When it comes to talking to your doctor about menopause, it can be challenging to get seen and heard by your doctor. Need a pep talk before you go in? Le’Nise Brothers, who specialises in women’s health, shares her advice on how to get the best out of your appointment, as well as a checklist of questions to ask.
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Make sure you are listened to
Menopause is complex and symptoms can appear gradually, which can be confusing. This is exactly how Celeste felt when she came to my clinic. From years of regular, easy periods and generally good health, she suddenly had very irregular and heavy periods. She was having trouble sleeping, was hot in the middle of the day and could barely concentrate.
When she went to her doctor, she was told that perimenopause wasn’t real and that she just needed to reduce her stress levels. While there are plenty of excellent doctors who signpost women to the help they need, unfortunately, experiences like Celeste’s are also not uncommon.
Feeling out of control
Menopause symptoms such as changing periods, moods, energy levels and others can leave you in shock. My menopausal clients say one of the hardest things about this phase of life is the lack of control. They’re so used to having control over the many balls they’re juggling and their changing hormones sends everything off kilter.
Don’t dismiss symptoms
There are a variety of symptoms that you may be normalising as ‘just part of getting older or being busy’. Perhaps you’re simply feeling ‘off’, not as engaged in life or overwhelmed by the responsibilities you used to be able to juggle. However you’re doing, it’s important to know that you deserve to feel your best, full of energy, with steady, even moods and brain clarity. Many women don’t prioritise their health needs due to busy lives but it’s vital you give yourself time to look after your body and mind. Getting older doesn’t mean we need to accept a gentle descent into poor health.
When to see your doctor about menopause
If you’re experiencing any of these symptoms below, please see your doctor for a health check, especially if you’re over the age of 40. There are at least 34 symptoms of menopause to look out for as well as red flag symptoms which may need a doctor’s advice. Even if you aren’t experiencing any of these symptoms or changes to your overall health, it’s still beneficial to have a check, so that you can go into this next phase of life with confidence.
You may start to notice:
- Brain fog, struggling to find words, issues with concentration
- Irregular periods when periods have usually been regular
- Heavier or lighter periods, especially when periods have been a more regular flow
- Vaginal dryness
- Greater urgency to urinate or a more frequent need to urinate at night
- Hot flushes or night sweats
- More frequent mood changes, anxiety, or depression
- Sleep problems – trouble falling asleep or staying asleep
- Muscle and joint pain
- Vaginal pain or discomfort, especially during sex
- Frequent urinary tract infections (UTIs)
- Heart palpitations (this is a red flag symptom, which means that you must see your doctor if you are experiencing this)
How to prepare for your next visit
Before you see the doctor, it’s important to prepare for your visit. This will help you get the best out of the appointment and help you feel empowered and in control.
Build your confidence
- Prepare yourself mentally – remind yourself that your health is important and you deserve to feel your best and get the support you need
- Ask if the surgery has a doctor with a special interest in menopause or a specialist nurse who looks after menopause
- Schedule your appointment for earlier in the morning when you’re likely to be more alert and less frazzled by the demands of the day
- Ask for a double appointment so you don’t feel rushed
- Do your research – look at our menopause symptoms library for guidance
- Rehearse what you want to say with a friend
- Go for a short walk beforehand or give your arms and legs a little shake – gentle movement helps to take you out of your head and connect back with your body
- Take a friend with you – if you are easily overwhelmed and flustered, they may be able to help you by taking notes
- Go with an outcome in mind – is it advice or treatment you are looking for?
Write down your symptoms and their impact on you, making notes of:
- Which symptoms you’ve been experiencing
- How long you’ve been experiencing them
- Which symptoms are most bothersome – the ones that you want treatment for
- When, if you’re still menstruating, these symptoms occur in your menstrual cycle
- The effect these symptoms have had on your day-to-day life
- If you’re still menstruating, the length of your menstrual cycle (from day 1 of your period all the way through to the day before your next period starts)
- Duration of your period
- Any changes in the last 3-4 cycles, are they heavier or lighter?
- What ovulation and menstruation usually feel like for you
- What you’ve already tried, if anything, to address these issues
- Your ideal outcome from the appointment – is it understanding which menopause stage you are in, getting a prescription or a referral to a specialist?
What to do during the appointment
- Use calming techniques. Try a gentle body scan while you’re in the waiting room. Begin by inhaling and exhaling through your nose, then use your breath to soften your body, noticing anywhere that feels tight. Start with the forehead, then the jaw, then the shoulders and work your way down the body to your feet
- During the appointment, take your time, refer to your questions and remember that you can book a follow-up appointment to go through anything else that you haven’t been able to cover
- If you think you may become emotional or cry and your doctor hasn’t got a good bedside manner, remind yourself that your health is important and you are doing the right thing by seeking out support
- If the doctor has got your information wrong, ask them if you can go back over your notes again until you are happy they are accurate. Again, you may need to try again with a second appointment or find another doctor
Checklist of questions to ask your doctor about menopause
It also may be helpful to familiarise yourself with the NICE guidelines on perimenopause and menopause to understand how the doctor will go about making a diagnosis and further recommendations. Doing your own research and taking notes will also be helpful because this will help you have a more informed conversation and learn some of the common acronyms that your doctor might use.
Here are some questions you might consider asking your doctor during your appointment:
- How can nutrition, exercise and other lifestyle changes help me manage my symptoms?
- How long will these symptoms last?
- Is hormone replacement therapy (HRT) right for me based on my history and lifestyle?
- Will HRT improve my specific symptoms?
- What are the different types of HRT and what is best for me and my symptoms?
- How long will I need to be on HRT?
- How often should I get my bloods checked while I’m on HRT?
Can your doctor test for menopause?
Menopause is a clinical diagnosis. This means that if you have typical symptoms (including hot flushes and irregular or absent periods), your doctor doesn’t need to do any further tests to tell if you are going through menopause.
There are other tests that you may be offered but these would be to check on your overall health rather than whether or not you are menopausal. These tests will depend on your doctor and your medical history and might include:
- Cholesterol levels
- Basic vitamins and minerals
- Liver and kidney function
- Immune function
- Blood sugar level
- Red blood cell count
- Thyroid function
Checking your thyroid is valuable because the symptoms of hypothyroidism (an underactive thyroid) can overlap with perimenopausal symptoms.
What to do if your doctor won’t prescribe HRT
Don’t be afraid to do your own research and ask for a second or third opinion if you feel you aren’t getting the support you need from your doctor. If your requests for blood tests or certain medications such as HRT are being refused, ask why. Before you go, you may want to read more about the risks and benefits of HRT.
It may be as simple as the doctor wants you to explore other non-medical treatment options first. Make sure this refusal is noted on your file, so that you can refer to it if you speak to a different doctor. Remember, not all doctors have undertaken specific training on perimenopause or menopause.
It’s important to acknowledge that what you’re experiencing isn’t just ‘all in your head’. Equally, it isn’t something that needs to be feared or pathologized. This is a natural phase of life, and everyone’s experience of perimenopause is different. You should feel confident seeking and receiving medical help and support if you need it.