What you could and should expect when you see your GP or nurse practitioner at your local surgery...
by Diane Trembath
You may already be going through menopause or just beginning to notice what could seem like random symptoms; wherever you are on your menopause journey, the chances are that, at some point, you’ll decide to see your GP. This is even more likely if you are trying to cope with severe symptoms or you are beginning to notice menopause-type earlier than you would have expected.
Now we look at what to expect when you talk to a doctor or nurse practitioner about anything to do with menopaise.
What to take with you to your menopause appointment
If you’ve followed our suggestions on how to prepare, you’ll have:
- a list of symptoms (see this symptom checker produced by Menopause Support)
- a list of questions and possible concerns about your menopause and possible treatment
- National Institute for Health and Care Excellence (NICE) guidelines on menopause diagnosis and management
- a note of any symptoms you think you will find difficult to talk about (if appropriate)
We also recommend that you take:
- details of any medication or supplements that you are currently taking. Your GP will have a record of your NHS prescriptions but not of any medication or supplements you’ve bought privately over the counter or online. If you have used anything that has helped any of your menopause symptoms, do let your GP know.
And don’t forget our advice to take along a friend or family member for support!
What to expect from your GP at your appointment
Questions about your menopause and lifestyle
If your GP is following NICE guidelines, they will go through a list of essential questions, so listen carefully and try to give your answers as clearly as possible. If there is anything you don’t understand or are unsure of, ask for an explanation. As well as asking specific questions about menopause, your GP may ask general questions about your diet and lifestyle, including how well you sleep and what exercise you take, whether or not you smoke or have ever smoked, and how much, if any, alcohol you consume during a typical week, so be prepared to answer these questions too.
Your menopause symptoms
Go through the symptoms listed on your symptom checker and make sure you mention any that are particularly severe. Try not to leave out any that you might find embarrassing or difficult to discuss, for example, the impact that menopause if having on your sex life. If you have brought a note of any symptoms that you find difficult to discuss, make sure that you give this to your GP.
Your questions and concerns about menopause
Go through your list of questions and ask any that have not already been covered. Menopause can affect you physically, mentally and emotionally and can have an impact on your life at home and at work, so it’s important to cover all aspects, from symptoms and their effects to treatment options. Your GP may not have all the answers at their fingertips and may want to check with a colleague or consult NICE or BMS guidelines before giving you a firm answer.
Will I have to have any tests?
Your GP should be able be able to tell from your symptoms whether or not you are menopausal but, if you are below the average age for menopause, they may arrange for you to have blood tests to check your hormone levels.
What if I am going through menopause because of surgery or medical treatment?
If you are have menopause symptoms because of surgery, such as a hysterectomy, or medical treatment, such as chemotherapy, or if you have an underlying medical condition or complex medical history, your GP should refer you to an NHS menopause centre or menopause specialist.
What will my GP prescribe for menopause symptoms?
If your symptoms are mild and not interfering with your ability to get on with your life, your GP may not think that you need medication, such as hormone replacement therapy (HRT). They may, however, suggest some adjustments to your diet or alcohol consumption or recommend exercise of some kind.
If your GP thinks that HRT or body-identical hormone therapy could help your symptoms, there are various options and they should go through these with you, outlining the benefits, the risks, and possible side effects of different types of HRT, so that you can make an informed decision about treatment. Many people think that body-identical hormone therapy isn’t available through the NHS – it is! So, if your GP doesn’t mention it, make sure that you ask about it. If you want to know more about body-identical hormone therapy, this article by menopause specialist, Dr Louise Newson, is up to date and very helpful.
HRT can be given as tablets, skin patches, gel or implants and your GP should prescribe the type they think most suitable for you. If you are suffering from vaginal dryness, they may also prescribe vaginal oestrogen, in the form of a pessary, cream or ring that you insert into your vagina.
If you are struggling with low mood, anxiety or depression caused by menopause, your GP may want to prescribe an anti-depressant but anti-depressants should not be the first choice of treatment, especially if you are perimenopausal. If your doctor wants to give you anti-depressants rather than HRT or body identical hormone therapy, make sure that you ask why. NICE guidelines make it clear that some form of HRT should be the first choice, unless there is a medical reason not to prescribe it.
You can read more about the long-term benefits, risks and side effects of HRT here.
What if I can’t take HRT or prefer not to take it?
‘I am very insistent with my doctors, and will not agree to something I don't want or I know that I have a problem, and insist that it's checked out, if not, a second opinion is in order.’ Live Better With community member
While many women take HRT and are happy to do so, that’s not the case for everyone. According to the NHS, HRT may not be suitable if you:
- have a history of breast cancer, ovarian cancer or womb cancer
- have a history of blood clots
- have untreated high blood pressure – your blood pressure will need to be controlled before you can start HRT
- have liver disease
- are pregnant – it's still possible to get pregnant while on HRT, so you should use contraception until 2 years after your last period if you're under 50 or for 1 year after the age of 50
(There are, however, many myths about HRT, which Dr Louise Newson dispels here.)
Apart from that, you may simply prefer not to take HRT, and you should not feel under pressure to do so. Whatever the reason, ask your GP to go through alternative options for treating menopause symptoms.
If you are interested in alternative approaches to menopause treatment, do take a look at these Live Better With articles:
I want to try HRT but my GP refuses to prescribe it
‘I was refused HRT for a very long time because I suffer with migraines. My menopause started after a hysterectomy when I was 34. I was 50 this year, and finally got given HRT patches just 8 months ago. If I had been aware that migraine sufferers CAN have HRT as long as it's delivered transdermally - via the skin in patch or gel form, I would have fought much harder to get the help I needed.’ Live Better With Menopause community member
Many of our members seem to have had this experience; in some cases, they have been prescribed HRT in the past but their GP has stopped their prescription and, in other cases, they have met with a blank refusal.
Provided that there is no medical reason preventing you from taking HRT, ask your GP to explain why they are not prepared to prescribe it – and for the medical evidence – and make a note of what they say.
What if I’m not happy with the outcome of my appointment?
'I’ve just had the best doctors appointment ever with a different GP…I came out feeling understood …I don’t weigh as much as I thought and she has prescribed HRT patches to try…She says I should then allow a period every three months but I’m going back to see her after two for a progress report.’ Live Better With community member
We’d like to think that this happens only in a minority of cases but from what some of our members – and menopause specialists – report, far too many women are not getting the menopause support and treatment they expect and which they are entitled to.
In an ideal world, your GP will be familiar with the latest research (and research reviews) into menopause treatment but, unless they have a particular interest in the subject, for example, if they are a qualified gynaecologist, that may not be the case. If you’re not happy with the outcome of your appointment, you can:
- ask to see a different GP at the practice, or
- ask for a referral to a menopause specialist (see below).
How can I find a menopause clinic or specialist near me?
Your GP can refer you to an NHS menopause clinic, specialist doctor, or nurse practitioner. Use this British Menopause Society (BMS) online search form to find out your nearest NHS menopause clinic or specialist. Waiting times can vary from weeks to months for an appointment with an NHS clinic or specialist.
If you want to consult a menopause specialist or nurse practitioner privately, to avoid lengthy waiting times, for example, you don’t need a GP’s referral and you can use the same BMS online search form to find private specialists and nurse practitioners in your area.
Contact them first to ask about referrals, appointments and, in particular, fees, as menopause treatment is not covered by private health insurance. Some private practices enable you to combine an initial private consultation with follow-up NHS treatment, so ask about that too, especially if you have a limited budget.
Where can I find out more about menopause and menopause treatment?
You’ll find current NHS information on the menopause, symptoms and treatment here. In addition, these organisations offer free information on a range of menopause-related topics, including symptoms, specialists, options for menopause treatment and support, and menopause news, which could help talk to your GP about menopause and your symptoms:
- British Menopause Society (BMS) - for healthcare professionals but carries the latest news on menopause research and treatment and has an online search facility to help you find a local specialist
- Henpicked - for women over 40, includes a section on menopause
- Menopause Support – menopause advice, information and support from Diane Danzebrink
- Women’s Health Concern - the patient arm of the BMS
Visit the Live Better With Menopause Community Forum for information, advice, and tips on talking to your GP - and to share your own questions and suggestions.