How do I ask my doctor about HRT?

Ask: 'Can we discuss my personal risk-benefit balance for HRT given my age, my symptoms, and my medical history?' Request specifically transdermal estrogen and micronised progesterone rather than the older oral combined formulation, which carries a different risk profile.

My doctor offered antidepressants for menopause — what should I say?

Say: 'Before I start an antidepressant, I would like to understand whether my mood symptoms could be hormonally driven and whether HRT might be more appropriate as a first step.' HRT has stronger evidence for perimenopausal mood symptoms than antidepressants in women without a prior history of clinical depression.

How do I raise vaginal dryness with my doctor?

Say directly: 'I want to raise something I find difficult — I have been experiencing vaginal dryness and discomfort that is affecting my daily comfort. I understand local vaginal estrogen has minimal systemic absorption and strong evidence. Can we discuss it?' This symptom is extremely treatable but rarely raised without prompting.

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Doctor conversation guides

Q: What do I say to my doctor if I think I am in perimenopause?

Tell your doctor: 'I have been experiencing changes in my periods, my sleep, my mood, and my energy. I am in my 40s and I am wondering whether perimenopause could be connecting these symptoms.' Ask specifically for the hormonal connection to be considered before treating each symptom separately.

Q: How do I ask about testosterone therapy for low libido?

Tell your doctor: 'I have read that testosterone therapy is recommended for low libido in postmenopausal women by the Menopause Society and the British Menopause Society. Is this something you can prescribe or refer me for?' Testosterone therapy for women is underused — many GPs are unaware it is an option.

What to say, how to say it, and what to do if you are dismissed. Six of the most common conversations menopausal women need to have — and have not been given the language for.

Rose

"The problem is rarely that your doctor is bad. The problem is usually that the conversation never quite happens the way it needs to. These guides give you the specific words — because knowing what you want to say and finding those words in the moment are very different things."

Before your appointment

Write down your three most disruptive symptoms and when they started. Note any medications you are currently taking. If your periods have changed, note how. You have limited time — knowing your priorities before you walk in means you use that time well. It is completely appropriate to bring notes to a medical appointment.

I think I am in perimenopause but my doctor has not mentioned it

The situation

You are in your 40s. Your periods have changed, your mood is different, you are not sleeping well, and nobody has connected the dots.

What often happens

Many doctors do not proactively raise perimenopause. They may treat each symptom separately — antidepressants for mood, sleep medication for insomnia — without considering the hormonal connection. Some will tell you a blood test rules it out. It does not.

What to say

• "I have been experiencing changes in my periods, my sleep, my mood, and my energy. I am 45 and I am wondering whether perimenopause could be connecting these symptoms."

• "I have read that perimenopause can begin in the early 40s and that blood tests are often inconclusive during this stage. Can we discuss whether my symptoms fit that picture?"

• "Before we treat each symptom individually, I would like to understand whether there is a hormonal explanation that could address them together."

If you are dismissed

If your doctor says "your blood tests are normal so it is not menopause" — ask specifically: "I understand FSH and estradiol fluctuate significantly in perimenopause and a single test can miss it. Can we discuss my symptoms and timeline rather than relying solely on bloodwork?"

Rose

"You know your body. A symptom pattern that changed in your 40s without another explanation is worth pursuing. You are allowed to name perimenopause specifically and ask for it to be taken seriously."

I want to discuss HRT but my doctor is resistant

The situation

Your doctor either has not offered HRT or has dismissed it citing the 2002 WHI study, breast cancer risk, or a general reluctance to prescribe hormones.

What often happens

Many doctors trained during or after the 2002 WHI controversy have an outdated view of HRT risk. They may cite the study without knowing it has been substantially revised. They may apply blanket caution without assessing your individual risk profile.

What to say

• "I have read that the guidance on HRT has changed significantly since the 2002 WHI study. Can we discuss my personal risk-benefit balance based on my age, my symptoms, and my medical history?"

• "I understand there are risks — I would like to understand what my specific risks are, not the population-level risks from a study of women who were on average 63 years old."

• "I would specifically like to discuss transdermal estrogen and micronised progesterone rather than oral combined HRT — I understand these may carry a different risk profile."

• "My symptoms are significantly affecting my quality of life. Can we discuss what the evidence shows for a woman of my age and history?"

If you are dismissed

If your doctor dismisses the conversation entirely, you are entitled to a second opinion. Ask for a referral to a menopause specialist. Telehealth menopause clinics (specialist menopause telehealth clinics) are significantly more current with the evidence.

Rose

"You do not need your doctor to agree with you. You need them to have the conversation with you properly. If they cannot do that, find one who can."

I have been offered antidepressants for menopause symptoms

The situation

Your doctor has suggested SSRIs or SNRIs for hot flashes, mood changes, or anxiety without first discussing HRT.

What often happens

After the 2002 WHI study, SSRIs became the default alternative to HRT. Many doctors still reach for antidepressants first for menopausal mood symptoms without discussing that HRT addresses the hormonal root cause and has stronger evidence for vasomotor symptoms.

What to say

• "Before I start an antidepressant, I would like to understand whether my mood symptoms could be hormonally driven and whether HRT might be more appropriate as a first step."

• "I understand SSRIs can help with hot flashes and mood — but I have read they are less effective than HRT for vasomotor symptoms and do not address vaginal dryness, joint pain, or bone density. Can we discuss HRT first?"

• "If we decide antidepressants are the right choice, I want to understand the sexual side effects and how we would manage stopping the medication if needed."

If you are dismissed

If your doctor insists SSRIs are the only appropriate option without a clear clinical reason, ask them to document in your notes why HRT was not discussed. This often prompts a more thorough conversation.

Rose

"Antidepressants are not wrong — they help many women. But they should be a considered choice, not the default because HRT feels complicated. You deserve the full conversation."

I want to discuss vaginal dryness and painful sex

The situation

You are experiencing vaginal dryness, discomfort, or pain during sex. Your doctor has not raised it and you find it embarrassing to bring up.

What often happens

Vaginal and sexual symptoms are the most underreported and undertreated menopause symptoms. Most doctors will not ask. Most women will not volunteer. The result is years of unnecessary suffering for a condition that responds very well to treatment.

What to say

• "I want to raise something I find difficult to discuss — I have been experiencing vaginal dryness and discomfort that is affecting my sex life and my daily comfort. I understand this is a menopause symptom. What are my options?"

• "I have read about local vaginal estrogen — a cream or tablet applied directly to the vagina. Is this appropriate for me? I understand it has minimal systemic absorption."

• "I have also read about ospemifene — an oral tablet for this symptom. Can we discuss whether that might be suitable?"

If you are dismissed

If your doctor minimises the symptom or suggests lubricants without discussing local estrogen, say: "I would like to try a medical treatment rather than only over-the-counter options. Can we discuss local vaginal estrogen specifically?"

Rose

"This symptom is extremely treatable. The barrier is not medicine — it is the conversation. You have started the hardest part by deciding to raise it."

I think my thyroid may be involved in my menopause symptoms

The situation

You have fatigue, weight gain, brain fog, hair loss, or mood changes. Some or all of these could be thyroid-related — but they could also be menopause. You want both investigated properly.

What often happens

Thyroid problems — particularly hypothyroidism and Hashimoto thyroiditis — are significantly more common in menopausal women and their symptoms overlap completely with menopause symptoms. Many women are treated for menopause when an undiagnosed thyroid condition is the primary driver, or vice versa.

What to say

• "I would like a full thyroid panel — not just TSH. I specifically want Free T4, Free T3, and thyroid antibodies (TPO and TgAb) to rule out Hashimoto thyroiditis."

• "I understand the standard TSH reference range is wide but I have read that symptoms often occur when TSH is above 2.0 even within the normal range. Can we discuss what my optimal TSH target should be?"

• "If my thyroid is normal, I would still like to discuss whether my symptoms could be menopausal and what hormonal options are available."

If you are dismissed

If your doctor only orders TSH and says it is normal, ask specifically: "Can we also test Free T3 and thyroid antibodies? I understand TSH alone can miss Hashimoto thyroiditis and subclinical hypothyroidism."

Rose

"Getting both thyroid and hormonal investigation done simultaneously — rather than sequentially — saves months of uncertainty. You are allowed to ask for both at the same appointment."

I want to discuss testosterone for low libido

The situation

Your libido has significantly decreased. You have heard that testosterone therapy is an option for women but your doctor has not mentioned it.

What often happens

Testosterone therapy for women is significantly underused — most GPs are unaware it is an option or are hesitant to prescribe it. Yet it has good evidence for low libido in menopausal women and is recommended by the British Menopause Society, the Menopause Society, and other major bodies.

What to say

• "I have read that testosterone therapy is recommended for low libido in postmenopausal women by the Menopause Society and the British Menopause Society. Is this something you can prescribe or refer me for?"

• "I understand it is given at much lower doses than male testosterone therapy and that the evidence for female sexual dysfunction is good. Can we discuss whether I am a candidate?"

• "If you are not comfortable prescribing it, can you refer me to a menopause specialist or gynaecologist who is?"

If you are dismissed

Many GPs have simply never been trained on female testosterone therapy. If your GP cannot help, a menopause specialist is the appropriate next step. Telehealth menopause clinics are increasingly offering testosterone as part of comprehensive menopause care.

Rose

"Low libido in menopause is not inevitable and it is not just in your head. It has a physiological cause and a physiological treatment. You are allowed to ask for it by name."

A word from Rose

"You are not being difficult. You are not being a hypochondriac. You are an adult asking for information about your own body from a professional whose job is to help you. That is not just allowed — it is exactly right. Every woman who advocates for herself in these conversations makes it slightly easier for the next woman who comes after her."

Written by

Rose

Navigating perimenopause · Researcher · Founded rosemyfriend.com

Research basis

PubMed · Cochrane reviews · NICE guidelines · British Menopause Society · The Menopause Society

Read methodology →

Last updated

March 2026

Key sources

NICE Menopause guideline (NG23)British Menopause Society — HRT guidance

Rose provides evidence-graded educational information — not medical advice. Always discuss health decisions with a qualified healthcare provider. Full disclaimer · About Rose