Perimenopause: when to see a doctor

Most women wait too long. Not because they don't notice — because there's no obvious threshold, and "I'm tired and my periods are odd and I snapped at everyone last week" doesn't feel like it earns an appointment.

It does. Here's when to go, what to bring, and what can actually be done.

Go now if

You're under 40 and your periods have changed significantly. This is the one that shouldn't wait. Menopause before 40 is premature ovarian insufficiency, and NICE is clear it should be diagnosed on symptoms plus raised FSH on two blood samples taken four to six weeks apart — not brushed off, and not diagnosed on a single test either. It's managed differently from menopause at 50, and the difference matters.

You're under 45 with menopause-associated symptoms. Early menopause is defined as menopause before 45, and NICE treats ages 40 to 44 as a distinct group where a blood test may be considered.

You have bleeding that needs looking at. Bleeding more than 12 months after your periods stopped. Bleeding on HRT that hasn't settled after six months. Bleeding heavy enough that you're organising your life around it.

Go soon if

Symptoms are affecting your daily life — work, sleep, relationships, mood, or just your sense of being yourself. That's the bar. It isn't "are these symptoms severe enough to justify the appointment", it's "are they affecting your life". Those are different questions and the second one is the one being asked.

You're not sure whether this is perimenopause at all. A GP can consider what else might explain it. That's a legitimate reason for an appointment on its own.

What will happen

If you're 45 or over and otherwise healthy, probably no blood test — and that's correct, not a fob-off. UK guidance says perimenopause should be identified in this group from symptoms and cycle changes, without laboratory tests, because the hormone being measured fluctuates too much during perimenopause to date anything reliably.

This catches people out. You go in expecting a test and come out with a conversation. But the conversation is the diagnostic method, which puts a lot of weight on what you bring to it.

What to bring

The single most useful thing: a record.

Cycle dates and rough flow. Which symptoms, when they started, how bad. How they're affecting work and sleep. Anything that seems unrelated — joint aches, itching, palpitations, brain fog — because the list of menopause-associated symptoms is longer than most people expect.

Two or three months is plenty. It doesn't need to be neat. It needs to exist, because reconstructing eight months of this from memory in a ten-minute appointment is how women end up leaving with nothing.

The Menopause Nutrition Planner includes a symptom and trigger log you can print and fill in — designed for exactly this.

Also worth writing down before you go: what you most want help with, and what you'd like to happen. Appointments are short and it's easy to leave having described everything and asked for nothing.

What a GP can offer

HRT is the main medicine treatment for menopause and perimenopause symptoms, and the NHS describes it as safe and effective for most people going through it. If you have a uterus, oestrogen is given with progesterone to protect the womb lining.

Non-hormonal medicines exist if you can't have HRT or would rather not — the NHS notes there are medicines that can help with hot flushes and night sweats, and that antidepressants can help with mood symptoms where depression or anxiety has been diagnosed. Worth knowing: NICE guidance says SSRIs, SNRIs and clonidine should not routinely be offered as first-line treatment for hot flushes and night sweats. If that's what you're offered first, it's reasonable to ask about the alternatives.

CBT is recommended for low mood or anxiety arising from menopause, and the NHS notes it can also help with some physical symptoms including hot flushes and joint pain. You can access NHS talking therapies without going to a GP first — you can self-refer. Very few people know this.

Vaginal moisturisers and local treatments for vaginal dryness, which is one of the most under-reported symptoms in the category and one of the most treatable.

Follow-up isn't optional

If you're started on treatment, NICE says it should be reviewed at three months to check it's working and tolerable, then annually — sooner if it isn't working or there are side effects.

Three months is the number to hold on to. If you're six months in and still feel awful, that isn't "giving it time". That's a review that hasn't happened.

When to ask for a referral

NICE sets out when referral to a healthcare professional with expertise in menopause should be considered:

• You have menopause-associated symptoms and contraindications to HRT
• There is uncertainty about the most suitable management options for your symptoms

And referral is indicated where there's been no improvement after trying treatment.

You're allowed to ask. If you've tried something, given it a fair run, been reviewed, and you're still struggling — "could I be referred to someone with expertise in menopause?" is a reasonable sentence to say out loud.

One honest caveat: specialist menopause services are unevenly distributed across the UK and waits in some areas are long. Knowing the criteria doesn't make a clinic appear. But it does mean you can ask from an informed position rather than hoping to be offered.

If the appointment goes badly

It happens. Not every GP has a special interest in this, and menopause training in primary care has been patchy.

If you're told you're too young without being assessed, or offered an antidepressant for hot flushes without HRT or CBT being discussed, or sent away with nothing when symptoms are affecting your life — you can book with a different GP at the same practice. That isn't making a fuss. It's what the option is there for.

Take the record with you again.