Talking to Your Doctor About Perimenopause: What to Say, What to Ask, and What to Do If You're Dismissed
Preparing for a perimenopause appointment makes a real difference. Scripts, test recommendations, and what to do if your doctor dismisses your symptoms.
You finally got the appointment. You've been waiting weeks to talk about the sleep, the hot flashes, the anxiety that came out of nowhere, the brain fog that won't lift. And then you have 15 minutes. The doctor asks what brings you in. You start talking. And somewhere in the middle, you can feel the conversation slipping away from you.
Maybe you left without answers. Maybe you were told your labs were normal. Maybe the word "perimenopause" never even came up.
This happens constantly, and it is not your fault. Most medical training includes very little on perimenopause. Many providers are not confident diagnosing or treating it. And the standard appointment structure, brief, problem-focused, test-oriented, is not well suited to a transition that shows up differently in every person.
But you can change the quality of that conversation. This guide tells you exactly how.
Why doctors often miss perimenopause
Perimenopause is genuinely difficult to diagnose through standard testing, and that creates a gap between what you're experiencing and what a doctor can confirm on a lab report.
Hormone levels fluctuate wildly. Estrogen and FSH (follicle-stimulating hormone) levels can be high, low, or anywhere in between on any given day of the month during perimenopause. A single blood test gives a snapshot of one moment, not a picture of the pattern. It is entirely possible to have classic perimenopause symptoms and completely normal labs on the same day. This is common and well-documented, but many providers interpret a normal FSH level as evidence that perimenopause is not the issue.
The symptom list is long and non-specific. Hot flashes are obvious. But the rest of the symptom list, anxiety, joint pain, brain fog, heart palpitations, itchy skin, worsening PMS, irregular periods, insomnia, low libido, fatigue, can each point to dozens of other conditions. Providers who are not thinking about perimenopause as a unifying explanation may investigate each symptom separately, missing the hormonal thread connecting all of them.
Many providers have limited menopause training. Studies consistently show that menopause education in medical schools is minimal. Many physicians report feeling underprepared to manage this transition in their patients. This is not an accusation. It is a systemic gap in training that directly affects the care you receive.
Age assumptions cut both ways. Some providers assume perimenopause cannot happen in the late 30s or early 40s, when in fact it can begin as early as the mid-30s for some people. Others assume symptoms in the late 40s must be something else entirely. If your provider seems surprised by the possibility, that is useful information about their familiarity with the topic.
Before your appointment: what to prepare
The most productive perimenopause appointments are the ones where you arrive organized. Here is what to do in the week or two before you go.
Write a symptom list, not a feeling list. Include every physical and emotional change you've noticed, even if they seem unrelated. Joint stiffness, irregular periods, worsened PMS, anxiety, changes in libido, skin or hair changes, digestive shifts. Doctors can work with a comprehensive list. They cannot easily reconstruct your experience from memory if you're describing it in the room.
Include timing and frequency. Not just "hot flashes" but "hot flashes three to five times per day, worse at night, started approximately eight months ago." Not just "sleep problems" but "waking between 2 and 4 a.m. three to four nights per week, often with night sweats." Specificity gives your provider something to work with and demonstrates that you've been paying attention.
Note your menstrual pattern changes. If your cycle has become irregular, note when it changed, how it's different (longer gaps, shorter gaps, heavier, lighter, spotting), and any patterns you've noticed. Cycle changes are often the clearest early signal of perimenopause.
Write down your questions in priority order. You may not get to all of them. Know your top two. Having them written down means you won't leave the room realizing you forgot the thing you most needed to ask.
Bring a list of your current medications and supplements. This prevents duplication and helps your provider think about interactions before recommending anything new.
What tests to ask for
There is no single test that diagnoses perimenopause. But certain tests help rule out other causes and establish a baseline your provider can track over time.
FSH (follicle-stimulating hormone). As your ovaries produce less estrogen, the brain releases more FSH in an attempt to stimulate them. Elevated FSH can support a perimenopause diagnosis, though as noted, it fluctuates significantly and a single normal result does not rule it out. Ask for this test, but understand its limitations.
Estradiol. This is the primary form of estrogen your ovaries produce. Testing it alongside FSH gives a more complete hormonal picture, though again, both are highly variable during perimenopause.
Thyroid function (TSH, free T3, free T4). Thyroid dysfunction and perimenopause share significant symptom overlap: fatigue, weight changes, anxiety, mood shifts, brain fog, hair thinning. Testing your thyroid is essential for ruling out a condition that is both common and highly treatable if caught.
Complete blood count (CBC) and iron levels. Heavy or irregular periods during perimenopause can lead to iron deficiency and anemia, both of which cause fatigue, brain fog, and low energy. Worth checking, especially if your periods have changed.
Vitamin D. Deficiency is extremely common and causes fatigue, bone pain, low mood, and immune dysfunction, all of which overlap with perimenopause symptoms. Low vitamin D and perimenopause together amplify each other.
Fasting blood glucose and insulin. If you're noticing weight changes, especially around your midsection, checking your insulin sensitivity gives you and your provider a clearer picture of your metabolic health during this transition.
Lipid panel. Estrogen is protective of cardiovascular health. As levels decline, cholesterol patterns can shift. Establishing a baseline now is good preventive care.
Scripts for the appointment
You don't need to walk in with a speech prepared. But having a few clear phrases ready helps you stay focused if the conversation starts drifting away from what you came to discuss.
Opening the conversation: "I've been tracking my symptoms for the past few weeks and I'd like to talk about whether what I'm experiencing could be perimenopause."
This is direct, grounded in observation, and positions you as informed and prepared. It also signals to your provider that you have done some thinking already.
If they suggest it's stress or anxiety: "I've been living with stress before, and this feels different. The symptoms started around the same time my periods became irregular. Can we explore whether hormonal changes might be contributing?"
This acknowledges their concern without dismissing it, while keeping the conversation on the hormonal track.
If they say your labs are normal: "I understand. I've read that FSH can fluctuate a lot during perimenopause and a single normal result doesn't always reflect the pattern. Given my symptom history, can we still discuss whether perimenopause is a likely explanation?"
This is factually accurate and shows you've done your research.
If you want to discuss treatment: "I'd like to understand all my options for managing these symptoms. Can we talk about both hormonal and non-hormonal approaches and what might be appropriate for my situation?"
This invites a full conversation rather than a single recommendation.
What to do if you're dismissed
Being dismissed or minimized by a provider is a genuine and documented experience for many people navigating perimenopause. If it happens, here is what you can do.
Ask specifically. "What would need to be true for you to consider perimenopause as an explanation for my symptoms?" This is not confrontational. It opens a diagnostic conversation about their reasoning and may shift the direction of the appointment.
Request a referral. If your primary care provider is not engaging with your concerns, ask to be referred to a gynecologist, an endocrinologist, or a specialist with training in menopause medicine.
Seek a second opinion. You are always entitled to see another provider. Finding a doctor who has specific training or interest in perimenopause and menopause medicine can transform your experience of care.
Find a menopause-specialist provider. The Menopause Society (formerly NAMS) maintains a directory of certified menopause practitioners in the United States. Similar directories exist in the UK (British Menopause Society) and other countries. These providers have dedicated training in perimenopause and menopause management and are significantly more likely to take your symptoms seriously and understand treatment options fully.
Bring documentation. If you've been tracking your symptoms, bring that record. Objective patterns over time are harder to dismiss than a description of how you feel in one appointment. Tracking through an app like PeriPlan means you arrive with data, not just a story.
What does the research say?
Research consistently shows that perimenopause is both undertreated and underdiagnosed. A 2022 survey by The Menopause Society found that a majority of respondents felt their healthcare provider did not take their menopausal symptoms seriously, and many had visited multiple providers before getting appropriate care.
Research on medical training confirms the gap. A 2019 study of medical residents found that most felt unprepared to counsel patients on menopause management. This isn't a personal failing. It is a structural problem in medical education that is only recently being addressed.
The evidence base for managing perimenopause symptoms is substantial. Menopausal hormone therapy (MHT) is the most effective treatment for vasomotor symptoms (hot flashes and night sweats), with strong evidence supporting its safety in healthy individuals under 60 who are within 10 years of their final period. Non-hormonal options including SSRIs, SNRIs, and the newer neurokinin B inhibitor medications (like fezolinetant) have solid evidence bases for symptom management in people who cannot or prefer not to use hormones. Your symptoms have evidence-based solutions. You deserve a provider who knows them.
What this means for you
1. Prepare a written symptom list before every appointment. Specificity (timing, frequency, duration) makes it easier for your provider to engage with what you're experiencing.
2. Ask for a hormone panel, thyroid testing, and iron levels. Even if results are normal, they help rule out other causes and establish a baseline.
3. Use the scripts. Knowing what to say when you're dismissed or redirected helps you stay on track in a short appointment.
4. Track your patterns beforehand. Arriving with a few weeks of symptom data is far more useful than trying to reconstruct your experience from memory.
5. Ask directly about both hormonal and non-hormonal options. Don't wait for your provider to offer them. Make it a question.
6. Know that a second opinion is always appropriate. If your care isn't addressing your symptoms, finding a menopause-specialist provider is a legitimate and reasonable next step.
7. Don't leave without a follow-up plan. Whether that's a return appointment to review labs, a referral, or a trial of a new approach, you should leave with a concrete next step, not just reassurance.
You know your body. The symptoms you are navigating are real, and they have explanations and options. A good medical partnership makes this transition significantly more manageable. You deserve one.
If your current provider isn't providing it, that is not evidence that nothing can help. It is evidence that you need a different provider. Keep looking. The right clinical support is out there.
This content is for informational purposes only and does not replace medical advice. Always consult your healthcare provider about your specific situation.
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