Menopause services

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 specialist advice to women who are in menopause from 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 few centres in the country to offer a hormone implant service.

Location

Birmingham Women’s Hospital

The menopause service is located in the Gynaecology OutPatient Department, on the ground floor, to the right of the main entrance.

Contacts

Birmingham Women’s and Children’s NHS Foundation Trust

To reschedule an appointment:
0121 335 8102

Advice to GPs before referral

Clinical advice on treatment of menopause.

• BMS Tools for Clinicians
• WHC Factsheets

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 outpatient 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. I am concerned regarding the 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 useful advice for you and your GP on equivalent HRT.

Q. I have had some bleeding while on HRT – what should I do?

A. 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 in women not on HRT.

If you are on a sequential (cyclical) HRT then we expect you to have a regular bleed, so do not be concerned.

If you have been commenced on a sequential (cyclical) HRT or a continuous combined (no bleed) HRT preparation 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 your last period) and have started bleeding.

It is likely your GP will arrange for you to be referred to the Birmingham Women’s Hospital for a pelvic ultrasound scan. This may be with or without a biopsy of the womb lining to rule out any problems.

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 continuously). 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 sequential (cyclical) intake of progestogen.
• For sequential (cyclical) HRT regimens: increase progestogen dose (e.g. Utrogestan 300 mg for 12 days a month instead of 200 mg) or increase the duration of progestogen intake (can take progestogen for 14 days a month or 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 your 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?

A. Most side effects from HRT are transient (e.g. mild headaches, nausea, bloating, breast tenderness) and while unpleasant they aren’t serious 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 you at your next follow-up appointment. 

Serious symptoms which may need you to stop the HRT are:

• New onset migraine or increase in the frequency of migraine
• Leg/calf pain or swelling

If you notice migraines starting/increasing then this would normally mean you are having fluctuating oestrogen 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 you are seen in the 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. If you are on HRT stop this until you have had it confirmed that you do not have a blood clot in the leg. Once this is confirmed,  you can restart the HRT.

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 of utrogestan daily to act as the progesterone arm of your HRT until you can access an appointment to have your coil replaced.