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Date of Publish:
February 15, 2024
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You’ve been feeling like a dog’s breakfast for months, but your doctor keeps sending you on your way with a smile that says, ‘It’s all in your head.’ A women’s health GP explains how to advocate for yourself to get the care you deserve.
Sabrina Rogers-Anderson
You wake up exhausted and drag yourself through your day. Coffee doesn’t even seem to make a dent in your overwhelming fatigue anymore.
And then there’s the anger (or is it rage?) that’s always simmering below the surface. No matter how often you vow to keep your cool, you find yourself snapping at your partner and kids before the sun is even up.
To make matters worse, your GP isn’t taking you seriously. They sent you for blood tests and you’re a little low on iron, so they put you on a supplement. But you may as well be swallowing Tic Tacs every morning because you still feel like hell.
“I literally couldn’t get out of bed for three to four days every month,” says Sonya, 47. “My periods were crazy heavy and I had debilitating cramps. I felt so low and I couldn’t face life or work. Thankfully, my boss was understanding, but something had to change. My GP was useless, so I made an appointment at a women’s health clinic and I finally felt heard. I’ve been on MHT [menopausal hormone therapy] for a year now and it’s been life-changing.”
But how do you know if you’re perimenopausal and what can you do about it?
Menopause usually occurs between the ages of 45 and 55, but it can happen earlier or later. You’re officially considered menopausal when you haven’t had a period in 12 months.
Some women go into menopause overnight due to surgery (such as having their ovaries removed) or cancer treatment. But for most women, the ovaries gradually stop working over a period of four to six years known as - you guessed it - perimenopause. It isn’t uncommon to start experiencing perimenopause symptoms in your late 30s or early 40s.
During perimenopause, you might experience:
“There aren’t currently any MHT medications approved by the TGA [Therapeutic Goods Administration] for use in perimenopausal women,” says Kelly Teagle, GP and founder of telehealth menopause clinic WellFemme. “So, if a woman comes in with cyclical mood symptoms, a GP who only uses TGA-approved medications will likely prescribe an antidepressant.
“While that can help, it isn’t the whole picture. If you’re of perimenopausal age and you suddenly start getting really bad cyclical mood symptoms, there’s a fair chance that there’s some hormonal basis to that. You might need a combination of psychological therapy and antidepressant medications if it’s severe, but sometimes hormonal treatments might be all you need. We often prescribe MHT off label to help perimenopausal women with mood and other symptoms.”
The landmark Women’s Health Initiative (WHI) study examined the effects of MHT on 17,000 menopausal women. When the initial results were released in 2002, the media widely reported that MHT was associated with an increased risk of breast cancer and heart disease, causing panic and a steep drop in MHT prescribing and use. But a reanalysis of the WHI and later studies found that these initial results were flawed and MHT may even reduce the risk of heart disease.
“When everyone was frightened off hormonal treatment because of the Women's Health Initiative, all these desperate women were left in a vacuum,” says Kelly. “They had terrible symptoms, but they didn’t have anything they could use to relieve them. Now we understand that the Women's Health Initiative got it wrong and MHT isn't the bogeyman we thought it was when it comes to heart disease and breast cancer. We know there can be long-term health benefits to oestrogen therapy for some patients.”
Many women come to Kelly and her colleagues for help because they’re frustrated with their GP’s lack of responsiveness to their concerns.
“The term medical gaslighting is used a lot, but I don’t think it’s intentional,” Kelly explains. “I don't think there are any GPs who want to make their patients suffer needlessly. The problem is that GPs are subject to a lot of myths and misconceptions about menopause, and while they might want to educate themselves, they're very time-poor because they’re trying to keep across developments in every area of health.
“When the focus goes into providing proper education for GPs about perimenopause and menopause, we can expect all GPs to have a decent knowledge base, but they just haven't been given the education yet.”
OK, so you shouldn’t hate on your GP for not knowing everything. But what can you do to get some peri-relief? Kelly shares her four top tips for having a successful perimenopause chat with your GP.
“Be clear about what your symptoms are,” advises Kelly. “We have a free menopausal health assessment tool on our website and the Australasian Menopause Society has a menopause symptom score sheet. Once you've figured out all your symptoms, decide what your top three priority symptoms are - the ones you most want help with. If you have a clear idea of what you want to talk about going in, that will really help.”
You should also be armed with your medical history and your family’s medical history to help your GP tailor your treatment to your needs.
GPs can sometimes get sidetracked or focus on something that isn’t on your priority list. “If that’s the case, you have to be gently assertive and say, ‘I’m not sure that’s right’ or ‘That’s not what my research has revealed,’” says Kelly.
“It isn’t necessarily a bad thing to challenge what your GP is saying. If you've collected solid information from reputable sources like the Australasian Menopause Society and it doesn't gel with what you're hearing, then you should ask questions.”
While it’s important to advocate for yourself if you feel like you aren’t being heard, try not to go into your appointment with a specific outcome in mind.
“We often hear, ‘I want what these other women were talking about on this Facebook page,’” says Kelly. “But it’s important to know that those women were given a certain treatment for a reason. It might have been the best one for them, but you’re a completely different person with a different medical background. It pays to see a GP who knows what they're talking about when it comes to treatments, but you have to be open-minded to the things they're suggesting.”
“Ultimately, if you feel like your GP is fobbing you off or feels uncertain about managing your symptoms, go somewhere else and get a second opinion,” advises Kelly.