“Eighteen months ago, I gathered the courage to go to my GP with menopause symptoms. I walked out five minutes later with antidepressants. I have struggled every day (and night) since, feeling like I’m going mad”

Unfortunately this is something I hear every single day from women who feel let down by their GP or health care team.

The facts don’t really make us women feel confident in the healthcare system:

For starters, research on menopause properly only began around 50 years ago with FEMALE BODIES only being used in this research in the 1990s

Yes, up until 1993 women were banned from taking part in clinical studies so a lot of the research we have on female health is actually based on a male’s body.

Only 20% of OBGYN’s are trained in Menopausal Health and by “trained” we mean have received on average 6 hours of menopausal education

Menopause is not a mandatory module in GP medical training. In fact if you look up GPs’ core curriculum you will find menopause in ‘Breast and Gynaecology’, under ‘Other’. In 2022 a study revealed that 78% of GP’s in the UK and Europe did not recall any lectures on menopause during their medical training.

Women’s Health deserves better than this

Recent studies unfortunately show that a woman will attend up to 10 GP appointments to get a menopause diagnosis and on average will receive 7 dismissals around being in Menopause

This is shocking that in 2024 something that every single woman will go through is still not taken seriously by the medical field.

Being dismissed as menopausal by a GP can be frustrating and disheartening. It’s also a MAJOR reason why so many women suffer unnecessarily for years in menopause when they don’t need to.

Common Dismissal Reasons

The two most common reasons for a dismissal of being in menopause are

AGE – being told you are “too young”

BLOODWORK – getting your bloods done and told they “look fine”

So firstly there is no NORMAL age to go through menopause.

The average age of MENOPAUSE – ie when your menstrual cycle completely stops – is around 45-51. However your periods don’t just stop overnight, your sex hormones slowly cease production over years prior. This time period is known as PERI MENOPAUSE

Peri menopause can last between 5-10 years so it’s very normal for women to experience menopause symptoms in their mid/late 30s.

If you are seeking HRT as a part of your approach to menopause symptom reduction then you can start HRT as soon as you experience SYMPTOMS – not when your periods stop. This is another misconception held by a lot of GPs – remember GPs do not receive any mandatory training on menopause hence the huge lack of education and understanding.

Secondly – there is no “test” for peri menopause – blood work is NOT a test.

The National Institute for Health Care and Excellence have created the guidelines for both the treatment and diagnosis of menopause that ALL healthcare professionals SHOULD follow (ie every doctor, GBYN, health coach, functional doctor and so on – WORLDWIDE)

The VERY first guideline is that peri menopause is a SYMPTOM based diagnosis and treatment. The very first guideline:

Women presenting menopausal symptoms are diagnosed with perimenopause or menopause based on their symptoms alone, without confirmatory laboratory tests

What can we do if we are dismissed?

With perimenopause starting around the age of 38-45 for most women and post menopause lasting until end of life – The menopause chapter in a woman’s life makes up a very large portion of her life

A loss of the menstrual cycle and the hormonal symptoms of this change (hot flashes, brain fog, mood swings etc) are one portion of menopause. The health risks associated with the lack of protection from estrogen is a large concern as they rise pretty quickly once a woman goes into POST menopause

• Bone density

• Gut health

• Metabolism

• Blood pressure

• Visceral fat

• Weight gain

• Heart Health

• Brain health

• Pelvic health

All the above are health concerns of a male as well but every single one declines at a quicker pace in females due to the lack of estrogen a woman experiences post menopause and the huge hormonal shifts that causes to the other 49 types of hormones in her body

So Menopause HEALTH is a very large and complex subject. Unfortunately until changes start to happen with education inside our health sector the responsibility falls onto women to start effective conversations about their own health during peri and in post menopause.

1. Before attending your GP appointment make a list of as many of the menopausal symptoms you are having, noting if they fluctuate and if yes how often

2. Knowing your family history of diseases and illnesses will be very helpful when discussing your hormonal health. Create a list of which relatives had certain illnesses/diseases and what age they developed these. This information could qualify you for certain medical tests you may not otherwise be qualified for. Your family history can also determine if you are a good candidate for certain hormone therapies, especially HRT

3. Before attending consider what are your preferences for managing your symptoms example do you want to try HRT, would you prefer a more holistic approach, would you like to know what lifestyle changes to make – This will help guide the conversation in a way that’s related to the outcome you prefer

4. Know YOUR normal – Hormonal Health is very unique to every single person. There is no “normal” level everyone’s hormones should be at – There is a healthy recommended range but that does not mean everyone will feel the same at the exact same hormone level. For example one person may have naturally lower cortisol readings and during menopause they start trending upwards but on blood work results it may fall inside a “normal” reading prompting your GP to say everything looks fine. However YOU know your body – YOU and only you know what’s normal for YOU

5. This is why between GP visits it’s very important to keep a symptom journal, noting any changes to your health since your last visit. You can do this in a notebook or if easier you can use a hormonal health app like FLO (good if you are in perimenopause still menstruating) or MENOLIFE if post menopause – Note I am not affiliated with either I have just researched them

Tracking symptoms between GP visits will help you navigate conversations around any new aches and pains, increased fatigue, hair loss, weight gain or loss, constipation, forgetfulness, depression, etc.

Note:

If you are new to HRT (i.e. within your first 12 months) you should NOT be on standard repeat prescriptions as the dosage in most cases needs to be altered as hormones continue to change and fluctuate during the early stages of menopause. An appointment to take new bloods and do a FULL hormonal symptom screening is recommended every 1-3 months within the first 12 months to ensure dosage is correct

A LOT of improving your health in menopause is down to making nutritional and lifestyle changes to suit the hormonal and metabolism shifts that have occurred. If you would like more information from a registered menopause specialist you can book a free menopause health consultation below

Example of letter to send to your GP/GBYN Practice if you are continually dismissed

If you follow the above and are still dismissed by your healthcare provider then you can use the below letter template to request proper treatment/diagnosis

Dear Dr. [GP’s/GBYN’s Name],

I hope this letter finds you well. I am writing to express my concerns regarding the ongoing symptoms I have been experiencing that I believe are related to menopause. Despite our previous consultations, I feel that my symptoms have not been adequately addressed.

Over the past [number] months, I have been dealing with [list your symptoms, e.g., hot flashes, night sweats, mood swings, irregular periods, and sleep disturbances]. These symptoms have significantly impacted my daily life and overall well-being.

I would like to draw your attention to the NICE guidelines for diagnosing menopause (NICE NG23), which emphasize the importance of recognizing and appropriately managing menopausal symptoms. According to these guidelines, the diagnosis of menopause should be based on a woman’s symptoms and medical history rather than solely relying on laboratory tests, especially in women under 45.

The NICE guidelines also recommend considering hormone replacement therapy (HRT) and other management options to alleviate symptoms and improve quality of life. I believe that a more thorough evaluation and discussion of my symptoms, in line with these guidelines, could lead to more effective management and relief.

I respectfully request the following:

1. A comprehensive evaluation of my symptoms, considering the NICE guidelines for diagnosing menopause.

2. A discussion of potential treatment options, including HRT or other therapies, to manage my symptoms effectively.

3. Any necessary tests to rule out other conditions that might be contributing to my symptoms, as recommended by the NICE guidelines.

I have attached a detailed record of my symptoms, including their frequency, duration, and intensity, to provide a clearer understanding of my situation.

I value your expertise and am eager to work collaboratively to find effective solutions for managing my symptoms. I am open to exploring various diagnostic and treatment options to improve my health and quality of life.

Thank you for your attention to this matter. I look forward to discussing this further at our next appointment.

Sincerely,

[Your Name]

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