What to expect at a menopause consult

Before the visit: what is worth noting down

You do not need homework, but two minutes of notes makes the consult sharper. Jot down your last dozen periods if you still have them, the symptoms that bother you most, anything you have already tried, and your family history of breast cancer, blood clots and heart disease. That last list is what makes prescribing safe and fast.

The symptom review

The consult starts with your story, structured by a validated menopause questionnaire so nothing is missed: flushes and night sweats, sleep, mood, brain fog, joint aches, cycle changes, libido, and vaginal dryness or discomfort with sex. The questionnaire matters because the quieter symptoms, especially the genital and urinary ones, are the most undertreated and the most fixable.

Why you may not need a blood test

This surprises many women: in your late 40s or 50s with a typical pattern, perimenopause and menopause are clinical diagnoses. Hormone levels swing so widely from week to week during the transition that a single blood test can look normal in the middle of severe symptoms. Bloods earn their place in younger women, in unclear pictures, and to exclude imitators such as thyroid disease, and an accredited pathology laboratory handles those where needed.

The safety check and the options conversation

Next comes a focused check: blood pressure, weight, relevant examination, and a walk through your personal and family history against prescribing guidelines. Then options, honestly laid out. For most healthy women within ten years of menopause, HRT is the most effective treatment for flushes, sweats and sleep, and transdermal oestrogen is preferred where suitable. Local vaginal oestrogen treats dryness with minimal absorption. Non-hormonal medication and CBT-based approaches exist for women who cannot or would rather not use hormones.

You should leave the options conversation knowing the actual numbers behind the breast cancer headlines, not just a yes or a no. The risks are real but small, they differ by HRT type, and they belong in context alongside the benefits.

The plan and the follow-up

The visit ends with a written plan and, where treatment is agreed, a script. A review about a month later checks how symptoms have responded and adjusts the dose; hormone treatment is titrated to the woman, not dispensed as one-size-fits-all. At PVT the first visit is R700 and the follow-up R500, each paid at the visit itself, with an invoice you can claim back from your medical aid.

Menopause care works best as an ongoing relationship with one doctor through a transition that can run for years. The first consult is where that starts.