Key takeaways
- It is built around a long conversation, not a long list of tests.
- Diagnosis is based mainly on symptoms. NICE says perimenopause in women over 45 is diagnosed without hormone blood tests.
- Tests are chosen for your situation and charged at actual cost. The consultation fee is shared when you book.
- You see a woman doctor in a private room, with a female coordinator. Partners and daughters are welcome if you wish.
- Reviews are fixed at three months, then yearly, with teleconsult follow-ups in between.
Why a dedicated check after 40?
I built my practice in IVF and fertility. And then something kept happening. Women I had treated in their 30s came back to me in their 40s and 50s, all with the same set of symptoms: poor sleep, hot flushes, low mood, aches, weight around the middle, and that one sentence, "I don't feel like myself anymore." Most had seen several doctors, been told their reports were normal, and left without a plan.
The years from perimenopause onwards can be 30 to 40% of a woman's life. Think about that. A third of your life, and it gets a shrug from women themselves, from doctors and from society. It deserves proper attention, not a quick prescription. That is why this check exists.
About two years ago I had hot flushes myself. Only then did I truly understand what my patients had been describing to me all those years. That experience shapes how much time I give each consultation.
What happens during the consultation?
The first visit is long by design. Expect to go through:
Your symptoms, one by one. Hot flushes, night sweats, sleep, mood, anxiety, memory and concentration, energy, joint pain, weight, hair and skin, bladder, dryness, desire, and your periods. Symptoms are symptoms. I don't dismiss any of them.
Your history. Periods, pregnancies, contraception, surgeries (including any hysterectomy or removal of ovaries), medicines, supplements, and previous reports.
Family history. Breast, ovarian or bowel cancer; heart disease; diabetes; osteoporosis or a parent with a hip fracture; early menopause.
Your lifestyle. Food, activity, sleep habits, work, stress, smoking and alcohol.
Examination. Blood pressure, weight, waist, and, only if needed and with your consent, a breast or pelvic examination.
What matters to you. What you most want help with, and how you feel about the different treatment options.
It helps to bring:
- Any previous blood reports, scans and prescriptions
- Your current medicines and supplements
- A rough record of your last few periods
- A list of your symptoms and questions
Which tests might be ordered, and why?
I don't believe in 70 or 80 test packages. Each test should answer a question.
| Test | When it is ordered | What it tells us |
|---|---|---|
| General bloods (for example haemoglobin, sugar, lipids, thyroid, vitamin D) | Based on your symptoms and risks | Anaemia, diabetes, cholesterol, thyroid problems, low vitamin D |
| DEXA bone density scan | Where risk factors or age make it useful | Bone density and osteoporosis risk |
| Pelvic sonography | Heavy or irregular bleeding, pain, or other findings | Fibroids, the womb lining, ovaries |
| Pap smear | When cervical screening is due | Early changes in the cervix |
| FSH or other hormone tests | Only in specific situations, such as women under 45 | Whether early menopause is likely |
Why not a hormone test for everyone? NICE guidance says that in women over 45, perimenopause is diagnosed from symptoms and cycle changes, without lab tests, and advises against using tests such as AMH or estradiol to diagnose it. Hormones swing through the day in perimenopause, so a single result is literally a snapshot of one moment and can mislead. See do you need a hormone test for perimenopause?.
Why DEXA only when indicated? The Indian Menopause Society suggests DEXA for women five or more years past menopause, or earlier with risk factors, rather than for every woman. The NHS notes it uses a much lower dose of radiation than a standard X-ray. See bone health after 40.
What happens after the tests?
Once results are back, we go through them together and agree a plan. Depending on your needs, it may include:
- Lifestyle changes for sleep, food, strength and stress, written down clearly
- Non-hormonal treatments for hot flushes, sleep or mood, where suitable
- Hormone therapy, if you choose it and it suits you. I use body-identical hormones such as estradiol and micronised progesterone. Whether hormone therapy is right for you is a prescription decision made after assessment of your personal risks and benefits
- Local treatment for dryness or urinary symptoms
- Referral to another specialist when needed, such as a cardiologist, endocrinologist, rheumatologist or breast surgeon
You may have heard frightening things about hormone therapy. A study published in 2002, the Women's Health Initiative, was widely misinterpreted. In November 2025 the US FDA began removing broad boxed warnings about heart disease, breast cancer and dementia from menopausal hormone therapy labels, while keeping the warning for estrogen-alone use in women with a womb. I discuss the evidence for your situation honestly, including the risks, and you decide.
I also don't wait for a full year without periods before treating troublesome symptoms. See, I'll tell you how I think of it. Waiting a year to "confirm" menopause is like getting down one bus stop after yours. You still reach somewhere, but not where you needed to be.
How do reviews and fees work?
Reviews. Your first review is at three months, then yearly. In between, follow-ups can be by teleconsult when you don't need to come in.
Fees. The Midlife Women's Health Check fee is shared with you when you book. Tests are charged at actual cost. If you continue with care, ongoing hormone care is Rs 4,000 to 9,000 a month, and the inflammation and bloating programme is Rs 5,000 to 20,000 a month, depending on what you need. Fees are given in writing before you pay.
Who you see. A woman doctor, a female coordinator, and a private consultation room. Partners and daughters are welcome in the consultation if you want them there. Read our guides for husbands and for daughters.
Where and when?
Cocoon × Dr Tvacha is on the 2nd floor of Suraj Arcade, Thane West, one floor above Dr Tvacha Thane (1st Floor, Suraj Arcade, Opp. Cosmos Bank, Gokhale Road, Thane West 400602). Consultation hours are Monday to Saturday, 9:30 am to 12 pm and 1:30 pm to 3:40 pm. You can call 97685 56666, WhatsApp the same number (replies within two hours on working days), or call 022 7123 7000. Consultations are in English, Hindi and Marathi.
How I approach this at Dr Tvacha
The Midlife Women's Health Check is the starting point of The Right Stop Programme: diagnosis first, fees in writing before you pay, review dates fixed on day one, and a plan for the long term. You can also find all our centres here.
Frequently asked questions
How long is the Midlife Women's Health Check consultation?
It is deliberately long, so that every symptom, your history and your concerns can be covered without rushing. I don't watch the clock. The exact time varies with how much there is to discuss. If tests are needed, a second visit or teleconsult is arranged to go through the results and agree your plan together.
Do I need to fast before the check?
You don't need to fast for the consultation itself. If blood tests such as fasting sugar or lipids are needed, you will be told whether to fast and for how long before the sample is taken. Please bring your previous reports, because some tests may not need repeating at all.
Which tests are included?
Only the tests you need. I choose them after the consultation, based on your symptoms and risks, and they may include general bloods and, where indicated, a DEXA bone scan, sonography or a Pap smear. Tests are charged at actual cost. I don't use large fixed packages of 70 or 80 tests.
Will I be put on hormone therapy?
Not automatically. Hormone therapy is one option among several, including lifestyle changes, non-hormonal treatments and local treatment. I explain the benefits and risks for your situation, and you decide. It is a prescription decision made after assessment, and some women are not suitable for it at all.
Can my husband or daughter come with me?
Yes, if you want them there. Many women find it helpful for a partner or daughter to hear the explanation directly, especially about mood changes, which are hormonal and not a change in personality. You can also see me alone first and invite them in later. The choice is completely yours.
Written by
Dr Anagha KarkhanisGynaecologist and Fertility Specialist · Reg. No. 2006/02/1187Leads midlife women's health at Cocoon × Dr Tvacha, Thane.
Sources
- Menopause: diagnosis and management, NICE NG23 recommendations
- Clinical Practice Guidelines on Postmenopausal Osteoporosis: Indian Menopause Society, Journal of Mid-Life Health
- DEXA scan: NHS
- Menopause symptoms: NHS
- HHS advances women's health, removes misleading FDA warnings on hormone replacement therapy: US FDA
This article is for general education and does not replace a consultation. Medicines and treatments are prescribed only after a doctor's assessment. Last reviewed 25 October 2026.