2Me Clinic recently delivered a talk at the prestigious CBRE firm to honour Menopause Awareness Month. It was a resounding success! We had such great feedback, so much so, that we decided to share the post-presentation Q&A session with you!
Question 1: “Is it correct that people who have had breast cancer should NOT have HRT?”
Not all forms of breast cancer are a contraindication to HRT. Usually, HRT is avoided after a diagnosis of hormone-sensitive breast cancer. ‘Hormone-sensitive breast cancer’ means that the cancer cells have receptors for the hormones oestrogen and/or progesterone on their surface. These receptors act like “locks” — when hormones (the “keys”) attach, they can stimulate the cancer cells to grow. But even in hormone sensitive breast cancer, management is individualised and, in some cases, tailored HRT may be considered after discussion with the patient’s cancer specialist.
Question 2: “Is it possible to use HRT ‘too early’ and risk not benefiting if you only have some symptoms? What is ‘too few symptoms’?”
Not really. If you’ve started to notice changes that suggest your hormones are fluctuating — such as irregular periods, night sweats, poor sleep, mood changes or brain fog, it’s not “too early” to think about HRT. In fact, research shows that starting HRT earlier in the menopausal transition (ideally before age 60 or within 10 years of your last period) offers the greatest long-term benefits for heart, bone and brain health.
We don’t prescribe HRT purely for prevention when there are no symptoms at all, but even a few mild symptoms can be enough to make a real difference to how you feel and function day to day. There’s no rule about having “enough symptoms.” What matters is how much they affect your wellbeing. For some women, one or two symptoms, like disturbed sleep or loss of focus, are enough to warrant support.
Question 3: “If you’re told you can’t have HRT due to medical conditions, is it worth a second opinion or are there alternatives?”
Yes, a second opinion is reasonable, especially if symptoms are severe. There are certainly non-hormonal options that can be offered safely and with a tailored approach. National Institute for Health and Care Excellence (NICE) and the British Menopause Society (BMS) recommend individualised care and referral when there are complex considerations or if you can’t have HRT.
Question 4: “Is it correct you can’t get testosterone from your GP? Or is it postcode lottery?”
Testosterone can be used in women to treat low libido. It is currently not licensed for use in women but can be prescribed ‘off label’ (‘off-label’ means taking a drug that has a license and using it in a different way). In this case, it means taking testosterone (which does have a license for use in men) but using it in much smaller doses in women. There are some useful guidelines (from NICE/BMS and the Global Consensus Document of 2019) on when and how to prescribe testosterone in women. As evidence and licensing are limited, prescribing does vary between practices/regions.
Question 5: “Is testosterone taken as a tablet and also as a cream? Could testosterone worsen female pattern hair loss?”
Testosterone is typically applied to skin as gels or by injections. Oral (by mouth) formulations for women are uncommon. Effects on hair are complex: external testosterone can theoretically worsen androgenic hair loss in some women, but small studies have also shown neutral or mixed effects. The risk depends on dose, formulation, and individual susceptibility. We recommend testing testosterone levels before starting the treatment and at 3 months. Repeating the test after 3 or 6 months is to ensure your levels are in the physiological (normal) female range.
Question 6: “If the symptoms are manageable, is HRT still recommended as a preventive measure for cardiac health?”
HRT is prescribed primarily to treat symptoms, not as a first-line cardiovascular prevention strategy. It’s important to mention that when using HRT to treat symptoms evidence supports a “window of opportunity”, which means that starting HRT close to the menopause (generally under age 60 or within ~10 years of menopause) is associated with a more favourable cardiovascular profile than starting much later.
If your symptoms are mild and not bothering you, there’s no medical need to start HRT just for heart health alone. But if you have even subtle symptoms and are at an age when your oestrogen levels are declining, HRT can both relieve symptoms and support long-term wellbeing, including bone and cardiovascular health.
Question 7: “I have Sertraline for hormonal change symptoms such as insomnia and headaches — is that off-licence too?”
Yes — Selective serotonin reuptake inhibitors (including sertraline) are commonly used off-label to treat symptoms associated with hormonal changes and can help sleep/mood. However, these should not be used as first line treatment for symptoms associated with the perimenopause/menopause if there are no contraindications to HRT and HRT is acceptable to the patient.
Question 8: “Last year I had night sweats for a few months but not this year — can peri-menopause symptoms come and go, or do you need continuous symptoms to get HRT?”
Perimenopausal symptoms commonly fluctuate — they can come and go over months or years. You do not usually need to show continuous symptoms over many months to be assessed; it’s a clinical decision based on symptom pattern, severity, impact on life, and timing relative to menopause.
Question 9: “What do you think about bioidentical hormone therapy vs traditional HRT?”
If you are referring to body-identical HRT, this contains hormones that are chemically very similar to those produced by the human body. So, lower risk of blood clots (especially if oestrogen is applied to the skin) and possibly lower breast-cancer risk compared with synthetic hormones. Body-identical HRT is often better tolerated with fewer mood swings, bloating, or breast tenderness. In fact, body identical HRT is supported by NICE, BMS, and the International Menopause Society as first-line where suitable.
If you are referring to compounded bioidentical preparations, these are unregulated and not recommended routinely because of variability in dosing, lack of regulation and unclear safety data.
Question 10: “How important is when the blood tests are taken if you are still peri-menopausal or on HRT?”
Hormone levels can be rather variable during perimenopause (so one test is often insufficient) so should not be used in isolation to guide management. When already on HRT, blood hormone levels are less helpful. NICE recommends a clinical diagnosis for most people, which means being guided by a person’s symptoms, medical history, and examination, rather than relying solely on a laboratory test. However, bloods tests can be useful when diagnosing premature ovarian insufficiency or if excluding other conditions.
Question 11: “Do you see any value in collagen supplements? I don’t see it on the alternatives list.”
Evidence is mixed. Some small trials and systematic reviews suggest modest benefits of hydrolysed collagen on skin elasticity and joint symptoms, but results are variable and not a substitute for proven bone health strategies (calcium, vitamin D, exercise, and HRT/other bone health treatments where indicated). Collagen supplements are not a proven treatment for menopausal symptoms.
Question 12: “I’m on HRT but have endometriosis/adenomyosis and severe cyclical pain. My gynaecologist said I must stop HRT if I need treatment for my endometriosis pain. Is oestrogen making it worse?”
It’s true that oestrogen can sometimes stimulate residual endometriosis tissue, especially if you still have your uterus or ovaries and are using oestrogen without enough or inadequate progesterone to balance it. However, that doesn’t mean you must automatically stop HRT. For many women with a history of endometriosis or adenomyosis, continuing HRT safely is possible, it just needs to be carefully tailored. Using the right balance of oestrogen and progesterone or adding other options such as a progestogen-releasing coil, (MIRENA coil) can often keep symptoms under control while maintaining the benefits of HRT for bone, heart and brain health.
If you’re having flare-ups of pelvic pain, it’s important to review your HRT regimen rather than stopping it abruptly. Sometimes switching to a different route or dose of hormone treatment, can make a big difference.
Question 13: “What is the name of the App?”
Yuka is a mobile app (available for iOS and Android) designed to help consumers evaluate food and cosmetic products
Question 14: “If you get prescribed HRT, will you then be getting enough Oestrogen and Testosterone or do these need to be prescribed as an addition? If so, what do you do if your doctor will not prescribe testosterone?”
HRT typically includes oestrogen, and if you still have a uterus, it also includes progesterone to protect the lining of the uterus. This combination is considered the standard and evidence-based treatment for managing perimenopausal and menopausal symptoms.
Testosterone is not routinely included in standard HRT. In the UK, it is currently licensed only for the treatment of low sexual desire (low libido) in women who have not responded to oestrogen therapy alone. That said, many women report additional benefits from testosterone, including improvements in energy, focus, and motivation, though these effects are not officially recognised in current guidelines. If these symptoms persist despite adequate oestrogen levels, a specialist may consider prescribing testosterone off-label, following a discussion of risks, benefits, and after appropriate blood testing.
If your doctor is reluctant to prescribe testosterone, you may wish to request a referral to a menopause specialist or a clinic with experience in female hormone care.
We hope this helps!
Remember, if you have any queries of your own after reading our Q&A, please do not hesitate to reach out to us at admin@2meclinic.com. Alternatively, you can book a 10-min free chat with one of our female health doctors. Stay connected!
