In short
This is the part of the clinic that deals with perimenopause, menopause and female hormone problems.
- Transdermal 17-beta oestradiol is the usual first choice, because it carries a lower clot and stroke risk than tablets.
- Micronised progesterone is preferred over older synthetic progestins.
- Compounded hormones and saliva testing are not used.
For a healthy woman under 60 or within 10 years of her last period, the benefits of treatment outweigh the risks. That is the group this clinic is built for.
Who This Service Is For
Who is this clinic for?
Women whose symptoms have started to interfere with sleep, work or relationships, and who want a plan rather than reassurance.
- Perimenopause. Cycles changing, flushes starting, mood shifting, and still needing contraception
- Menopause. Twelve months past the last period, with symptoms that have not settled
- Already on treatment. A prescription that has been repeated for years without anyone re examining the dose
- Hormone problems before menopause. Irregular cycles, high prolactin, PCOS, or periods stopping before 40
- On compounded hormones. Wanting to move to a regulated equivalent at a known dose
Who is it not for?
Hormone therapy is not used where there is a history of breast cancer, coronary heart disease, stroke, a previous clot, active liver disease, or unexplained vaginal bleeding that has not been investigated.
Where that applies, non hormonal treatment is still available and still works. What is not on offer is a way around a contraindication.
Why does this clinic exist?
Because menopause care fell off a cliff after 2002 and has never recovered. Hormone therapy use fell from 27 per cent of women in 1999 to 4.7 per cent by 2020.
Training followed. In one survey of final year internal medicine and obstetrics residents, 30 to 50 per cent said they felt not at all prepared to manage menopausal women, and half could not identify the right treatment for a 52 year old with severe symptoms.
Treatment Programs Under This Pillar
Why Physician-Led Care Matters
What does physician led mean here in practice?
It means the decisions that carry risk are made by a doctor who has calculated your risk, and it means some things are refused.
Risk is calculated before, not after
Cardiovascular and breast cancer risk are worked out before hormones are started, because they decide the route and sometimes the answer.
- Moderate cardiovascular risk, 5 to 10 per cent over 10 years, means transdermal rather than oral oestrogen
- High cardiovascular risk over 10 per cent, or breast cancer risk above 1.67 per cent over five years, means non hormonal treatment is suggested instead
Dose is set by symptoms, not by numbers
Treatment starts low, usually transdermal oestradiol 0.025 mg twice weekly or oral 0.5 mg daily, and goes up only if flushes persist past three to four weeks.
Endometrial protection is not negotiable
If you still have a uterus, a progestogen is added. Hyperplasia can develop after as little as six months of unopposed oestrogen. The form can be changed, the protection cannot.
Some things are declined
- Custom compounded hormone mixtures, which had potencies ranging from 67.5 to 268 per cent of label when tested
- Saliva hormone monitoring to steer doses
- Routine testosterone for women without a specific indication
- Quarterly progestogen regimens at standard oestrogen doses, which do not protect the womb lining adequately
How the Consultation Works
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1
The history
How your cycles changed, which symptoms bother you most, and what you have already tried. In perimenopause this is worth more than any hormone level, because levels swing week to week and can look normal on a good month.
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2
The risk calculation
Cardiovascular and breast cancer risk are worked out before anything is prescribed, along with screening status and any contraindication. These decide the route and sometimes the answer.
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3
Targeted testing only where it helps
Hormone therapy is dosed by symptoms. Where cycles have stopped or become irregular before menopause, a short panel is used instead: pregnancy test, prolactin, TSH, FSH and oestradiol, with androgens where PCOS is in the picture.
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4
The plan and the first review
A named dose, a named preparation, a clear answer on endometrial protection, and a review at three to four weeks, which is when hot flush relief should be showing.
Frequently Asked Questions
For a healthy woman under 60 or within 10 years of her last period, the benefits outweigh the risks. Over five years starting between 50 and 59, combined therapy means about three extra breast cancers per 1000 women against five fewer deaths from any cause.
Through the skin for most women. Transdermal oestradiol avoids the liver first pass and carries a lower risk of clot and stroke. It showed no excess clot risk even in women with a clotting mutation or a high BMI.
No. Both the Menopause Society and ACOG say the decision should be individualised and not made on age alone. Over 40 per cent of women aged 60 to 65 still have disruptive flushes.
Yes, the regulated kind. 17-beta oestradiol and micronised progesterone are both bioidentical and both are first choice here. What is not prescribed is a custom compounded mixture.
During perimenopause, yes. Oestrogen improves mood symptoms in the transition but not after menopause. Where mood and flushes are both severe, both hormone therapy and an SSRI are often needed.
Yes. Standard hormone therapy is not contraception and you need it until 12 months without a period. A low dose pill or a hormonal coil can cover symptoms, contraception and heavy bleeding together.
There are effective non hormonal options, including SSRIs, gabapentin and the newer neurokinin 3 receptor antagonists. What is not recommended by the Menopause Society is supplements, soy, acupuncture, cannabinoids or paced breathing.
Dubai Healthcare City. Consultations are in English and German.
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.
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.