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Dr. Chrysoula I. Liakou MD, PhD
- Treated online: Yes, usually. Menopause is diagnosed from age, symptoms and cycle pattern, so the doctor assesses by video, checks blood pressure and risk factors, and prescribes HRT or non-hormonal treatment when suitable; bleeding after the menopause, a breast lump or symptoms before 40 need in-person assessment.
- What it is: the end of ovarian activity and periods, confirmed after 12 months without one, between 45 and 55 for most women and at 51 on average; the symptomatic run-up, perimenopause, often starts in the mid-40s, and about 1 in 100 women reach menopause before 40.
- How long: menopause symptoms last about 4 years after the final period on average, and over 10 years for about 1 in 10 women; HRT eases hot flushes within weeks, is reviewed at 3 months and then yearly, and has no fixed time limit.
- HRT in context: oestrogen through the skin as a patch, gel or spray carries no extra clot risk, unlike tablets; combined HRT used beyond about 5 years adds a small breast cancer risk, similar to being overweight or drinking 2 units of alcohol daily, falling after stopping.
- Not just flushes: hot flushes affect about 3 in 4 women around the menopause, but poor sleep, anxiety, low mood, brain fog, joint and muscle aches, palpitations, vaginal dryness, recurrent urinary infections and low libido are all menopause symptoms, and all treatable.
- Emergency: menopause is never a 112 emergency; call 112 for sudden chest pain, breathlessness, a hot swollen leg, a drooping face, arm weakness or slurred speech, the signs of a clot or stroke, whether or not you take HRT.
Bleeding after the menopause, bleeding between periods, or bleeding after sex is never part of normal menopause and needs an in-person gynaecological assessment, because it can be an early sign of a womb or cervical problem. Book prompt face-to-face care for any of these, and see the referral criteria below before booking.
Can an online doctor treat menopause symptoms?
Often, yes. Menopause is usually diagnosed from a woman's age, symptoms and menstrual pattern rather than a blood test, so a video consultation can gather what is needed to plan treatment, including hormone replacement therapy or non-hormonal options.[1] Prescribing HRT still requires a proper risk assessment, and some situations need in-person review.
On Mobi Doctor, the doctor treats this as a genuine consultation. The point of menopause care is matching the right option to your symptoms and your personal risk, then reviewing it, and that is a conversation that works well by video for most women.
Listen: Menopause Treatment Online
The audio version of this topic from the Mobi Doctor podcast. Open the episode.
How an online consultation helps with menopause
- Symptoms taken seriously: hot flushes are only part of it. The doctor asks about sleep, mood, brain fog, joint aches, low libido and vaginal or urinary symptoms, and treats the picture rather than one headline complaint.
- An honest HRT conversation: the benefits, the risks for your history, the different forms (patch, gel or tablet), and why one route may suit you better than another, so any prescription follows a real discussion, not a sales pitch.
- Non-hormonal options too: if HRT is not right or not wanted, there are evidence-based alternatives, and the doctor sets them out plainly instead of leaving you to guess.
- A plan with a review date: menopause treatment is adjusted over months. You leave with a starting plan, a date to review how it is working, and clarity on what to watch for.
What are the symptoms of menopause?
Menopause symptoms reach well beyond hot flushes. Falling and fluctuating oestrogen affects the whole body, and the most common effects fall into a few groups that the doctor asks about directly:
- Vasomotor: hot flushes and night sweats, the symptoms most people recognise, which can disrupt sleep and daily life.
- Sleep and energy: waking through the night, difficulty falling asleep, and daytime fatigue, sometimes independent of night sweats.
- Mood and thinking: low mood, anxiety, irritability, loss of confidence, and the "brain fog" of poor concentration and word-finding, which many women find more troubling than the flushes.
- Genitourinary: vaginal dryness, discomfort during sex, urinary urgency and more frequent urine infections, grouped together as the genitourinary syndrome of menopause.[1]
- Musculoskeletal: joint and muscle aches and stiffness, which are common and often unexpected.
- Periods and libido: irregular, heavier or lighter periods in the run-up, and a change in sex drive.
Symptoms vary enormously between women in type, severity and how long they last, and there is no single "normal". Treatment is offered when symptoms interfere with daily life, not simply because you have reached a certain age.[1]
What is perimenopause, and how do I recognise it?
Perimenopause is the transition of several years before your periods stop completely, when hormone levels swing and symptoms often begin while you are still menstruating. Recognising it matters, because this is when many women are told, wrongly, that they are "too young" for menopause to explain how they feel.
The classic clue is a change in your periods, becoming irregular, closer together or further apart, heavier or lighter, alongside new hot flushes, sleep disturbance, mood changes or brain fog. It commonly starts in the mid-forties but can begin earlier.[4] Blood tests are not usually needed to diagnose it in women over 45, because levels fluctuate so much that a single result can mislead; the pattern of symptoms is more reliable.[1] Under 45, and especially under 40, the picture is different and the doctor will consider blood tests and early or premature menopause, which is managed differently and often needs specialist input.
Which menopause treatment might the doctor recommend?
Treatment follows your symptoms, your preferences and your personal risk. This is the framework the doctors use, aligned with European and national menopause guidance:[1][2]
Swipe sideways to compare →
| Presentation | Likely first step | Suitable for online care? | When referral or in-person care is needed |
|---|---|---|---|
| Typical perimenopausal symptoms, age 45+ (flushes, sweats, sleep, mood, irregular periods) | Discuss HRT versus non-hormonal options; lifestyle measures | Usually yes | Diagnostic uncertainty, or symptoms not settling on treatment |
| Mainly genitourinary symptoms (vaginal dryness, discomfort, recurrent urinary symptoms) | Vaginal moisturisers and lubricants; local vaginal oestrogen[1] | Usually yes | Any abnormal bleeding, or no improvement with treatment |
| Under 45 with menopausal symptoms (possible early or premature menopause) | Blood tests and structured assessment; HRT usually recommended | Initial assessment, then coordinated care | Premature ovarian insufficiency needs specialist involvement |
| Higher personal risk (previous breast cancer, blood clots, migraine with aura, uncontrolled high blood pressure) | Individualised risk discussion; non-hormonal options often first | Case-dependent | Specialist or in-person review often needed before starting HRT |
| Bleeding after the menopause, or between periods or after sex | Prompt in-person gynaecological assessment | No | Same-week face-to-face assessment (red flag) |
Not sure which row is you? A doctor can tell you in one consultation.
See available times →HRT online: what an honest assessment involves
Hormone replacement therapy replaces the oestrogen your ovaries no longer make, usually as a skin patch, gel or spray, or a tablet, with a progestogen added if you still have a womb to protect its lining. For most women with troublesome symptoms and no specific contraindication, the benefits of HRT outweigh the risks, and it remains the most effective treatment for hot flushes and night sweats.[1] The point of the consultation is to work out whether that is true for you specifically.
An honest online HRT assessment covers your symptoms and how much they affect you, your menstrual and pregnancy history, and a careful personal and family history: previous breast cancer, blood clots, stroke or heart disease, migraine with aura, liver disease and smoking all change the picture. Your blood pressure matters too, and because it cannot be measured over video, the doctor may ask for a recent reading or arrange one before starting certain treatments. Risk is discussed individually, not as a blanket figure: for example, oestrogen delivered through the skin (patch or gel) carries a lower blood-clot risk than tablets, which can make it the safer route for some women.[1]
Non-hormonal options for menopause symptoms
If HRT is not suitable, not wanted, or you prefer to try something else first, there are options with real evidence behind them. Cognitive behavioural therapy (CBT) is recommended for hot flushes, night sweats, sleep problems and low mood linked to menopause, and it helps without any drug.[1] Certain antidepressants used at low dose, such as venlafaxine or an SSRI, can reduce hot flushes for women who cannot take oestrogen, for instance after breast cancer. Fezolinetant, a non-hormonal medicine that acts on the brain's temperature control, is approved in Europe for moderate to severe hot flushes and night sweats and gives women another route when hormones are off the table.[3] For vaginal dryness and discomfort, moisturisers, lubricants and low-dose local vaginal oestrogen work well and, because very little is absorbed, local oestrogen can often be used even by many women who cannot take systemic HRT.[1]
Lifestyle measures are worth doing alongside any treatment: regular physical activity, keeping a healthy weight, cutting back on alcohol and caffeine where they trigger flushes, and protecting sleep. Supplements such as black cohosh or soy isoflavones are popular, but the evidence is inconsistent and their quality and safety vary, so tell the doctor what you are taking rather than relying on them as a treatment.[2][5]
What the doctor checks in an online menopause consultation
The assessment is structured, because the whole value is in matching treatment to you safely. In a menopause consultation, the doctor will typically check:
- Your symptoms and their impact: which symptoms you have, how severe they are, and how much they affect your work, relationships and sleep.
- Your cycle and stage: whether you are still having periods, how they have changed, and your age, to place you in perimenopause or after the menopause.
- Personal risk history: previous breast or womb cancer, blood clots, stroke or heart disease, migraine with aura, liver disease and smoking.
- Blood pressure: a recent reading, or an arrangement to obtain one, before starting certain treatments.
- Bleeding pattern: any bleeding after the menopause or between periods, which is a red flag that changes the plan entirely.
- Current medicines and preferences: what you already take, what you have tried, and whether you lean towards hormonal or non-hormonal treatment.
When menopause symptoms are treated online, and when you need in-person care
Treated online: typical perimenopausal and menopausal symptoms in women over 45; starting, adjusting or reviewing HRT where there is no contraindication; genitourinary symptoms suitable for moisturisers or local vaginal oestrogen; and non-hormonal treatment for women who cannot or prefer not to take HRT. The same assessment can help with overlapping problems such as recurrent urinary tract infections, thrush or changes in vaginal discharge, and with hormone-related headaches.
In-person care: any bleeding after the menopause, between periods or after sex, which needs an in-person examination; suspected premature menopause under 40, which needs specialist care; a complex risk history, such as previous breast cancer or a strong clotting history, where HRT decisions are made with a specialist; and symptoms that do not settle despite treatment, where a review in person is the honest next step. In those cases the consultation gives you a clear plan and the right referral, not a prescription that papers over the problem.
When to get in-person care
Menopause itself is not an emergency, but a few situations need prompt face-to-face care: bleeding after the menopause or unusual bleeding between periods, a new breast lump or breast changes, or severe low mood with thoughts of self-harm. If you develop sudden chest pain, breathlessness, a hot swollen leg (possible blood clot), weakness on one side or difficulty speaking, call 112 immediately.
How Mobi Doctor works
- Book a time that suits you: open daily 7am–11pm CET. You can see a doctor over video, usually within 15 minutes. No subscription, exact price up front.
- Speak to a licensed doctor about menopause: a private video call: you describe what you feel, the doctor asks what matters, and you agree the right plan together.
- Get your treatment plan and review date: if the doctor prescribes, you can use the prescription at a local pharmacy; if your doctor decides you need to be seen in person, you get a full refund.
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Frequently asked questions about menopause
What is the menopause, and what causes its symptoms?
The menopause is the end of periods, reached when the ovaries run out of responsive eggs and stop making oestrogen; it is confirmed after 12 months without a period, usually between 45 and 55. Symptoms come from the hormone swings of the perimenopause and then from low oestrogen, which affects the brain's temperature control, sleep, mood, joints, skin, bladder and vaginal tissue; removal of the ovaries, chemotherapy and some conditions bring it on earlier.
What are the symptoms of menopause and perimenopause?
Menopause symptoms reach well beyond hot flushes and night sweats: changed periods (irregular, heavier, lighter or further apart), waking at night, anxiety, low mood, irritability, poor concentration and memory, joint and muscle aches, palpitations, headaches, vaginal dryness and pain during sex, recurrent urinary infections, reduced libido, thinning hair and dry or itchy skin. Most women notice several of these in their mid-40s, often while periods continue.
Can an online doctor prescribe HRT in Europe?
Yes, after a proper assessment. The doctor reviews your menopause symptoms, cycle history, medical history and risk factors by video, asks about your blood pressure, and prescribes HRT when it is suitable, choosing a patch, gel, spray or tablet and adding a progestogen if you still have a womb, with the prescription usable at a pharmacy near you. A prescription is never issued without a consultation, and a review follows at about three months.
Do I need a blood test to diagnose menopause?
Usually not. Over 45, the menopause is diagnosed from your symptoms and the pattern of your periods, because hormone levels swing so much from week to week that a single result can mislead. Between 40 and 45 a blood test for FSH can support the diagnosis, and under 40 two FSH tests 4 to 6 weeks apart are needed to confirm premature ovarian insufficiency, which is treated differently and for longer.
Is HRT safe, and what are the risks?
For most women with troublesome menopause symptoms and no specific contraindication, the benefits of HRT outweigh the risks, especially when started before 60 or within 10 years of the final period. Oestrogen through the skin adds no clot risk, unlike tablets; combined HRT taken beyond about 5 years adds a small breast cancer risk that falls after stopping; and HRT protects bones. Breast cancer, a recent clot or untreated high blood pressure change that.
What if I can't or don't want to take HRT for menopause symptoms?
There are menopause treatments with real evidence that contain no hormones: cognitive behavioural therapy for flushes, sleep and mood; certain antidepressants at low dose for hot flushes; fezolinetant, a newer non-hormonal tablet that acts on the brain's temperature control; vaginal moisturisers and lubricants for dryness; and, where appropriate, low-dose vaginal oestrogen, which barely reaches the bloodstream and is often used even after breast cancer. The doctor sets out what suits you.
I still have periods but feel awful. Could it be perimenopause?
Very possibly. The perimenopause, the run-up to the menopause, often begins in the mid-40s while periods continue, with irregular cycles alongside flushes, broken sleep, anxiety, low mood or brain fog, and it can last several years. You do not have to wait for periods to stop: HRT, or a combined contraceptive pill in some women, can be started during the perimenopause, and treating it early prevents years of feeling unwell.
How long do menopause symptoms last?
Menopause symptoms typically begin a few years before the final period, peak around it and last about 4 years afterwards on average, though about 1 in 10 women have hot flushes for more than a decade and vaginal dryness tends to persist without treatment. Treatment shortens nothing but makes the years comfortable: HRT eases flushes within weeks, and when it is stopped, gradually, symptoms may return for a while before settling.
What can I do myself to ease menopause symptoms?
Ease menopause symptoms by keeping the bedroom cool and dressing in layers, cutting caffeine, alcohol and spicy food if they trigger flushes, stopping smoking, exercising regularly, including weight-bearing and strength work for the bones, keeping a healthy weight, protecting sleep with a fixed routine, practising paced breathing during a flush, eating calcium-rich food with vitamin D, using vaginal moisturisers, and talking about symptoms rather than hiding them at work and at home.
Can menopause symptoms be prevented?
The menopause itself cannot be prevented, but its impact can. Not smoking delays it by a year or two and reduces flushes, a healthy weight and regular exercise reduce symptom severity, and CBT skills learned early lessen the distress of flushes. Starting HRT or non-hormonal treatment when symptoms begin, rather than enduring them, and keeping bones strong with exercise, calcium and vitamin D, prevents the sleep loss, mood decline and fracture risk that follow.
Do I still need contraception during the menopause?
Yes, until the menopause is confirmed. Pregnancy remains possible in the perimenopause, so contraception continues until 2 years after the last period if that was before 50, and until 1 year after it if you were over 50, or until 55 if HRT makes the last period hard to judge. HRT is not a contraceptive; a hormonal coil can supply both the progestogen part of HRT and contraception.
What is early or premature menopause, and is it treated differently?
Early menopause means periods ending before 45, and premature ovarian insufficiency before 40, affecting about 1 in 100 women; causes include surgery, chemotherapy, autoimmune and genetic conditions, and often no cause is found. It is treated differently: HRT or the combined pill is recommended until at least the natural menopause age of around 51 to protect the bones, heart and brain, with specialist input and a fertility discussion where relevant.
Could my symptoms be something other than the menopause?
Yes, and the doctor checks. An overactive or underactive thyroid causes sweats, palpitations, weight change and tiredness; anaemia and iron deficiency cause fatigue and brain fog; anxiety and depression overlap with the mood symptoms; pregnancy still explains missed periods in the perimenopause; and some medicines cause sweating. Simple blood tests rule these out where the pattern does not fit the menopause, and treating both when they coexist is common.
Is bleeding after the menopause normal?
No. Bleeding more than 12 months after your last period, bleeding between periods or after sex in the perimenopause, or unexpected bleeding on HRT after the first 3 to 6 months, is never a normal part of the menopause. The cause is usually harmless, such as thinning tissue or an HRT adjustment, but it can be an early sign of a womb or cervical problem, so it needs an in-person gynaecological check.
- Menopause: identification and management (NG23), NICE, National Institute for Health and Care Excellence, updated 2024.
- Menopause fact sheet, World Health Organization (WHO), 2024.
- Veoza (fezolinetant): summary of the European public assessment report, EMA, European Medicines Agency, 2023.
- Menopause overview, HSE, Health Service Executive (Ireland), accessed August 2026.
- Black cohosh (Cimicifuga spp.) for menopausal symptoms (Cochrane Review), Cochrane, Cochrane Collaboration, accessed August 2026.
- Menopause and perimenopause, NHS, National Health Service (UK), updated May 2026.
This page is for information only and is not a substitute for a medical consultation. Guideline links are provided for transparency; treatment decisions are made with your doctor.
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