How to Talk to Your Doctor About Severe Menopause Symptoms

If you’re in menopause, you probably expected symptoms such as mild hot flashes or forgetting where you left your keys. But women often are blindsided by just how many menopause symptoms they can experience and how disruptive they can be.

“There are dozens of menopause symptoms, many of which can negatively impact a woman’s well-being and quality of life,” says Sheetal Dedania, MD, an obstetrician-gynecologist and physician manager at Reiter, Hill & Johnson of Advantia in Chevy Chase, Maryland, and a Menopause Society certified practitioner. “These unpredictable symptoms may disrupt sleep, reduce libido, increase anxiety, cause physical discomfort, or create other concerns.”

Just because menopause is a natural transition of life doesn’t mean you have to suffer through severe symptoms. “There is no reason to just endure something that is having such a big impact on your life every day,” says Dr. Dedania.

Treatments are available, and your doctor can help you navigate symptoms and find the right solutions for yourself.

Everyone experiences menopause differently, and a symptom doesn’t have to be deemed “severe” to warrant a visit to your doctor. If there’s something that’s bothering you, it’s worth seeing a healthcare professional, such as your primary care doctor or obstetrician-gynecologist (ob-gyn).

“Seeking care can help women understand their options, find appropriate relief, and make sure another medical condition is not causing or worsening their symptoms,” says Cathleen M. Brown, DO, a board-certified ob-gyn and medical director at Winona who is based in Philadelphia. “It also creates an opportunity to discuss preventive health needs that become increasingly important as we get older.”

If you’re unsure, below are a couple of signs that you should see a healthcare practitioner for a menopause symptom:

• It’s disruptive to your life. Dr. Brown says any symptom that regularly interferes with your sleep, work, concentration, exercise, sexual health, relationships, daily activities, or quality of life is worth chatting about with your doctor — for example, hot flashes that keep you up at night or brain fog that affects your ability to function at work.
• The symptom is new, different, or rapidly changing. It’s important to listen to your body and notice changes. Brown recommends going to your doctor when a symptom is new, rapidly worsening, or outside of the expected menopause transition. Although symptoms such as lack of energy, low mood, menstrual changes, and trouble sleeping may be chalked up to menopause, “Thyroid disease, anemia, sleep disorders, depression, medication effects, and other conditions can sometimes cause similar symptoms,” says Brown.

At times, menopause symptoms can threaten your health or be a sign of another condition that needs medical treatment.

Brown says there are some red flags to look for that aren’t typical for menopause and require prompt medical attention. They include:

• Chest pain or significant shortness of breath
• Persistent or irregular heart palpitations
  
• Difficulty speaking
  
• One-sided weakness or numbness
  
• Sudden confusion or severe headaches
• Vision changes
• Severe depression or thoughts of self-harm
• Difficulty managing basic daily activities
• Night sweats accompanied by fever, unexplained weight loss, or other signs of illness
  
• Fainting
• Vaginal bleeding after 12 months without a period
  
• Very heavy or prolonged bleeding
• Blood in the urine
• Severe pelvic pain
• Fever with urinary symptoms
• Recurrent urinary tract infections
• Any new genital sore, lump, or lesion
  

“If you have an urgent issue, such as the signs of a heart attack or stroke, or wish to do harm to yourself or others, you should not wait for an appointment,” says Dedania. “Seek care immediately.”

You’ll get the most out of your appointment for severe menopause symptoms if you do some prep work, says Stephanie Faubion, MD, medical director of The Menopause Society and director of Mayo Clinic’s women’s health center in Jacksonville, Florida.

Before you arrive, consider making a list that includes your:

Questions and Concerns

Jot down a list of questions or topics you want to discuss during that specific visit, says Dr. Faubion. “[Your visit] may be short, and you may have limited time [with the healthcare provider].”

Some examples of questions to ask are:

• Are these symptoms all due to menopause, or could they be something else?
• What are my treatment options?
• What are the risks and benefits of these options?
• What can I do to keep myself healthy going forward?

Symptoms and How They’re Affecting You

Depending on the symptoms you’re having, it could help to track them for a short time. Write down when and how often you’ve experienced them, especially if they’ve interfered with sleep, work, or other daily activities. This may help you communicate your experience and any notable patterns to your doctor.

But even if you haven’t kept a symptom log, don’t worry. You can still let your doctor know how you’ve been affected. “Tracking can be helpful for some people,” says Faubion. “It gives me some objective data, but all I need is for you to tell me how bothered you are by your symptoms.”

Health History

During the visit, your doctor will likely ask you a range of questions about your health history. Brown says these questions may be about:

• Menstrual history
• History of breast or uterine cancer
• History of blood clots, unexplained bleeding, heart disease, stroke, liver disease, migraines, or osteoporosis
• Medications and supplements you’re taking
• Treatments you’ve tried for symptoms
• Previous surgeries

“These details help determine which treatments may be most appropriate, which route or formulation may be most suitable, and whether additional monitoring is needed,” says Brown.

There’s a wide range of treatment options available to help women with menopause symptoms. Dedania recommends keeping an open mind about how to manage symptoms best. For example, hormone therapy gets a lot of attention, but it may not fix every problem.

Brown says that for any treatment, women should ask:

• Which symptom (or symptoms) is this treatment intended to improve?
• What degree of improvement is realistic for me, and when might I notice it?
• What are the possible side effects and risks, based on my health history?
• Will I need certain tests or other monitoring?
• How can I tell whether the treatment is working? How long will it take?
• What alternatives are available if it doesn’t help or causes side effects?

Together with your doctor, you can decide which medication option best fits your symptoms, goals, health history, and preferences. But your journey doesn’t end there. You’ll likely have to try the treatment for a while to see if it works well for you.

“Finding the right treatment may require adjustments to the dose, formulation, route, or type of medication,” says Brown. Remember that you haven’t failed if the first option doesn’t work or causes side effects. “Menopause care should be individualized and revisited as symptoms, preferences, and health needs change.”

If a doctor dismisses you and the symptoms you’re having or isn’t helping you find the best treatment option, consider seeing a menopause specialist. You can search for one on The Menopause Society’s practitioner directory.

“The general principle is there’s no one-size-fits all treatment,” says Faubion. “And women shouldn’t hear that there’s nothing that can be done for them when they go into the doctor’s office.”