Frequently asked questions

Often through changes in your cycle. Perimenopause usually starts gradually: your period comes earlier or later, becomes heavier, lighter or more irregular.

Other symptoms often follow, such as poor sleep, mood swings, brain fog, difficulty concentrating, hot flushes, night sweats, exhaustion, joint pain or changes in weight and libido. How strong these symptoms are varies greatly from woman to woman.

It can, if your symptoms affect your quality of life and your personal benefit-risk assessment supports it. It is not necessary for every woman.

What matters is not a single lab value, but the full picture: your symptoms, your cycle and your medical history.

Yes, if you want to reliably prevent pregnancy. Ovulation can still happen, even when your periods are irregular.

Important: bioidentical hormone therapy does not protect against pregnancy. Contraception does not have to be hormonal, though.

In principle, yes. Age alone does not automatically rule out hormone therapy.

The later you start, the more important a careful, personal benefit-risk assessment becomes. We do this individually for every patient.

“Bioidentical” (also called “body-identical”) means the hormone has exactly the same chemical structure as the hormone your body makes.

For almost all of our patients, we work with specialised compounding pharmacies. Which therapy you receive is always decided individually, based on your symptoms, your medical history, your personal risk factors and how well you tolerated previous treatments.

Conventional vs. bioidentical hormone therapy

In principle, yes. Whether and how a switch makes sense depends on why you are taking your current medication and whether you still need reliable contraception.

Important: bioidentical hormone therapy is not a method of contraception and cannot replace one.

In certain cases, yes. Particularly for certain sexual complaints or lack of energy, testosterone therapy can be an option after a thorough medical assessment.

Whether it makes sense for you is assessed individually, and the treatment is monitored by a doctor.

Yes. Hot flushes and night sweats are among the most typical symptoms of perimenopause and menopause, and they can improve significantly with individually tailored hormone therapy.

If they persist, that is an important sign for us to adjust your dose.

Yes, if your sleep problems are linked to hormonal changes. In that case, personalised hormone therapy can have a positive effect on your sleep.

Progesterone in particular, but also estradiol, can play an important role.

Yes, if your heavy periods are caused by a hormonal imbalance. In that case, hormone therapy can help regulate your bleeding. It usually takes about two to three months before you notice the full effect.

Heavy or changed bleeding should always be checked by a gynaecologist first, to rule out other causes such as fibroids or polyps.

It can be one part of the treatment if your symptoms are linked to hormonal changes. In perimenopause, fluctuating hormones often affect mood, sleep and resilience. If your symptoms match that timing, individually tailored hormone therapy can be part of your treatment.

Important: a diagnosed depression or anxiety disorder always needs its own treatment. Please do not change or stop any existing medication without medical supervision.

Yes, this is common. Brain fog, difficulty finding words and poor concentration are often reported in perimenopause and menopause. Besides hormones, poor sleep, hot flushes, stress and mood swings can also contribute.

If your symptoms get worse, are unusually severe or there is a relevant family history, we also look for other causes.

Yes, if hormonal changes are one of the causes. But desire is complex: pain during sex, lack of sleep, stress, medication, emotional wellbeing and your relationship can all play a role.

That’s why we always look at loss of libido in the full picture and treat what is actually behind it for you.

You don’t have to simply put up with these symptoms. They are often caused by falling oestrogen levels, which affect the vagina, bladder and urethra (medical term: genitourinary syndrome of menopause, GSM).

Depending on your symptoms, local treatment, systemic hormone therapy or other supportive measures may be an option. Which therapy suits you is decided individually.

It can be, but hair loss has many possible causes. Besides hormones, these include thyroid disorders, genetics, iron or nutrient deficiency, medication, illness or severe physical stress.

That’s why we first look for the cause and then recommend targeted treatment.

Yes, that’s possible. Joint and muscle pain becomes more common in perimenopause and menopause and, in some women, is linked to hormonal changes.

Because there are many other possible causes, we look at the full picture. If hormones play a role, your symptoms can improve with the right treatment.

Hormones influence where your body stores fat. With menopause, many women store more fat around the belly, often even when their weight barely changes. Age, muscle mass, insulin sensitivity, nutrition and exercise also play an important role.

That’s why, when your weight changes, we don’t only look at sex hormones but at your whole metabolism.

It can have a positive effect on certain metabolic processes and on body composition. How much varies from person to person.

For us, hormones and metabolism belong together. Depending on your situation, we look at blood sugar and insulin sensitivity, thyroid, body composition, nutrition and exercise together.

Possible, yes. Guaranteed, no. Hormones are only one of several factors that affect weight and body composition.

If weight loss is one of your goals, we create an individual plan that takes hormonal and metabolic factors into account together.

Weight & metabolic health

No hormone therapy is completely risk-free, but the risk varies greatly from woman to woman. It depends on factors such as age, when treatment starts, existing conditions, family history and the type, dose, form and duration of treatment.

Temporary side effects such as breast tenderness, bleeding, headaches or water retention can occur. That’s why we weigh the benefits and risks for you personally and monitor your progress regularly.

There is no one-size-fits-all answer. It depends on which hormones are used, whether you still have a uterus, how long you are treated and your personal risk factors.

Body weight, alcohol, exercise and family history also affect certain cancer risks. We include all of this in your personal benefit-risk assessment.

Why the uterus matters: oestrogen alone can build up the lining of the uterus. If you still have a uterus, progesterone is therefore always added to protect it.

Not automatically ruled out, but it requires a particularly careful assessment. A family history of breast cancer, a previous thrombosis and migraines are each assessed differently and can influence which hormones and which form of application are suitable for you, for example a gel instead of a tablet.

If your risk is higher, an additional specialist assessment may be needed.

Yes, it can slow down bone loss. Oestrogen is important for maintaining bone density. Menopausal hormone therapy can reduce bone loss and lower the risk of osteoporotic fractures during treatment.

If osteoporosis runs in your family, we look at further risk factors and decide individually whether additional tests, for example a bone density scan, or specific measures for bone health make sense.

Ideally, as soon as perimenopause begins. Bone loss speeds up in the years around the last period, and bone that has been lost is hard to rebuild completely. Treatment can slow further loss and partly improve bone density, but prevention is key.

How and when to start depends on your personal risk, including your body composition, muscle mass, exercise and family history.

There is no evidence that hormones protect against Alzheimer’s. Hormonal changes can temporarily affect concentration and memory, but that is not the same as dementia.

Alzheimer’s is a complex disease with many causes. Hormone therapy is currently not recommended to prevent dementia. For long-term brain health, metabolism, blood pressure, exercise, sleep and other cardiovascular risk factors all matter.

Sex hormones influence blood vessel function, blood fats and metabolism, among other things. At the same time, women’s cardiovascular risk rises with age.

However, hormone therapy is not used solely to prevent cardiovascular disease. For your personal assessment, we also look at blood pressure, blood fats, blood sugar, weight, exercise and family risk factors.

Not from a single blood test. In perimenopause, hormone levels fluctuate strongly, so one value is only a snapshot.

We look at your cycle, symptoms, medical history and, where medically useful, selected lab values together. Which tests you actually need is decided individually.

Because blood testing is the established method for most medically relevant hormone and metabolic values. Saliva and urine tests can be useful for certain questions, but they are not generally better.

Saliva tests are not routinely needed to guide menopausal hormone therapy. We always choose the tests that fit the specific medical question.

That depends on your therapy and your situation. While your treatment is being adjusted, checks are usually more frequent; once it is stable, the intervals become longer.

Not every hormone therapy needs regular measurement of all hormone levels. We check what adds real medical value to your treatment.

You can often use results you already have, if they are recent and suitable for the question. That’s why we review your existing results first before recommending new tests.

If further values are needed, you receive a targeted lab recommendation from us and have your blood taken at a lab near you. You pay the lab fees directly to the lab.

That is very individual. Some women feel a difference within days or weeks. For others, it takes two to three months to find the right dose.

We adjust your treatment step by step until it fits you.

There is no fixed maximum duration and no fixed cut-off date. Whether treatment is started or continued depends on your symptoms, your personal risks and the benefit for you.

We reassess this regularly. If you want to stop, or if it makes medical sense, we discuss the right approach and possible alternatives together.

They can. It depends on what we are treating and how: whether the treatment eases your symptoms while you take it, or addresses a cause that can be resolved.

If you want to stop, we plan the next steps carefully with you.

As a general rule, once a year for your routine check-ups, if nothing has changed.

If you notice any changes, such as unexpected bleeding or new symptoms, please let us know. We will advise you and refer you if needed.

Easily and comfortably from home. Book a time that suits you in your patient portal, and at your appointment simply join the video consultation right there in the portal, on your phone, tablet or computer. No app needed. All you need is a stable internet connection and a quiet place where you can talk openly.

No. If you have recent results, you’re welcome to upload them to your patient portal beforehand. Which further tests make sense is decided together in your consultation, based on what we discuss. You then have your blood taken at a lab near you and pay the lab fees directly to the lab.

Yes, you can book from anywhere in the world. Consultations take place online, in English, German, Greek or Romanian. Please note that our prescriptions are valid within the EU.

We are a private clinic, so whether your insurance covers the costs depends on your policy. As our practice operates from Cyprus, we don’t issue invoices according to the German fee schedule (GOÄ). You’ll receive a detailed invoice that you can submit to your insurer.

No problem. You can cancel or reschedule free of charge up to 24 hours before your appointment, directly in your patient portal, by email or via WhatsApp at +357 94 309399. For cancellations less than 24 hours before your appointment, we charge a fee of €20.