Why GP appointments are so difficult
The average GP appointment in the UK is ten minutes. Perimenopause is a complex, multi-system transition that affects sleep, cognition, mood, energy, muscle function, cardiovascular health and bone density. The mismatch is obvious.
Add to this the fact that many GPs have received limited training in menopause — a 2019 survey by the British Menopause Society found that many medical schools dedicate less than an hour to menopause in the entire curriculum — and the conditions for dismissal are set.
Women report being told their bloods are normal. Being offered antidepressants for symptoms that are hormonal in origin. Being told they are too young for perimenopause. Being sent away with no investigation and no treatment.
This is not universal. Many GPs are knowledgeable and supportive. But the experience of not being taken seriously is common enough that preparation is essential.
Before the appointment
Track your symptoms first. A list of vague complaints is easy to dismiss. A structured record of specific symptoms, their frequency, their severity, and their impact on your daily life is much harder to ignore.
Track for at least four to eight weeks before your appointment if possible. Note which symptoms are affecting your sleep, your work performance, your relationships and your overall quality of life. Quantify where you can — how many nights per week are you waking? How many days per week are you experiencing brain fog severe enough to affect your work?
Research the NICE guidelines. NICE published updated guidelines on menopause in 2015, with ongoing updates. These guidelines are explicit that perimenopause is a clinical diagnosis — it does not require a blood test to confirm. FSH levels are unreliable during perimenopause because they fluctuate significantly. A GP who insists on waiting for blood test confirmation before discussing treatment is not following current guidelines.
Knowing this before your appointment means you can respectfully reference it if needed.
Write down what you want from the appointment. Do you want a referral to a menopause specialist? Do you want to discuss HRT? Do you want a blood test to check Vitamin D, B12 or iron levels? Being specific about what you are asking for makes the appointment more productive and harder to deflect.
In the appointment
Lead with impact, not just symptoms. GPs are trained to assess functional impact. "I am experiencing hot flushes" is a symptom. "I am waking four to five times a night with night sweats, which means I am operating on broken sleep every day, which is affecting my ability to do my job" is an impact statement. It is harder to minimise.
Use the word perimenopause. Do not wait for your GP to raise it. Name what you think is happening. "I believe I may be in perimenopause and I would like to discuss this" is a clear, direct opening that signals you have done your research and are not looking to be managed away.
Ask specific questions. Open-ended appointments drift. Specific questions get specific answers. Some useful ones:
- Would you consider a trial of HRT given my symptom profile?
- Can you refer me to a menopause specialist?
- What would you recommend for sleep support while we work out the longer-term plan?
- Can we check my Vitamin D, B12 and iron levels as part of ruling out other causes?
Do not accept "your bloods are normal" as a complete answer. Standard blood tests do not measure everything relevant to perimenopause. Normal thyroid function, normal iron levels and normal FSH do not rule out perimenopause — particularly during perimenopause, when FSH fluctuates. If your bloods are normal but your symptoms are significant, that warrants further conversation, not dismissal.
If you are not getting anywhere
Ask for a second opinion. You are entitled to one. If your GP is not engaging with your symptoms, requesting a referral to a colleague with a specific interest in women's health or menopause is a reasonable next step.
Ask for a referral to a menopause specialist. NHS menopause clinics exist, though waiting times vary. Private menopause clinics — including services like Newson Health and Stella — can provide specialist assessment more quickly.
Know your rights. If your symptoms are significantly affecting your ability to work, you may have rights under the Equality Act 2010. Employers have a duty to make reasonable adjustments for conditions that amount to a disability — and significant menopause symptoms can meet that threshold.
What to bring
- A written symptom diary covering at least four weeks
- A list of your specific questions
- Any previous blood test results you have
- A note of any supplements or medications you are currently taking
- A clear statement of what you are hoping to achieve from the appointment
The practical summary
- Preparation is essential — a structured symptom record is far more effective than a general description of feeling unwell
- Perimenopause is a clinical diagnosis that does not require blood test confirmation under NICE guidelines
- Lead with functional impact rather than just symptoms
- Ask specific questions about HRT, referral and blood tests
- Normal blood results do not rule out perimenopause
- You are entitled to a second opinion and to specialist referral
This article is for informational purposes only and does not constitute medical advice. If you are experiencing significant perimenopause symptoms, please speak to your GP or a qualified menopause specialist.