12 Questions to Ask Your Doctor About Perimenopause

By Jennifer Seguancia, NP · The Perimenopause Playbook · Education only

Many women tell me the hardest part of perimenopause isn't any one symptom. It's walking out of an appointment feeling like they didn't get to say what they came to say. The visit was short, they got nervous, and the conversation ended with "let's just keep an eye on it."

A little preparation changes that. From the other side of the exam room, here's what helps a clinician help you: a clear opening, a short list of focused questions, and a record of what's been happening. Below are the questions I'd want you to have ready, grouped so you can pick the ones that matter most to you.

Before the appointment: three quick steps

1. Book it as a perimenopause visit. When you schedule, say you want to talk about perimenopause or menopause symptoms. Australia's national health department suggests asking for a longer appointment if you can. If you tuck it onto the end of a visit for something else, it tends to get squeezed.

2. Bring a record, not just a memory. Mayo Clinic recommends bringing a record of your menstrual cycles (start and end dates, and whether flow was light, moderate or heavy) and writing down your symptoms, including ones that seem unrelated. Australia's health department suggests a 2–4 week symptom diary. I suggest 30 days if you have time.

3. Bring your medication and supplement list, with doses. Include vitamins, herbs and anything over the counter.

Open with a 3-sentence summary

The first minute sets the tone of the visit. Try this structure:

"I'm here because I think I may be in perimenopause. For the past [X months], my main symptoms are [top 1–3], and they're happening [how often]. It's affecting my [sleep / work / relationships], and I'd like to understand what's going on and what my options are."

That one opening tells your clinician your concern, your timeline, how severe it is, and what you want from the visit. Then hand over your tracker.

Questions about what's happening

1. Based on my symptoms and cycles, could this be perimenopause? Perimenopause is usually recognized from age, symptoms and period changes (ACOG). Asking directly invites your clinician to tell you how they're thinking about it.

2. What else should we rule out? Thyroid problems, anemia, sleep apnea, depression, medication side effects and pregnancy can all overlap with perimenopause symptoms. NICE notes that tests like a blood count or thyroid function may still be needed when another cause is suspected.

3. Do I need any lab tests, and what will they tell us (and not tell us)? Hormone levels swing a lot in perimenopause. For most women over 45, guidelines don't rely on hormone blood tests to diagnose it (ACOG; NICE). Asking how your clinician uses labs helps you understand the plan, and avoids the "your labs are normal, so it's nothing" dead end.

4. Is my bleeding pattern expected for this stage, or should it be checked? ACOG advises discussing bleeding changes with your clinician, especially bleeding between periods, after sex, or heavier than usual.

Questions about your options

5. What are my options for my top symptom: lifestyle approaches, non-hormonal treatments, and hormone therapy? Asking about all three gets you the full menu, not just one path. The Menopause Society notes that non-hormone options exist for people who can't or don't want to use hormones.

6. Am I a candidate for menopausal hormone therapy? What in my health or family history affects that? History of blood clots, stroke, heart disease, certain cancers, liver disease or migraine with aura can all matter. Your clinician weighs these with you.

7. What are the benefits and risks for someone my age and health? Current guidelines emphasize being well informed about benefits, risks and alternatives so you can decide together (European Society of Endocrinology).

8. What about vaginal dryness or urinary symptoms specifically? These are common, often under-discussed, and may have their own options. Bring them up even if they feel awkward.

9. Do I still need contraception? Yes, you can still get pregnant in perimenopause even with irregular cycles. The Menopause Society advises using birth control, if you don't want a pregnancy, until menopause is confirmed a year after your last period.

Questions about your long-term health

10. What should I be doing now for my bones, and when should I have a bone density test?

11. How does this stage affect my heart health, and what numbers should I know? Blood pressure, cholesterol and blood sugar are common starting points.

12. Which screenings am I due for? Mammogram, cervical screening and colon screening are worth checking while you're there.

Questions to close the visit

Before you leave, make sure you know the plan:

• "If we try something, how long until we'll know if it's working, and when do we follow up?"
• "What side effects or symptoms should make me call you?"
• "If you don't routinely manage menopause care, can you refer me to someone who does?" The Menopause Society keeps a directory of certified practitioners at menopause.org.

If you still don't feel heard

Sometimes, even with great preparation, a visit doesn't go the way you hoped. That's not a failure on your part. A few things that can help:

• Ask for your tracker to be scanned into your chart so there's a record of what you reported.
• Repeat back the plan: "So the next step is ___, and we'll follow up in ___?"
• Book a follow-up specifically for perimenopause if time ran out.
• Seek a second opinion from a clinician who focuses on menopause care. That's a reasonable, common step.

Don't wait for an appointment if…

Some symptoms need prompt care rather than a list of questions:

• Bleeding after 12 months without a period
• Bleeding that soaks through a pad or tampon every hour for several hours
• Chest pain, fainting, or shortness of breath
• One-sided leg swelling or a sudden severe headache
• A new breast lump
• Thoughts of harming yourself (call or text 988)

Get the printable question list and 30-day tracker (free)

The free Perimenopause Starter Kit puts all of this on paper: 15 questions to ask your provider (circle your top 5), a 30-day symptom tracker, and a one-page summary to hand across the desk.

Send me the free Starter Kit →

Education only. This article is general information, not medical advice, diagnosis or treatment, and it isn't a substitute for care from your own clinician. Reading it doesn't create a clinician–patient relationship with Jennifer Seguancia, NP. If you think you have a medical emergency, call 911.

Sources

• Mayo Clinic. Perimenopause: diagnosis and treatment. https://www.mayoclinic.org/diseases-conditions/perimenopause/diagnosis-treatment/drc-20354671
• Australian Government Department of Health. Perimenopause: Getting help. https://www.health.gov.au/perimenopause/management-and-support/getting-help
• ACOG. Do I need to have testing of my hormone levels during perimenopause? https://www.acog.org/womens-health/experts-and-stories/ask-acog/do-i-need-to-have-testing-of-my-hormone-levels-during-perimenopause
• ACOG. Perimenopausal Bleeding and Bleeding After Menopause. https://www.acog.org/womens-health/faqs/perimenopausal-bleeding-and-bleeding-after-menopause
• NICE. Menopause quality standard QS143, statement 1. https://www.nice.org.uk/guidance/QS143/chapter/quality-statement-1-diagnosing-perimenopause-and-menopause
• European Society of Endocrinology guideline on menopause and perimenopause. https://doi.org/10.1093/ejendo/lvaf206
• The Menopause Society. Perimenopause. https://menopause.org/patient-education/menopause-topics/perimenopause
• Society for Women's Health Research. Menopause Preparedness Toolkit. https://swhr.org/wp-content/uploads/2024/03/SWHR-Menopause-Toolkit-UPDATED-2023Oct.pdf

Keep reading:

• Perimenopause Symptoms but Normal Blood Tests? Here's Why
• Free Printable Perimenopause Symptom Tracker (30 Days)

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