Perimenopause and Menopause Symptom Treatment in Marylebone, London
We are not a menopause clinic in the conventional sense. We do not prescribe hormone therapy. What we can help with is the brain side of the transition: the fog, the broken sleep, the low mood and the anxiety that does not feel like your usual self.
Overview
Understanding perimenopausal and menopausal symptoms
Perimenopause is the run-up, when oestradiol starts to fluctuate rather than fall steadily. Menopause is the point twelve months after your last period. The hormonal part is well understood. The brain part is the bit most people are not warned about.
Oestrogen receptors sit in the prefrontal cortex and the hippocampus, which are the regions that handle attention, word finding and memory. When oestradiol swings, those regions get an unstable signal. Night sweats then break your sleep, and broken sleep degrades attention and mood on its own. The two effects stack.
Hormone replacement therapy is the first-line treatment for menopausal symptoms in the UK, set out in NICE guideline NG23. We do not prescribe it and we are not a substitute for the clinician who does. If you have not had that conversation yet, have it first.
What the evidence does and does not say. Magnetic stimulation has a substantial evidence base in treatment-resistant depression, and that is a depression indication. NICE has issued interventional procedures guidance on rTMS for depression. There is no established regulatory position, and no large trial base, for magnetic stimulation in menopausal cognitive or mood symptoms specifically. So the useful question is not "does this treat menopause". It is whether what you are experiencing is a depressive episode that happens to be occurring during the transition, in which case the depression evidence applies, or cognitive symptoms in the absence of that, in which case it does not and we will tell you.
Either way, we start by measuring. A NayaScore assessment gives you a number for attention, processing speed and the other cognitive domains, alongside continuous heart rate variability. Feeling foggy and being measurably slower are different findings, and it is worth knowing which one you have.
Why it happens
What causes perimenopausal and menopausal symptoms?
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Fluctuating and then falling oestradiol acting on oestrogen receptors in the prefrontal cortex and hippocampus
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Night sweats and vasomotor symptoms fragmenting sleep, which degrades attention, mood and processing speed on its own
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Autonomic changes across the transition, often visible as lower heart rate variability
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A pre-existing vulnerability to depression or anxiety re-emerging as hormones shift
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Life-stage load arriving at the same time: senior work responsibility, teenagers, ageing parents
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Other conditions that peak in the same decade, including thyroid disease and iron deficiency
Treatment approach
How we treat perimenopausal and menopausal symptoms in Marylebone
NayaScore assessment
On enquiryThe first thing worth having is a number. NayaScore measures attention, processing speed, working memory and the other cognitive domains, plus continuous heart rate variability from a wearable ring. It tells you whether your fog is measurable or not. It is a measurement tool rather than a diagnostic test, and results are interpreted alongside clinical judgement.
See treatment detail →Precision rTMS
From £350 a sessionWhere the clinical picture is a depressive episode occurring during the transition, the depression evidence base applies and stimulation is a reasonable option to discuss. Where the complaint is cognitive fog with no depressive episode, that evidence does not transfer, and your clinician will say so at the free consultation.
See treatment detail →Heart-brain coupling
On enquiryRather than fixing a scalp coordinate, candidate sites over the dorsolateral prefrontal cortex are tested and the one producing the clearest slowing of your heart rate is treated. Since autonomic regulation shifts across the transition, choosing the target from your own physiology rather than an average matters here.
See treatment detail →Restore programme
From £350 a sessionRestore is the pathway for people below their own baseline. It fixes the course length, the review points and the measures before you start, so at the end you are looking at repeated scores rather than trying to remember how bad February was.
See treatment detail →Integrated therapy
On enquirySleep, mood and the sense of losing your grip feed each other during the transition. Psychological work addresses the parts stimulation does not reach, and it runs alongside whatever your GP or menopause specialist is doing about hormones rather than competing with it.
See treatment detail →Progress tracking
On enquirySymptoms in perimenopause fluctuate with the cycle, so a single good week proves very little. Repeating the same measures over a course separates a real trend from normal variation, which is the only way to judge whether treatment is doing anything.
See treatment detail →FAQ
Perimenopause and menopause questions
Is rTMS approved for menopause symptoms?
No, and we will not suggest otherwise. The substantial evidence base and the NICE interventional procedures guidance both relate to depression, which is a separate indication. There is no established regulatory position for magnetic stimulation in menopausal cognitive or mood symptoms. Your clinician will be specific about which category applies to you.
Do you prescribe HRT?
No. We are not a menopause clinic in the conventional sense and we do not prescribe hormone therapy. Hormone replacement is the first-line treatment for menopausal symptoms in the UK, set out in NICE guideline NG23. Have that conversation with your GP or a menopause specialist first, then come to us.
Is my brain fog hormonal or is something else going on?
That is exactly what the assessment is for. Thyroid disease, iron and B12 deficiency, sleep apnoea and depression all produce the same complaint and all peak in the same decade. Your GP should run the bloods. We measure the cognitive side, so you can see whether your fog shows up in numbers.
Can I have this alongside HRT?
Yes, and most people here do. The two work on different systems, so there is no reason to choose. Tell us what you are taking and who prescribes it, and do not change a dose because of anything we say. Your prescriber stays in charge of the hormonal side throughout.
What happens at the free consultation?
Fifteen minutes with a clinician about what has changed, what has already been tried, and whether stimulation is a reasonable option for you. There is no obligation and no cost. If your symptoms are better addressed by hormone therapy or by your GP, they will tell you that instead.
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Naya • 1 Orchard Street, London W1H 6HJ
BookAppointments typically available within 1–2 weeks