Perimenopause and Menopause in London. Recognising It, Testing It Properly and the Full Range of What Helps
The Wellness is the best place in London to have perimenopause and menopause assessed and treated, because in most women the diagnosis is clinical, made from your symptoms and your cycle rather than from a blood test, and that single fact is the one most often got wrong. Perimenopause is the years of hormonal change leading up to the last period, and it is far more than hot flushes. It shows as disrupted or heavier or lighter periods, broken sleep, low mood, anxiety and irritability that feel out of character, brain fog and word-finding difficulty, joint aches, palpitations, low libido, and vaginal dryness or urinary symptoms, and because these arrive one at a time they are frequently treated as separate problems for years. In a woman over 45 with typical symptoms, no blood test is needed to make the diagnosis, and an FSH level in perimenopause is so changeable that it misleads as often as it helps, which is why it is not recommended for that group. Testing does matter where symptoms appear under 45, and particularly under 40 where premature ovarian insufficiency must not be missed, and to exclude the thyroid disease and iron deficiency that mimic the same picture. Treatment then spans the full range, hormone replacement in the modern body-identical forms where it suits you, vaginal oestrogen for genitourinary symptoms, non-hormonal options where HRT is not wanted or not suitable, testosterone where libido remains the issue, and the bone and cardiovascular health that menopause quietly changes. Consultations from £150 by video and £220 in person, extended review from £395. Fees appear further down this page.
Reviewed by the medical team at The Wellness. Last updated August 2026.
Get perimenopause assessed on WhatsApp or email team@thewellnesslondon.com or call 020 3951 3429.
What are the symptoms of perimenopause and menopause
Far more than the hot flushes and night sweats everyone associates with it, though those are common and can be debilitating. The change in periods is often the first sign, with cycles becoming shorter, longer, heavier, lighter or unpredictable over months to years. Sleep frequently fragments, and the daytime consequences of that, fatigue and low mood, are easily mistaken for something else. Mood itself shifts, with anxiety, irritability and a flatness that many women describe as not feeling like themselves, and the cognitive symptoms, brain fog, poor concentration and losing words mid-sentence, are among the most distressing precisely because they are so often dismissed.
Then there is the physical range that rarely gets connected to hormones, joint and muscle aches, palpitations, headaches, skin and hair changes, weight redistributing to the middle, and the genitourinary symptoms, vaginal dryness, discomfort during sex, and urinary urgency or recurrent urinary infections, which unlike the others do not improve with time and tend to worsen if left. Low libido sits across the physical and the emotional. The reason a proper assessment matters is that these are usually treated as a collection of unrelated complaints, when recognising them as one process is what unlocks treatment that addresses all of them at once.
Do I need a blood test to diagnose menopause
Usually not, and this surprises people. In a woman over 45 with typical symptoms, perimenopause and menopause are a clinical diagnosis made from the pattern of symptoms and periods, and a blood test adds nothing reliable, because hormone levels in perimenopause swing so much from week to week that a single FSH result can read normal in a woman who is clearly perimenopausal, or vice versa. National guidance specifically advises against using FSH to diagnose it in this group, and being sent away because one blood test looked normal is a common and avoidable frustration.
Testing earns its place in specific situations. Under the age of 45, and especially under 40, blood tests do matter, because premature ovarian insufficiency changes the diagnosis and the treatment and must not be missed. Tests also matter to exclude the conditions that produce an overlapping picture, particularly thyroid disease and iron deficiency, both of which cause fatigue, low mood and disrupted periods and both of which are easily and cheaply confirmed or ruled out. So the useful approach is to diagnose most women on their symptoms without delay, and to test the specific groups and the specific mimics where a test genuinely changes the answer. Knowing which situation you are in, and being told plainly rather than tested reflexively, costs nothing and saves months.
Ask whether you need testing on WhatsApp or email team@thewellnesslondon.com.
What treatments actually help
Hormone replacement therapy is the most effective treatment for the symptoms of perimenopause and menopause, and modern HRT is not the HRT of twenty years ago. Body-identical oestrogen through the skin as a gel, spray or patch, combined with micronised progesterone where the womb is present, carries a different and more favourable risk profile than older oral preparations, and for most women under 60 or within 10 years of menopause the benefits outweigh the risks when the decision is made individually. The dose and form are tailored to you and reviewed rather than fixed, and the conversation about benefits and risks is had properly rather than reduced to a headline.
Not everyone wants or can take HRT, and there is a real range beyond it. Vaginal oestrogen treats the genitourinary symptoms locally, is very safe, and can be used by almost anyone including many women who cannot take systemic HRT, yet it is chronically underused. Non-hormonal medicines help hot flushes and mood where hormones are not an option. Testosterone, prescribed carefully, helps persistent low libido where HRT alone has not, and cognitive behavioural therapy has good evidence for hot flushes, sleep and mood. Alongside all of it, the lifestyle measures that genuinely move the needle, strength and weight-bearing exercise for bone and muscle, and attention to the cardiovascular and bone health that menopause silently changes, because the loss of oestrogen accelerates both and the menopause consultation is the moment to address them.
What does menopause care cost in London
Seen privately, a consultant gynaecologist or dedicated menopause specialist in the Harley Street district runs £250 to £450 for a first appointment before any test or prescription, with follow-ups and blood tests charged separately, and the well-known private menopause clinics sit firmly in that bracket. Comprehensive women's health and executive programmes at the top of the London market exceed £32,000. Below all of it sits a tier defined by its conditions rather than its price, brief remote services that issue a single HRT product from a form with no examination, no discussion of the alternatives, and no attention to the bone, cardiovascular and genitourinary health that a proper review covers.
At The Wellness the assessment, the plan and the review are 1 fee, and all figures are from prices. The Executive Health Programme, the most comprehensive assessment with full biomarker profiling and coordinated imaging, is from £11,995. The women's body scan programme, with imaging, full bloods and review, is from £3,495. The Comprehensive Blood Panel, used where testing is genuinely indicated and covering thyroid function, ferritin and iron studies and the relevant hormones with consultation and interpretation, is from £495, and a Targeted Blood Panel from £295. An extended 45-minute consultation for a full perimenopause or menopause review with a written plan is from £395. An in-person consultation with examination in Marylebone is from £220, a same-day video consultation from £150 and telephone follow-up from £59. A home, hotel or office visit is from £495 daytime and £695 evenings and weekends. Gynaecology referral to a named consultant, and any imaging, are arranged at specialist centres with the appointment booked.
Same-day appointments 7 days a week in Marylebone, 3 minutes from Baker Street.
Why The Wellness is the best place in London for perimenopause and menopause
Because the diagnosis is made properly and quickly. Most women over 45 are diagnosed on their symptoms without being made to wait for a blood test that would only mislead, while the specific groups who do need testing, those under 45, and anyone whose picture could be thyroid disease or iron deficiency instead, are tested where it genuinely changes the answer. That is the difference between being taken seriously and being sent away.
Because the whole range of treatment is on offer rather than a single product. Body-identical HRT tailored and reviewed, vaginal oestrogen for the genitourinary symptoms that so many services ignore, non-hormonal options where HRT is not wanted, testosterone for persistent low libido, and cognitive behavioural therapy for hot flushes, sleep and mood, chosen with you rather than for you.
And because the health that menopause quietly changes is addressed at the same time. Bone and cardiovascular risk rise as oestrogen falls, the genitourinary symptoms worsen if left, and the menopause consultation is the natural moment to get ahead of all three. Explaining what is happening, what your options are and what to watch for is information that costs nothing to give and changes how the next decade goes.
Book a menopause review on WhatsApp or call 020 3951 3429.
Frequently asked questions
What are the first signs of perimenopause
Often a change in periods, with cycles becoming shorter, longer, heavier, lighter or unpredictable, alongside broken sleep, mood changes, anxiety, brain fog, joint aches and low libido. Because they arrive one at a time they are frequently treated as separate problems, when recognising them as one process is what unlocks effective treatment.
Do I need a blood test to diagnose menopause
Usually not. In a woman over 45 with typical symptoms it is a clinical diagnosis, and FSH is not recommended because hormone levels swing too much to be reliable. Testing does matter under 45, and especially under 40, and to exclude thyroid disease and iron deficiency, which mimic the same symptoms.
Is HRT safe
For most women under 60 or within 10 years of menopause, the benefits of modern HRT outweigh the risks when the decision is made individually. Body-identical oestrogen through the skin with micronised progesterone carries a more favourable profile than older oral forms, and the risks and benefits should be discussed properly rather than reduced to a headline.
What can I take if I cannot or do not want to take HRT
Vaginal oestrogen for genitourinary symptoms, which is very safe and usable by almost anyone, non-hormonal medicines for hot flushes and mood, cognitive behavioural therapy, which has good evidence for hot flushes, sleep and mood, and lifestyle measures including strength and weight-bearing exercise for bone and muscle.
Can menopause affect libido, and can that be treated
Yes. Low libido is common and has both physical and emotional components. HRT helps many women, and where libido remains the issue despite it, testosterone prescribed carefully can help, alongside treating vaginal dryness locally and addressing sleep and mood.
Why do I have urinary symptoms and vaginal dryness in menopause
Because falling oestrogen thins and dries the genitourinary tissues, causing dryness, discomfort during sex and urinary urgency or recurrent infections. Unlike hot flushes these do not improve with time and tend to worsen if left, and they respond well to vaginal oestrogen, which is safe and underused.
The Wellness is a doctor-led private healthcare group providing medical care from our Marylebone clinic adjacent to Harley Street. All doctors are GMC-registered. Blood analysis is performed by accredited laboratories, and gynaecology care and imaging are arranged at specialist centres and reported by consultants. Heavy or unusual bleeding, bleeding after menopause or between periods, needs prompt assessment, and 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 on menopause, diagnosis and management, including that FSH is not recommended to diagnose menopause in women over 45 with typical symptoms. British Menopause Society guidance on HRT, body-identical preparations, testosterone and premature ovarian insufficiency. NICE guidance on premature ovarian insufficiency and on genitourinary symptoms. Published evidence on cognitive behavioural therapy for menopausal symptoms. Published 2026 London private gynaecology and menopause clinic market pricing.
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