines starting/increasing then this would normally mean you are having fluctuating oestogen levels. Women with a history of migraine will have been offered transdermal HRT but if you are on this and still find you are having problems it would be best to stop HRT at this time and we will reassess you when we can see you in clinic. You should take your usual anti-migraine medication,
If you have sudden calf or leg pain or swelling you should contact your GP urgently and if on HRT stop this until you have had it confirmed that you do not have a blood clot in the leg. If you don’t you can restart the HRT.
Q. I normally have oestrogen/testosterone implants inserted and my appointment has been cancelled. What can I do?
A. We are sorry that we cannot accommodate you for your implant insertion and we ask for your understanding regarding this at this time. We are sending letters to all our implant patients with instructions on HRT you can convert to at this time and if necessary we will send you a prescription to help you with this. It is imperative that if you have a uterus and you do not have a Mirena coil and you use implants that you continue with progestogens regardless of whether you continue to have oestrogen prescribed or not. This is because your oestrogen levels will still be high enough to require endometrial protection for progestogen.
Q. My Mirena coil is due to be changed and my appointment for this has been cancelled- what should I do?
A. We recommend that your GP prescribes you 100mg utrogestan daily to act as the progesterone arm of your HRT until you can access an appointment to have your coil replaced.