How do I talk to my GP about perimenopause?

Book an appointment, say plainly that you think your symptoms could be perimenopause, and bring a short written list of your symptoms, your period pattern and two or three questions. That’s the heart of it. Your GP can usually tell from your age and symptoms whether you’re in perimenopause or menopause, and they can talk you through HRT and other options. If they can’t help, or your symptoms don’t improve, you can ask about a referral to a specialist.

When is it worth seeing your GP?

The HSE suggests contacting your GP if:

• your menopause or perimenopause symptoms are worrying you or affecting your daily life
• you’re having symptoms before the age of 45
• your periods have stopped for a year or more before 45

You don’t need to wait until symptoms are severe. If they’re getting in the way of sleep, work or relationships, that’s reason enough. Many women put it off, worried about wasting the doctor’s time. You’re not: perimenopause is a normal reason to see a GP.

Before your appointment

Keep a symptom diary for a few weeks. Note what you notice, when it happens, how it affects your day and the dates of your periods. Symptoms like anxiety, joint pain, brain fog or poor sleep are easy to forget in the moment or to mention as separate problems. A booklet hosted by the British Menopause Society includes a symptom checklist you can fill in and bring.

Write down your questions. The NHS advises picking your two or three most important questions and writing them down, along with when your symptoms started and what makes them better or worse.

List your medicines, including any vitamins, supplements or herbal remedies, and any relevant history such as migraines, blood clots or breast cancer in you or your family. These can affect which treatments suit you.

Ask who to see. The BMS-hosted booklet suggests asking the receptionist, when you book, whether a doctor or practice nurse has a special interest in menopause. Some have done extra training.

Bring someone if it helps. Both the NHS and the booklet suggest taking a friend or family member if you’re anxious.

During the appointment

Start with the most important thing. Something like “I think I might be in perimenopause, and it’s affecting my sleep and my work” tells your GP straight away why you’re there.

Do I need a blood test? Often not. The NHS and HSE say a GP can usually diagnose perimenopause or menopause from your age and symptoms. The BMS-hosted booklet explains that NICE guidance says healthy women over 45 should be diagnosed on symptoms alone, partly because hormone levels go up and down during perimenopause, so a single test can be misleading. Blood tests are more likely if you’re under 45.

Useful questions to ask, adapted from the NHS:

• Could my symptoms be perimenopause, or could something else be causing them?
• What are my treatment options, and what do you recommend for me?
• What are the benefits, risks and side effects of each?
• How will I know if the treatment is working, and when should I come back?
• Who do I contact if things get worse?
• Do you have any written information, or know of a support group?

The booklet also suggests it’s fine to make two appointments: one to talk through your symptoms and options, and a second to decide on treatment once you’ve had time to think and read up.

What your GP might offer

The HSE says hormone replacement therapy (HRT) is the main medicine treatment for perimenopause and menopause symptoms. The type depends on things like whether you still have periods and whether you’ve had a hysterectomy.

If HRT isn’t suitable for you, or you’d rather not take it, the NHS says there are other options. These include cognitive behavioural therapy (CBT, a talking therapy that can help with hot flushes, sleep and anxiety), and some non-hormonal medicines for hot flushes or low mood. For vaginal dryness, your GP may suggest vaginal oestrogen, and the HSE notes that moisturisers and lubricants are available from pharmacies without a prescription.

Your GP will talk through what suits your health and history. Don’t start, stop or change any medicine without their advice. A pharmacist is also a good person to ask about how to use what you’ve been prescribed.

Follow-up: if you start HRT, the HSE says you’ll usually have a review after 3 months and then once a year.

What about the cost of treatment?

In Ireland, HRT is free on prescription from participating pharmacies if you have a medical card or a Drugs Payment Scheme card, as the HSE explains. The GP visit itself isn’t covered by that scheme. Our guide to free HRT in Ireland has the details.

In the UK, prescription charges work differently in each nation, and England has an HRT prescription prepayment certificate. The same free HRT guide explains how it compares.

If you’re not getting the help you need

The HSE says your GP may refer you to a specialist menopause service if treatment isn’t helping, you have ongoing side effects, you can’t take HRT, or you have a complex medical history. In Ireland, these specialist complex menopause clinics see the most complex cases. In the UK, the NHS says you can be referred to a specialist menopause centre if treatment and lifestyle changes haven’t helped.

The BMS-hosted booklet says not to be afraid to ask for a second opinion, or for a referral, if your GP isn’t able to help. Seeing a different GP in the same practice is often the simplest first step.

When not to wait

Some symptoms need a prompt GP visit rather than a routine one:

• any bleeding after menopause (12 months or more without a period), even if it’s only spotting
• bleeding between periods or after sex, or periods that are suddenly much heavier
• bleeding that hasn’t settled after the first six months on continuous HRT, according to the BMS-hosted booklet

If your mood is very low or you’re having thoughts of harming yourself, don’t wait for a routine appointment. Talk to your GP today, call Samaritans free on 116 123 (Ireland and UK, any time), in Ireland call Pieta on 1800 247 247 or text 50808, in the UK text SHOUT to 85258, and in an emergency call 999 or 112.

What to do next

• Start a symptom diary today and keep it for two to four weeks, with your period dates.
• Write down your top two or three questions and your list of medicines and supplements.
• When you book, ask whether a GP or nurse at the practice has a special interest in menopause.
• At the appointment, say clearly that you think it might be perimenopause, and agree when you’ll go back to review how things are going.
• If things don’t improve after a few months, ask about a referral or a second opinion.