In short
An HRT consultation decides whether hormone therapy is right for you, which preparation, and at what risk. Over the age of 45 the diagnosis comes from your cycle pattern and your symptoms. A hormone blood test adds nothing and can mislead, because levels swing wildly during the transition. The work of the appointment is your personal risk: breast cancer history, clots, stroke, heart and liver disease, and whether you still have a womb. That decides the route as much as the answer. You should leave with the absolute numbers for your age group, not a general reassurance.
Treatment Overview
What does this appointment decide?
Four things, in order: whether your symptoms are menopausal, whether hormone therapy is safe for you, which preparation fits, and what you are actually taking on.
It is deliberately not a prescription visit with a questionnaire attached. Most of the time is spent on the second and fourth points, because that is where the decision is really made and where most women arrive with either too much fear or too little information.
Why are hormone blood tests not used?
Because over the age of 45 a hormone test adds nothing to the diagnosis and can point the wrong way.
The diagnosis of the menopause transition in a woman over 45 is made from irregular cycles plus symptoms such as hot flushes, mood change or disturbed sleep. No further testing is suggested. FSH is often measured anyway, and it offers no additional information and may be misleading.
The reason is the biology. During the transition, FSH and oestradiol swing dramatically from week to week. A single sample can look fully menopausal, and a sample taken soon afterwards can be back in the normal premenopausal range. AMH, antral follicle count and day-three FSH are used to assess ovarian reserve in fertility care, but none of them is validated for working out menopausal status.
Testing is appropriate at other ages, and that is a different question: between 40 and 45 the same evaluation as for any woman with irregular cycles applies, including hCG, prolactin, TSH and FSH. Under 40, a full assessment for primary ovarian insufficiency is needed.
Blood tests are still done at this appointment, but for a different purpose: blood pressure, cholesterol, glucose, thyroid, liver function and iron form the baseline against which treatment is judged and pick up the conditions that mimic menopause.
Who is a candidate, and who is not?
The group where the balance is clearly favourable is healthy women with moderate to severe symptoms who are within ten years of their last period, or under 60, according to the 2022 position statement of the Menopause Society.
The exceptions are specific rather than vague. Hormone therapy is not prescribed, or is prescribed only after specialist input, in the following situations:
- A personal history of breast cancer. Systemic oestrogen is not used, and symptoms are managed by other routes.
- Coronary heart disease, or a previous heart attack.
- A previous blood clot in a vein or lung, or a previous stroke.
- Active liver disease.
- Unexplained vaginal bleeding, which is investigated first.
- Age 65 or over and starting for the first time, which the American Geriatrics Society advises against. From 70 it is avoided.
Two things that are commonly assumed to rule women out, and do not: migraine, with or without aura, is not a contraindication, and for women whose migraines worsen in perimenopause a continuous transdermal regimen often improves both. A family history of breast cancer does not by itself exclude treatment, although it raises the baseline risk against which the same relative risk is applied.
How is the preparation chosen?
By your risk profile first, then your preference. All routes relieve hot flushes equally well, so effectiveness does not decide it.
| Finding | What it means for the preparation |
|---|---|
| Womb still present | A progestogen is needed alongside the oestrogen. This is not optional |
| Hysterectomy | Oestrogen alone, no progestogen |
| Raised triglycerides, gallbladder disease, migraine, or a clotting tendency | Skin route rather than tablets |
| Only vaginal dryness and discomfort, no flushes | Local vaginal treatment rather than systemic hormone therapy |
| Menopause before 40, or both ovaries removed young | Higher doses, and treatment planned to continue to around age 50 |
| Still having periods, even irregularly | A cyclical regimen, and the contraception question has to be settled |
A patch or gel through the skin is the usual first choice, with micronised progesterone alongside it if you still have a womb. The preparations compared.
Hormone therapy is not contraception. In perimenopause you can still conceive. What that means in practice.
What numbers should you be given?
The absolute figures for your age group, expressed as cases per 1,000 women over five years, not as percentages of a percentage.
The difference matters. A statement that a treatment increases breast cancer risk by a quarter sounds very different from three extra cases per 1,000 women over five years, which is under one per 1,000 a year, and both describe the same Women’s Health Initiative finding. The second is the one you can actually weigh against your symptoms.
For a healthy woman starting in her fifties the absolute numbers are small, and they differ for oestrogen alone and oestrogen with a progestogen. The risks in absolute numbers.
You should also be told what is not known. The figures come from an older regimen and are applied to a newer one that may be safer, and that uncertainty belongs in the conversation rather than being smoothed over.
When is the answer no, or not yet?
When the symptoms have another cause, when a contraindication is present, or when something needs investigating first.
Thyroid disease, iron deficiency, sleep apnoea, depression and anxiety all produce symptoms that overlap with the menopause transition, and all are treatable in their own right. Unexplained bleeding is investigated before any hormone is prescribed, not alongside it.
Where hormone therapy is not appropriate, that is the start of a plan rather than the end of the appointment.
Where oestrogen is not an option, the tested alternatives are specific antidepressants, gabapentin and the newer neurokinin blockers, not supplements. The nonhormonal options.
What happens after the consultation?
You leave with a written plan, a first review date and a clear description of what to expect in the first three months.
Where treatment starts, the first review is at three months, for dose, bleeding pattern, blood pressure and tolerance. After that the cycle is annual.
Treatment is reviewed once a year, and stopping is planned rather than abrupt. What the yearly review covers.
Contact between appointments runs through the membership programmes.
Menopause assessment in Dubai and the UAE
What about the hormone panels sold here?
Direct-to-consumer hormone panels are widely available in Dubai, and for a woman over 45 with menopausal symptoms they will not answer the question she came with.
A single FSH and oestradiol result during the transition reflects the week it was taken. It cannot confirm the menopause, it cannot predict when the last period will come, and it cannot be used to set a hormone dose. Where such a panel has already been done, it is read in that light rather than ignored, and it is not repeated to settle the diagnosis.
Saliva hormone testing, which some clinics use to steer dosing, is a separate problem and is not used here.
Compounded hormone mixtures and saliva testing are not used here, and the reason is not brand preference. What is wrong with compounded hormones.
Coming from another health system
Many women in the UAE have had part of their menopause care somewhere else, and bringing the records matters more than repeating the tests.
What is useful: what you have taken, at what dose and by which route, for how long, why it was changed, your last mammogram and its result, and any bleeding investigations. With that, the assessment can move straight to the decision rather than starting again.
If you are currently taking hormone therapy prescribed abroad and are travelling with it, the ministry permit rules for controlled and semi-controlled medicines apply. What the permit needs.
Not sure your symptoms are menopause? The 2-minute menopause self-check scores them first. Periods still coming: perimenopause treatment.
Who Is a Good Candidate?
- Women over 45 with hot flushes, night sweats, disturbed sleep or mood change and irregular or absent periods.
- Women who want the actual risk figures for their age group before deciding, rather than a general reassurance.
- Women already on hormone therapy who want the preparation, the dose and the ongoing need reviewed.
- Women who have been told they cannot take hormone therapy and want that checked properly.
- Unexplained vaginal bleeding: this is investigated before any hormone is prescribed.
- A personal history of breast cancer, coronary heart disease, a previous clot or stroke, or active liver disease.
- Women under 40 with irregular or absent periods: this needs a full assessment for primary ovarian insufficiency, not a menopause consultation.
- A request for compounded hormones, pellets or saliva-guided dosing: not offered.
What Happens During the Consultation
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1
Symptoms and cycle pattern
Which symptoms, how severe, what they cost you in sleep and function, and how your cycles have changed. Over 45 this is what makes the diagnosis.
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2
Your personal risk
Breast cancer in you and your family, clots, stroke, heart disease, liver disease, migraine, blood pressure, smoking, weight, and whether you still have a womb. This decides route as much as it decides yes or no.
-
3
Examination and baseline tests
Blood pressure, weight and waist, breast and pelvic examination as appropriate, plus baseline bloods: thyroid, glucose or HbA1c, lipids, liver, kidney and iron. Not a hormone panel.
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4
The decision, with the figures
The absolute numbers for your age group and the proposed regimen, the alternatives if hormones are not suitable, and a written plan with the first review date.
Program Structure & Follow-Up
How long does it take to get an answer?
Usually one appointment, because the diagnosis does not wait on a laboratory:
- The appointment itself: history, examination, the risk discussion and, in most cases, the decision.
- Baseline bloods: taken around the visit, to establish the starting point and exclude the look alike conditions.
- Three months: first review of dose, bleeding and tolerance.
Where something needs investigating first, such as unexplained bleeding, that step comes before any prescription and the timing follows it.
Can you change your mind?
Yes, in both directions, and neither decision is permanent. Women who decide against treatment can come back if symptoms worsen. Women who start and dislike it can stop, although stopping abruptly usually brings symptoms back quickly, so a planned reduction is easier.
Treatment is reviewed once a year, and stopping is planned rather than abrupt. What the yearly review covers.
Benefits, Limits & Safety
What this consultation cannot do
It cannot tell you when your last period will be, and it cannot predict how long your symptoms will last. No test does either. Symptoms last a median of 7.4 years in total across the transition, but the spread around that is wide and the individual course is not predictable.
Why some women are put on treatment they do not need
Because a symptom list plus a low hormone reading looks like a diagnosis and is not one.
Tiredness, weight change, low mood and poor concentration are common in midlife and have many causes. Where a hormone panel is run and comes back low, as it often will during the transition, the two are joined up and a prescription follows. The symptoms that actually respond to oestrogen are specific: hot flushes, night sweats, the sleep disruption they cause, and vaginal dryness.
What is not offered here
Compounded hormone mixtures, implanted pellets and dosing steered by saliva or blood hormone levels are not used, and the reason is the evidence rather than preference.
Compounded hormone mixtures and saliva testing are not used here, and the reason is not brand preference. What is wrong with compounded hormones.
What you get from the appointment
A clear answer on whether your symptoms are menopausal, whether hormone therapy is safe for you, which preparation fits, and the absolute risk figures for your age group in writing.
What is actually tested
Blood pressure, weight, and baseline bloods including thyroid, glucose, lipids, liver, kidney and iron. Not FSH or oestradiol, which do not help over the age of 45.
When the answer is no or not yet
A personal history of breast cancer, coronary heart disease, a previous clot or stroke, active liver disease, or unexplained vaginal bleeding that has not been investigated.
Cost & Program Investment
The consultation covers the history, examination, baseline blood tests and the written plan, and what that comes to is set out before anything is booked. Where treatment follows, the cost of the preparation and the reviews is explained at that point. Ongoing care runs through the membership programmes.
Frequently Asked Questions
Not to make the diagnosis. Over the age of 45, the menopause transition is diagnosed from irregular cycles plus symptoms, and a hormone test adds nothing and can mislead, because FSH and oestradiol swing from week to week. Baseline bloods are still done, for thyroid, glucose, lipids, liver, kidney and iron.
Because during the transition a single sample can show high FSH and low oestradiol, consistent with menopause, and a sample soon afterwards can be back in the normal premenopausal range. AMH and antral follicle count are used for ovarian reserve in fertility care but are not validated for menopausal status.
Between 40 and 45 the same evaluation applies as for any woman with irregular cycles, including hCG, prolactin, TSH and FSH. Under 40, irregular or absent periods with menopausal symptoms need a full assessment for primary ovarian insufficiency, which is a different pathway.
By your risk first. Raised triglycerides, gallbladder disease, migraine or a known clotting tendency point to the skin route. For a healthy woman with none of those, a tablet is a reasonable choice if she prefers it. Both relieve hot flushes equally well, so the choice is about safety, not effectiveness.
If you still have a womb and you are taking systemic oestrogen, yes, because oestrogen alone thickens the womb lining. If you have had a hysterectomy, no. If you are using only low-dose vaginal oestrogen for dryness, no.
Then systemic hormone therapy is usually not the answer. Dryness and discomfort are treated locally, starting with a moisturiser and lubricant and moving to low-dose vaginal oestrogen if that is not enough. No progestogen is needed with low-dose vaginal oestrogen.
A family history does not by itself rule it out. A personal history of breast cancer does. A family history raises your baseline risk, so the same relative effect translates into a larger absolute number, and that is part of the discussion rather than an automatic no.
No. Migraine, with or without aura, is not considered a contraindication. For women whose migraines worsen during perimenopause, a continuous transdermal regimen often improves both the migraines and the flushes, and avoids the withdrawal headaches a cyclical regimen can trigger.
Then the plan moves to the tested nonhormonal options, which are specific antidepressants, gabapentin and the newer neurokinin blockers, plus local treatment for dryness. Herbal supplements, soy and acupuncture are not among the options the Menopause Society recommends.
No. There are no randomised trials of their efficacy or safety, and their contents, dose, quality and sterility are not subject to regulatory oversight. Regulated body-identical oestradiol and micronised progesterone are available and are what is prescribed here.
No. The dose is set by whether your symptoms are controlled and whether you tolerate it. Dosing steered by hormone levels, and by saliva tests in particular, belongs to compounded hormone programmes and has no evidence behind it.
Yes, in both directions. Deciding against treatment now does not close the door, and starting does not commit you. Stopping abruptly usually brings symptoms back quickly, so a planned reduction is easier than simply stopping.
Evidence
Where this information comes from
Every figure on this page is taken from the sources below. All of them are free to read, so you can check them yourself.
- The 2022 hormone therapy position statement of The North American Menopause Society
- Treatment of Symptoms of the Menopause: An Endocrine Society Clinical Practice Guideline
- Risks and benefits of estrogen plus progestin in healthy postmenopausal women (Women's Health Initiative)
- Menopausal hormone therapy and health outcomes during the intervention and extended poststopping phases of the Women's Health Initiative randomized trials
- Duration of menopausal vasomotor symptoms over the menopause transition (SWAN)
- Compounded Bioidentical Hormones in Endocrinology Practice: An Endocrine Society Scientific Statement
- The 2023 nonhormone therapy position statement of The North American Menopause Society
- Drug Control
This page is general medical information and does not replace a personal consultation. Trial results are averages across large groups, not a prediction for any one person.