Most menopause care can be started and reviewed by video, which makes it one of the most practical things an online doctor does. NICE guidance is clear that women over 45 with typical symptoms can be diagnosed with perimenopause or menopause from their symptoms and periods alone, without blood tests, so the most important part of the assessment is a careful conversation. Hormone replacement therapy, or HRT, is the most effective treatment for hot flushes and night sweats, and the evidence on risk is more reassuring than many people think. NICE states that HRT started under the age of 60 does not increase the risk of heart disease, that oestrogen alone is associated with little or no change in breast cancer risk, that combined HRT can increase breast cancer risk in a way linked to how long it is taken and that falls after stopping, and that oestrogen through the skin, as a gel, patch or spray, at standard doses carries no increased risk of blood clots. Cognitive behavioural therapy can help with low mood and anxiety during menopause. After starting treatment, NICE recommends a review at 3 months and then once a year. At The Wellness an initial menopause consultation by video or in person is from £395, follow-up reviews from £195, and a Year One Menopause Programme from £1,395. Fees appear further down this page.
Reviewed by the medical team at The Wellness. Last updated 14 October 2026.
Book a menopause video consultation on WhatsApp or email team@thewellnesslondon.com or call 020 3951 3429.
Key facts about HRT and menopause care online
Women over 45 with typical symptoms can be diagnosed without blood tests, according to NICE.
HRT is the most effective treatment for hot flushes and night sweats.
HRT started under 60 does not increase the risk of heart disease, according to NICE.
Transdermal oestrogen, as a gel, patch or spray, carries no increased risk of blood clots at standard doses.
Combined HRT can increase breast cancer risk, linked to duration, and the risk falls after stopping.
Review is recommended at 3 months, then once a year.
Can menopause be diagnosed by video
For most women, yes. NICE advises that perimenopause can be diagnosed in women over 45 from hot flushes and changes in their periods, and menopause after 12 months without a period, without blood tests. Hormone levels fluctuate widely during perimenopause, so a single result can be misleading.
Blood tests are considered for women aged 40 to 45 with symptoms, for those under 40 where early menopause is suspected, and to check other causes of symptoms, such as thyroid problems or iron deficiency.
What happens in a menopause video consultation
The doctor takes a full history of your symptoms, periods, sleep, mood, bladder and sexual health, your personal and family medical history, including breast cancer, blood clots, migraine and heart disease, and what matters most to you.
You discuss the options, including HRT, non-hormonal treatments and lifestyle measures, with the benefits and risks explained for you specifically. You leave with a plan, and a prescription sent to a pharmacy near you if you choose to start treatment.
Blood pressure and weight help with planning, and you can share recent readings or have them checked in person.
Ask whether video suits you on WhatsApp or email team@thewellnesslondon.com.
What are the benefits and risks of HRT
Benefits. HRT reduces hot flushes and night sweats, and can improve sleep, mood, joint aches and vaginal symptoms. It also protects bone density while it is taken.
Breast cancer. NICE states that oestrogen alone is associated with little or no change in breast cancer risk, and that oestrogen with a progestogen can increase it. Any increase is related to how long HRT is taken and falls after it is stopped.
Blood clots and stroke. Oral oestrogen increases the risk of blood clots, and causes a small increase in stroke risk. Transdermal oestrogen at standard doses does not increase either risk above baseline, which is why it is often preferred for women at higher risk.
Heart disease. HRT started under the age of 60 does not increase the risk of heart disease.
Dementia. The effect of HRT on dementia risk is not known.
What are the alternatives to HRT
Non-hormonal medicines can reduce hot flushes for women who cannot or prefer not to take HRT. Vaginal oestrogen treats vaginal dryness and urinary symptoms with very little absorbed into the body. Cognitive behavioural therapy can help with low mood and anxiety. Regular exercise, a healthy weight, reducing alcohol and stopping smoking all help.
How often is HRT reviewed
NICE recommends reviewing a new treatment at 3 months to check how well it is working and whether there are side effects, then once a year, or sooner if there are problems. Many reviews can be done by video.
Unexpected bleeding on HRT, particularly after the first 3 to 6 months, needs to be assessed and may need an ultrasound scan.
Do you pay for HRT prescriptions
On the NHS in England, an HRT prescription prepayment certificate costs £19.80 and covers many HRT medicines for 12 months. With a private prescription, you pay the pharmacy’s price for the medicine. Many women start privately and later have their NHS GP continue the prescription, and a letter to your GP can be provided to make that straightforward.
What does private menopause care cost in London
Specialist menopause clinics in central London commonly charge several hundred pounds for a first appointment, and membership practices charge annual retainers running into thousands.
At The Wellness each appointment is a single fee, with prescriptions and letters to your GP included. The medicine itself is paid for at the pharmacy. All figures are from prices.
Signature Membership, with ongoing access to a doctor, from £6,950 a year or £610 a month.
Year One Menopause Programme, initial consultation, 2 follow-ups and 2 blood panels, from £1,395.
Initial menopause consultation, 45 to 60 minutes, by video or in person, from £395.
Hormone and menopause blood panel where it is indicated, from £295.
Follow-up and dose review consultation, by video, from £195.
Appointments are available by video across the UK, or at our London clinics, including Marylebone and Belgravia.
Why women choose The Wellness for menopause care
Because a full consultation can be done by video, from home or work.
Because advice follows NICE guidance, with blood tests used when they help and not routinely.
Because benefits and risks are explained for you, based on your own history.
Because reviews at 3 months and each year are easy to keep.
And because a letter to your NHS GP is included, so care can continue wherever you choose.
Related reading
Private menopause clinic and HRT covers menopause care in detail, perimenopause symptoms covers the early signs, menopause hair loss covers changes in hair, and osteoporosis and bone health covers bone density.
Book a menopause consultation on WhatsApp or call 020 3951 3429.
Frequently asked questions
Can I get HRT through a video consultation
Yes. Most women can be assessed and, where appropriate, prescribed HRT by video, with the prescription sent to a pharmacy near you.
Do I need a blood test to start HRT
Usually not if you are over 45 with typical symptoms. NICE advises diagnosis from symptoms and periods. Blood tests are used for women aged 40 to 45, under 40, or to check other causes.
Does HRT cause breast cancer
Oestrogen alone is associated with little or no change in breast cancer risk. Combined HRT can increase the risk, linked to how long it is taken, and the risk falls after stopping, according to NICE.
Is HRT safe for my heart
NICE states that HRT started under the age of 60 does not increase the risk of heart disease. Transdermal oestrogen does not increase the risk of blood clots or stroke at standard doses.
How often should HRT be reviewed
At 3 months after starting, then once a year, or sooner if there are side effects or it is not working.
How much does a private menopause consultation cost
At The Wellness an initial menopause consultation is from £395, follow-up reviews from £195 and the Year One Menopause Programme from £1,395.
The Wellness is a doctor-led private healthcare group providing medical care from our London clinics, including Marylebone and Belgravia. All doctors are GMC-registered. Prescriptions are issued only following a consultation and clinical assessment. In an emergency call 999. This article is general information and not a substitute for medical advice about your own health.
Enquire now on WhatsApp or email team@thewellnesslondon.com or call 020 3951 3429.
References
NICE guideline NG23, menopause, identification and management, recommendations
NHS Business Services Authority, HRT prescription prepayment certificate
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