# Talking to a doctor about perimenopause

> How to get the most from your appointment

Category: Perimenopause · 4 min read · Written by the Splash team · Sources checked October 2026
URL: https://splash.care/learn/perimenopause/talking-to-doctor

## Quick answer

- Track symptoms and periods before your appointment.
- Over 45, diagnosis is usually based on symptoms, not blood tests.
- Bring your questions and history, and ask about review at 3 months.
- You can ask for a menopause specialist if things are complex.

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](https://splash.care/learn/movement-sleep/sleep-cycle), work, relationships.
3. List any medicines, including hormonal [contraception](https://splash.care/learn/contraception/methods-overview), and your personal and family history (like breast cancer, blood [clots](https://splash.care/learn/period-care/clots), [osteoporosis](https://splash.care/learn/glossary/osteoporosis)).
4. Write down your questions and what you hope for, such as trying [HRT](https://splash.care/learn/glossary/hrt), [CBT](https://splash.care/learn/glossary/cbt) or something non-hormonal.

## What NICE says about testing

If you are 45 or over with typical symptoms, NICE says [perimenopause](https://splash.care/learn/glossary/perimenopause) can be identified from your symptoms alone, without blood tests. That means changes to your periods plus recent [hot flushes](https://splash.care/learn/perimenopause/hot-flushes) or night sweats. [Menopause](https://splash.care/learn/glossary/menopause) can be identified after 12 months without a period if you are not using hormonal contraception. NICE says not to use other [hormone](https://splash.care/learn/cycle-basics/hormones-explained) or scan tests (like AMH or oestradiol) to identify menopause. An [FSH](https://splash.care/learn/glossary/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.

**Myth:** You need a blood test to prove you are perimenopausal.

**Fact:** For most people over 45, a diagnosis is based on symptoms. Hormone levels swing so much in perimenopause that a single test is often not helpful. A thyroid or iron test may still be done to rule other things out.

## 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.

**Quick quiz:** What does NICE say about blood tests for over-45s with typical symptoms?

1. Always do an FSH test
2. No tests are needed to identify perimenopause
3. An ultrasound is required

Answer: No tests are needed to identify perimenopause. NICE says for people aged 45 or over with typical symptoms, perimenopause and menopause can be identified without lab tests.

> **Splash says:** it is OK to ask for a longer appointment, or to see a GP with a special interest in menopause. You are your own best advocate.

### When to see a doctor

Book an appointment if symptoms affect your life, if you are under 45 with symptoms, or if you have bleeding after sex, between periods, heavier than before, or at any time after menopause. If you are in crisis, call 999 or Samaritans on 116 123.

## Sources

1. [NICE NG23: Menopause: identification and management](https://www.nice.org.uk/guidance/ng23)
2. [NHS: Menopause and perimenopause](https://www.nhs.uk/conditions/menopause-and-perimenopause/)
3. [NHS: Treatment for menopause and perimenopause](https://www.nhs.uk/conditions/menopause-and-perimenopause/treatment/)
4. [British Menopause Society](https://thebms.org.uk/)

This is general information, not medical advice. Splash can’t diagnose. If you’re worried, talk to a GP, pharmacist or sexual health clinic. In an emergency call 999 (UK) or 911 (US).