Welcome to the Somerset NHS Menopause Service webpage which has information for both patients and clinicians.
The service is mainly an advice service for NHS clinicians. All referral letters are triaged and many queries can be answered with an Advice and Guidance letter back to the clinician. Women with more complex issues may be offered an appointment if clinically appropriate. The service is unable to issue prescriptions but will advise clinicians on suitable options.
GENERAL INFORMATION ABOUT THE PERIMENOPAUSE AND MENOPAUSE
Here is the link for a patient webinar on the menopause recorded by Dr Juliet Balfour in November 2024:
Patient webinar on the menopause (YouTube)
THE ‘UNDERSTANDING MENOPAUSE’ BOOKLET AND PDF IS AVAILABLE FOR PATIENTS. See the Resources section of menopausesupport.co.uk to download the pdf of the booklet and a poster. GPs can order the paper booklets (available in various languages) at https://menopausesupport.co.uk/?page_id=17128
NEWS
August 2026
All referrals from primary and secondary care clinicians are triaged. Many queries can be answered via an Advice and Guidance letter back to the referring clinician. Some patients are given an Advice and Guidance letter suggesting changes before they are also seen in clinic at a later date. Face to face or telephone appointments are allocated according to clinical need.
Advice and Guidance – the response time is currently 3 to 6 weeks, depending on workload and annual leave.
Face to face and telephone new patient appointments if indicated after triage – we are currently booking patients in from January 2027 onwards.
Please note that the service does not have the capacity to fit or remove the Mirena or other 52mg levonorgestrel IUD (LNG-IUD).
From June 2025 – a new service
Dr Philippa Girling (a BMS registered menopause specialist) from Grove House Surgery in Shepton Mallet is now running a menopause service for patients from Grove House Surgery, Park Medical Practice, Oakhill Surgery, Beckington Family Practice and Mendip Country Practice. If your GP feels you need a referral, one of the receptionists at your practice can book you in to one of these appointments.
STAFF AT THE SOMERSET NHS MENOPAUSE SERVICE
Dr Sophie Aldridge
We also have Eve Allen working as our admin assistant.
ABOUT THE SERVICE
This service was founded by Dr Juliet Balfour, who has been a GP at Glastonbury Surgery for many years and is a British Menopause Society registered menopause specialist with the Advanced Certificate in Menopause Care. She is also a member of the BMS Medical Advisory Council.
Dr Sophie Aldridge is working alongside Dr Balfour at the clinic and became a British Menopause Society recognised menopause specialist in 2025.
The service is only available for patients who are registered with Somerset GP surgeries that are part of the Somerset ICB (previously CCG). However, see June 2025 news section re a new service for some Mendip practices.
GENERAL REFERRAL INFORMATION
Most women with menopausal symptoms can be managed by their GP with lifestyle advice and menopause hormone therapy (MHT) if indicated. Some women may have more complex issues that need specialist advice. Please see the referral criteria below.
The clinic is held at Glastonbury Surgery. If patients need to be seen in the clinic, the first appointment will usually be face to face but patients can request a telephone consultation instead if preferred. They may be seen by Dr Juliet Balfour or Dr Sophie Aldridge.
Follow-up appointments, if needed, will usually be via telephone.
All appointments will be sent out by text with an opportunity for the patient to indicate whether they can attend or not, and a telephone number to ring if they can’t make that date or would rather convert it to a telephone consultation. If seen in the clinic, the GP will be emailed a detailed letter summarising the consultation and the suggested treatment plan and the patient will be sent a copy of this. Please be aware that it may take several weeks for the letter to be sent to the GP and patient. The patient will need to contact their GP surgery to action any of the suggestions.
Please note that this service cannot usually provide urgent clinic appointments and does not have the capacity to give medical advice directly to patients apart from during a consultation.
FURTHER REFERRAL INFORMATION FOR CLINICIANS
The referral email address below is for health care professionals to use. THIS IS NOT FOR PATIENT USE.
IF BEING REFERRED TO CONSIDER A TRIAL OF TESTOSTERONE, THE PATIENT WILL NEED A BLOOD TEST TO CHECK HER BASELINE TESTOSTERONE LEVEL AT LEAST 3 WEEKS BEFORE HER APPOINTMENT.
The email address for referrals is [email protected]
This clinic aims to give clear advice to HCPs on prescribing MHT and non-hormonal alternatives but is unable to issue prescriptions. If blood tests are needed e.g. for testosterone monitoring, the clinic will ask the patient to arrange these with their own GP. Please note that Dr Balfour is a menopause specialist but not a gynaecologist so any gynaecological investigations will need to be arranged via the GP. Unfortunately the clinic is unable to process A&G requests to other specialists (as this will deregister the patient from their usual GP) so we will have to ask the GP to do any A&G if needed.
All letters will be triaged by Dr Balfour or Dr Aldridge to decide if the patient can be managed with advice and guidance or if they need to be seen face to face. Due to the large number of women needing this service, the aim will be to provide a detailed management plan to the GP via letter when suitable and if there is enough information in the referral letter. If complicated or needing detailed counselling about options and individual benefits and risks, then the patient will be sent an appointment via AccuRx text to be seen in the clinic.
Information needed for the referral:
- why specialist advice is needed
- what the patient is hoping for
- if there is a particular reason why the patient may need a face to face appointment rather than advice and guidance (but a face to face appointment cannot guaranteed)
- what MHT has been tried before (dose, length of use and brand names needed)
- a summary printout of past medical history and operations, medication, allergies and any blood results from the last 2 years
- if the patient is under 40, please check FSH levels twice, 6 weeks apart if possible. You can still refer your patient even if the levels are normal. The progestogen-only pill and Mirena coil do not affect FSH levels but there is no point checking FSH if the patient is on the combined pill or MHT. If on Depo-provera, please do the blood test just before giving the next dose.
- oncology letters if a history of breast cancer or any hormone sensitive cancer
- any letters from the Family History Breast Clinic or genetics
- any letters from private menopause clinics
- if referring a patient to consider adding in testosterone, please make sure they are already on transdermal oestrogen and have had a testosterone level checked as detailed below. You can send the results with the referral letter or email them afterwards if done later. Please see the testosterone prescribing guidelines in the box below for further information
Please inform the patient that:
- they may not be seen in the clinic if appropriate advice can be given via advice and guidance
- the initial offer of an appointment will be sent by text
- they can ask to change to a telephone appointment if travelling to Glastonbury would be difficult for them
- patients with a history of breast cancer or another hormone sensitive cancer will not be prescribed MHT at the first appointment (more information below)
Patients suitable for referral for advice or an appointment as appropriate:
- patients with complex medical histories when the HCP is not sure if MHT is a safe option e.g. significant active liver disease, a history of heart disease, VTE or stroke
- patients with complex gynaecological history e.g. endometriosis
- patients who have tried numerous MHT options but have not yet found something that works for them
- patients needing specialist advice on local (vaginal) oestrogen options for genitourinary syndrome of the menopause (once other causes have been diagnosed or excluded e.g. lichen sclerosus)
- patients who would like to try adding in testosterone, if there is no HCP at the practice who has done training on how to do this yet. Testosterone for women is now green on Somerset ICB prescribing formulary if the HCP is competent to prescribe it. See the information below about the blood test needed before the appointment
- older women (over 60 or over 10 years since their last period) keen to start or restart MHT if the HCP is not confident about current guidelines
- patients with premature ovarian insufficiency (POI) or an early menopause (see definitions below)
- patients at high risk of osteoporosis or who already have osteopenia or osteoporosis
- younger patients with possible perimenopausal symptoms if the HCP is not sure about the diagnosis
- patients on MHT with unscheduled bleeding but only after the current joint guidelines re investigations have been followed first
- patients with a strong family history of breast cancer – please first check NICE guidelines in case they need to be referred to the Family History Breast Clinic in Taunton for assessment of their degree of risk and to consider more regular screening and/or genetic testing. These can be found via the cks.nice.org.uk guidelines:Family history guidelines
- patients with a history of any type of breast cancer or another hormone sensitive cancer Hormone sensitive cancers include the majority of breast cancers, endometrial cancer and some types of ovarian cancer. Meningiomas and other brain tumours, gastric, liver, bladder and lung cancers may also be hormone sensitive. Clinicians may need to contact the patient’s oncologist for advice if they have one of these cancers and you need to find out the hormone sensitivity
- N.B. Non-hormonal medication, CBT and lifestyle changes are first line for patients with a history of a hormone- sensitive cancer and these will be discussed at the first clinic appointment. Certain types of local (vaginal) oestrogen are usually a safe option, unless on an aromatase-inhibitor (AI). The management options for patients on AIs can be discussed via the menopause specialist and will also need to be discussed with oncology if vaginal oestrogen is being considered)
- MHT will NOT be prescribed at an initial appointment in breast cancer patients as other, safer options need to be tried first. If a patient’s quality of life is severely affected, the other options are not helping and the patient is keen to try systemic MHT despite the possible risks, Dr Balfour or Dr Aldridge will need to liaise with their oncology team and then discuss further with the patient. Please make sure your patients are aware of this before the referral to manage their expectations
Patients not suitable for referral to this service:
- patients with premature ovarian insufficiency or early menopause if they mainly want to discuss fertility issues
- patients with unscheduled bleeding on MHT which hasn’t been assessed according to guidelines – these patients can be referred to the menopause service for advice on adjusting their MHT but only after the latest guidelines have been followed. Please note it is common to have some unscheduled bleeding in the first 3 to 6 months after starting MHT or in the first 3 months after changing MHT. See information re updated guidelines in relevant box below
More general information for both patients and health care professionals:
