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You may not be able to get a face-to-face appointment with your doctor at the moment, unless your problem needs immediate attention, but doctors are still conducting virtual and telephone consultations with their patients. If you want to speak to your doctor about your menopausal symptoms, it is important to prepare in advance. If you are worried about any symptoms, whether or not they are related to coronavirus, it is essential to call your GP surgery for advice.

This article was included in issue 82 (autumn 2019) of The Menopause Exchange newsletter.

If you’re 40 to 55 years young and you’ve had no periods for 12 months or more, then you’ve possibly reached the menopause. While many women sail through the menopause, others suffer from debilitating symptoms.

Most women could benefit from help and guidance during what could be a difficult time in their lives. If you wish to see your GP to learn more about the menopause or discuss treatment options, here’s some useful information.

Arranging an appointment
GP surgeries usually have waiting lists for non-urgent appointments. Factor in the waiting times at your local surgery and plan in advance so you can see your GP as early as possible. There’s no need to wait until your symptoms feel unbearable. If you can request longer appointments, ask for a 30 or 45 minute slot. The menopausal transition affects almost all organ systems in your body. So your GP will need ample time to review your symptoms, past medical history and any relevant test results to decide on the right management strategy for you.

Do your homework
It’s useful to read about any issues that concern you before seeing your doctor. This isn’t difficult as there are plenty of high-quality books and online resources available. Not all menopausal issues may be relevant, so narrow these down to make the most of your consultation time. It may also be useful to read the recent National Institute for Health and Care Excellence (NICE) guidelines on the menopause, as these contain useful information on diagnosis and treatment. You could refer to the guidelines while you discuss your treatment options with your GP.

What to tell your doctor
Provide information about the following – period patterns, time since your last period, frequency and severity of your symptoms, any medicines you’re currently taking, results of any blood tests, pelvic scans or bone scans, any previous gynaecological issues or surgeries, past history of blood clotting or any major medical conditions, family history of heart disease, strokes or cancers and any complementary therapies, herbal medicines or food supplements that you’re taking.

If you have any preferences about how to manage your symptoms and any long-term health goals, tell your GP. They’re there to help and support you, and you should feel comfortable and confident in talking to them about your symptoms and the help you need.

Tests and examination
Although blood tests or pelvic scans aren’t routinely needed to diagnose and treat the menopause, they may be useful in certain situations. These include premature menopause, when the diagnosis isn’t clear or if you’ve had gynaecological or medical issues in the past. Blood tests leading up to the menopause aren’t always available or accurate – your hormones can fluctuate daily during this time. But sometimes your GP may need to use blood tests to rule out other medical conditions, such as iron deficiency or an underactive thyroid, as these may cause symptoms similar to those of the menopause.

Speak to your doctor about whether you need any tests and when they should be done. Unless you’re having symptoms such as vaginal dryness, discharge or abnormal bleeding, a pelvic examination isn’t routinely necessary.

What your GP may discuss
At your first visit, your GP will obtain your medical history, discuss your symptoms/health concerns and agree a treatment plan with you. They’ll talk to you about your lifestyle and how to manage both your symptoms and your longer-term health. They’ll offer advice on HRT, non-hormonal medicines and other non-medical options that may help to manage your symptoms and benefit your bone, sexual and cardiovascular health. They’ll talk about the benefits and risks of each approach to help you make an informed decision.

You’ll generally be offered a follow-up consultation after starting HRT in about three months. Most menopausal symptoms are likely to have responded to oestrogen in this time period, and any residual problems may need different management. The long-term plan will consist of annual follow-up visits to make sure that it’s safe for you to continue on HRT and that you’re on the right type of hormone preparation. Your doctor will make sure you have access to regular health screening, such as bone scans, cervical screening and breast screening, depending on your medical history.

Write it down and ask questions
You’ll possibly receive quite a lot of information on the day and it may be too much to take in. It’s good practice to write down important points while you talk to your GP, so you can go over them again and read more about the specific advice at a later stage. Don’t hesitate to ask questions if you want to know more or if something isn’t clear. Your doctor is there to make sure you understand the benefits and risks of the various treatments and to support you in making an informed choice.

Take someone with you
You may want your partner, another relative or a friend to accompany you to your appointment. They may be able to remember important parts of your discussion with your doctor and help you put everything together afterwards. Your partner or a friend will sometimes be best able to describe how the symptoms are affecting you, and they can also find out how they can continue supporting you.

If you’re not happy
For most healthy women under 65 with severe menopausal symptoms, the benefits of HRT far outweigh associated risks. But myths regarding HRT safety prevail among the public and some healthcare professionals. If you feel your concerns haven’t been addressed or your symptoms/situation isn’t straightforward, request a referral to a specialist NHS menopause clinic (there are many around the country).

About the author
Dr Vikram Talaulikar is Associate Specialist in Reproductive Medicine and Menopause Specialist at University College London Hospital.

Created Autumn 2019

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