Menopause & HRT
Body-identical HRT · Testosterone · Vaginal oestrogen
Perimenopause and menopause deserve time and care. A specialist appointment with Mr Orabi looks at the whole picture — symptoms, history, preferences and any contraindications — and builds a treatment plan that fits your life.
Understanding
Menopause is when your periods stop because hormone levels fall, usually between the ages of 45 and 55. It can happen naturally or follow surgery, cancer treatment or certain medical conditions.
Perimenopause is the stage leading up to it: periods continue, but symptoms have already started. Both stages can affect daily life. The good news is that they are highly treatable, and the earlier you start a plan, the easier it usually is to manage.
Typical age
45 – 55
Symptom count
30+
Common symptoms
Hot flushes are the symptom most people associate with menopause, but they are just one of more than thirty changes patients describe in clinic. The most disruptive ones are often the least expected.
The classic vasomotor symptoms, often the first to disrupt sleep and work.
Waking at 3am is a common pattern, even without overt hot flushes.
Sudden anxiety, low mood or irritability that feels new and disproportionate.
Word-finding difficulty, lost names and difficulty concentrating at work.
Particularly in the morning, sometimes mistaken for arthritis.
Brief flutters or awareness of the heartbeat, often at rest.
Drier skin, thinning hair and more brittle nails.
Vaginal dryness, urinary urgency, recurrent UTIs.
Changes in sex drive and arousal, often distressing and treatable.
HRT explained
HRT is the main and most effective treatment for menopausal symptoms. It replaces oestrogen, with progesterone added if you still have a womb to protect the lining.
Benefits
Reduces symptoms, protects bones, and is associated with cardiovascular benefits when started near the time of menopause. Risks are small and depend on the type of HRT, your age and personal history — explored in detail at your consultation.
Patches, gels and sprays. Modern body-identical preparations derived from plant sources.
Tablets, considered alongside personal history and cardiovascular risk.
Long-acting subcutaneous implants for the right patient.
Oral micronised progesterone for womb-lining protection.
Oestrogen and progesterone in a single patch.
Intrauterine progesterone, also used for contraception and bleeding.
Symptoms can return if HRT is stopped. Plans are reviewed at three months, then yearly.
Testosterone is naturally produced in small amounts by women and falls with age. It is not the answer for everyone, but for women whose libido, mood or energy have not improved on standard HRT, a low-dose testosterone gel may help.
Testosterone for women is not currently licensed in the UK; it is prescribed off-label by specialists like Mr Orabi using evidence-based dosing. Side effects (acne, unwanted hair growth) are uncommon at the doses used.
Around half of women develop vaginal dryness, discomfort, itching or urinary symptoms after menopause — sometimes called the genitourinary syndrome of menopause (GSM).
Vaginal oestrogen comes as a small tablet, cream or ring placed in the vagina. It works only where it is applied (almost none is absorbed into the rest of the body), and it is safe to use long-term, alongside standard HRT.
Non-hormone medicines
For women who cannot or prefer not to use HRT, there are good non-hormonal options that can be combined with lifestyle and psychological support.
Clonidine (a blood-pressure medicine) or gabapentin (originally for epilepsy) can help.
SSRIs / SNRIs for true depression or anxiety, sometimes reducing flushes too.
Non-hormonal vaginal moisturisers and water-based lubricants.
Cognitive Behavioural Therapy (CBT) has good evidence for helping with low mood, anxiety, sleep problems, hot flushes and joint pain in menopause. It is available through NHS talking therapies, and Mr Orabi can guide you to appropriate local services in Jersey or via online platforms.
Lifestyle
Protein at every meal, plenty of vegetables, calcium-rich foods and stable blood-sugar choices.
Weight-bearing and resistance training for bones, plus cardiovascular work for the heart.
A regular routine, a cool bedroom, and limited screens before bed.
Vitamin D, sunlight exposure, and where appropriate a DEXA scan to baseline bone density.
Both worsen vasomotor symptoms and bone loss. Limit alcohol; avoid smoking.
Your consultation
The first appointment is one hour. We work through your symptoms, your cycle pattern, your medical history and your preferences. Where appropriate, body-identical HRT is discussed, including the difference between transdermal oestrogen and oral preparations, and the role of progesterone or the Mirena coil for womb protection.
Vaginal oestrogen for genitourinary symptoms is usually addressed at the same visit. If HRT is not right for you, the conversation moves to non-hormonal options.
Follow-up
Reviews are at three months (to check the plan is working) and then yearly. At each review we look at symptoms, side effects, bleeding pattern, weight, blood pressure and whether the type or dose of HRT still fits.
For patients in Jersey, we can liaise with your GP for ongoing shared care if you would like.