Having Productive Conversations With Your Doctor

What a good consultation should cover

Medical history

Bleeding patterns, past surgeries (hysterectomy, oophorectomy, endometrial ablation), current hormones or contraceptives, family history (cardiovascular disease, osteoporosis/fractures, breast cancer, dementia), personal history of DVT/PE, breast cancer, liver disease, diabetes, depression, recurrent UTIs. Smoking and alcohol use. Current medications. Social history and sexual wellbeing.

Examination

Height, weight, blood pressure. Breast examination if no recent imaging.

Investigations

FSH and estradiol (in selected cases). Complete blood count, iron studies, thyroid function, fasting glucose, fasting lipids, kidney and liver function. Cervical screening and mammogram. DXA bone density scan where indicated.

Questions to ask your doctor

Is what I’m experiencing consistent with menopause, or do we need to rule out other causes?
What are my options? Can we discuss both hormonal and non-hormonal approaches?
What are the specific risks and benefits of MHT for me, given my health history?
Is transdermal estrogen appropriate for me?
Do I need a bone density scan?
Are my vaginal/bladder symptoms being addressed? (Raise this if your doctor doesn’t — many don’t ask.)
What should I do about contraception?
If we try MHT, when will we review it?
Are there lifestyle changes that would particularly benefit me?

Notes

If you feel dismissed

If you feel your symptoms are being minimized, you are entitled to ask for a second opinion or to see a specialist in menopause management. In many countries, menopause clinics and specialist practitioners exist with dedicated expertise. Organizations such as the International Menopause Society, the Australasian Menopause Society, and the British Menopause Society maintain registers of accredited practitioners. (In the U.S., The Menopause Society lists certified menopause practitioners.)

A final word

Menopause is a profound physiological transition — not an illness, but not something to be silently endured either. You deserve accurate information, genuine partnership with your healthcare providers, and access to the full range of evidence-based treatments.

The science of menopause management has advanced considerably. The old fears about hormone therapy are giving way to a more nuanced and individualized understanding. Most women will experience menopause. Most will have symptoms that affect their quality of life. And most of those symptoms can be effectively treated.

Sources

Davis SR, Taylor S, Hemachandra C, et al. The 2023 Practitioner's Toolkit for Managing Menopause. Climacteric. 2023;26(6):517–536.