If you suspect that you’re perimenopausal or menopausal, and your symptoms have started to interfere with your quality of life, it’s a good idea to make an appointment to see your doctor or a healthcare professional who specialises in the menopause.
In most cases, your first point of contact will be your GP or the practice nurse at your local surgery – but it’s always worth asking there’s a particular person who specialises in the menopause. Some areas have specialist menopause clinics, but these are few and far between. Unless you have a complex medical history, your menopause care is likely to be managed by your GP.
Preparing for your appointment
If your local surgery offers double appointments it’s a good idea to book one of these so that you’ll have enough time discuss your symptoms and concerns. Before your appointment, take a look at the symptoms list to record the menopausal symptoms that you’re experiencing.
Make a note of any changes to your periods, and bring a list of any medications that you’re taking, including herbal supplements. It’s also wise to jot down any questions or concerns, so that you don’t forget to mention them during your appointment. If you’re feeling anxious, you can bring along a friend or family member for moral support.
Your first appointment
According to the 2015 NICE menopause guidelines, your doctor should discuss the following:
- the stages of menopause
- common symptoms of the menopause
- how the menopause is diagnosed
- lifestyle changes that can help your health and wellbeing
- benefits and risks of treatment
- how the menopause can affect your future health
Your doctor may want to carry out blood tests to check your hormone levels, but this isn’t usually necessary as these can vary by the hour. Most women can start HRT without needing any investigations or blood tests.
Sometimes your doctor may want to carry out blood tests to rule out other underlying issues, such as an underactive thyroid, and they will also check your blood pressure.
If you would like to take HRT and you feel you would benefit from taking it then you should ask at your first appointment for a prescription of HRT. The majority of women benefit from taking HRT and women can start taking HRT during their perimenopause. No women is usually too old to start taking HRT, even if it is many years since your menopause then you should still be able to take HRT.
Try to leave the room with as many questions answered as possible, ask if your doctor has any leaflets or information they can share with you, and check if you need a follow-up appointment. NICE guidelines recommend a review three months after your first appointment, but you should ask for an earlier review if you are experiencing side effects or the treatment doesn’t seem to be working.
A second opinion
Unfortunately, some doctors and healthcare professionals still believe outdated reports that HRT is linked to cancer, blood clots and heart problems, so they may be reluctant to prescribe HRT. If there’s no medical reason why HRT is unsuitable for you, then it’s important to speak up and, if necessary, ask for a second opinion.
You could ask to speak to another healthcare professional at your surgery, or ask to be referred to a specialist. Alternatively, you could refer yourself to a private menopause clinic. In the UK, the British Menopause Society has a register of recognised menopause specialists at thebms.org.uk. If you live outside the UK, you can contact the International Menopause Society.
What happens if my doctor / nurse won’t give me HRT?
- Informing your doctor about what you are wanting to discuss prior to the appointment or at the start of your consultation will help to ensure you get the most out of your consultation.
- Know your rights as a patient. Doctors will be more likely to consider your views if you can show you are fully informed and understand what any risks are and explain clearly why you still wish to have that treatment option because of the benefits to your life and health you believe it would bring.
- Be persistent but polite. If you do not get the desired outcome at the first appointment, try again another time. You can ask to see another doctor within your practice.
In general, your best approach when talking to your doctor about your menopause is to clearly state your reasons for what you would like, explain what information has led you to this decision, and that you know what the associated risks might be but that it is still what you choose to do. This information may need repeating on several occasions, to several doctors or nurses, but persistence often pays off when you can give a clear and rational argument that shows careful consideration of the evidence of the benefits to your health.