Does private health insurance cover menopause treatment?

The menopause is an inevitable and natural process that affects biological women. Symptoms are broad and affect people in different ways, but treatment can help you manage the effects. Here, we look at whether private health insurance covers menopause treatment and the support offered by some insurers.

What are the symptoms of menopause?

The menopause is when your hormone levels change, and your periods stop. This means you won’t be able to become pregnant naturally (although it’s possible with specialist fertility treatment).

Menopause generally begins anytime between the ages of 45 and 55, but it varies from person to person, so it could be earlier or later. Symptoms also vary, and you won’t necessarily have all of them, but typical characteristics include:

Irregular periods when they were previously regular (although you won’t necessarily be aware of this if you’re on the contraceptive pill).Hot flushes sometimes accompanied by dizziness.Sleeping difficulties as well as night sweats.Palpitations when you can feel your heart beating faster than usual.Joint pain.Changes in your body (usually weight gain, but if you lose muscle mass, you could also lose weight).Skin problems such as dryness or irritation with it sometimes cause acne as your hormone levels change.Lower sex drive, vaginal dryness pain, itchiness or discomfort during sex.Repeated urinary tract infections (UTIs).

As well as physical changes, you may notice changes in your mood. For example, you may experience anxiety, mood swings and bouts of low self-esteem. Brain fog (memory and concentration loss) is another common feature of menopause.

Bear in mind that if you’ve had a hysterectomy or an oophorectomy (where your ovaries are removed), your operation can trigger menopause. However, your consultant should discuss this with you before any surgery.

What is perimenopause?

Perimenopause is the run-up to the menopause when you experience symptoms but continue to have periods.

The perimenopause ends when you haven’t had a period for 12 months. At this point, perimenopause becomes the menopause.  

How can menopause symptoms be treated?

You can treat menopausal symptoms with HRT (hormone replacement therapy), which can only be prescribed by a doctor.

If you think you’ve started the menopause (are perimenopausal), you should speak to your GP about your symptoms and options. You don’t have to take HRT (and it isn’t suitable for everyone), so a discussion about what you can do generally can be helpful if you prefer to avoid taking medication.

What is HRT?

There are two main types of HRT available: one is oestrogen-only, and the other is a combined oestrogen and progesterone treatment. You can receive HRT in several ways, for instance, pills, patches, implants or a coil. Your doctor will discuss which option you feel most comfortable with, so don’t be afraid to ask about the pros and cons of each.

If you’re experiencing other effects, such as a low sex drive, your doctor may also offer treatment, which includes testosterone.

HRT is not covered by private health insurance. It is, however, offered on the NHS, but you’ll need to pay for it. The good news is that since April 2023, HRT medication has been heavily subsidised.

Now, you can buy a prepayment certificate (PPC), entitling you to one year of HRT treatment. There is no limit to the number of items you can claim with your PPC within that year; currently, it costs £19.30, and you can buy one here.

If you need other medicines beyond HRT, you could buy a standard prepayment certificate, which is more expensive at £111.60, but if you have numerous prescriptions each year, it could offer quite a saving. You can buy a standard PPC here.

Does health insurance cover menopause treatment?

Private health insurance doesn’t usually cover menopause treatment or prescriptions of HRT. That said, private health insurance with outpatient cover could play a part in the initial diagnosis.

While many women will receive their perimenopause and menopause diagnosis from their GP, there are times when additional tests, scans and gynaecologist consultations are required to reach a diagnosis. This could be for several reasons, such as you being younger than 40 or perhaps experiencing other symptoms which aren’t typical. Generally speaking, if your GP doubts the diagnosis, they will likely refer you to a gynaecologist.

Health insurance with outpatient cover will usually cover the cost of gynaecologist consultations

Assuming you have outpatient cover (and your symptoms aren’t associated with a pre-existing condition) when your GP refers you for further investigations, your health insurance should cover the cost of going private for those.

Remember, though, private health insurance won’t cover the cost of treatment, so as soon as you receive a diagnosis of menopause, you’ll be referred back to the NHS for treatment. 

Atypical symptoms and other conditions

While menopause treatment isn’t covered by private health insurance, if you experience severe or atypical symptoms which you and your GP think could be something other than menopause, you should be able to use your health insurance as you usually would to have it investigated. 

Why is menopause treatment not covered by insurance?

Private health insurance covers acute conditions. These illnesses can be resolved with treatment, such as broken bones or a hernia. Policies can also cover elective surgery, such as a hip replacement.

As perimenopause and menopause are natural biological processes and not acute conditions, they’re excluded from policies.

Does private health insurance provide any menopause support?

Although HRT treatment is not covered, some insurance providers offer menopause support. This typically includes access to mental health advice and information about relieving symptoms through diet and lifestyle. Don’t forget that private healthcare plans usually include access to a virtual GP or nurse 24/7 as standard. So, if you have any particular concerns, you can speak to someone sooner rather than later.

A few health insurers offer more bespoke support as part of a standard healthcare policy. For example, Vitality policies include an app that provides access to a menopause expert for one-to-one advice. There are also links to support groups and forums where you can exchange thoughts and meet (virtually) others going through the menopause.

Bupa also offers a menopause plan package with tailored advice and support for one year. However, these Bupa plans are not included in a standard policy. Instead, you’ll need to pay for a menopause package, which is currently £299 (you can buy a plan whether you’re an existing customer or not).

How can I access private healthcare as I get older?

Menopause is a natural part of ageing, which may lead you to think more about your overall health and the benefits of private health insurance.

Not only can policies help you access treatment quickly, depending on the level of cover you have, but they could also enable you to choose where you’re treated and by whom. Finally, as we mentioned earlier, if you have atypical menopause symptoms and your GP suspects it could be caused by something else, you can use your health insurance for specialist consultations and tests (assuming you have outpatient cover).

For more information or to speak to an expert, contact us. We can put you in touch with a regulated broker who can explain your options and help you choose a policy that best fits your needs and your budget.

You can also explore private health insurance in more detail with our in-depth guides:

Disclaimer: This information is general and what is best for you will depend on your personal circumstances. Please speak with a financial adviser or do your own research before making a decision.