Menopause is not a single event. The hormonal transition that begins in perimenopause can last a decade, and for many women the symptoms are significant enough to affect work, sleep, relationships, and quality of life. Despite this, many women find it difficult to access timely, thorough menopause care through the NHS, and leave appointments uncertain about whether their symptoms are normal, what their options are, and whether HRT is appropriate for them.
At AristoGP, Dr Anastasia Mermigka offers a dedicated Menopause Consultation for women at any stage of the menopausal transition. The appointment is 45 minutes, costs £200, and does not require a referral. It covers a full symptom assessment, a discussion of all management options including HRT, and produces a written plan agreed with you before you leave.
What the Consultation Covers
- Full symptom assessment: Dr Mermigka takes a detailed history of your symptoms including hot flushes, night sweats, sleep disturbance, mood changes, brain fog, vaginal dryness, joint pain, and changes to your periods. The timing, severity, and impact on daily life of each symptom are documented.
- Menstrual and gynaecological history: Your cycle changes over recent months and years, any previous gynaecological conditions, surgical history, and current contraception are reviewed and documented.
- Personal and family medical history: Cardiovascular risk, bone health, personal or family history of breast cancer, thrombosis, and other conditions that influence whether HRT is appropriate and which type is safest for you.
- HRT discussion: A thorough explanation of the different types of HRT, routes of administration (patches, gels, tablets, Mirena coil for the progestogen component), the evidence on benefits and risks, and which approach is most appropriate for your individual situation.
- Non-HRT options: Where HRT is not appropriate or not preferred, Dr Mermigka discusses alternative approaches to symptom management including lifestyle measures, vaginal oestrogen, and other medications.
- Written management plan: A summary of the consultation, the decision reached, the treatment plan, and the follow-up schedule, issued the same day.
Perimenopause vs Menopause: What Stage Are You At?
Many women attend their first menopause consultation uncertain whether they are perimenopausal or menopausal, and this uncertainty is part of why the appointment is needed. Dr Mermigka will clarify your stage based on your symptoms, your cycle pattern, and where indicated, blood tests.
- Perimenopause begins when cycles become irregular and symptoms start, usually in the mid-40s. Oestrogen levels fluctuate unpredictably. Periods may still occur but the pattern changes. Symptoms can be severe even while periods continue.
- Menopause is defined as 12 consecutive months without a period. The average age in the UK is 51, but it can occur earlier. Some women have no preceding symptoms; others have had significant perimenopause symptoms for years.
- Premature ovarian insufficiency (POI) is menopause before age 40, affecting around 1 in 100 women. It requires specific investigation and management and is an area Dr Mermigka is experienced in assessing.
Ongoing Menopause Care
The initial consultation is the starting point. Women who begin HRT or another treatment plan require follow-up to review symptom control, adjust the type or dose of HRT if needed, and monitor for any side effects. Dr Mermigka offers follow-up appointments at 3 and 12 months, and ongoing annual review appointments for women on long-term HRT. This gives you a consistent specialist relationship rather than needing to explain your history from scratch at each appointment.
Optional Blood Tests
Blood tests are not required to diagnose menopause in women over 45 but can be useful in certain situations, particularly for younger women where POI needs to be excluded, or where the clinical picture is unclear. If Dr Mermigka recommends blood tests, samples can be taken at the clinic and results reviewed by email at no additional charge. Tests that may be relevant include FSH, LH, and oestradiol (hormonal status), TSH (thyroid function, which can mimic menopausal symptoms), testosterone (which declines at menopause and can affect energy and libido), and a lipid profile where cardiovascular risk assessment is relevant.
Who Is This Consultation For?
- Women with hot flushes, night sweats, or sleep disturbance that is affecting daily life
- Women whose periods have become irregular and who want to understand whether this is perimenopause
- Women who have been told HRT is not suitable for them and want a second opinion or a fuller discussion
- Women who have tried HRT and found it did not work well, or experienced side effects
- Women under 45 with menopausal symptoms who need assessment for premature ovarian insufficiency
- Women who want to start HRT but have not been able to get a timely appointment with their NHS GP
- Women who want a thorough, unrushed discussion of all their options with a specialist
About Dr Anastasia Mermigka
Dr Mermigka is a female consultant gynaecologist with specialist experience in menopause, reproductive medicine, and preventative health. She holds full GMC registration and sees patients at AristoGP, 1-5 Portpool Lane, London EC1N 7UU, near Chancery Lane.
Pricing and Booking
Menopause Consultation — £200
45-minute consultation with Dr Mermigka. Full symptom assessment, HRT discussion, written management plan. No referral needed.
Follow-up appointments: £120 (30 min). If a pelvic ultrasound is indicated it can be added on the day (total £300).
Select A1 — F2F Gynaecology Consultation (45 min) when booking.
Book Menopause Consultation — £200Frequently Asked Questions
Do I need a referral for a menopause consultation?
No. You can book directly at AristoGP. Select A1 when booking online.
Can Dr Mermigka prescribe HRT?
Yes. Dr Mermigka is a GMC-registered consultant gynaecologist and can prescribe all forms of HRT following a thorough consultation and assessment. Prescriptions can be taken to any pharmacy.
I have been told HRT is not suitable for me. Is that worth reconsidering?
Possibly. Advice on HRT safety has changed significantly in recent years. The blanket contraindication that many women were given a decade ago is no longer the position of NICE, the British Menopause Society, or most specialist guidelines. A thorough individual assessment with Dr Mermigka can determine whether HRT is appropriate for your specific history and risk profile.
How much does a menopause consultation cost in London?
The AristoGP Menopause Consultation costs £200. Follow-up appointments are £120. Blood tests can be arranged if indicated and results are reviewed at no additional charge.
What is the difference between perimenopause and menopause?
Perimenopause is the transitional period before menopause when oestrogen levels fluctuate and symptoms begin. Menopause is defined as 12 consecutive months without a period. Many women have significant symptoms during perimenopause that warrant treatment, even while periods are still occurring.