Physician-led · assessment first
Hormone replacement therapy
For hot flushes, night sweats, broken sleep and the other changes of perimenopause and menopause. It starts with a conversation with a physician about your history and your symptoms, and ends with a plan — which may or may not include hormones.
- Minute assessment
- 60
- Months to first review
- 3
- Review after that
- Yearly
What it is
Menopause is the point twelve months after your last period; perimenopause is the years of change before it, and for many people those years are the harder part. As estrogen and progesterone fall and fluctuate, the common result is hot flushes and night sweats, poorer sleep, changes in mood and concentration, aching joints, and vaginal dryness or discomfort. None of this is imagined, and none of it is something you are required to put up with.
Hormone replacement therapy — HRT, increasingly called menopausal hormone therapy — replaces some of the estrogen the body no longer makes. If you still have a uterus it is combined with a progestogen, which protects the lining of the womb. It comes in several forms: patches, gels and sprays through the skin, tablets, and low-dose vaginal preparations for local symptoms. The form, the dose and whether it suits you at all are decided from your own history, not from a menu.
For people who cannot or would rather not take hormones there are other options, including non-hormonal prescription treatments and changes that help with sleep and hot flushes. At our North Vancouver clinic the assessment covers all of it, and the physician will say so plainly if hormones are not the right answer for you.
Decided from your history
Your symptoms, your family history and your risks set the plan — not your age alone, and not a standard protocol.
The form is chosen, not assumed
Through the skin, by mouth or locally — each carries different risks, and the choice is explained rather than defaulted to.
Reviewed, not simply renewed
A review at about three months and at least once a year after that, with a real decision each time about whether to continue.
Honest about the alternatives
Including the non-hormonal ones, and including the answer that nothing needs treating.
Other things that look like menopause
Several common conditions produce the same tiredness, sleep and mood changes, and some are found with a routine blood test. They are worth excluding before hormones are blamed.
- An underactive or overactive thyroid
- Iron deficiency, especially with heavy or irregular periods
- Sleep apnoea, which becomes more common after menopause
- Depression and anxiety, which can arrive at the same time and deserve their own treatment
- Side effects of medications you already take
Usually a good fit
- Hot flushes or night sweats that disturb your days or your sleep
- Irregular periods with new symptoms in your forties or early fifties
- Vaginal dryness, discomfort or urinary symptoms since menopause
- Menopause before the age of 45, which is worth assessing whatever your symptoms
- You want to understand your options before deciding anything
Usually not, or not before more investigation
- A personal history of breast or endometrial cancer, unless your oncology team is part of the decision
- A history of blood clots in the legs or lungs, or of stroke — some forms may still be possible, and this needs a careful discussion
- Unexplained vaginal bleeding, which is investigated before any hormone is started
- Active liver disease
- Pregnancy or breastfeeding
- You are looking to slow ageing or to lose weight — that is not what hormone therapy is for
Before
- Note when your symptoms started, what they are and what makes them better or worse — a few weeks of notes is more useful than memory
- Bring a list of every medication and supplement you take
- Know the dates of your last mammogram and cervical screening, if you can
- Tell us about any personal or family history of breast cancer, blood clots, stroke or heart disease
- You do not need bloodwork before the first appointment; if it is needed, it is arranged from there
The assessment
- 01HistoryYour symptoms, your periods, your health and your family's — the part that decides most of what follows.
- 02ExaminationBlood pressure, weight, and anything else your history points to.
- 03Tests where they helpMenopause is usually recognised from your history rather than from a blood test. Bloodwork is used to rule out other causes, or where the picture is unclear.
- 04A plan in writingWhether hormone therapy is reasonable for you, in which form, what else is possible and what it would cost — so the decision is yours, not the appointment's.
If treatment starts
- Expect some adjustment in the first months — breast tenderness, bloating or irregular bleeding are common early on and often settle
- A review at about three months to see how you are and adjust the plan
- At least a yearly review after that, including whether to continue
- Keep up your routine mammograms and cervical screening
- Tell us promptly about calf pain or swelling, chest pain, breathlessness, a new breast lump or unexpected bleeding — those are not side effects to wait out
What can go wrong
Hormone therapy has real risks as well as real benefits, and the balance depends on your age, how long it has been since your last period, the form used and your own history. For many healthy people who start within about ten years of menopause, current guidance considers the balance acceptable; for others it is not. That is what the assessment is for.
- Breast cancer: a small increase in risk with combined estrogen and progestogen, which grows with longer use. Estrogen alone, for people without a uterus, carries a different and generally lower risk
- Blood clots and stroke: higher with tablets than with forms through the skin, and higher in people with other risk factors
- Endometrial cancer, if estrogen is taken without a progestogen by someone who still has a uterus — which is why the two are combined
- Gallbladder disease
- Side effects such as breast tenderness, headaches, nausea, bloating and irregular bleeding, most common in the first months
Questions we get
Do I need a blood test to know I am in menopause?
Usually not, if you are over 45 and your symptoms fit. Hormone levels swing widely in perimenopause, so a single result can mislead. Bloodwork is still useful for ruling out other causes of the same symptoms, and in younger people.
How soon would I notice a difference?
Hot flushes and night sweats often ease within weeks; other changes can take a few months, which is why the first review is at about three months. How much changes varies from person to person, and some people notice little.
How long can I stay on it?
There is no fixed limit. The decision is reviewed at least once a year — the reasons you started, how you are, and your risks as they change with age — and continuing, reducing or stopping are all reasonable outcomes.
I have a history of breast cancer or blood clots. Is there anything for me?
Possibly, but not by default. Some non-hormonal treatments help with hot flushes, and local vaginal treatment is sometimes possible with your oncology team's agreement. It is a conversation to have with the full history in front of the physician.
Will it help with weight or with ageing?
It is not a weight-loss treatment and it does not stop ageing. Some people find their sleep and energy improve as other symptoms settle, which can help indirectly — but if weight is the main concern, that is a different assessment.
Can my family doctor do this instead?
Yes. Menopause care is part of family medicine, and if you have a family doctor who is comfortable prescribing it, that is a good route. People come here for time, for an appointment in Mandarin or Cantonese, or because they do not have a family doctor.
Is the assessment covered by MSP?
No. This clinic is self-pay and does not bill MSP; the fee is confirmed when we call to arrange the appointment. Prescription costs, if any, are separate, and extended health plans often cover part of them.
Request an assessment
Request an assessmentWho does this
Assessment, prescribing and follow-up for these programmes are by a licensed physician in British Columbia, at the Lonsdale Avenue clinic in North Vancouver. Nothing is prescribed without an assessment. Who the physician is, and who else you will meet, is on the team page.
Other programmes here
Everything listed here is offered at the Lonsdale Avenue address in North Vancouver. Names, durations and prices come from the clinic’s live schedule rather than from this page, so what you see is what is bookable today.
- Medical Weight Loss ConsultationPhysician assessment first
- Testosterone Replacement Therapy (TRT) ConsultationPhysician assessment first
Other places people start
These are sorted by what is bothering you rather than by treatment name. Each page says what actually helps, what does not, and when the honest answer is that nothing here is needed.
- Loose Skin After Weight LossLosing the weight is the hard part and you have done it. What is left is usually a skin problem rather than a fat problem, and those have completely different answers.
- Fatigue & Low EnergyThis is the concern where we are least likely to sell you anything, and we would rather say that at the top of the page than at the end of a consultation.
- Dullness & Uneven ToneDullness and dehydration are a texture problem, not a shape problem. That distinction decides which half of the menu is even relevant.
- Volume Loss & HollowsVolume loss is the change people describe as looking tired or gaunt without being able to name a line. It is also the one where over-treatment is most visible from across a room.
- Forehead & Frown LinesForehead and frown lines are muscle before they are skin. The question that decides your result is not the dose — it is whether the line is still only there when you move.
- Hooded Upper LidsThe line where this stops being an injectable question and becomes a surgical one is unusually clear, and you are entitled to be told which side of it you are on.
- Jawline & Contour LossThe most common reason people book here, and the one where the honest answer changes most with age. In your forties a device usually does it. In your sixties it usually does not.
- Nasolabial FoldsNasolabial folds are usually a symptom. Filling the fold itself is the most common way to end up looking heavy in the lower face.
- Stubborn Body FatA pocket that stays the same size while the rest of you changes. Usually the flanks, the lower abdomen, or under the chin. The useful question is not which machine to use — it is whether what you are looking at is fat at all.
- Under-Eye Hollows & ShadowsThe most common request here, and the one where the answer is most often no. Under-eye shadow has at least four causes and filler helps exactly one of them.