When should you see a doctor?

Menopause is a natural phase of life, and most symptoms are entirely expected. But sometimes it is important to let a doctor assess what you are experiencing, either because the symptoms may have other causes or because there is treatment that can make your daily life much better. Here is an overview of the situations where you should get in touch, and what to expect from the appointment.

Bleeding after menopause

If you have gone at least twelve months without a period and then experience bleeding again, you should always contact your doctor. In medical terms, bleeding after menopause is considered possible cancer until proven otherwise. That sounds frightening, but the probability that it actually involves uterine cancer is between 5 and 10 per cent. The vast majority of cases have a harmless explanation, such as polyps, thin lining, or effects of hormone therapy.

In Norway, over 700 new cases of uterine cancer are diagnosed each year, and 90 per cent of them are in women over 50. That is precisely why it is important to investigate all bleeding that occurs after menopause. The earlier it is detected, the better the prognosis. Your doctor will usually refer you for an ultrasound and possibly a tissue sample to rule out serious disease.

Symptoms before the age of 45

Most women experience menopause between the ages of 45 and 55, with a Norwegian average of 53. If you notice irregular periods, hot flushes, or other typical symptoms before the age of 45, you should contact your GP.

Early menopause, and especially premature menopause before the age of 40, affects 1 to 2 per cent of all women. It is called premature ovarian insufficiency, and it is important to get the diagnosis because early oestrogen deficiency increases the risk of osteoporosis, heart disease, and other long-term health effects. These women are recommended hormone therapy at least until the average age of menopause, regardless of whether they have bothersome symptoms.

The diagnosis is made by measuring FSH in a blood test twice, at least four weeks apart, and you are usually referred to a gynaecologist for follow-up.

Symptoms that affect daily life

You do not need to have anything dramatic to contact a doctor. If hot flushes, sleep problems, mood swings, or other symptoms mean you are functioning less well at work, struggling in your relationships, or simply not feeling well, that is reason enough to get in touch.

Many women wait too long because they think this is something they just have to endure. That is a misconception. There are effective treatment options, from lifestyle changes to hormone therapy, and your doctor can help you find what works for you.

Mood and mental health

The risk of depression increases two to four times during perimenopause, even in women who have never had mental health issues before. If you are experiencing persistent low mood, loss of interest in things you normally enjoy, or anxiety that does not subside, you should speak with your doctor.

Thoughts of self-harm or suicide require immediate help. Call emergency services if there is acute danger, or contact the out-of-hours medical service.

It is important to know that current guidelines recommend that hormone therapy be considered before antidepressants for mood changes linked to menopause. A doctor who understands the connection between hormones and mood can provide better care.

Do you need blood tests?

A common question is whether blood tests can confirm that you are in menopause. The answer is usually no. The Norwegian recommendation from "Gjor kloke valg" (the Medical Association's campaign to avoid unnecessary investigations) states it clearly: avoid hormone analyses in women over 45 with menopausal symptoms to establish menopause.

The reason is simple. Hormone levels fluctuate dramatically throughout the cycle during perimenopause, and a single blood test provides very limited information. If you are over 45 and have typical symptoms such as irregular periods and hot flushes, that is enough to make the diagnosis. Blood tests are most useful for women under 45 with early symptoms, to rule out low thyroid function, or to check for other possible causes of your symptoms.

What happens at the GP?

When you visit your GP for menopausal symptoms, the doctor will usually go through your medical history, including when the symptoms started, your menstrual pattern, any medications you are taking, and relevant family history. It is a good idea to have thought this through beforehand.

The doctor will discuss treatment options with you. For women over 40 with significant symptoms, hormone therapy can be prescribed on a subsidised prescription in Norway (blå resept), meaning you pay a lower co-payment. Most cases can be managed by the GP, but in some situations you will be referred to a gynaecologist, especially for bleeding after menopause, suspected premature ovarian insufficiency, or if standard treatment has not been effective.

Tips for the appointment

Prepare by keeping a simple record of your symptoms over the past few weeks: what you experience, how often, and how it affects you. Write down the questions you want answered. Remember to mention all medications and supplements you are using. And do not be afraid to say that you want treatment. If the symptoms are significant enough for you to have booked an appointment, they are significant enough to do something about.

The key takeaway

Your doctor is a resource, not a last resort. Most menopausal symptoms can be managed with straightforward measures and good guidance. The sooner you get in touch, the sooner you can get help. And remember that asking for help is not making a fuss out of nothing. It is taking responsibility for your own health.