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Wondering whether you're in perimenopause or not can be confusing, especially when symptoms are vague and often mistaken for other conditions.
Although the average age of menopause is 51, the perimenopause generally starts in your early to mid 40s (although it can happen earlier or later due to genetics or surgery for example).
One of the first signs is usually a change to your menstrual cycle. Your ovaries may not release an egg every month due to your fluctuating oestrogen levels.
If you're experiencing irregular periods, mood changes or hot flushes and suspect you might be entering perimenopause, understanding the process of getting a diagnosis through the NHS can feel overwhelming.
Many women unfortunately face delays in diagnosis due to the varied nature of symptoms and the lack of education and resources in some areas of the healthcare system.
According to a recent study of 6,000 women, nearly one in 10 were forced to sit through between six and ten appointments before getting a perimenopause diagnosis.
In this guide, I’ll break down the process of receiving a prompt perimenopause diagnosis through the NHS, including what to expect at each stage and how to advocate for yourself.
By the end, you'll feel confident in taking the next steps toward managing your symptoms and improving your well-being.
Table of Contents
Preparation and Planning for Your NHS Perimenopause Diagnosis
Proper preparation is key to making the most of your NHS perimenopause appointment.
Being well-organised and informed allows you to communicate your symptoms clearly and ensure nothing important is overlooked.
By planning ahead, you’ll have better results in terms of both diagnosis and treatment.
Taking the time to prepare can also reduce stress and give you confidence when discussing your health concerns with your GP.
How to get prepared:
Track your symptoms
Start keeping a log of your symptoms, especially any changes in your periods, sleep, mood, or energy levels.
Find out your family history
Gather information on any family history of menopause-related conditions, as this may be relevant to your diagnosis.
List your medications
Make sure you have an updated list of any medications, supplements or treatments you're using, as these can influence hormonal changes.
Prepare questions
Write down any questions you have about perimenopause, treatment options or what to expect during the NHS consultation.
Review NHS resources
Familiarise yourself with any available NHS guidelines or leaflets on perimenopause to better understand what your GP might recommend.
Step-by-Step Guide to Getting a Perimenopause Diagnosis on the NHS
Book a GP Appointment
The first step is making an appointment with your GP.
The government’s Women’s Health Strategy for England plans to create women’s health hubs bringing together healthcare professionals and existing services to provide integrated women’s health services in the community, aiming to improve access to and experiences of care and improve health outcomes for women.
Ask if there is a GP at the practice with an interest in women’s health (many practices now have one).
Since perimenopause symptoms often overlap with other conditions, it’s crucial to clearly communicate why you believe your symptoms may be hormonal.
What to take with you to your appointment
A detailed list of your symptoms (including their frequency, severity and impact on your daily life)
A calendar or diary to track your menstrual cycle and any other changes
Any relevant medical history, including medications or pre-existing conditions
Written questions for your GP so you don’t forget to ask
Attending Your GP Consultation
During your consultation, your GP will likely ask about your symptoms, lifestyle and medical history. They may order blood tests to rule out other conditions, especially if you are under 45.
Don’t downplay your symptoms—be honest about how they’re impacting your daily life.
Some women forget to mention irregular periods because they assume it’s normal. This can be a critical sign of perimenopause.
Summary of the Perimenopause NHS Guidelines your GP should follow
Your GP should follow the NICE Menopause guidelines (National Institute for Health and Care Excellence).
NICE guidelines are evidence-based recommendations for health and care in England and Wales.
They help health and social care professionals to prevent ill health, promote good health and improve the quality of care and services.
Here are some of the key points:
Diagnosis
Women over 45 with menopausal symptoms (hot flushes, irregular periods) can be diagnosed with perimenopause or menopause without lab tests.
FSH blood tests are only recommended for women under 45 with symptoms or under 40 with suspected premature menopause.
Information and Support
Women should receive clear explanations about the stages of menopause, common symptoms, and treatment options (including HRT and non-hormonal therapies like cognitive behavioural therapy).
Managing Symptoms
HRT is recommended for vasomotor symptoms (hot flushes, night sweats) after discussing risks and benefits. Other treatments like isoflavones and black cohosh may help, but their safety is uncertain.
Psychological symptoms like low mood or anxiety may benefit from HRT or CBT, though SSRIs and SNRIs are not first-line treatments unless depression is diagnosed.
Sexual function: Testosterone supplementation may be considered for low sexual desire if HRT alone is ineffective.
Urogenital symptoms (like vaginal dryness) can be treated with vaginal estrogen.
Women should keep up with regular health reviews, and referrals to menopause specialists are recommended if symptoms persist or treatments are ineffective.
For full details, read the full NICE guidelines here.
Follow-up and Ongoing Monitoring
After your initial consultation, the next steps might involve monitoring your symptoms or starting treatment.
Your GP should schedule a follow-up appointment to check on your progress.
Ongoing monitoring ensures that any treatment you start is working and that your symptoms are being managed effectively.
Continue to track your symptoms over time and bring updates to your GP.
Don’t skip follow-up appointments, even if symptoms improve; it’s important to continue tracking your progress.
Tips for Success:
Know Your Rights
You have the right to ask for a second opinion or a referral to a menopause clinic if you feel your GP is not addressing your concerns adequately.
NHS Menopause Clinics
In some areas, there are specialised menopause clinics within the NHS where you can receive more specialised care.
Blood Tests for Women Under 45
If you’re younger than 45, blood tests are more likely to be offered, but remember that they aren’t conclusive for diagnosing perimenopause.
Perimenopause and the NHS - Common Issues and Solutions
When seeking a perimenopause diagnosis on the NHS, many women encounter roadblocks that can delay treatment or lead to frustration. Below are some of the most common issues and practical ways to address them:
1. Your GP dismisses your symptoms
It’s not uncommon for some women to feel dismissed when they first approach their GP with perimenopause concerns. The symptoms of perimenopause can mimic other conditions, and if you're under 45, your GP may be more hesitant to link your symptoms to hormonal changes.
Be Persistent
If you believe your symptoms are related to perimenopause, insist on a deeper conversation. Bring a symptom log and make it clear how these symptoms are impacting your life. You can also ask for a second opinion or request a referral to a menopause specialist.
Self-Advocacy
If your GP is unfamiliar with the latest guidance on perimenopause, politely point them to resources like the NICE guidelines on menopause care.
Remember that the NHS follows a 'shared decision making' procedure which is a joint process in which a healthcare professional works together with a person to reach a decision about care.
It involves choosing tests and treatments based both on evidence and on the person's individual preferences, beliefs and values.
It makes sure the person understands the risks, benefits and possible consequences of different options through discussion and information sharing.
2. Blood Tests Inconclusive
GPs might order blood tests to check hormone levels, but these tests aren’t always reliable due to fluctuating hormone levels during perimenopause.
Focus on Symptoms
Remind your GP that perimenopause is primarily diagnosed based on symptoms, especially for women over 45. Even if your blood test results are inconclusive, insist on discussing treatment options based on your symptom severity, in line with the NICE guidelines.
Track Over Time
Continue tracking symptoms for a few more months and share the updates with your GP. Consistent tracking can help reinforce the case for a perimenopause diagnosis.
3. Difficulty Accessing Specialist Care
Women are frequently struggling to get referred to NHS menopause clinics or specialists, particularly in areas with fewer resources.
Request a Referral
If you aren’t getting the support you need, ask specifically for a referral to a menopause specialist, clinic or women’s health specialist. You may need to advocate strongly for this, but it’s within your rights.
Consider Private Care
If the waiting times for specialist NHS care are long, consider consulting a private menopause specialist, even for a single consultation to confirm a diagnosis and discuss treatment options.
Be mindful of the costs and whether your GP will cooperate in managing your care afterward. If the specialist recommends HRT then this can often be moved to an NHS prescription.
FAQs - Perimenopause and the NHS
What are the main symptoms of perimenopause?
Common symptoms include irregular periods, hot flashes, night sweats, mood changes, increased anxiety, fatigue, and difficulty sleeping. Symptoms can vary greatly among women; some experience more physical symptoms whilst some may experience more emotional or cognitive issues, like anxiety or memory lapses.
How is perimenopause diagnosed?
Your doctor should follow the NICE guidelines for menopause diagnosis and management. Read more about them here
How long does it take to get a perimenopause diagnosis on the NHS?
The timeframe for a diagnosis can vary. Some women may receive a diagnosis quickly if their symptoms are clear and they are over 45. For others, especially younger women, the process might take longer due to the need for blood tests and ruling out other conditions.
Can blood tests definitively diagnose perimenopause?
No. Blood tests are often inconclusive, especially as hormone levels can fluctuate wildly during perimenopause. Doctors usually rely on a woman’s reported symptoms and age to make the diagnosis. Blood tests are more common for women under 45 but should not be the sole diagnostic tool.
What should I do if my GP refuses to discuss perimenopause?
If you feel your concerns are being dismissed, it’s important to advocate for yourself. Ask for a second opinion or request a referral to a menopause specialist. You can also point your GP toward the NICE guidelines on menopause, which support a symptom-based approach to diagnosis.
What kind of treatment can the NHS offer for perimenopause?
The NHS typically offers treatments like hormone replacement therapy (HRT), lifestyle advice, and sometimes cognitive behavioural therapy (CBT) for mood-related symptoms. HRT is one of the most common treatments, but your GP will discuss the options based on your symptoms and medical history.
Conclusion
Understanding the process of getting a perimenopause diagnosis on the NHS can empower you to take control of your health journey.
By following the steps outlined—from preparing for your GP consultation to advocating for yourself when necessary—you can ensure you receive the support and treatment you need.
Next Steps
Now that you understand how to approach the NHS for a perimenopause diagnosis, consider the next steps.
You may want to explore treatment options such as hormone replacement therapy (HRT) or alternative therapies to manage symptoms.
Staying informed on the latest research and guidance on menopause will equip you with the knowledge to make the best decisions for your health.
For further insight, check out our articles on ‘Menopause without HRT’ or ‘HRT - What does it do?’ and ‘The Best Vitamins for Perimenopause’ together with many further articles.
Further Help
Jane offers affordable one-to-one sessions or a 12-week programme to women online throughout the UK.
She is an affiliate member of The British Menopause Society and a member of The International Practitioners of Holistic Medicine.
Find out more about Jane’s services at www.janemackaycoaching.com or contact Jane directly at jane@janemackaycoaching.com
And don’t forget to download your FREE Menopause Health Guide so you can make a start on improving your menopause health TODAY!
Menopause Resources
If you're looking for more detailed information on navigating perimenopause and getting the most out of the NHS, here are some helpful guides and tools that align with your next steps:
NICE Guidelines on Menopause
Read the full guidelines here to understand the NHS’s approach to diagnosing and managing perimenopause and menopause.
NHS Menopause Overview
Visit the NHS menopause page for a basic overview, including when to seek help and treatment options available.
Symptom Tracker Tool
Use the Balance Menopause app with symptom tracker to monitor your symptoms over time and share the data with your GP.
British Menopause Society Resources
Explore the British Menopause Society’s resources for additional support.
DISCLAIMER: This page does not provide medical advice; it is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Always seek professional medical advice on any of the topics covered on this page.
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