Admin

After your consult Prescriptions Blood tests Scans Letters & invoices

Guidance

Cyclical progesterone Estrogen patches Estrogen gel Vaginal estrogen

Side effects

HRT side effects Progesterone intolerance Skin reactions Bleeding on HRT Weight gain & HRT

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Admin

After your consult

Here is what to expect following your appointment with us.

On the day of your appointment

If your plan involves starting any medications including HRT, your script will be emailed the same day directly to your preferred pharmacy (as specified on your registration form).
If any blood tests or scans were deemed necessary, these will also be ordered on the same day (see Blood tests and Scans below). This is ordered electronically in the lab's system, so you can visit them directly — no form needed. To find your local lab, check out our lab finder.

Please note: if your script, blood test or scan request form are not sent on the day of your appointment, please call us on 07 242 4600 or email clinic@menodoctor.com.

Within 2–4 weeks

We aim to complete and send your clinic letter to both you and your GP within 2–4 weeks of your appointment.
On receiving the letter, your GP can review your treatment, make any adjustments and issue repeat prescriptions as needed.

Please note: if you indicated on your registration form that you did NOT want a letter sent to your GP, then we just send the letter to you.

Still have medical questions?+

If after reading this guide you still have questions or issues, you can:

Call us on 07 242 4600 for an administrative query
Book a follow-up appointment with one of our doctors for medical advice
Contact your GP for non-urgent advice, or ED / urgent care for emergencies

We don't have the capacity to provide medical advice by email, but these FAQs answer the most common questions, and there's also a Help section on our website.

Please note: we cannot offer emergency or urgent advice. If you are having any severe issues or reactions, please attend an urgent care service or ED / A&E.

Ordering repeat scripts+

If you need a repeat prescription, you can order one via our website under the Patients tab.

As we send a letter to your GP, it is also usually possible to order a repeat script through them — although they may request you see them for an appointment first.

Prescriptions

Where is my prescription?+

We normally email your prescription on the same day as your appointment, directly to the pharmacy you stated on your new patient registration form.

You can usually collect your prescribed items later that same day. We recommend you phone your pharmacy to make sure they have received the script before you go to collect it.

My pharmacy does not have the prescription+

If your pharmacy has not received a script from us, please ask them to check their spam folder (as it sometimes ends up in there!).

If they have definitely not received it, please call us on 07 242 4600 or email clinic@menodoctor.com and we will ensure your script is sent as soon as possible.

My pharmacy does not have the medication prescribed+

If the pharmacy does not have any stock of the items we have prescribed, please call around other pharmacies near you to find one with stock, then email clinic@menodoctor.com and we can send the script to that pharmacy for you instead.

My pharmacy charged me for the prescription+

All scripts from Menodoctor are classed as private prescriptions — this means the pharmacy might add an extra charge of $15 per item, as allowed by the Ministry of Health.

My pharmacy has only given me 1 month's supply+

All our prescriptions usually ask for 3 months of medications — but sometimes pharmacies do not have enough stock to give you all of this amount at once. You will then be able to collect repeats from your pharmacy before you need a whole new prescription.

How do I get a repeat prescription?+

You can either see your GP or request one through our website, under the Patients tab. We charge $35 for a repeat prescription.

Please note: if you have just started your first 3 months of HRT, then we need a follow-up appointment before the first repeat prescription is issued by our clinic.

If you have been on your regime for longer than 3 months, then we are happy to issue repeats through our website under the Patients tab. We will require a follow-up appointment once a year if we are issuing ongoing repeats for you.

Blood tests

Do I need a blood test?+

We don't always need to order a blood test for you, especially if you have had a general health check blood test within the last 6 months prior to your appointment.

Where is my blood test form?+

If your doctor decides that blood tests are needed, we send the request electronically directly to the labs in your region, so you will NOT be emailed a copy of this request. You can just turn up at any blood testing lab in your region, give them your name and have the blood test taken.

Where do I go for my blood test?+

You can attend any blood testing lab in your area and have the blood test taken. There are three different lab providers within NZ: Awanui, Pathlab and Medlab Central. You can find your nearest collection centre with our lab finder.

I went to the lab and they did not have a request for me+

We are so sorry if this happens! It is either because the blood test request was not created (our mistake) or because our electronic request did not go through (the system's mistake).

Either way, we know how inconvenient it is to attend for a blood test that doesn't happen. Please call us on 07 242 4600 or email clinic@menodoctor.com and we will sort a request for you.

Will I get copies of my blood test results?+

We aim to send you all your results within two weeks of you having the blood test. You can email clinic@menodoctor.com if you have not heard anything from us by this time.

Please note: we are not able to upload your test results to your GP's system (e.g. Manage My Health, Tend Health app, Health 365, etc.).

Scans

Do I need a scan?+

We don't always need to order any scans or imaging for you, but sometimes your doctor may advise one. This may include scans such as a pelvic ultrasound scan or a bone mineral density scan.

Where is my scan request?+

If your doctor thinks a scan is needed, you should have been emailed a scan request form. If a scan was discussed during your consult but you have not received a request form, please email clinic@menodoctor.com and we will sort a request for you.

How do I book my scan?+

You can use the request form to book your scan at any local private radiology service near you. You simply call them to make a booking.

Please note: we can only provide a private scan referral, so the radiology service will charge you and prices vary between providers. You can ask them the price before booking. You may also be able to claim on your health insurance cover, if this includes scans. If you would prefer a funded referral instead, you will need to book and see your GP to discuss this.

Will I get copies of my scan report?+

We aim to send you a copy of the report within two weeks of you having the scan. You can email clinic@menodoctor.com if you have not heard anything from us by this time.

Please note: we are not able to upload your test results to your GP's system (e.g. Manage My Health, Tend Health app, Health 365, etc.).

Letters & invoices

Do I receive a letter after my appointment?+

All our patients receive a clinic letter summarising the appointment and treatment plan. We aim to get this emailed to you within 2 to 4 weeks of your appointment.

Do I need to send the letter to my GP?+

No — we will send the letter to your GP for you, so you don't need to worry about getting a copy to them yourself.

What if I don't want a letter sent to my GP?+

The patient registration form that you complete prior to your appointment asks whether you are happy for us to write to your GP. If you select "no", then we will only send the clinic letter to you and will not send a copy to your GP.

We prefer to write to your GP if possible, as it's better to keep them informed about your menopause care. They can also provide repeat prescriptions and reviews for you moving forward.

What if I need a referral to another specialist?+

If during your appointment our doctor thinks you need to see another specialist for further advice, then we will provide a referral letter for you.

Please note: we can only provide a private specialist referral. If you would prefer a funded referral instead, you need to book and see your GP to discuss this.

Can you provide additional letters for me?+

If you want to request an additional doctor's letter — such as a medication list for travel, an off-work certificate or another referral outside of your appointment time — you can request this under the Patients tab. We charge $50 for additional letters.

Can you provide an invoice or receipt?+

Yes — we can create a full invoice / receipt for your appointment costs. You can request this through our website under the Patients tab. There is no charge for this invoice / receipt.

Guidance

Taking cyclical progesterone

Our standard cyclical regime for most patients is to prescribe progesterone for 2 weeks out of every 4 weeks.

How do I work out what day of my cycle I am?+

We count any spotting as day 1 of your cycle. You then count to day 14 and start the progesterone then. You take it for 2 weeks and then stop it for 2 weeks (regardless of when your period comes).

Ideally we advise women to start the two weeks of progesterone on day 14 of their cycle, as this is usually when you would start making your own natural progesterone. But not every woman has a perfect 28-day cycle (especially in perimenopause, when periods can become erratic), so do your best to match your current cycle — but don't get too fixed on matching it perfectly.

The important thing is to take the progesterone for at least 14 days a month, to make sure your womb is getting enough progesterone to prevent the estrogen from causing womb problems or even womb cancer.

Do I need to wait until my period comes before I take the progesterone?+

No. Just continue the 2 weeks on, 2 weeks off rhythm. This means you may be taking the progesterone even if you are having your period / bleeding.

What if my period comes at the wrong time or lasts longer or shorter?+

Even if your period comes earlier or later than expected, just continue to take the progesterone for 2 weeks on, then 2 weeks off, and repeat. Eventually your cycle usually gets into this rhythm.

What if my periods remain very irregular?+

This is likely just because of perimenopause itself and nothing to worry about. But you should see either your GP or book a follow-up with any one of our doctors to discuss the change in bleeding, so we can decide if further tests are needed and can change your progesterone to try and regulate your periods better.

Estrogen patches

How do I use estrogen patches?+

The estrogen patches are ideally placed on your lower belly and you change them twice a week — e.g. Mondays and Thursdays. Some women prefer to place the patches on their lower back or thigh, and we think this is likely OK.

When changing the patch, change the precise location / side you choose, so you are not using the exact same place all the time.

What if I forget to change my patch?+

The patches stop releasing estrogen when they are due to be replaced, so if you accidentally leave a patch on for too long, you will not be getting excessively high levels of estrogen. As soon as you remember, just remove the old patch and place on a new one.

Can I get the patch wet?+

Yes — although you may find they do not stay well adhered if you are doing a lot of swimming / bathing, especially in hot water. Spas and hot tubs may also increase the absorption of the estrogen, meaning the beneficial effects could wear off sooner.

How do I get rid of the glue marks?+

If the patch leaves behind some glue residue on your skin, this comes off easily with some baby oil and a dry flannel.

Can patches be cut?+

It is fine to cut estrogen patches to achieve a lower dose. They can be cut into halves, quarters or even thirds. Store the other part of the patch back in the packet until you are ready to use it.

Are all the patch brands equally effective?+

Most women get on OK with any brand of estrogen patch. But some women are sensitive to different brands — so if you experience a change in your symptoms within a few weeks of being switched to a different brand, this likely applies to you and you should request a specific brand on all your prescriptions moving forward. You may need to call around different pharmacies to find one with the specific brand you need.

What if the patch causes a rash?+

If the rash is mild, you can try some antihistamine tablets or apply some steroid cream to the skin an hour before applying the patch. If the rash is significant, then you should stop the patches and see your GP, as it's likely you will need to use an alternative form of estrogen.

Estrogen gel

How do I use estrogen gel?+

Estrogen gel is applied every day, either in the morning or evening. If you are on quite a high daily dose of gel, you can split the dosing into two separate applications twice a day.

The Estrogel brand is applied to either the arm or thigh. The Sandrena brand is applied to either the lower abdomen or thigh. With both types of gel, it should be spread thinly and not rubbed in too aggressively, then left to dry for around 5 minutes before getting dressed.

Will the gel transfer to other people if they touch my skin?+

Avoid other people coming into contact with your skin for at least one hour — after this time, there is no danger of the gel transferring to them.

Can I get my skin wet?+

You should avoid getting the skin wet for at least one hour after applying the gel.

Can I apply other lotions and sunscreen?+

You should wait at least one hour after applying the gel before you apply any other lotions.

How do I switch from patches to gel?+

There are roughly equivalent doses between patches and gels, as below. Switching is not always this straightforward though, and some adjustment of gel dose is often needed.

Patch	Estrogel pumps	Sandrena sachets
25	1	0.5
50	2	1
75	3	2
100	4	3

Can patches and gel be used at the same time?+

Yes — it is possible to use both gel and patches. Some women find the combination offers them the best control of their symptoms, but you would need to discuss trying this regime with your GP or one of our doctors first.

Vaginal estrogen (Ovestin)

If you have been prescribed Ovestin (cream or pessaries), this is to help with vaginal dryness or soreness, pain during sex, vaginal itching, urine infections, urinary frequency, nocturia (passing urine at night) and urgency.

How do I apply Ovestin cream?+

If you have the cream version, you can either use the applicator supplied, or just squeeze a small amount of cream onto your finger and apply it that way — you don't have to put the cream too high up inside the vagina.

Using your finger to apply the cream also means you can apply some externally too, if you have any symptoms around the vulva / clitoris area. If you have urinary symptoms, you can apply the cream around the urethra (where your urine comes out).

How often do I use Ovestin?+

Normally we advise using it every night for 1 or 2 weeks until things improve, and then you get into a routine of using it twice per week. If you are also using estrogen patches, you can pick the same days as you change your patches so it's easier to remember — but apply the cream at night so it can soak in while you sleep.

Sometimes we increase the frequency to three times per week or alternate nights, if your symptoms are quite significant.

How long can I use Ovestin?+

It is usually safe for women to use Ovestin forever.

Are there any side effects?+

Some women get an initial irritation from Ovestin, but this usually resolves after 1 to 2 weeks. If side effects do not settle, or if the Ovestin is not helping your symptoms, you should see your GP or book a follow-up with us to discuss alternatives.

Side effects

HRT side effects

For many women, HRT causes no side effects — but this is not the case for everyone. If side effects occur, they tend to be mild and get better on their own over a few weeks.

What are the possible side effects?+

Breast pain, tenderness, engorgement or lumpiness
Spotting or bleeding
Pelvic pains or cramps
Headaches or migraines
Nausea
Gut symptoms (e.g. bloating, stomach pains, diarrhoea)
Mood changes (e.g. anxiety, depression, irritability)
Weight gain (see Weight gain & HRT below)
Feeling dizzy or lightheaded
Feeling sleepy or tired
Skin changes

If your side effects do not settle after 2 or 3 weeks, or are very severe, you should see your GP or one of our doctors for advice. If you experience significant changes in your bleeding after starting HRT or increasing your dose, see Bleeding on HRT below.

How can side effects be minimised?+

Side effects are less likely to happen if you start with a low dose of HRT and increase slowly as needed. There are also sometimes changes we can make to your HRT regime to reduce certain side effects.

Can I just stop taking HRT?+

Yes — if you have any effects that are severe or really concerning you, then you can simply stop the HRT at any time. You do not need to wean down slowly.

What side effects should I be most worried about?+

Allergic reactions: if you develop a widespread itchy rash, swollen eyes, swollen lips or tongue, or have difficulty breathing or feel wheezy after starting HRT — please STOP the HRT and attend ED / A&E or an urgent care clinic immediately.

Progesterone intolerance

For some women, progesterone can cause adverse effects — this is known as progesterone intolerance. Even body-identical progesterone (Utrogestan) can cause side effects.

Why am I not feeling good on the progesterone?+

Possible effects include:

Sedation / feeling tired
Dizziness or lightheaded feelings
Headaches / migraines
Mood changes — low mood, anxiety or irritability / anger
Gut symptoms (e.g. nausea, bloating, constipation / diarrhoea)
Breast pain
Acne or other skin changes

How can I improve my symptoms from progesterone?+

Sometimes the adverse effects wear off over time as your system settles into the HRT — so if they are not too severe, you can persist for a few weeks and see if things improve.

The side effects haven't improved. What can I do next?+

There are various options we sometimes advise:

Switch to the vaginal route (if using Utrogestan). The Utrogestan capsules can be inserted vaginally — you simply insert them high into your vagina at night instead of taking them orally.
Switch to a different oral progesterone. Some women feel better on synthetic progesterone tablets rather than body-identical Utrogestan.
Try a Mirena coil. This releases synthetic progesterone directly into the womb and can cause fewer side effects for some women.

You can book a follow-up appointment or see your GP to discuss these options.

Skin reactions and rashes

Both estrogen and progesterone can sometimes cause skin reactions.

Estrogen patch reactions+

Patches can sometimes cause localised itchy rashes on the skin where they are placed. If the rash is mild, you can try some steroid cream and antihistamines. Switching to a different brand of patch, or trying estrogen gel or pills instead, is another option.

If the rash is very severe, or you have other signs of allergic reaction such as swollen lips / tongue or difficulty breathing, then you should remove the patches immediately and see a doctor urgently for treatment / advice.

Histamine intolerance+

Taking estrogen can sometimes cause a reaction of histamine release. This can lead to skin rashes, and also other problems including gut symptoms. If you think you may have histamine intolerance, you should see your menopause doctor for advice on how best to manage your HRT.

Progesterone dermatitis+

Progesterone can also sometimes cause skin rashes. This is called progesterone dermatitis. The skin reactions can often look like hives.

Bleeding or spotting on HRT

Can taking HRT cause bleeding?+

It is common for some women to get a change in their bleeding after they first start HRT or whenever they change their dose. HRT can also sometimes trigger a period even in a woman who has already gone through menopause and whose periods had previously stopped.

There can be a 'settling in' phase of up to six months before all bleeding stops. Unscheduled bleeding is unlikely to represent any serious underlying problem, but it's important to let your GP or menopause doctor know, as you may need your HRT regime changing to prevent the bleeding.

When should I worry about the bleeding?+

If the bleeding does not settle within 6 months of first starting HRT, or within 3 months of increasing your dose, or is very heavy or very painful — then you should see your GP or book a follow-up appointment with us.

Some women also have a higher risk of problems like womb cancer than others, and should seek review sooner if any change or new bleeding occurs. Factors that can increase your risk of womb cancer include:

BMI over 30
Lynch syndrome
Cowden syndrome
Diabetes
PCOS
Family history of womb cancer

Weight gain and HRT

Weight gain is one of the most challenging symptoms of menopause, and unfortunately does not always improve with HRT.

Does HRT make you gain weight?+

For most women, taking HRT does not have any impact on their weight. For some it can reduce weight gain, but for others it can worsen or increase weight gain. If you feel that taking HRT has led to you gaining weight, you can stop taking it at any time.

What things can help with weight loss during menopause?+

While there is not always an easy answer to the weight gain that happens around menopause, here are some tips that can be helpful:

Making muscle. Weight training is the secret weapon against weight gain. The more muscle we build, the higher our metabolic rate.
Eating more protein. Try to eat protein with every meal, aiming for around 30g with each one.
Time-restricted eating. Some women have good results with intermittent fasting — but this does not work for everyone.

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