Why Women Wait to Book a Menopause Consultation, and Why You Don't Have To

"I'll book once I've had my bloods done." "I'm still having periods, so it can't be that yet." "It's probably just stress. Everyone's tired."

I hear some version of this a lot. And waiting until it feels serious enough, or until there's a blood test to prove it, is one of the most common reasons I see women wait. Sometimes for months, while the sleep goes, the patience goes, and the woman they recognise in the mirror gets harder to find.

I'm 4 months into my own treatment, and I feel more me again. This post goes through the reasons women wait, what's actually true about each one, and what happens when you stop waiting.

"I need a blood test first"

This is the big one, so it goes first.

If you're over 45 and your symptoms point to perimenopause or menopause, you usually don't need a blood test to be diagnosed or to start treatment. It's diagnosed from your symptoms: hot flushes, night sweats, broken sleep, mood changes, and periods that have started to change.

The reason is that in perimenopause your hormones go up and down from one day to the next. FSH (follicle-stimulating hormone, the message your brain sends to wake up your ovaries) and oestrogen can look completely normal one week and very different the next. So 1 normal result doesn't rule perimenopause out, and 1 high result doesn't confirm it.

Under 45, it's different. Between 40 and 45, an FSH test can help. Under 40, testing is essential, and 1 test isn't enough on its own.

Blood tests still matter, just for a different reason. A thyroid problem, low iron, or low vitamin D or B12 can feel a lot like perimenopause. If something else could be behind your symptoms, the blood test is how we find it. That's why the clinic works in this order: talk, start, test, review. The conversation comes first, and where treatment is right for you, it can start after that first appointment.

"I'm still having regular periods"

Periods can stay regular for a while in perimenopause. For a lot of women, the first signs are something else entirely: waking at 3am, anxiety that wasn't there before, brain fog, aching joints, losing words halfway through a sentence, or feeling flat for no obvious reason.

So if your cycle is still on time and you don't feel like yourself, it can still be your hormones. And it can also be something else, which is exactly why it needs going through properly, with your whole history in front of us.

"I'm too young for this"

Perimenopause usually starts in your mid-to-late 40s, but for some women it starts in their late 30s or early 40s. Being told you're too young is one of the most frustrating things to hear when you know something has changed.

If you're under 45 and your periods have changed, or you have flushes, night sweats or vaginal dryness, it needs to be checked. Under 40, it needs checking promptly, because early menopause and POI (premature ovarian insufficiency, when the ovaries stop working normally before 40) are treated, and treatment matters for your bones and heart.

"It's probably just stress"

It might be. Stress, poor sleep and a full life all make you tired and short-tempered. But perimenopause and stress feed each other: falling oestrogen can make sleep lighter and anxiety louder, and then everything feels like stress.

The useful question is whether the pattern has changed. If you used to cope with the same workload and now you can't, if the 3am waking is new, or if your mood changes in a way that isn't like you, that needs going through with someone who looks at all of it together. A free Symptom Tracker is a good place to start, because it shows you the pattern in black and white.

"It's not bad enough to bother anyone"

There's no level of bad you have to reach first. Not sleeping, not feeling like yourself, snapping at the people you love and then feeling guilty about it: that's enough. Many women who wait are still coping at work and at home, and paying for it in sleep and patience.

And the sooner you start, the sooner you find out what helps you. For some women that's HRT (hormone replacement therapy). For others it's a non-hormonal option, local treatment for vaginal dryness and bladder symptoms, or changes to sleep, food and strength training, with supplements where they help. Usually it's a mix.

"I was told my results were normal"

Normal blood results don't mean your symptoms aren't real. We interpret investigations alongside your symptoms, medical history and clinical circumstances to decide what, if anything, needs further assessment.

If you've had bloods recently, bring them, normal ones included. Ask for the numbers, not just "normal". A result at the very edge of the range can still be part of the story.

What happens when you stop waiting

The Menopause Consultation is 45 minutes online, by video or voice call, wherever you live in the UK. You can do it from your sofa, or from your car on a lunch break.

• Your story. What's changed and when: your periods, sleep, mood, and what you've already tried. Lists on your phone are welcome.
• Your health history. Your medicines and supplements, your medical history and your family history, so the options we talk about are safe for you.
• Your options. What's most likely behind your symptoms, and what could help.
• Your plan. We decide together what to start. You'll know whether a blood test would help and when we review.

If you'd like to go through yours, you can book a Menopause Consultation here. If something other than menopause is going on, like your periods, weight, gut, skin or hair, the Women's Health Consultation is the one for you.

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Debora Tentis, Women's Health Pharmacist.