I am a doctor with over 25 years experience in many areas of general medicine. I became a Sexual Health Consultant in 2008. I am also a menopause specialist.

My focus has always been to improve the outcomes and wellbeing of my patients and this has led me to an increasingly integrative approach, combining the latest science in medicine, nutrition but also neuro-biology, mindset and stress management.

I find the most rewarding way to achieve optimal health long term is through a triad of nutritional and bio-identical hormone interventions alongside nourishing our minds and prioritising self-care.

Balanced Hormones- personalised plan

.

Your Personalised food plan

Your Self-care plan

Why Hormone harmony?

Hormones work together and influence each other’s functions continually. Stress hormones can impact sex hormones and thyroid function. Insulin and sugar metabolism can also impact sex hormones and vice-versa- a lack of sex hormones can contribute to weight gain. They are like an orchestra- when they are all working in harmony we feel optimal.

My advice focuses on optimising and balancing all hormones (not just estrogens) alongside lifestyle recommendations, such as food plans, targeted supplements and advice on self care, including relaxation techniques and movement/exercise.

The peri-menopause and menopause are times of significant hormonal changes and may result in a range of symptoms such as hot flushes, weight gain, sleep and mood disturbances as well as being linked to an increased risk of heart disease, bone and muscle mass loss and increased risk of cognitive decline.

Our life span has increased dramatically, yet evolutionary we have not adapted and menopause still occurs in our early 50’s, leaving us for decades in a state of hormone deficiency. Our environment has changed too, and stress and environmental toxins have a huge impact on our hormones.

Bio-identical/ body-identical hormones are chemically identical to the hormones our own bodies produce, with a molecular structure that is an exact match of the hormones found in the human body. Bio-identical hormones are derived from pre-cursors found in soya beans and yams and undergo further transformation in a lab to become identical chemically with body’s own.

Hormone harmony > more than HRT

HRT vs BHRT- a brief history and current practice

Bio-identical hormones (BHRT) are hormones with the same structure that the body makes naturally. When hormones become imbalanced, there are many physical and emotional symptoms.

HRT

Conventional HRT is defined as estrogen replacement therapy, licensed for the management of hot flushes (vasomotor symptoms) and used in the management of osteoporosis.

However, hormone deficiency impacts our mood and brain functioning and psychological complaints largely outweigh hot flushes in the patients I see.

Conventional HRT means estrogen replacement therapy, which may indeed use the human-like estradiol

As estrogens increase the lining of the womb, giving them alone has been shown to cause endometrial cancer (cancer of the lining of the womb). Therefore, if you have a uterus, in order to protect it, you will be recommended a progestin/progestogen - a synthetic progesterone-like drug. Some gynaecologists still lament on the easier menopause management in women with hysterectomies (the removal of the uterus), which makes for “much easier menopause management”. Progestins have a higher risk of breast cancer. More recently, natural progesterone has been recognised as safer and better tolerated and is increasingly being prescribed to protect the lining of the womb by most menopause specialists.

Therefore, there are now licensed hormones that are identical with the ones we naturally produce (bio-identical/body-identical), which come in a variety of doses (for estradiol) and one licensed natural progesterone in a fixed dose capsule of 100mg.

These medications containing human-like hormones are essentially licensed bio/body identical hormones that have been through a process of clinical trials and are now approved and have thankfully become the preferred method of menopause treatment in most menopause centres for the past few years. But this has not always been so.

Bio-identical hormones have however existed for a long time (natural progesterone was first made in 1947!). As there were no licensed alternatives for a long time, they were made in compounding pharmacies. Their use is sometimes criticised as they are not made by a pharmaceutical company and they have not undergone ‘rigorous clinical trials’. However, they have been used for decades, at a time when conventional guidelines advocated equine estrogens and synthetic progestins, which have since been shown to increase risks of breast cancer, stroke, hypertension and have now thankfully been largely abandoned in favour of human-like hormone use.

In some ways, conventional medicine has now caught up with the BHRT way of practice, acknowledging that transdermal estradiol is safer than oral estradiol and natural progesterone (micronised oral tablets) is safer and better tolerated than their synthetic counterparts the progestins.

The fact that a medication is licensed does not always mean it is 100% safe and indeed the licensed equine estrogens used previously on a large scale have now been largely discontinued.

The use of human identical hormone therapy has now gained almost universal recognition as being the safest way forward using available licensed products.

How I work

Functional hormone therapy aims for optimal hormone balance across the whole hormone circle (steroid hormone pathway). It aims not just to replace estrogen . For example, it takes into account the benefits of progesterone not just in protecting the lining of the womb but also the role of progesterone on the brain and mood (calming and anxiety relieving). It also aims to achieve optimal levels of testosterone and looks at optimising stress, by acknowledging the influence of cortisol on disrupting hormone balance.

My focus is holistic and, to achieve it, I spend time with my patients understanding both their medical and emotional symptoms.

We take stock of current diet and lifestyle habits and we agree on a plan that includes food and self-care interventions.

We assess all the hormones in the pathway and aim to achieve balance. Sometimes we can do this using available licensed estradiol and progesterone preparations and I will certainly discuss this first.

Other times, when those are not tolerated or smaller doses are required, I may prescribe dose-adjusted compound bio-identical hormones; Compound pharmacies are regulated by the General Pharmaceutical Council and are often used by hospitals to make smaller doses for people with special circumstances.

Personalised medicine often recognises that the “one-size fits all” approach does not work for everyone and I think it is important to have the knowledge to make our own decisions when it comes to our own health.

What I treat:

Menopause

Perimenopause

Pre-menstrual syndrome

Polycystic Ovarian syndrome

Chronic Fatigue

How I work

I like to spend time with my patients. It’s not just HRT…

During the initial 1 hour consultation we go through your full medical history and take stock of all the physical and emotional symptoms that you may have as well as lifestyle factors- nutrition, exercise, sleep and relaxation. We do the initial tests. At review, usually 1-2 weeks later we review the results and issue a prescription, which may include licensed or unlicensed preparations (I will discuss all options available). I aim to optimise hormone levels across the board and meet you where you are to begin implementing sustainable lifestyle changes.

You will leave with a clear hormone plan, a food plan and a self care plan.

Further reviews happen at different intervals, usually on a six monthly basis.

Tests: 

I may recommend blood tests to determine exactly what hormone imbalances are affecting you or, if you are not feeling well balanced on the current hormone treatment.

More detailed hormone tests are also available and everyone looking to optimise their wellbeing may benefit from a detailed analysis of their hormone profile in my opinion. I favour the DUTCH test -Dried Urine Test for Comprehensive Hormones- which also includes detailed estrogen metabolism tests. This test (only available privately) may be particularly useful if you have a family history of breast cancer or suffer with severe fatigue or stubborn weight gain or simply if previous conventional HRT has not worked out for you so far; these tests will be discussed with you at the time of consultation.

If you would like however to consider testing ahead of your consultation, please enquire below.

Other tests

Monitoring with a pelvic ultrasound is usually required every 2 years for safety monitoring. Blood tests monitoring may also be required (if you don’t feel balanced).

Mammograms are also recommended, usually as part of NHS screening or more often, on a case by case basis. Thermograms can be discussed also.