If you need to talk to your doctor about menopause symptoms a little homework can make all the difference. Here's how to prepare for an appointment with your GP...
An estimated 13 million women in the UK are going through perimenopause or menopause, according to research published in 2014 by Nuffield Health. One in every four of those women struggle with symptoms severe enough to have a profound impact on their daily lives but some specialists think that the figure could be much higher.
Despite this, and five years on, there are still relatively few NHS menopause centres across the UK, which can mean a lengthy wait for an appointment.
So, most women who have severe symptoms, are left with little choice but to consult their GP and, if the Live Better With community members are anything to go by, many women feel that they are being let down in terms of the response and treatment they deserve. That’s not always the case and, thankfully, other members have had a more positive experience.
So, at what point should you consult a GP about your menopause or menopausal symptoms and what, if anything, can you do beforehand to help you get the answers and support that you need?
When and why should I consult a GP about menopause?
If your symptoms are mild and manageable, and not affecting your daily life, you may not feel the need to consult a GP, and that’s fine. However, you might want to have your hormone levels checked to confirm that you are, in fact, menopausal or perimenopausal, so that you can make adjustments, in terms of diet or exercise, for example, that could help you during this time of transition. Symptoms can last for as long as 15 years and could change or become worse at some point, so don’t suffer in silence. If your symptoms are severe or you start having symptoms before you are 45, the NHS recommends that you see your GP.
You may have some of the more common symptoms of menopause, such as changes in the pattern of your periods, anxiety, lack of sleep and fatigue, for example, and are looking for something that will help. There are, however, many more symptoms that we now associate with menopause, triggered by changing hormone levels. The NHS guide to menopause symptoms lists just 12 but some specialists have identified as many as 34. For example, if you have started to experience joint pain, it could be menopause related. You may have very few symptoms or you could have many but, if any of them are severe and are affecting your ability to cope with daily life, you should consult your GP.
If you have not had a period for a year, you are now – in medical terms - in full menopause. The average age for this in the UK is 51 but you will almost certainly have started to experience some symptoms as you moved into perimenopause, probably several years earlier. However, if you have menopause type symptoms before the age of 45, the NHS recommends that you should see your GP, as you could be going through early menopause. GPs are now seeing women in their late 20s and 30s, with perimenopausal or menopausal symptoms so, if you are in that age group, don’t assume that you are too young. Your GP can refer you for blood tests, to check your hormone levels, which can indicate whether or not you are perimenopausal or menopausal.
Keep a note of your menopause symptoms
Keep a note of any menopause symptoms you may have, even if they are mild, and note down what, if anything seems to trigger them or make them worse or better. This will give you and your GP a much better picture of how menopause is affecting you overall.
What to expect when you see your GP or nurse practitioner about menopause
When you see a health professional, such as your GP or nurse practitioner, they should be following the menopause guidelines produced by the National Centre for Clinical Excellence (NICE).
We know, however, that GPs and other NHS professionals are currently overwhelmed – a point made on BBC Radio 4’s Woman’s Hour (BBC Radio 4) by consultant obstetrician and gynaecologist, Dr Melanie Davies, in a feature on menopause (starts 18 minutes into the programme).
They may not be fully aware of, or have enough time to, follow the guidelines to the letter. So, we recommend that you print and read through the guidelines yourself before your appointment, so that you have a better idea of what you are entitled to expect at your appointment.
What to ask when booking your menopause appointment
‘After dreading the appointment, I was really impressed with her (the GP). She worked with a top gynaecologist in the past and has been through it herself.’ LBWM Community member
When you contact your GP’s practice to book your appointment, make sure the person you speak to knows that you want to see a GP or nurse practitioner, (see below) about menopause symptoms. The receptionist may recommend a particular GP but, if not, ask them who would be the best GP to see.
You may find it easier to talk about health issues, such as menopause, with a female GP, who might be more understanding but – as some of our members have discovered – that’s not always the case. It’s professional knowledge, expertise, experience and empathy that are paramount. Some practices have nurse practitioners, who have had professional training in menopause support and treatment, so it’s worth checking if your medical centre has one. If you’re not offered a double appointment, ask for one, as this will give you more time to discuss your symptoms.
The practice manager of a busy West London medical centre told us that patients who want to discuss menopause are automatically given a double appointment and referred to one of the centre’s women GPs or the nurse practitioner. All are very experienced in working with women going through menopause and in identifying and treating menopause symptoms. They refer patients for blood tests to check hormone levels (if appropriate – see NICE guidelines), order any other diagnostic tests that may be indicated, and then make recommendations about symptom management and prescribe medication if that is indicated. We know that not every woman will have the same experience but it’s good to know that some GPs’ practices are doing their best to follow NICE guidelines.
Make a list of your questions about menopause
You’re bound to have many questions about menopause, how it’s affecting you, and what could help, such as diet, exercise, general lifestyle, or medication – or a combination of all of these. So take some time before your appointment to make a list of those questions and be sure to take them to your appointment.
And a special plea, do make sure you ask about everything that concerns you, whether it’s about your body or your feelings or intimate matters like sex and intercourse. Don’t let embarrassment get in the way of asking about things that matter to you, or that are making you unhappy or uncomfortable. If it helps, write a short note about anything you find difficult to talk about; you can give this to your GP when you see them. The more information you can share, the better placed your GP will be to advise you on the best treatment or support for you during menopause.
Take someone with you to your menopause appointment
It can be very helpful to have someone you know and trust – perhaps a good friend or family member, who is going or has gone through menopause –with you at your appointment, for reassurance and to prompt you if you forget to ask an important question. It’s so easy to forget things, especially if you are feeling anxious or tired.
Alternatively, you might want to take your husband or male partner, if you have one. Although this shouldn’t be the case, some women report that they had a far more sympathetic response from their GP when the man talked about the effect that his partner’s menopause was having on him… Whoever you ask to accompany you, spend some time with them beforehand, going through your symptoms and questions. They might also suggest questions or concerns that have not occurred to you.
Keep an open mind about menopause treatment
You may have been thinking about the sort of treatment you want, based on what you’ve read, seen or heard, whether in books, online or on television or radio – or maybe as the result of discussions with friends or work colleagues. But we’re all unique and what’s right for one woman may not be right for you.
The ideal way to make an informed decision about your own menopause treatment or support is to prepare in the way we’ve suggested and then have a full discussion with your GP. If you’re not satisfied with the outcome of your appointment, you are entitled to seek a second opinion and consult another doctor or ask for a referral to a menopause clinic or specialist (see below).
The best treatment for you is the one that will help you best and that you feel reassured about - because you have all the information you need to make an informed decision and you know your own body. This may not be the same as the best treatment for the woman sitting next to you in the waiting room! No treatment suits all women equally and some treatments may not be suitable for you because of your medical history (or your family’s), an existing medical condition, or the way it might affect or interact with medication you are currently taking.
What if there is no menopause specialist at my GP’s practice?
If this is the case and you want to see a specialist, your GP can refer you to an NHS menopause clinic, specialist doctor, or nurse practitioner. Use this British Menopause Society online search form to find out your nearest NHS menopause clinic or specialist. Do be aware, however, that waiting times can vary from weeks to months for an appointment with an NHS clinic or specialist.
You may decide that you want to consult a menopause doctor or nurse practitioner privately, perhaps to avoid lengthy waiting times. In this case 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.
Finding out more about menopause
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 you prepare for your appointment:
- 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
By Diane Trembath
Visit: the Live Better With Menopause Community Forum for information, advice, and tips on preparing to see your GP - and to share your own questions and suggestions.