Who to see for perimenopause and how to obtain HRT in England

Katerina Galkina · EN · 07/10/2026

Start with your GP or relevant nurse

Book a consultation for troublesome hot flushes, cycle changes, sleep problems, dryness or other changes. Prepare symptoms, period dates, medicines and their effect on daily life. Perimenopause does not require periods to have stopped completely.

The NHS describes treatment options ↗. Complex history, diagnostic uncertainty or treatment difficulties may need specialist referral; a private endocrinologist is not the compulsory first step.

Discussing HRT

Ask about expected benefits, risks, contraindications and formulations. Treatment depends partly on whether you have a womb and your current cycle. Systemic therapy and local treatment for vaginal symptoms address different needs.

Mention cancer, clotting, migraine and liver history, and unusual bleeding. Do not copy a friend's regimen or transfer doses between gels or patches yourself. Ask separately about contraception and any necessary investigations.

Other approaches

If HRT is unsuitable or unwanted, discuss alternatives, including appropriate psychological support and treatment of specific symptoms. Herbal or bioidentical marketing labels do not guarantee effectiveness or safety. Show all supplements for interaction checking.

Check a private doctor through the GMC ↗. Clarify initial assessment, follow-up, prescription and test fees before paying. Do not buy a large hormone panel without understanding how results would change care.

Review and prescription costs

Agree a review date, reasons for earlier contact and continuing-prescription responsibility. Discuss new unusual bleeding with a clinician rather than independently increasing hormones.

In England, an HRT PPC ↗ currently costs £19.80 for 12 months and covers only listed HRT medicines. Other prescriptions need separate payment or an ordinary PPC. Check free NHS prescription eligibility first. The certificate does not cover private prescriptions or consultations.