Perimenopause

The perimenopause for some ladies can be very debilitating and symptoms can occur due to the change in the levels of hormones produced by the ovaries. It is commonly thought that it is all due to depleting oestrogen levels but in some ladies it can also or mainly be due to a change in progesterone levels as well.

A lady who has previously suffered with PMS, PMDD or postnatal depression will be affected more in the perimenopause by changes in progesterone levels. For most ladies, progesterone is typically regarded as the calming, anxiety-relieving hormone as it is converted to a neurotransmitter called Allopregnanolone which interacts with GABA receptors and GABA is considered the bodies ‘off switch’. Hence, in some ladies as their progesterone levels start to lower they can experience mood swings, migraines, PMS (premenstrual syndrome), fibroids, irregular/short cycle, painful/heavy periods, depression/anxiety, and disrupted sleep as there is less Allopregnanolone to interact with the GABA receptors.

Having variances on the genes which prevent or slow conversion of progesterone to this calming neurotransmitter can lead to even lower levels. Knowing your genetic tendency for how you convert progesterone and knowing what you can do to improve this conversion or optimise your progesterone levels will help your transition through the perimenopause.

The body has mechanisms in place to try to balance the interaction of all hormones. These include not only our sex hormones but other hormones too including adrenaline, noradrenaline, dopamine, GABA, and serotonin. Having genetic variances on any part of the pathways of these hormones can mean some people are more at risk of symptoms relating to either too much or too little of any of them.

Although the hormone balance can be challenged after puberty, eg. with pregnancy, for lots of ladies the first real destabilisation occurs again with changes in our hormone levels as our ovaries start to reduce production of our sex hormones. This can affect the balance of any of the other hormones creating symptoms beyond what might be expected to be down to depleting oestrogen or progesterone levels.

In women, progesterone is naturally produced once ovulation has occurred and is produced to prepare the lining of the womb for implantation. In most ladies it is typically regarded as the calming, anxiety-relieving hormone as it is converted to a neurotransmitter called Allopregnanolone which interacts with GABA receptors and GABA is considered the bodies ‘off switch’. As our ovaries produce less oestrogen and progesterone and we no longer ovulate each month, this can destabilise the situation and cause symptoms relating to the other neurotransmitters as well as the lack of calming progesterone.

Having variances on the genes which prevent or slow conversion of progesterone to this calming neurotransmitter can lead to lower levels. The progesterone might also be being preferentially converted to cortisol aggravating anxiety. Knowing your genetic tendencies on your hormone and nervous system pathways is life changing, especially when it is simple enough to support them with nutritional and lifestyle changes.

Autoimmune Thyroid Disease (AITD) occurs when the body’s immune system becomes overactive and starts to launch an immune cascade against itself. The 2 majors AITDs are Graves’ Disease and Hashimoto’s Thyroiditis. Whilst clinically they present differently, the underlying cause can be the same and having either of these conditions makes you more susceptible to other autoimmune conditions, Type 1 Diabetes, Coeliac Disease, Pernicious Anaemia, Rheumatoid Arthritis. It is therefore important to know your predispositions to prevent further diseases. Some people have genetic predispositions which mean they are more susceptible to inflammation. An infection, too much cortisol or elevated blood sugar levels can all cause inflammation. Dairy and gluten can be inflammatory to most people if the integrity of the gut wall isn’t optimal, but to others they can be a major source of inflammation due to genetic predispositions. A lack of ability to absorb vitamins which help our immunity or an increased need for them can also make us more susceptible.

Our hormones are very good at helping to reduce inflammation, hence why lots of ladies experience autoimmune thyroid disease when there are big fluctuations in their hormone levels, eg. pregnancy and the perimenopause/menopause. It is therefore even more important to consider optimising your hormones and other predispositions that might cause inflammation at this stage in your life.

As well as testing for autoimmune genes, intolerances, and vitamins, we have a specific thyroid report which will allow you to look at optimising any functioning thyroid that you may still have. The thyroid hormones set our basal metabolic rate which is important for weight management as well as energy levels. This thyroid report will also allow you to make sure that you can utilise levothyroxine (T4) which is now the only thyroid replacement generally offered on the NHS. At this stage in your life, it is often difficult to understand whether your symptoms are hormone or thyroid related and often it is a combination of both. Knowledge is powerful and to know why you have experienced thyroid problems, how you can optimise your current situation and, even better, prevent any other autoimmune conditions is what most women want to know, and now they can.

The causes of hair loss are multiple and often as we approach menopause, we become aware of an increase in the volume of our previous ‘normal’ hair shedding. Other ladies suffer from more diffuse hair loss, and some can also experience discrete areas of hair loss, all of which can lead to anxiety. Discrete areas of baldness are referred to as alopecia and this tends to be hereditary (androgenic) or due to autoimmune conditions. Diffuse hair loss known as Telogen effluvium is generally a result of nutritional deficiencies, hormonal changes, stress, or side effects from drugs. It is always sensible to check that you aren’t anaemic or have thyroid issues as these can both cause hair loss. Although it is reassuring to hear your blood results are normal, it doesn’t give you any more answers to the possible cause. Knowing what your DNA tendencies are towards inflammation (which can trigger autoimmune conditions), your nutrient status (do you need higher doses of the essential vitamins needed for healthy skin and hair growth), any genetic tendency to insulin resistance (which can mean you could be processing your testosterone now in a less favourable way) and how you process your hormones generally (whether that be with HRT or without HRT) will help you to get to the root cause of your hair loss issues. Knowledge is powerful and once you know the cause you can optimise nutrition and lifestyle to help resolve the problem.

Whether it has taken you some time to reach this stage in your menopause journey or you were lucky enough for this to be a smooth transition, now that you feel well and are aware of the all the health benefits that oestrogen offers you, it will always be a difficult decision to reduce or stop your HRT and some ladies may decide to never stop.

This means that our bodies are going to be exposed to hormones for many more years than they ever have been. It has therefore never been more important to make sure that you have the right dose of HRT in your body for the optimal length of time and that it is removed from the body in the safest way, thereby getting all the benefits without any potential risks. Oestrogen is detoxified in the body in various ways, it is important for this to happen in the safest way to prevent toxic metabolites from being produced, which have been shown to damage DNA and potentially initiate cancer. Your DNA will show you how your body preferentially eliminates your hormones, and we can then advise you of any simple nutritional and lifestyle changes needed so that you can feel reassured that you are getting all the benefit from your HRT and minimising any potential risks. For the ultimate reassurance, once they have made changes based on their DNA, some ladies may decide they would also like some further functional tests to allow them to look at a snapshot of their excreted hormones to reassure them that they are now processing them efficiently. The joy of the DNA reports, however, is that they aren’t affected by any supplements, medication, or diets. This is the ultimate personalisation of your HRT and for ladies trying to make an informed choice, as to whether to take or continue HRT, this is the perfect solution.

The most likely reason for ongoing bleeding in the absence of any pathology is that the balance of your hormones isn’t correct and hence the lining of your womb isn’t stable and therefore bleeding will continue to occur. Although there is lots of talk in menopause circles about offering a personalised HRT regime, in reality, there are only a handful of HRT preparations that are used in replacement therapy and in most ladies a similar dose is used of the 2 or sometimes 3 female hormones. Over our reproductive life we have all experienced different hormone levels and the way our bodies have metabolised and detoxified these hormones and our nervous system hormones, is individual to us. This process can be affected by many different variables and the joy of looking at your DNA is the ability to see how you are likely to be doing this and more importantly if you are doing it optimally. If not, how you can improve this process with nutritional assistance. Making sure the hormones you are using are being processed, detoxified and excreted correctly will mean that you aren’t getting a build-up of hormones or being exposed to re-circulating hormones. In doing this, as well as having the correct amount of hormones in your body for the optimum amount of time which are then processed in the safest way, it is very likely that your hormone levels will be stabilised and hence your bleeding should stop.

Histamine is a product made by the body (released from mast cells) as a protective mechanism. It has many important roles to play, it supports digestion, immunity, aids the sleep-wake cycle and helps memory. Both oestrogen, progesterone and testosterone play an integral role in mast cell degranulation and hence the potential to release histamine. Changes in hormone levels in the perimenopause and menopause with the introduction of HRT or at certain times in the menstrual cycle can therefore produce unwanted symptoms in some ladies with particular genetic tendencies. We can also introduce histamine to the body with the foods we eat, and the build-up tends to be cumulative, making it more difficult to decide if any specific foods might be aggravating the situation. As long as excess histamine can be broken down, it shouldn’t cause any adverse symptoms. Too much histamine in the body however can cause lots of unwanted symptoms. For those atopic ladies it might be worsening eczema and/or hay fever. For other ladies with no apparent previous histamine/allergies it can present with the onset of asthma, or other symptoms including, reflux, indigestion, migraines, hives, swollen breasts, bloating and/or anxiety.

Histamine is broken down by several different processes, one is by an enzyme located in the gut wall lining called DAO. DAO helps to breakdown excess ingested histamine. If a lady has a genetic variance on this gene, it can mean that she can less effectively break down histamine she has taken in with food. This potential will have always been present, but like all DNA variances, it doesn’t mean it will always cause issues, just that it has the potential to. Disturbances in the gut microbiome is very common with hormonal changes and often triggers this tendency.

Histamine made by the body requires good methylation for it to be processed. Methylation slows as we age and can be slowed more dramatically in some women in the perimenopause or menopause depending on their gene tendencies. It is important for both systems to be working as efficiently as possible to remove histamine safely and efficiently from the body and prevent the unwanted symptoms it can cause.

Knowing if you have a genetic tendency for your DAO gene to work less effectively and/or reduced efficiency of methylation at this stage in your life, will be a game changer for you in managing your symptoms and your ability to benefit from your HRT.

For ladies suffering with these symptoms, it is likely that you are experiencing symptoms of high histamine levels, sometimes referred to as histamine intolerance.

Histamine is a product made by the body (released from Mast Cells) as a protective mechanism. It has many important roles to play –it supports digestion, immunity, aids the sleep-wake cycle and helps memory. Both oestrogen, progesterone and testosterone play an integral role in mast cell degranulation and hence the potential to release histamine. Changes in hormone levels in the perimenopause, menopause, with the introduction of HRT or at certain times in the menstrual cycle can therefore produce unwanted symptoms in some ladies with particular genetic tendencies.

We also introduce histamine to the body with the foods we eat, and the build-up tends to be cumulative, making it more difficult to decide if any specific foods might be aggravating the situation. As long as excess histamine can be broken down by the body, it shouldn’t cause any adverse symptoms. Too much histamine in the body however can cause lots of unwanted symptoms. For those atopic ladies it might be worsening eczema and/or hay fever. For other ladies with no apparent previous histamine/allergies it can present with the onset of asthma, or other symptoms including, reflux, indigestion, migraines, hives, swollen breasts, bloating and/or anxiety.

Histamine is broken down by several different processes, one is by an enzyme located in the gut wall lining called DAO. DAO helps to breakdown excess ingested histamine If a lady has a genetic variance on this gene, it can mean that she can less effectively break down histamine she has taken in with food. This potential will have always been present, but like all DNA variances, it doesn’t mean it will always cause issues, just that it has the potential to. Disturbances in the gut microbiome is very common with hormonal changes and often triggers this tendency.

Histamine made by the body requires good methylation for it to be processed. Methylation slows as we age and can be slowed more dramatically in some women in the perimenopause or menopause depending on their gene tendencies. It is important for both systems to be working as efficiently as possible to remove histamine safely and efficiently from the body and prevent the unwanted symptoms it can cause.

Knowing if you have a genetic tendency for your DAO gene to work less effectively and/or reduced efficiency of methylation at this stage in your life, will be a game changer for you in managing your symptoms and your ability to benefit from your HRT.

Progesterone is naturally produced by the ovaries once ovulation has occurred and is produced to prepare the lining of the uterus for implantation. If the released egg doesn’t create a pregnancy then the progesterone levels drop and the woman has a period. Progesterone is essential for the maintenance of pregnancy and for normal cycle regulation. In most ladies it is typically regarded as the calming, anxiety-relieving hormone as it is converted to a neurotransmitter called Allopregnanolone which interacts with GABA receptors and GABA is considered the bodies ‘off switch’. This is why lots of ladies find utrogestan (a body identical micronized progesterone) helps them sleep.

We know that an imbalance in progesterone levels in women can cause mood swings, migraines, PMS (premenstrual syndrome), fibroids, irregular/short cycle, painful/heavy periods, depression/anxiety, disrupted sleep, and infertility/recurrent miscarriage. Suffering with these symptoms during the menstrual cycle, together with suffering with postnatal depression or experiencing a more troublesome perimenopause are likely indicators of the ladies who are more likely to struggle with the progesterone component of HRT.

Having variances on the genes which prevent or slow conversion of progesterone to this calming neurotransmitter can lead to lower levels and hence side effects. Instead the progesterone might be preferentially converted to cortisol, oestrogen or testosterone resulting in higher levels of these hormones in the body, and causing symptoms such as anxiety, irritability, aggression, restlessness, panic attacks, low mood, poor concentration, forgetfulness, heightened emotions, acne, greasy skin, abdominal cramping or bloating, fluid retention, fatigue, headaches, dizziness, and breast tenderness.

Knowing your genetic tendency as to how you process progesterone and more importantly, knowing what you can do with nutrition to improve this situation will allow you to tolerate progesterone much better, allowing you to get all the benefits of HRT.

In the perimenopause, it is natural to need to increase your oestrogen dose over time to alleviate new symptoms as you proceed further into the menopause and your own levels drop further. Once menopausal there should be no further requirement for you to increase your dose and the doses needed in the perimenopause should be appropriate and not need to be excessive.

Our body controls our oestrogen levels using oestrogen receptors, but unfortunately some ladies have genetic variances on these oestrogen receptors which means they can be less sensitive. Hence the receptors get used to a dose but then want more to achieve the same response at a later date. There are two types of oestrogen receptors, and each has an important role to play in regulating oestrogen doses in the body.

It is essential to have the correct amount of oestrogen in the body for the optimal amount of time and for it to be eliminated from the body in the safest way. Rather than keep increasing the dose of oestrogen in ladies and putting them at danger from too higher levels, if you know you have these genetic tendencies on your oestrogen receptors, doses can be managed more efficiently with nutritional input, allowing your symptoms to be alleviated by appropriate normal doses of oestrogen.

Too much oestrogen can be detrimental to the body, it can cause cysts, fibroids, endometriosis, adenomyosis and weight gain. If the high dose of oestrogen is then potentially not metabolised in the safest way, it can promote synthesis of the harmful molecules, 3,4 semi-quinones, which release free radicals, damage DNA and potentially initiate cancer. Your DNA can also advise you on what you may need to do to make sure that you prevent this from happening and to detoxify your hormones in the safest way.

The reason for this could be multifactorial, the cells in breast tissue have hormone cell receptors within them, so changes in hormone levels can affect these receptors. Some ladies may have experienced similar symptoms at different times in their natural cycle giving an indication of how sensitive these receptors in their breast tissue might be. Being given HRT to replace their own depleting levels or a dose that is too high, might initially stimulate these cells, creating breast tenderness. However, for most ladies this will generally settle as the receptors get used to the hormones again or the dose is adjusted.

Our individual mechanisms for processing our hormones will also affect these receptors. Some oestrogen detoxification pathways can produce toxic substances which if not removed from the body safely have been shown to promote synthesis of harmful molecules, 3,4 semi-quinones, which release free radicals, damage DNA, can cause dense breasts and potentially initiate cancer. The same is true for how some ladies process progesterone, variances on the enzymes that breakdown progesterone can also cause dense breast tissue. In addition to this, some ladies don’t excrete their sex hormones efficiently so they can be recycled within the body causing levels far higher than those thought to be given with their dose of HRT. Hormones can also cause the release of histamine and if this isn’t broken down efficiently it can be a contributory factor to breast swelling and tenderness.

All or any one of these factors can cause ladies to experience breast tenderness. Knowing your genetic tendencies and more importantly how you can optimise your nutrition and lifestyle to help resolve these symptoms and reassure you that you are processing your hormones in the safest way doesn’t get much more bespoke.

Breast tissue is sensitive to female sex hormones and therefore the levels of our hormones or the metabolites produced from our partially metabolised hormones can affect the density of breast tissue. The way your body processes and detoxifies hormones is therefore a likely contribution. If you are a lady who has already suffered with these symptoms, it is likely that by continuing the use of HRT beyond the menopause will mean you will continue to experience these symptoms unless you make some changes to the way your hormones are processed and metabolised. Having breast cysts is both uncomfortable and worrying for ladies, having dense breast tissue makes mammogram screening more difficult and less reliable at picking up early-stage breast cancers.

There is power in knowing how your DNA variances affect how you process your hormones, and more importantly what simple measures you can take to allow this process to work more optimally.

Whether these are conditions that you have been diagnosed with recently or if it has affected you for most of your reproductive life, you will be well aware of the pain and heartache these can cause. We know that certain genetic tendencies make a diagnosis of endometriosis and fibroids much more likely. The ability to detoxify and utilise your sex hormones appropriately, so that they are in the body for the correct amount of time at the correct dose is essential to help prevent these debilitating conditions.

Ladies are often advised that these symptoms will resolve once they reach the menopause, as they are hormone dependent. However, what the same people fail to tell you, is that it is likely that you will in exchange, suffer with a wealth of other symptoms and reduced general wellbeing due to your lack of hormones.

By choosing to take HRT, will mean that you will continue to experience these symptoms unless you make some changes to the way your hormones are processed and metabolised. There is power in knowing how your DNA variances affect how you process your hormones, and more importantly what simple measures you can take to allow this process to work more optimally.

Women are often advised, and it is generally true, that the weight we start to gain in our perimenopause which is more central (waist and hips) is because depleting oestrogen levels can cause insulin resistance. By replacing oestrogen you should therefore lose weight not gain weight and for most ladies this is true.

However, the causes of weight gain at this stage in your life are more complex than just ‘reduced oestrogen levels cause insulin resistance’.

The body works hard to harmonise all our hormones not just our sex hormones, so genetic tendencies affecting your thyroid, cortisol production, sleep, or appetite can all be multifactorial in weight gain and metabolism at this stage in your life. Knowing what your predispositions are and how you can stabilise the situation through nutrition and lifestyle will not only help you reduce and maintain a healthy weight but help you on your way to optimal aging.

There are lots of mixed messages regarding whether HRT helps dementia, has no effect or could be detrimental, which isn’t helpful if you are weighing up all the pros and cons of whether to start HRT or not. The research – as with most women's health – is lacking, but there are some facts that we do know which may help you decide. Dementia can be caused by vascular changes or due to Alzheimer’s Disease. Health and lifestyle play a huge role in cardiovascular disease, regardless of any additive risk that you may have from your DNA tendencies. We know that Alzheimer’s Disease is far more common in women than men and women are twice as likely to develop it compared to breast cancer. We also know that Apolipoprotein E (APOE) is important for removing cholesterol from the bloodstream and that genetic variances on APOE4 have been found to give a significantly increased risk of cardiovascular disease and Alzheimer’s. If you know you have a higher-risk version of APOE4 you can reduce your risk of Dementia by making changes to your health and lifestyle. We know that oestrogen is cardioprotective and that the sooner HRT is started within perimenopause or menopause the more protective it is. In view of this, most menopause specialists believe that the research will in time show that HRT is protective of Dementia and that the earlier it is started the better, especially in those ladies with additive risk factors. We can’t change our genes but we can make sure they have the least detrimental impact on our health.

We appreciate this is a very difficult decision, especially if you are struggling with debilitating menopausal symptoms that haven’t responded to other management options. Your HRT prescriber will help you decide based on your own individual risk and the evidence available to you, but we feel that knowing your DNA tendencies will also help you make a more informed decision by helping you see why you may have been at increased risk in the first place, and how you could best mitigate any future risk. Tumours can occur for many reasons and often it is multifactorial: the inability to repair cells or DNA as needed, being prone to inflammation which causes cellular damage, not being able to efficiently produce or absorb antioxidants which leaves the body vulnerable, and having a poor ability to efficiently metabolise, regulate and detoxify your hormones. This final cause will be important to know, especially if you decide to reintroduce hormones into your body, as your HRT will be processed in the same way as your own hormones. Knowing all these facts will be powerful information and will allow you to make lifestyle and nutritional choices that will help reduce any future risk. Should you decide to start HRT, knowledge of your DNA tendencies will allow you to make sure that you have only an optimal dose in your system to treat your symptoms, for the least amount of time, and that it is detoxified and excreted in the most appropriate, least harmful way.

Genetics can play a major role in our susceptibility to low energy states including Fibromyalgia, CFS and Long COVID. This susceptibly can also be exacerbated further in some ladies with depleting oestrogen levels. A process called Methylation is needed for so many aspects of healthy life, it produces products that support our mitochondria which make energy, it helps us sleep, is responsible for making serotonin, it supports detoxification and aids metabolism. If this process isn’t working efficiently, it can mean we may struggle to produce optimal energy levels, can be more sensitive to pain and more vulnerable to stress.

Inflammatory tendencies and cytokines play a huge role in our predisposition and the severity of these conditions and hence how our bodies react and are able to recover after any infection, including COVID. Reducing oestrogen levels can also affect this predisposition.

Genetic variances in our Nervous System can also make us more sensitive to pain, along with pre-dispositions to low mood, energy and fatigue.

We can look at your gene tendencies and teach you how you can support these genes through diet, lifestyle and potentially supplements when we know where the weak spots are.

A genetic risk for autoimmunity doesn’t necessarily mean that you will develop a condition, but the beauty of knowing any genetic predisposition is that you can be in control of modifying your behaviour or environment to optimise your health and do all you can to keep autoimmunity at bay.

One of the main triggers of autoimmune conditions is body inflammation. Too much cortisol can cause inflammation as can elevated blood sugar levels. Some people have genetic predispositions which mean they are more susceptible to inflammation because of infections. Dairy and gluten can be inflammatory to most people if the integrity of the gut wall isn’t optimal. A lack of ability to absorb vitamins which help our immunity or an increased need for them can also make us more susceptible. Our hormones are very good at helping to reduce inflammation hence why lots of ladies experience autoimmune thyroid disease when there are big fluctuations in their hormone levels, eg. pregnancy and the perimenopause/ menopause. It is therefore even more important to consider optimising your hormones and other predispositions that might cause inflammation at this stage in your life. We are able to look at your DNA to see if you are more genetically vulnerable to developing autoimmunity. As well as testing for autoimmune genes, we can also test for nutrition and lifestyle genes which if optimised can help reduce your overall risk.

Once you have all this information and we know of any weak spots, we can advise you how to support yourself through diet, lifestyle and potentially supplements in order to reduce your risk of triggering your autoimmune tendencies.

The liver is crucial for metabolising and detoxifying all medicines, chemicals and toxins and therefore plays a major role in protecting the body, it is therefore essential that it can work at maximum capacity. There are several genetic factors that can affect the way our bodies process and remove cholesterol and triglycerides, which ultimately causes NAFL. Having a fatty liver can be indicative of other health issues in the future and hence the importance of making changes to your health and lifestyle. Excess sugar in the blood stream is stored as fat, reduced Methylation and genetic weaknesses on the APOE gene can all put people at increased risk. NAFL is more prevalent in menopausal women. Depleting hormone levels can increase risk by reducing methylation further, adding to blood sugar destabilisation and increased inflammation in those ladies with genetic predispositions.

Having knowledge of any predispositions that could have caused this, will allow you to make sustainable nutrition and lifestyle changes to prevent future chronic diseases, especially Cardiovascular Disease.

If you feel well then it is likely to be a suitable diet for you. The body is pretty good at telling us if things aren’t right. However, we see lots of ladies who don’t feel themselves during this time in their lives and look at making lifestyle changes including changes to their diet. They often decide to follow the latest advice that plant-based diets are best, and often it can worsen their symptoms, albeit they don’t realise that this is the reason.

Most people following a vegan/vegetarian diet know they should supplement with B12 and iron, as these nutrients are more difficult to get in the correct amounts from this diet. However, they are less aware that genetic variants could mean that they may also struggle to get enough Vitamin A which is vital for immunity, appropriate anti-inflammatory responses, eye health and for the thyroid to function efficiently.

For some ladies who have genetic variants affecting methylation, the lack of choline in their bodies from a vegan diet can have profound effects, causing amongst other things brain fog, poor mucus membranes, reduced energy levels and anxiety. Knowing how efficient you are at methylating and whether your natural tendency for this to slow down with age could be heightened due to your change in hormones, will also allow you to choose the correct diet or most appropriate supplements to optimise your health.

The nutrient core report gives a really good overview of your genetic tendencies with regard to lots of vitamins, which will allow you to make a more informed choice about the diet you choose to follow or how you can appropriately supplement.

This is the ultimate health MOT. Your DNA is your bodies instruction booklet, your lifestyle, diet and the environment around you can all influence these instructions. Being able to choose a diet and lifestyle to suit your DNA can help prevent problems before they appear.

Don’t worry, we know this is a financial investment and we are more than happy to give advice. You can complete a Discovery Questionnaire, and should you proceed with any of our suggested reports within 3 months, we will deduct half of the cost (£100) from your order.