HRT monitoring is a clinical review, not a blood timetable

You have usually arrived here because someone said HRT has to be monitored, and you pictured a regular blood panel that would prove the dose is right. That picture is how people book a laboratory visit when they needed a doctor to ask how they are, and how they delay a review while waiting for a kit to come back.

Monitoring hormone replacement therapy at Medical Express Clinic is a GP consultation with Dr Penny Sheehan, GMC 6056535, at 117a Harley Street on Mondays and Wednesdays. You can book without a referral. History and any suitable recent results are reviewed before new tests or a prescription, and a prescription is not guaranteed at the first visit.

Is this visit for starting, transferring or monitoring HRT?

The question in the room 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.

Those three jobs share a diary because they are all GP prescribing work, not because they are the same conversation.

Dr Sheehan takes the history, including any previous HRT, current medicines and the symptoms you want help with, and looks at any recent blood results she judges suitable. Treatment, if it is offered, is individualised. Some women leave with a different plan, or with no hormone treatment at all. Wanting HRT does not make a prescription automatic.

If what you mainly want is symptoms sorted, or the comprehensive menopause health screen with DEXA, a mammogram, spirometry, Seca body composition and bundled bloods, this is the wrong booking. That wider midlife assessment lives on the menopause clinic page.

Why is monitoring clinical, not a laboratory timetable?

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

NICE menopause guidance is public on diagnosis. In otherwise healthy women over 45 with typical symptoms, FSH is not required to diagnose menopause. The same guidance identifies perimenopause, without laboratory tests, in otherwise healthy women aged 45 or over who have recently started vasomotor symptoms and any change in their menstrual cycle. It identifies menopause, again without laboratory tests, if they have not had a period for at least 12 months and are not using hormonal contraception.

That is not an anti-test slogan. Hormone levels fluctuate during perimenopause, so a single blood result does not diagnose menopause and does not, on its own, prove a dose is right. NHS pages say it can take time to find the right type and dose, and that you should talk to a doctor if treatment is not helping.

NICE does consider serum FSH in people aged 40 to 45 with menopause-associated symptoms including a change in menstrual cycle, and in people under 40 in whom menopause is suspected. Even then, a single result is not enough to diagnose premature ovarian insufficiency.

What if you already have a prescription from another clinic?

Bring the current prescription and any recent blood results that are still useful. After that review Dr Sheehan decides whether to continue, adjust or stop. A previous prescription does not guarantee that the same regimen will be repeated.

A transfer is not an administrative reprint. It is a clinical review of the medicine you are taking, how you have responded, and whether that plan still fits. Some women continue on the same patches or gel, some change dose, route or progestogen, and some stop because the original indication has changed or the balance of benefit and risk no longer looks right. New tests, if needed, are chosen for the decision in front of her rather than copied from another clinic's last panel.

What may be discussed if treatment is appropriate?

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 is indicated. NHS pages describe daily tablets, patches changed once or twice a week, gel on the skin, and progestogen with oestrogen to protect the lining if a womb is present. Treatment is individualised, so a friend's preparation is not automatically yours.

NICE asks clinicians to talk about combined versus oestrogen-only HRT, transdermal versus oral HRT, types of oestrogen and progestogen, sequential versus continuous combined regimens, and dose and duration, tailored to age, circumstances and risk. Combined HRT is the usual discussion if you have a uterus, and oestrogen-only HRT after a total hysterectomy. Transdermal oestrogen is often discussed when venous thromboembolism risk is higher. NICE notes that VTE risk is increased with oral HRT and is not increased with transdermal HRT.

Testosterone is considered where clinically indicated, including, in NICE guidance, for low sexual desire associated with menopause if HRT alone has not been effective. It is not a routine add-on. If HRT is not the right treatment, non-hormonal options may be discussed instead.

When are blood tests used?

Blood tests are chosen by the doctor when they are needed, not as a fixed package on every visit, and they are not included in the consultation unless they already sit inside a booked screen. When indicated, tests may include oestradiol, FSH, progesterone, testosterone, liver function tests, lipids, thyroid function and a full blood count. Those results help decide whether a prescription, a change of dose or a different plan is appropriate. A blood result is not a diagnosis on its own.

Women often expect oestradiol at every review, as if a target range were the whole of monitoring. That is not how this clinic works. Oestradiol can still matter for absorption from a gel or patch, and FSH can still 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 symptoms. Bring recent work if you hold it; new tests that would change the plan can be arranged here.

How soon is follow-up?

HRT, once started, still needs review for dose, for results, and for a prescription to be adjusted when that is still appropriate. How soon you return depends on how you are and what the doctor needs to check. 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.

A woman who is newly started, still bleeding in a way that needs watching, or struggling with side effects is not in the same place as a woman stable on a well-tolerated patch. NICE treats the review as a look at efficacy and tolerability, and as a chance to talk again about benefits and risks of continuing, rather than as a laboratory appointment because the calendar turned.

When is this GP clinic the wrong booking?

Postmenopausal bleeding, heavy or irregular bleeding, or pelvic pain needs a gynaecology assessment: at Medical Express Clinic with Dr Hikmat Naoum, Consultant Gynaecologist. Any bleeding after the menopause should be checked promptly. For menopause care itself, the sister clinic also runs a specialist menopause service.

New, severe or rapidly worsening symptoms need same-day GP or emergency assessment, not a booked Monday or Wednesday HRT slot. Sudden chest pain, collapse, or bleeding that is heavy enough to worry you now is not a reason to wait for Harley Street.

DEXA, mammogram, spirometry, Seca body composition and bundled screening bloods are not part of a standard HRT consultation. If that bundled baseline is what you wanted, the menopause assessment named above is the right booking.

What helps beforehand?

Write down what has changed since the last prescription.

• Sleep, flushes, mood, bleeding, breast tenderness and how you use the patch, gel or tablet are the monitoring.
• Bring the current prescription if you have one, recent blood results if you already hold them, and a medicine list that includes anything you take for the heart, blood pressure, clotting or breast disease.
• Those facts change both safety and which preparations can be discussed.
• Say whether you still have a uterus, whether you have had a hysterectomy, and whether you are still having periods.
• Combined and oestrogen-only regimens are not interchangeable.
• If you are under 45, say your age at the start.
• If the main wish is a wider midlife screen rather than the prescription itself, say that when you book so you are not in this diary by accident.

What should you avoid?

Do not treat a single FSH or oestradiol result as a diagnosis or as proof that a dose is right.

• Do not arrive without the prescription you already hold and then expect the same regimen to be copied from memory.
• Do not assume a previous clinic's panel will be repeated as a package on every visit here.
• Do not book this HRT slot because you wanted DEXA, a mammogram, spirometry, a Seca scan or bundled screening bloods.
• Do not bring heavy, irregular or postmenopausal bleeding, or pelvic pain, into this GP clinic and expect consultant gynaecology.
• Do not use a planned HRT review for new, severe or rapidly worsening symptoms.
• That is same-day GP or emergency care.
• If you do want HRT started, transferred or monitored, Medical Express Clinic sees women with Dr Penny Sheehan at 117a Harley Street on Mondays and Wednesdays, without a referral.
• A prescription is not guaranteed at the first visit.
• The details sit on the HRT clinic page, or you can call 020 7499 1991.

Related guides: whether you need a blood test before a menopause appointment and whether to see a GP or a gynaecologist first.