What happens at an HRT review, and when are blood tests needed?

Someone told you HRT has to be monitored, and you pictured a regular blood panel that proves the dose is right. In practice, the most useful part of monitoring is a doctor asking how you are, and listening to the answer.

At Medical Express Clinic, that's a GP consultation with Dr Penny Sheehan, GMC 6056535, at 117a Harley Street on Mondays and Wednesdays. You can book without a referral. She reviews your history and any suitable recent results before ordering new tests or writing a prescription, and a prescription isn't guaranteed at the first visit.

If you already know what you need, you can book an HRT consultation online today. It's £150, and each follow-up review is £100.

Which appointment fits your question?

This clinic is for women whose question is already the prescription: starting treatment after a conversation about symptoms and risk, moving an existing regimen from another clinic or an NHS GP, or looking again at the dose, the preparation or the side effects. All three are GP prescribing work, which is why they share one clinic.

Dr Sheehan takes a history of any previous HRT, your current medicines and the symptoms you want help with. Treatment, if it's offered, is individualised. Some women leave with a different plan, or with no hormone treatment at all.

If what you mainly want is symptoms sorted, or a full midlife baseline with DEXA, a mammogram, spirometry, Seca body composition and bundled bloods, the menopause clinic is the better choice. Those investigations sit in the comprehensive menopause health screen, at £1,599, outside a standard HRT consultation.

Why is HRT monitoring a conversation more than a blood test?

Monitoring is a clinical judgement about sleep, flushes, bleeding, side effects, and whether the benefits and risks of continuing still look right for you.

Hormone levels fluctuate, which is the key thing to understand. A single blood result can't diagnose menopause, and on its own it can't prove a dose is right either. NHS pages say it can take time to find the right type and dose of HRT, and that you should talk to a doctor if treatment isn't helping.

The same thinking runs through diagnosis: NICE doesn't require an FSH test to diagnose menopause in otherwise healthy women over 45 with typical symptoms. Our guide on whether you need a blood test before a menopause appointment explains when FSH does help. If you're under 45, say your age at the start, because NICE treats that group differently.

What if you already have a prescription from another clinic?

Bring the current prescription and any recent blood results that are still useful. Dr Sheehan reviews the medicine you're taking, how you've responded and whether the plan still fits, then decides whether to continue, adjust or stop. A previous prescription is a starting point rather than a promise of the same regimen.

Some women continue on the same patches or gel. Some change dose, the way it's taken or the progestogen. Some stop because the original reason has changed or the balance of benefit and risk no longer looks right. If new tests are needed, they're chosen for the decision in front of her, rather than copied from another clinic's last panel.

What treatments might be discussed?

When HRT is clinically appropriate, the conversation may include body-identical oestradiol with micronised progesterone, conventional HRT as patches, gel or tablets, and testosterone where it's indicated. NHS pages describe daily tablets, patches changed once or twice a week, and gel rubbed into the skin. If you have a womb, progestogen is taken with oestrogen to protect its lining.

NICE asks clinicians to talk through combined versus oestrogen-only HRT, patches and gel versus tablets (transdermal versus oral), the types of oestrogen and progestogen, sequential versus continuous combined regimens, and dose and duration, all tailored to your age, circumstances and risk. Combined HRT is the usual discussion if you have a uterus, and oestrogen-only HRT after a total hysterectomy.

One point many women find useful: NICE notes that the risk of venous thromboembolism (VTE) is increased with oral HRT and isn't increased with transdermal HRT. That's why patches or gel are often discussed when clot risk is higher, and why a friend's preparation may be quite different from yours.

Testosterone is considered where clinically indicated, including, in NICE guidance, for low sexual desire associated with menopause when HRT alone hasn't been effective. It's a specific treatment for a specific problem rather than a routine add-on. If HRT doesn't suit you, non-hormonal options may be discussed instead.

When are blood tests used?

When the doctor thinks a result would change the plan. Tests may then include oestradiol, FSH, progesterone, testosterone, liver function tests, lipids, thyroid function and a full blood count. Even then, a blood result is never a diagnosis on its own.

Each has a job. Oestradiol can matter for checking absorption from a gel or patch. FSH can matter in younger women or where the diagnosis is uncertain. Liver function, lipids, thyroid tests and a full blood count look for other conditions that can mimic menopause symptoms.

Blood tests are charged separately from the consultation, unless they're already part of a screen you've booked. If you hold recent results, bring them. Anything new that would change the plan can be arranged here.

How often should HRT be reviewed?

NICE suggests a review about 3 months after starting or changing treatment, then usually once a year, or sooner if bleeding, side effects or new symptoms need it. Each review looks at how well the treatment works and how well you tolerate it, and it's a chance to talk again about the benefits and risks of continuing. A follow-up review here is £100.

A woman who has just started, is bleeding in a way that needs watching, or is struggling with side effects needs a closer eye than someone settled on a well-tolerated patch.

Bleeding or pelvic pain: booking gynaecology here

Postmenopausal bleeding, heavy or irregular bleeding, or pelvic pain are best assessed in a gynaecology consultation, which at Medical Express Clinic is with Dr Hikmat Naoum, Consultant Gynaecologist. It's £250, or £450 with an ultrasound in the same visit. Any bleeding after the menopause should be checked promptly. Our sister clinic also runs a specialist menopause service.

New, severe or rapidly worsening symptoms need same-day GP or emergency assessment rather than a booked Monday or Wednesday review. For sudden chest pain, collapse, or bleeding heavy enough to worry you now, use emergency care straight away.

How to get the most from your review

• Write down what has changed since your last prescription: sleep, flushes, mood, bleeding, breast tenderness, and how you're using the patch, gel or tablet. That is the heart of monitoring.
• Bring your current prescription if you have one, any recent blood results, and a medicine list that includes anything for the heart, blood pressure, clotting or breast disease. These affect safety and which preparations can be discussed.
• Say whether you still have a uterus, whether you've had a hysterectomy, and whether you're still having periods, because combined and oestrogen-only regimens suit different situations.
• If what you really want is a wider midlife screen, mention it when you book. The Well Woman health check and the comprehensive menopause screen both cover more ground than a prescribing review.

For the bigger picture, read our guide on whether to see a GP or a gynaecologist first.