Talking to a doctor about perimenopause

Appointments can feel rushed, and symptoms can be hard to explain when you are in the chair. A little preparation helps you feel heard.

Before you go

1. Track your periods and symptoms for a few weeks (this app can help).
2. Note which symptoms bother you most and how they affect daily life: sleep, work, relationships.
3. List any medicines, including hormonal contraception, and your personal and family history (like breast cancer, blood clots, osteoporosis).
4. Write down your questions and what you hope for, such as trying HRT, CBT or something non-hormonal.

What NICE says about testing

If you are 45 or over with typical symptoms, NICE says perimenopause can be identified from your symptoms alone, without blood tests. That means changes to your periods plus recent hot flushes or night sweats. Menopause can be identified after 12 months without a period if you are not using hormonal contraception. NICE says not to use other hormone or scan tests (like AMH or oestradiol) to identify menopause. An FSH blood test is considered only if you are 40 to 45 with symptoms and period changes, or you are under 40 and menopause is suspected.

Questions worth asking

• What are all my options, hormonal and non-hormonal? What would suit me, given my history?
• If HRT: which type, what dose, and what are the risks for me? (NICE has a discussion aid with numbers.)
• When will we review how it is working? (NICE says at 3 months, then every year.)
• What should I do about bleeding, and which side effects should I report?
• Can I see someone with extra training in menopause if this is complicated?

NICE says to consider referring you to a menopause specialist if you have symptoms but cannot take HRT, or if the best choice is unclear. The British Menopause Society keeps a list of specialists. You can also ask for a longer appointment or a doctor with a special interest in menopause.