Setting up a private menopause clinic: a playbook for GPs

A private menopause clinic run by a GP is mostly good general practice done with time: a thorough first assessment, HRT prescribed to NICE NG23 and British Menopause Society (BMS) guidance, a review at 3 months and then every year, and a clear route for anything that needs a specialist.

The short answer: what it takes to launch a menopause service

If you are already a registered private GP, adding menopause care is usually an extension of what you do, not a new business. In England it falls under the treatment of disease, disorder or injury regulated activity you probably already hold. You only need to vary your registration if you add something like coil fitting or ultrasound. The clinical standard is NICE NG23, which was substantially updated in November 2024 and again in April 2026, together with BMS tools and guidelines.

What makes or breaks the service is operational: a prescribing protocol covering progestogen protection and off-label testosterone, a bleeding pathway, recalls, pharmacy options during shortages, and honesty about cost, because the NHS HRT prepayment certificate does not cover private prescriptions.

Demand and service models for a private menopause clinic

Patients usually come to a private menopause clinic for a longer appointment, a second opinion, or quicker access to a clinician with a special interest. Most have mild to moderate symptoms that a well-trained GP can manage. The BMS says its advanced specialist training is aimed at the 5% or so of patients who need referral for specialist menopause care. The other 95% are the core of a GP-led clinic.

Common models are:

• One-off consultation. A long first appointment with a written plan, prescribed privately or handed to the NHS GP. You still own any prescription you issue until care is handed over.
• Programme. The first assessment, a 3-month review and an annual review, sold as a package. It maps neatly onto NICE's review schedule and makes income more predictable.
• Membership. A monthly fee covering reviews, messaging and repeat prescriptions, for patients who want continuity.

Delivery can be in person, by video or hybrid. Video suits history-taking and most reviews; keep in-person capacity for examinations and coil fitting. If you run a remote-only service, remember that the GMC's remote prescribing principles expect you to identify vulnerable patients, check identity and make sure you have enough information to prescribe safely.

Regulation: CQC regulated activities, HIW, HIS and RQIA

In England, the CQC regulated activity treatment of disease, disorder or injury applies when a listed healthcare professional, such as a doctor or nurse, provides treatment, and it explicitly covers situations where a professional is required to prescribe medicines. A private GP practice already registered for this activity can usually add menopause consultations and HRT prescribing without a new activity. Two additions often catch people out:

• Family planning services covers inserting or removing any intrauterine contraceptive system or device. If you plan to fit a 52 mg levonorgestrel intrauterine system (LNG-IUS) as the progestogen part of HRT, check with the CQC whether you need to add this activity.
• Diagnostic and screening procedures covers examining the body with ultrasound, X-ray or MRI. If you add pelvic or transvaginal ultrasound in-house, you need this activity. Referring out does not trigger it.

Adding an activity means applying to vary your registration, so build that time into your launch plan. Our guide to CQC registration for different services explains the process.

The other nations use different regulators and definitions:

Nation	Regulator	What a menopause clinic is likely to need
England	CQC	Treatment of disease, disorder or injury. Add family planning for coil fitting and diagnostic and screening procedures for ultrasound.
Wales	Healthcare Inspectorate Wales (HIW)	Registration as an independent clinic if private-only medical services are provided regularly by doctors at an establishment, or as an independent medical agency if the service is remote with no fixed establishment.
Scotland	Healthcare Improvement Scotland (HIS)	Registration as an independent clinic. The definition covers premises where doctors, nurses, midwives, pharmacists and some other professionals provide services.
Northern Ireland	RQIA	Registration as an independent clinic or independent medical agency, depending on how the service is delivered.

Clinical governance: NICE NG23 and British Menopause Society guidance

NICE NG23, Menopause: identification and management, is the benchmark an inspector or indemnifier will compare you with. Know what changed recently:

• November 2024 update. New or updated recommendations on menopause-specific cognitive behavioural therapy (CBT), managing genitourinary symptoms, and the effects of HRT on specific health outcomes. NICE also clarified what to discuss about fertility, when to refer to a healthcare professional with expertise in menopause, and how to address effects on mental health.
• April 2026 update. The advice on bleeding on HRT was aligned with NICE's suspected cancer guideline (NG12), and it now points to the BMS guideline on unscheduled bleeding.
• Non-hormonal options. NG23 now links to NICE's technology appraisal recommending fezolinetant for moderate to severe vasomotor symptoms when HRT is unsuitable (TA1143, 2026).

Key recommendations to build into your protocol:

• Diagnosis without blood tests in otherwise healthy women aged 45 or over: perimenopause based on vasomotor symptoms and cycle change, and menopause after 12 months without a period when not using hormonal contraception. NICE advises against using FSH and other tests to identify menopause in this group. Consider FSH only for people aged 40 to 45 with symptoms, or under 40 when menopause is suspected.
• Shared decision-making. Discuss the benefits and risks of each option, tailored to the person, using NICE's tables and discussion aid. Talk about the likely duration of treatment at the outset and again at every review.
• Medical history. Consider transdermal rather than oral HRT for people at increased risk of VTE, including those with a BMI over 30. Refer people with a personal history or high risk of breast cancer, or with contraindications to HRT, to a healthcare professional with expertise in menopause.
• Unregulated products. Explain that the efficacy and safety of unregulated hormone preparations, such as compounded "bioidentical" hormones, are unknown.

Name the BMS tools for clinicians (the HRT guide, HRT preparations and equivalent alternatives, progestogens and endometrial protection, and testosterone replacement) in your protocol so every clinician prescribes the same way.

The consultation model

NICE says to review each treatment at 3 months to assess efficacy and tolerability, and then annually unless there is a reason to review sooner. A practical pathway is:

1. Pre-consultation questionnaire. Symptoms (a validated score helps you measure change), menstrual and bleeding history, contraception, personal and family history of breast cancer, VTE and cardiovascular disease, migraine, current medicines and what matters most to the patient.
2. Initial assessment (40 to 60 minutes). History, blood pressure and BMI, and a shared decision on treatment. Cover contraception, bone health and cervical and breast screening. Give written information and a clear plan, including what bleeding to expect.
3. 3-month review. Symptom response, side effects, bleeding pattern and adherence. Adjust the dose or route. NICE's bleeding advice says people will be asked about bleeding at this review.
4. Annual review. Rediscuss the benefits and risks of continuing, check blood pressure and BMI, review contraception needs and screening, and decide whether to continue, change or stop.

Consent, safeguarding and audit

Record the information you gave and the patient's decision, especially for off-label prescribing. Menopause consultations can surface domestic abuse, low mood and suicidal thoughts, so make sure every clinician knows your safeguarding procedure. Useful audits include the proportion of patients reviewed at 3 months, recording of the bleeding discussion, progestogen dose and duration matching the oestrogen dose, and outcome measures such as change in symptom score.

When to refer

• Unscheduled bleeding on HRT. NICE NG23 says bleeding is common in the first 6 months of systemic HRT and within 3 months of a dose or preparation change, and that people should seek help promptly if bleeding happens outside these windows. The BMS guideline (reviewed May 2026) sets out who needs an urgent transvaginal ultrasound within 6 weeks, who can have HRT adjusted first, and who needs an urgent suspicion of cancer pathway referral. For example, it says referral is needed if the endometrium is thicker than 4 mm on continuous combined HRT or 7 mm on sequential HRT, or if there is one major or three minor risk factors for endometrial cancer. Agree in advance how you will get a private scan quickly, and how you will make an urgent referral to the NHS through the patient's GP when that is the right route.
• Post-menopausal bleeding not explained by HRT. NG12 says to refer people aged 55 and over with unexplained post-menopausal bleeding that cannot be attributed to HRT on a suspected cancer pathway, and to consider it for those under 55.
• Premature ovarian insufficiency (POI). NICE says to diagnose POI in people under 40 based on menopausal symptoms, including no or infrequent periods, and raised FSH on 2 samples taken 4 to 6 weeks apart, never on a single blood test. Offer HRT or a combined hormonal contraceptive until at least the age of natural menopause, unless contraindicated. Refer if there is doubt about the diagnosis, and consider referring to professionals who can support all aspects of physical and psychosocial health.
• Complexity. Refer when treatment is not working or side effects persist, when HRT is contraindicated, or when the patient has a personal history of breast cancer, high VTE risk, or a history of coronary heart disease or stroke.

HRT prescribing guidelines: oestrogen, progestogen and testosterone

NICE says to offer combined HRT to people with a uterus and oestrogen-only HRT to people who have had a total hysterectomy, using the lowest effective dose. Most clinics build their formulary around:

• Oestrogen routes. Transdermal gels, sprays and patches, oral tablets, and vaginal oestrogen for genitourinary symptoms. NICE says vaginal oestrogen can be used alongside systemic HRT, serious adverse effects are very rare and the amount absorbed is minimal.
• Progestogen protection. Anyone with a uterus on systemic oestrogen needs endometrial protection, as sequential or continuous combined therapy. Options include micronised progesterone, other oral progestogens, combined products and the 52 mg LNG-IUS. Guidance from the Faculty of Sexual and Reproductive Healthcare (FSRH, now the College of Sexual and Reproductive Healthcare, CoSRH) supports any 52 mg LNG-IUS for 5 years of endometrial protection as part of HRT. Use the BMS progestogen tool to match the progestogen dose and schedule to the oestrogen dose.
• Testosterone for low sexual desire. NICE NG23 says to consider testosterone for low sexual desire associated with menopause if HRT alone is not effective. It notes that this is off-label.

Testosterone: governance and consent

The BMS testosterone tool (reviewed May 2026) says most UK prescribing uses licensed male testosterone products at about a tenth of the male dose. A female 1% cream licensed in Australia is imported for private use. Because these uses are off-label or unlicensed, GMC prescribing guidance applies. You must be satisfied there is enough evidence or experience to show safety and efficacy, take responsibility for the prescribing and for monitoring and follow-up, and record your reasons where you are not following common practice. Where the use is not routine, you should explain this to the patient and give your reasons. In practice:

• restrict testosterone to people on optimised HRT who still have distressing low desire, and record that assessment
• check total testosterone before starting, recheck after starting, and then every 6 to 12 months, as the BMS tool recommends
• explain the off-label status, the expected benefit, possible side effects such as acne and hair growth, and the limits of long-term safety data, and record the consent
• review efficacy within 3 to 6 months and stop if there is no benefit

Testosterone is a Schedule 4 Part 2 controlled drug, so a prescription for it can only be dispensed within 28 days of its date. Expect some NHS GPs to decline to take over testosterone prescribing. Plan to keep it in your service.

Contraception overlap

FSRH guidance is clear that HRT is not a contraceptive. Perimenopausal women on sequential HRT who are sexually active need effective contraception, and in general all women can stop contraception at 55. A 52 mg LNG-IUS can provide both contraception and endometrial protection, but when it is used as the progestogen part of HRT it must be changed every 5 years. Build a contraception check into every initial and annual review.

Prescribing, pharmacy partners and HRT supply

Most GP-led clinics prescribe in-house and send private prescriptions electronically to a pharmacy, or issue paper prescriptions. Private prescriptions must meet the legal requirements set out in our private prescribing checklist. Remember that NHS electronic prescribing systems carry NHS prescriptions only.

Supply problems are a real operational risk. HRT shortages led to a run of NHS serious shortage protocols in 2022 and 2023, and protocols for Estradot patches in several strengths are active until 8 January 2027. Your protocol should include equivalent products for each item on your formulary, using the BMS guide to HRT preparations and equivalent alternatives, and a way to switch patients quickly when a pharmacy cannot supply. Being able to send prescriptions to more than one pharmacy helps.

A good example is Jump, a newer system on the market, which offers private e-prescribing with a choice of pharmacy partners (SignatureRx, Roseway, Chemist4U, Healistic and CloudRx), so you and the patient keep a choice when one is short of a product. It also checks prescriptions against dm+d. Hero Health also offers private e-prescribing through SignatureRx alongside EMIS Web. Whichever system you use, compare which pharmacies each system connects to and how it handles a change of pharmacy mid-course.

The HRT prepayment certificate and private prescriptions

In England, the NHS HRT prescription prepayment certificate (HRT PPC) costs £19.80 for 12 months, the price of two prescription items. It covers an unlimited number of listed HRT medicines on NHS prescriptions. It does not apply to private prescriptions, because a private patient pays the pharmacy's private price for the medicine, not an NHS prescription charge. The NHSBSA also says the HRT PPC only covers medicines licensed to treat the menopause in the UK, so off-label testosterone is not on its list. NHS prescriptions are free in Wales, Scotland and Northern Ireland, so the HRT PPC is an England-only issue.

Tell patients this before they book. Many will want you to assess and start treatment privately, then ask their NHS GP to continue it so they can use the HRT PPC. That is reasonable, but it is the NHS GP's decision (see the NHS interface below).

Systems: questionnaires, records, e-prescribing and recalls

You need the usual private GP systems, set up for a long-term pathway:

• Pre-consultation questionnaires sent at booking.
• Clinical records with coded diagnoses and medicines, so you can find and audit every patient on HRT or testosterone.
• E-prescribing with drug dictionary checks and a choice of pharmacies.
• Recalls for the 3-month and annual reviews, LNG-IUS change dates and testosterone blood tests. Missed reviews are the commonest governance gap in menopause care.
• Results handling with a named clinician responsible for each result.
• Letters to the NHS GP after the first consultation and every change of treatment. See how to send consultation notes back to the NHS GP.

Staff, training and menopause specialist routes

A small clinic can run with one GP lead and grow by adding nurses or pharmacist prescribers. Typical roles are:

• GP lead. Owns the protocol, prescribing policy, complex cases and audit.
• Nurse or pharmacist independent prescribers. Run reviews and straightforward initiations within their competence. Where a non-prescribing nurse does follow-ups, a prescriber signs off any changes.
• Coil fitter. A clinician trained and current in intrauterine techniques (for example, holding the CoSRH letter of competence), if you offer LNG-IUS fitting.
• Administrator. Manages questionnaires, recalls and pharmacy queries.

The British Menopause Society offers two main training routes:

• BMS Management of the Menopause Certificate. A BMS qualification in menopause management for registered healthcare professionals. It is the theory component the BMS lists for its advanced training, and it is the sensible baseline for every clinician in a GP-led menopause clinic.
• BMS Advanced Certificate in the Principles and Practice of Menopause Care (PPMC). Competency-based training with a BMS menopause trainer and an e-portfolio, for doctors, nurse and pharmacist independent prescribers who take referrals and manage complex cases. The BMS lists GPs with an extended role and people leading menopause services in private organisations among its audience, but says there is no need to consider it unless a specific role requires it.

A BMS menopause specialist holds a recognised qualification (the Advanced Certificate or an equivalent such as the RCOG special interest training module or the CoSRH Menopause Care Professional Diploma), is a BMS member, attends a menopause conference at least every three years and does at least 100 menopause consultations a year, of which 50 are new. At the time of writing, the BMS says applications to register as a BMS menopause specialist are closed while it reviews the programme. Don't describe a clinician as a "BMS menopause specialist" unless they are on the BMS register, and take care with "specialist" in any marketing.

Indemnity. Tell your indemnity provider before launch that you are adding menopause care, and say specifically whether you will prescribe testosterone off-label, prescribe remotely or fit coils. Check that cover extends to nurses and pharmacists working under your protocol.

Premises and equipment

A video-first service needs little more than a private consulting room. In person, you need a validated blood pressure monitor, calibrated scales, a couch, chaperone arrangements and phlebotomy or a laboratory partner. Coil fitting adds an equipped treatment room, single-use instruments, emergency drugs for vasovagal reactions and a clinical waste contract. Ultrasound adds the equipment, a trained operator and reporting arrangements.

Pricing and unit economics (illustrative)

The figures below are an illustrative example only, not market data or a recommendation. Use your own costs and local prices.

Item	Illustrative price	Clinician time
Initial menopause consultation, with questionnaire and written plan	£250	50 minutes plus 10 minutes admin
3-month review	£130	20 minutes plus 5 minutes admin
Annual review	£150	25 minutes plus 5 minutes admin
Programme: initial, 3-month and first annual review	£475	About 2 hours in total
Membership: reviews, messaging and repeat prescriptions	£35 a month	Variable

In this example, a GP costing £150 an hour delivers the programme for about £300 of clinician time, leaving about £175 to cover the room, systems, admin, indemnity, card fees and marketing. Medicines and blood tests are charged separately at cost or with a small handling fee.

What drives margin:

• Admin time. Pharmacy queries during shortages and chasing results add up.
• Skill mix. Reviews by a nurse or pharmacist prescriber cost less than reviews by a GP.
• Retention. Patients usually stay on treatment for years, so a membership or programme model earns far more than one-off consultations.
• Handover. Patients who move to NHS prescribing may stop paid follow-up, so price the first consultation to stand alone.

Cost lines to budget for: clinician sessions, admin, room hire, the record and prescribing system, the questionnaire tool, laboratory fees, indemnity for the new activity, BMS membership and training, CQC fees if your registration changes, payment processing and marketing.

Marketing and advertising rules

Regulation 284 of the Human Medicines Regulations 2012 prohibits any advertisement likely to lead to the use of a prescription-only medicine, and rule 12.12 of the CAP Code says prescription-only medicines or treatments may not be advertised to the public. The ASA's menopause guidance reminds marketers that HRT is a prescription-only medicine. In practice:

• advertise the consultation and the clinician's time, not HRT, testosterone or a named product
• don't promise a prescription, or imply that every patient will leave with one
• avoid claims that compounded or "bioidentical" HRT is safer, more natural or more effective. The ASA says it has not seen evidence that compounded HRT is more effective, and that claims such as "we can tailor the treatment to your specific needs" are unlikely to be acceptable
• use "specialist" carefully, and only with qualifications you can evidence
• keep information on your website factual and balanced, and make sure symptom claims point patients to a clinician, not a product

For patient acquisition, local search and directory listings work well for a new service. A bookable marketplace such as Quokka Health, where patients compare named clinicians on price and availability and book online, is one option, alongside your own website and GP referrals. Our guide to advertising rules for private GPs covers the wider rules.

The NHS interface: letters, continuing prescriptions and shared care

With the patient's consent, write to their NHS GP after the first consultation and after every change of treatment. Say what you diagnosed, what you prescribed (with doses and the progestogen regimen), when the next review is due and who is responsible for prescribing. GMC guidance on remote prescribing highlights the patient safety risks when a service is not linked to the patient's NHS GP or regular healthcare provider.

Be realistic about what the NHS GP can be asked to do:

• Continuing prescriptions. BMA guidance says that if a private provider asks an NHS GP to start or continue a medicine, and the GP agrees with the advice, this could be appropriate. If the GP does not feel competent, or is not sure the medicine meets the patient's needs, they should tell the private provider that the specialist should prescribe. Standard HRT is something many GPs will take on. Off-label testosterone and unusual regimens often are not.
• Shared care. BMA guidance says shared care with private providers is not recommended, because NHS and private care should be kept as separate as possible. All shared care is voluntary, and practices can decline on clinical and capacity grounds. If they do, prescribing stays with you.
• Tests. The BMA says NHS practices do not have to arrange tests requested by a private provider unless the GP needs them for their own care of the patient. Arrange and pay for your own blood tests and scans.
• Medication bridging. When you hand prescribing over, give enough supply to last until your letter has reached the GP and they can act on it. The BMA says NHS advice to consider at least 7 days' supply applies equally to private providers.

Tell patients at booking that any move to NHS prescribing is up to their GP.

Launch checklist for a private menopause clinic

1. Decide the scope: what you will manage, what you will refer, and whether you will offer testosterone, coil fitting or ultrasound.
2. Check your registration. In England, confirm treatment of disease, disorder or injury covers the service, and apply to vary for family planning or diagnostic and screening procedures if needed. In Wales, Scotland or Northern Ireland, confirm with HIW, HIS or RQIA.
3. Tell your indemnity provider about the new activity, including off-label testosterone and remote prescribing, and get written confirmation.
4. Make sure every prescriber has completed menopause training (at least the BMS Management of the Menopause Certificate), and name a clinical lead.
5. Write the protocol: NICE NG23 diagnosis and treatment, BMS tools for HRT, progestogen and testosterone, contraception checks, and safeguarding.
6. Write the bleeding and referral pathway using the BMS unscheduled bleeding guideline and NICE NG12, including how you will get an urgent scan and how you will make urgent NHS referrals through the patient's GP.
7. Agree a formulary with equivalent alternatives for shortages, and set up e-prescribing with more than one pharmacy option.
8. Set up questionnaires, coded records, recalls for the 3-month and annual reviews and LNG-IUS changes, and results handling.
9. Create templates for the first letter to the NHS GP and for change-of-treatment letters, and a patient consent form for off-label prescribing.
10. Set prices, write a plain-English page explaining that the HRT PPC does not cover private prescriptions, and decide your one-off, programme and membership options.
11. Check every advert and web page against CAP rule 12.12 and the ASA's menopause and BHRT guidance.
12. Plan the first audits: 3-month review rates, recording of the bleeding discussion, progestogen adequacy and symptom score change.