Laura sat in front of her GP, and sobbed. At 39, she was experiencing symptoms that she believed to be early signs of perimenopause – but her GP disagreed. “Let’s do blood tests, and go from there.” he said. “It’s more likely deficiencies. Many women at your age have low B12, for example, and as a mum it’s no wonder you are tired.” He gave her form, explaining that the bloods would give him an idea of her hormone levels too. He offered her a trial of antidepressants for the anxious feelings she was experiencing, and offered beta blockers for the heart palpitations. She turned both down.
And then that was that, and she left his office.
Laura had made the appointment because she ticked 30 out of 34 of the common symptoms of perimenopause. In fact, she ticked more, depending on the list she found that day on Google. “I felt like I was going mad”, she says. “I wasn’t depressed. I knew I was perimenopausal – but how can you get them to help you if they just refuse to listen in the first place?”
Laura’s experience is unfortunately more common than we would like to hope. Research by Newson Health (UK) found that 1 in 10 saw their GP 10 times before receiving any diagnosis of perimenopause or menopause. A study by FemtechWorld found 44% of women felt unsupported by their GP when seeking help with early perimenopause symptoms – and a study in 2022 revealed that 78% of GPs could not recall any lectures about menopause in medical school.
What are the most common signs of perimenopause?
Perimenopause is the time leading up to menopause, when hormone levels start to fluctuate. It can last for years – on average, 6 to 8 years, but for some women up to ten is normal. There are many different signs of perimenopause beyond the stereotypical brain fog and hot flashes. They often overlap with the hormonal transitions that occur in motherhood (and the inevitable exhaustion), which is exactly why it gets missed so often.
Typically, women start to experience:
- Brain fog/ fuzziness and poor recall
- Hot flashes or night sweats
- Interrupted sleep and insomnia
- A change in peeing habits – ie. leaks and urgency
- Dryness – mouth, eyes, vulva and vagina
- Low libido
- Headaches and migraines
- Irregular periods, or heavier bleeding
- Joint pain, especially in the morning
- Changes in mood, including feelings of overwhelm and anxiety
- Weight gain (especially around the mid-section)
Why 38 isn’t too young for perimenopause
Although largely ignored in our mother’s generation, perimenopause occurs in the years before ‘menopause’ – which is actually only 24 hours and marks the moment that we’ve not had a period for 12 consecutive months. (After that day, you are ‘post-menopausal’). Perimenopause usually starts in our early 40s, but for some women they will experience this onset as early as their mid-30s. There are loads of reasons why we might experience an earlier onset of peri, but if your mother went through early menopause then its likely you’ll follow her too.
So what should we look out for? The hormonal shifts of perimenopause can show up as anxiety, fatigue, low libido, poor concentration, worsening PMS, and more. These are all signs of perimenopause, and according to the NICE menopause guidelines, they’re enough to make a diagnosis – especially if you’re over 45.
For those of us under 45, it may be a bit trickier. There’s still a hangover of the idea that menopause only occurs in our 50s, and many women who seek help in their late 30s can find they are up against a brick wall. “You are too young”, “it’s unlikely”, “you are probably tired from parenting” are all frequent refrains that we hear before we’re encouraged to jump through hoops and a merry-go-round of blood tests or antidepressants. So how can we leave the GP feeling we’ve been listened to?
The problem with ‘women should advocate for themselves’
First things first – let’s talk about self-advocacy. Yes, it’s important to speak up – but if you feel you are up against a brick wall every time you do, it can feel pretty disempowering. Let’s be honest, the problem isn’t with women not advocating for themselves; it’s a systemic problem of women’s health issues – including signs of perimenopause – being dismissed and invalidated. And this isn’t a one off issue, either. We see similar problems with women seeking help with menstrual issues, or hormonal conditions like endometriosis.
For example, many women who are under the 45 year old threshold feeling frustrated as their GP suggests blood work knowing that the NICE guidelines recommend that symptoms should be used for diagnosis, not bloods. They aren’t totally wrong – blood work is useful to rule out other conditions, such as vitamin deficiencies, or thyroid problems – both of which can echo signs of perimenopause symptoms. But because our hormones fluctuate so significantly day to day, blood tests aren’t recommended as a useful tool to confirm perimenopause.
So why are so few women taking MHT?
That means you shouldn’t have to jump through hoops to be taken seriously – and yet, many of us are. Only 15% of menopausal women in the UK take MHT (menopause hormone therapy, aka HRT), and in some areas it’s as low as 7%. This is despite MHT being the first-line treatment recommended by NICE.
For Laura, speaking to another GP in the practice finally helped her seek support for her symptoms. “I phoned the receptionist and asked which of the GPs working there were best to see for women’s health. I had to wait, but eventually 4 weeks after I called I had an appointment. She listened to my worries and agreed it sounded like signs of perimenopause.” Laura started a low-dose combination of estradiol and progesterone and within a week felt much better. “We did test my folate levels too, and that was useful to know as they had dipped. Sorting both out – MHT and folate – meant I feel much better and importantly, symptoms like the anxiety have almost totally gone. To think I was about to start taking antidepressants is crazy.”
Preparing for your appointment
Going into your GP appointment feeling informed and confident is key. Start by jotting down your symptoms: what they are, when they started, how often they happen, and how they impact your day-to-day life. Mention specific examples – can’t remember the school run? Snapping at your partner for breathing too loudly? Waking up drenched in sweat at 3am? Use an app, like Balance, or our printable perimenopause check list, and take it with you to your appointment.
Then brush up on the guidelines your GP should be following. The General Medical Council’s (GMC) Decision Making and Consent guidelines state that doctors should:
- keep their professional knowledge up to date
- work in partnership with patients
- listen to and respond to patients’ concerns
- respect their right to make decisions about treatment and care
Similarly, the NICE Shared Decision Making guidelines (NG197) make it clear that clinicians should:
- take your preferences and priorities into account
- explain your treatment options, including risks and benefits
- allow you time to ask questions and think about your choices
- work with you to find a solution that feels right
This is your body. You’re allowed to ask questions and expect clear, compassionate answers, and for your choices to be taken into consideration when developing a treatment or management plan for your symptoms.
But could it be something else?
Yes, it could be. Because the signs of perimenopause overlap with other health issues, it’s important to rule out things like low folate, vitamin B12 deficiency, thyroid problems or anaemia – all of which can mimic menopause symptoms. Ask for a blood panel to check these. They’re standard, quick to run, and give a clearer picture of what’s going on.
But don’t let “normal bloods” stop the conversation if your symptoms still point to perimenopause. You also don’t need to wait for these bloods to be done in order to start hormone therapy, either (unless there is a specific medical reason to do so, and this should be clearly explained to you). MHT is safe, effective, and backed by NHS guidance as the most appropriate first treatment for menopausal symptoms. You don’t need a hormone test to access it – you just need your GP to listen.
Don’t give up – keep pushing
If you feel dismissed, it’s okay to ask for a second opinion. Ask to see another GP at your practice, like Laura did. Ask the receptionist who the menopause specialist is , or who has an interest in women’s health. Typically every GP practice will appoint a lead – ideally one with a women’s health interest – or look into specialist menopause services in your area.
You’re not imagining it. You’re not overreacting. And you don’t need to wait until you’re at breaking point to deserve support. The more of us who speak up, the more we shift the system and demand better care for perimenopause and women’s health.
