“You can’t pretend it’s not happening; accept it and if you need help, go and get it…I promise that afterward there’s life and it’s all fine.”

DAWN FRENCH,

COMEDIAN AND AUTHOR

My Story

I was a bit intimidated the first time I went to talk to my doctor about what was going on. My anxiety, low mood, and forgetfulness made it challenging, and there’s a lot that I wish I had known before that initial appointment.

My first tip would be to see a gynecologist who has experience with menopausal women. The majority of general practitioners don’t get perimenopause and menopause training at medical school, and it is up to them to take training courses, which is ridiculous given half the population will be affected by menopause at some point. Also, they have limited time per appointment, so a practitioner who has an in-depth knowledge and can give you a bit more time might be a better option.

I would also advise listing all your symptoms and what you have done to try and alleviate them to make the most of the time you have at the appointment. You could take the symptom checker in the first chapter in with you (see this page). Every woman experiences menopause differently, so it is useful for the doctor or nurse to know what you are experiencing. It can also help them decide if any tests should be done to see if there is an underlying issue that may not be menopause-related. For example, weight gain and fatigue could be signs of an underactive thyroid. I always make sure I have my blood tested every year just to rule out any anything that isn’t menopause-related—I do tend to worry, so this gives me peace of mind. I also ask for a printout of the results to take with me—someone advised me to do that, and I was glad I did. I was told on the phone everything was normal, but when I got the results some showed up as abnormal. Nothing major, but I was glad I asked.

Next, I would suggest that you do some research. You don’t need to be an expert, but I found having enough knowledge to have conversations and discussions with the professionals ensured I played an active role in the decision-making around my treatment. For example, the British National Institute for Health and Care Excellence (NICE) guidelines state that HRT should be considered for low mood resulting from menopause, and CBT should be considered for low mood and anxiety. Despite this, I was offered only antidepressants when I first approached the doctor, and I hear constantly from women who are given this as the only option.

I also found writing down all the questions that occurred to me and taking them with me helped (I knew menopausal brain fog would otherwise lead me to forget to ask half the things I needed to know on the day of the appointment!). If you are nervous or anxious, it is also fine to take someone with you for support who can act as your advocate if you forget anything or feel a bit overwhelmed. I often use breathing exercises to relax me.

Don’t be afraid to ask for what you want. Doctors are not mind readers and often would prefer if you were honest and direct about what you want and what you’re experiencing. I have a friend who wanted counseling and just asked straight out to be referred to a therapist (she had to wait seven months but found it to be highly beneficial when she got it).

Many women have very positive experiences with the medical profession, so please don’t be afraid to seek help if you need it. There are excellent doctors and nurses out there who really know their stuff and do a brilliant job. We have come a long way from the days when we were expected to just soldier on.

expert view

Let’s Talk
About…
How to talk
to your doctor about
menopause

WITH DR. LOUISE NEWSON, GENERAL PRACTITIONER AND MENOPAUSE SPECIALIST

It isn’t always easy to approach your doctor about menopause. Sometimes it’s embarrassment that makes things tricky, but often women feel uncomfortable talking to their physicians about menopause because it is a natural process rather than a disease, and they don’t feel they should need help getting through it. Remember, menopause can increase the risk of other diseases such as heart disease, depression, and osteoporosis, so it is both okay to seek advice and important that you do.

• Talking about your symptoms and potential solutions is going to take some time to cover, so it’s a good idea to ask the receptionist to book you more time than usual so that you have slightly longer to talk. It’s not always possible, but it’s always worth asking.

• When you do go to the appointment it’s important that your doctor considers menopause, as many women find that when they go with common menopause symptoms, such as palpitations, low mood, memory problems, or urinary symptoms, the doctor may focus on tackling those individual problems, rather than discussing the cause. If your doctor wants to prescribe antidepressants, for example, rather than considering HRT, you should definitely ask why. There is no evidence that antidepressants improve the low mood associated with menopause.

• Even if you’re considering HRT you might not walk out of the doctor’s office that day with a prescription. That’s okay. It might not be the right time for you to start it yet, or you might want to gather more information, read some more, and then go back to discuss HRT. If you’re very well-informed and the doctor agrees that it’s the right choice for you, then it would be appropriate to start HRT following the first consultation. Whatever happens, you should, however, leave feeling that you’ve been listened to and reassured that things will move forward in a positive way.

• Admittedly, some doctors still do have issues with prescribing HRT, which is often due to a lack of menopause training for doctors and healthcare professionals. Then it can be difficult. On my website (www.menopausedoctor.co.uk) we have a letter template that approaches the subject in a positive but assertive way, and we’ve found it helps many women (just search for “letter” in the search box on the home page). Some patients do have to see a different doctor to get results. That’s okay. It’s fine to ask for a second opinion.

Even if you do have the odd bump in the road, in most cases a physician is the best person to help you through menopause, but some women will also see a menopause specialist. This is most likely if you have a complicated medical history. Say, for example, you’ve had breast cancer or blood clots in the past and your regular doctor doesn’t feel experienced enough to prescribe HRT to you, then you may well be referred to a gynecologist.

Whoever you see, the most important thing is that you have an open-ended conversation and that you feel empowered and informed. That’s what most of my work is about: ensuring women get the right help at a time that can feel very isolating and scary. But it is possible and you can do it.

Your Pre-appointment Checklist

So, you want to talk to your physician about the symptoms you are experiencing, and you think it might be perimenopause or menopause. Here are a few things to think about to help you get the most from your appointment:

• Ask if there’s a menopause specialist at your doctor’s office.

• See if you can book a longer appointment.

• Do you want to take a friend with you? See if anyone is free for your appointment.

• Fill in the symptom checker on this page and take it along, or make a note of your key symptoms.

• Read up on HRT and get questions ready for your doctor.

• Write down any other questions or concerns.

A letter for your doctor

If you feel that you have not been listened to and need to contact your physician again, there is a template of the letter on Dr. Louise Newson’s website (www.menopausedoctor.co.uk).