If it feels like nobody warned you, you're not the only one
8 in 10
women notice symptoms as hormones shift
30+
recognised symptoms; hot flushes are just the famous one
~51
average age menopause begins, though it's rarely that tidy
7–10 yrs
years perimenopause can start before your last period
None of it means you’re stuck with it. There’s usually a lot that can be done.
UNDERSTANDING MENOPAUSE
What's actually happening?
Menopause usually arrives between 45 and 55, as the ovaries produce less oestrogen and progesterone. That drop doesn’t just affect your periods. It can reach into sleep, mood, skin, joints, memory, energy and libido – often long before you connect the dots.
As a private menopause specialist in London, Dr Katy Kasraie treats menopause as a medical transition worth taking seriously, not a phase to push through quietly. Her approach at the Harley Street clinic pairs current HRT protocols with lifestyle guidance and ongoing monitoring, because what works for one patient rarely works identically for the next.
Why I specialise in menopause
I became a patient too
Perimenopause crept up on me in my early forties – not with hot flushes, but with brain fog. I couldn’t think clearly, I didn’t feel like myself, and even with two decades of clinical experience behind me, I found it hard to be taken seriously.
If I was finding it this hard, I kept thinking – what must it be like for the women in my waiting room, with no medical background and no one in their corner?
Then came a breast cancer diagnosis. Surgery, chemotherapy, radiotherapy – and a medically induced menopause that arrived suddenly, in a way perimenopause never had. I have now sat in the chairs I used to stand beside, and that has changed everything about how I practise.
I understand what it feels like not to be heard. That’s why you will be.
Who it's for
You might be in the right place if...
- You're functioning fine on the outside, but something has felt quietly off since your early forties
- Your bloods came back "normal," but you know your body and you know something isn't right
- The fog, the broken sleep, the flat mood - none of it felt like you, and nobody has connected the dots
- You want a proper conversation about HRT - its real risks, its real benefits - not a quick dismissal
- You'd like to see a doctor who has been through this herself, and still understands it from a clinical position
- You leave appointments with questions you didn't get to ask - and you'd like that to change
SYMPTOMS
Common Symptoms of Perimenopause & Menopause
A Patient Guide
Hormonal changes during perimenopause and menopause can affect almost every part of the body. Every woman’s experience is different – but these are some of the most common symptoms.
Hot flushes
Night sweats
Irregular periods or Heavy Periods, or Lighter or Skipped Periods
Weight gain, particularly around the abdomen
Bloating
Breast tenderness
Joint pain and stiffness
Persistent Fatigue
Headaches or worsening migraines
Heart palpitations
Dry skin
Hair thinning or hair loss
Brain fog
Difficulty concentrating
Memory lapses and word-finding difficulty
Anxiety
Panic attacks
Low mood or depression
Mood swings
Irritability or sudden rage
Feeling overwhelmed / sensory overwhelm
Reduced confidence
Tearfulness
Feeling unlike yourself
Difficulty falling asleep
Frequent waking during the night
Early morning waking
Poor-quality or unrefreshing sleep
Night-time anxiety / 3am racing thoughts
Worsening snoring or sleep apnoea
Fatigue and low energy
Daytime sleepiness
Vaginal dryness
Vaginal burning or irritation
Vaginal itching or vulval soreness
Pain during sex
Reduced libido
Difficulty becoming aroused
Recurrent urinary tract infections (UTIs)
Urinary urgency
Urinary frequency
Stress urinary incontinence
Nocturia (waking to pass urine)
Genitourinary syndrome of menopause (GSM)
HOW WE HELP
Our approach to menopause treatment in London
Dr Kasraie builds each plan from a thorough starting assessment, then adjusts it as your body and needs change, all from her private clinic on Harley Street.
01
Comprehensive initial consultation
A detailed exploration of your symptoms, medical history and goals. Typically 45-60 minutes - far longer than a standard NHS appointment.
02
Personalised HRT prescription
Treatment tailored to your hormonal profile, lifestyle and preferences. Transdermal oestrogen and body-identical progesterone are prescribed where suitable - not a one-size-fits-all protocol.
03
Lifestyle & nutritional guidance
Evidence-based recommendations on diet, exercise and sleep that work alongside medical treatment - because hormones are only part of the picture.
04
Regular reviews & monitoring
Ongoing follow-up to adjust your plan as your body and needs change over time. Treatment that evolves with you.
Treatment Options
You won't leave with a one-size-fits-all prescription.
Treatment is always built around your symptoms, your history and what matters most to you – not a standard protocol. Whether that’s HRT, a non-hormonal approach, or something in between, the right option is the one that fits your body and your life. Every option is explained clearly, so you can make an informed choice.
Hormone Replacement Therapy (HRT)
Still the most effective option for the majority of women dealing with flushes, sweats, disrupted sleep and mood changes. Where suitable, I prescribe transdermal oestrogen and body-identical progesterone - dosed to you, reviewed regularly, and adjusted as your needs change.
- Estrogen
- Progesterone
- Testosterone
- BMS prescribing guidelines
Non-hormonal support
For women who can't or would rather not take HRT - including those with a history of hormone-sensitive breast cancer - there are genuinely effective non-hormonal options for sleep, anxiety, low mood and hot flushes. This is a conversation I'm particularly well placed to have, having navigated it myself.
Vaginal & Bladder Health
Dryness, discomfort, painful sex and urinary symptoms are among the most under-reported symptoms I see —collectively known as Genitourinary Syndrome of Menopause (GSM). Local treatments are safe for long-term use and highly effective - but most women never get to discuss them in a standard appointment. Here, there's time.
BEYOND MENOPAUSE
The decade-ahead health audit
Menopause is the moment most women finally have a full picture of their health risks. I use it as an audit – a chance to look ahead and protect what matters most over the decades to come.
Memory, focus & brain health
Brain fog and memory lapses are often the first thing women notice - and the last thing they connect to hormones. Evidence increasingly supports early HRT as protective for long-term cognitive health.
Bone strength & fracture prevention
Bone loss accelerates sharply at menopause. HRT is one of the most effective tools for reducing fracture risk. Where indicated, I assess bone density baseline and advise on supplementation alongside medical options.
Weight, metabolism & midlife change
Hormonal changes shift fat distribution and insulin sensitivity - particularly around the abdomen. Weight gain at menopause isn't inevitable; with the right approach to HRT and lifestyle it can be managed effectively.
Heart & circulation health
Oestrogen protects the heart. After menopause, cardiovascular risk rises significantly. Blood pressure, cholesterol and lifestyle factors are reviewed as part of every initial assessment.
Strength & mobility as you age
Oestrogen supports muscle mass and joint health. Loss of strength in midlife isn't just about fitness - it affects independence and quality of life decades later. Targeted advice on resistance training and nutrition is included.
About
About Dr Katy Kasraie, Menopause Specialist on Harley Street
Dr Katy Kasraie is a Family Medicine Physician and BMS-accredited Menopause Specialist on Harley Street, with twenty years of clinical experience across the UK, United States and Ireland. She trained at the University of California San Diego, qualified in medicine at Trinity College Dublin, and gained her MRCGP through the Ipswich and St George’s Hospital GP training schemes.
Her interest in menopause medicine is personal as well as clinical. She went through perimenopause herself – her first symptom was brain fog, not hot flushes – and later experienced a treatment-induced menopause following her own breast cancer diagnosis and treatment. She has sat on both sides of the desk, and it shows in how she consults.
- Board-certified Family Medicine Physician (GP) UK
- Postgraduate Training in Clinical Dermatology
- Member Royal College of General Practitioners
- Menopause Specialist, British Menopause Society
Languages
- English
- German
- Farsi/Persian
- Spanish proficient
PRICING
Private menopause consultation fees
Initial consultation
£450
45-60 minute in-depth assessment at 10 Harley Street. A full picture of symptoms, history and goals – with a treatment plan you leave with on the day.
Follow-up appointment
£300
Reviews are built into the care plan, so treatment evolves as your symptoms and circumstances change.
Follow-up Video consultation
£225
For existing patients. Prescriptions or further tests are quoted separately – no surprises.
Most major UK insurers are accepted, including Bupa, AXA Health, Aviva, Vitality and WPA.
Your consultation fee covers the full appointment, your assessment and plan including writing any prescription you need. It does not cover the cost of medication itself (paid at the pharmacy) or any blood tests, scans, or other investigations.
FAQ
Questions patients ask most about menopause treatment
Is HRT actually safe?
For most women, yes—when it’s prescribed after an individualized risk assessment. It’s rarely a blanket yes or no; it depends on your health history. Dr. Kasraie carries out a thorough, risk assessment before recommending any treatment.
I had breast cancer. Can I still discuss HRT?
Yes, and it’s a conversation Dr. Kasraie is particularly well-placed to have, having navigated breast cancer treatment herself. Whether HRT is appropriate depends on your specific cancer type, treatment history, and risk profile. Effective non-hormonal options are also available.
What’s the difference between body-identical HRT and standard HRT?
Body-identical hormones are chemically identical to those produced naturally by your body—typically transdermal oestrogen (gel or patch) and micronised progesterone. Unlike older synthetic progestogens, body-identical HRT has a more favourable risk profile and is well-tolerated.
My main symptom is brain fog, not hot flushes. Could this still be perimenopause?
Absolutely. Brain fog is often an initial symptom. There are over 30 recognised symptoms of perimenopause; hot flushes are simply the most famous. Cognitive changes, memory lapses, and feeling unlike yourself often go unconnected to hormones for years.
My GP said my bloods were normal. Are blood tests needed to diagnose perimenopause?
Not usually. Perimenopause is a clinical diagnosis based on symptoms and age, not blood tests. Hormone levels (FSH and oestradiol) fluctuate wildly and can read “normal” even when symptoms are severe. Normal blood work does not mean your symptoms aren’t real.
Can I be seen for perimenopause even if I haven't stopped my periods?
Yes. Perimenopause is assessed and treated in its own right during the transition phase, so you don’t need to wait until your periods stop or until you reach full menopause to benefit from expert support.
I'm already on HRT prescribed elsewhere but it's not working well. Can I see you?
Yes. Many patients seek a review for HRT that hasn’t been properly dosed or formulated. Adjusting the formulation, dose, and delivery route (transdermal vs oral) makes a significant difference. Bring your records, and we will review your plan.
How quickly will symptoms improve once treatment starts?
Most patients notice an initial improvement within 4–8 weeks, with full therapeutic benefits settling in around three months. Your progress is reviewed regularly to fine-tune dosages as needed.
Will treatment change over time?
Yes, and it should. Regular reviews are built into your care plan so your treatment continuously evolves alongside your changing symptoms, lifestyle, and health requirements.
Do I need a referral to see a private menopause specialist?
No referral is needed. You can book an appointment directly online or by phone at your convenience.
Does the consultation fee include prescriptions or tests?
Your consultation fee covers the full appointment, your assessment and the written plan you leave with – including writing any prescription you need. What it does not cover is the cost of the medication itself, which you pay at the pharmacy, or any blood tests, scans or other investigations. Those are always quoted to you before anything is arranged, so nothing appears on a bill you did not agree to.