GYNAECOLOGY
Changing periods, hot flushes, disrupted sleep or vaginal discomfort can affect work, relationships and how you feel day to day. You do not need to work out whether the cause is hormonal before booking. We look at the pattern, consider other explanations where needed and agree what may help.
UNDERSTANDING THE TRANSITION
Hormone levels fluctuate during the transition towards menopause. Periods may change and symptoms can begin while you are still menstruating. You do not have to wait until your periods stop to discuss treatment.
Menopause is usually recognised after 12 months without a period, when you are not using hormonal contraception and there is no other explanation. Hormonal treatment or hysterectomy can make this less straightforward. Symptoms may continue afterwards.
Hot flushes, night sweats, changes in sleep, mood or concentration, vaginal discomfort and sexual concerns can affect people differently. We consider other possible causes too; not every new symptom is due to menopause.
START WITH WHAT MATTERS TO YOU
Explore a change you recognise or a treatment you are considering. More than one concern may apply, and you can book even if you are unsure.
UNDERSTANDING YOUR OPTIONS
Your symptoms, medical history and preferences guide the choice. Different treatments have different roles, and some can be used together.
When usual treatments are unsuitable or have not helped, we can discuss further options. In selected circumstances, access to an unregistered medicine may be considered through SAHPRA’s Section 21 process. This requires individual assessment and regulatory authorisation; approval and supply are not guaranteed.
Pregnancy may still be possible during perimenopause. HRT does not provide contraception. We consider bleeding and contraception together so your plan addresses both.
YOUR CONSULTATION
We discuss what is affecting daily life, your period pattern, medicines, relevant medical and family history, and any treatment already tried. Your priorities and preferences help shape the plan.
Tests are chosen for your circumstances; unusual bleeding needs its own assessment. If an examination would help, we discuss it first. You can pause or stop the examination.
We agree what improvement would mean for you, what to try next and how to review the response. Treatment is usually reviewed around three months, then annually, with earlier review for problems.
If a previous treatment has helped only partly or caused side effects, that is part of the discussion. A review can consider what needs adjusting and whether another cause should be explored.
Back to contents ↑VAGINAL, SEXUAL & PELVIC HEALTH
Vaginal tissue changes, bladder problems and pelvic floor symptoms can occur together. My urogynaecology background helps me assess how they relate and which need their own treatment. Discomfort with sex, recurrent urinary symptoms or a feeling of a bulge are all worth discussing.
WHEN MENOPAUSE HAPPENS EARLIER
If menopause may be happening before 45, seek assessment. Before 40, premature ovarian insufficiency (POI) is one possible cause. Removal of both ovaries or some cancer treatments can bring menopause forward or make it abrupt. Hysterectomy with the ovaries retained does not necessarily cause immediate menopause.
After ovarian surgery or cancer treatment, bring the treatment record. We consider symptom relief, fertility where relevant and a plan coordinated with your treating team. Hormone suitability depends on the treatment and cancer type.
LOOKING AFTER YOUR HEALTH OVER TIME
We can consider bone health, physical activity, cardiovascular risk and appropriate screening alongside symptom treatment. The aim is to identify what matters for your health and agree which checks or further input would be useful.
COMMON QUESTIONS
Yes. Perimenopausal symptoms can occur before periods stop. Treatment can be considered during this time, with attention to your bleeding pattern and contraception needs.
You do not need to arrange hormone tests before booking. In otherwise healthy people aged 45 or over, symptoms and menstrual history usually guide diagnosis without routine hormone panels. Tests may be helpful at younger ages or to investigate other explanations.
You can still seek help. We discuss non-hormonal options and treatments directed at particular symptoms. A history such as breast cancer needs an individual discussion about what is appropriate.
Yes. A review can consider symptoms that persist, side effects or questions about continuing treatment. Bring the names and doses of what you use, if possible.
A note of your main concerns, period pattern, medicines and previous treatments can help. Bring relevant results if you have them. A detailed diary or a new set of tests is not required to book.
YOUR NEXT STEP
Book if symptoms are affecting your life, you are uncertain about the changes, or you want to review treatment. You can bring questions without committing to hormone therapy.
Consultations in Claremont, with additional appointments in Simon’s Town on selected Mondays. Reception will confirm your date, time and venue.
General information to support your consultation. Your assessment and treatment plan are individual. Content updated .
Further reading: NHS: menopause and perimenopause · NICE: menopause guidance · The Menopause Society: hormone therapy · BMS: bleeding on HRT · SAHPRA: Section 21 access guidance