What OB-GYNs Want You To Know Before Your First Perimenopause Appointment

It happens all the time: A woman walks into her annual gynecology exam with a list of concerns, from irregular periods to itchy ears, and leaves disappointed when there’s no time to address them all. That’s because perimenopause and its myriad potential symptoms are a massive transition for all the systems in your body — meaning it deserves its own appointment, rather than trying to get all your questions answered between your Pap smear and breast exam.

Scary Mommy spoke with two perimenopause experts about when you should make an appointment just to talk perimenopause with your OB-GYN, and how to best prepare to get the most from your time with them.

When should you see your doctor about perimenopause?

Perimenopause isn’t a disease; it’s a normal part of life, says Dr. Alyssa Dweck, a board-certified OB-GYN, Menopause Society-certified practitioner, and chief Medical Officer at Bonafide Health. If you just want to check in about where you might be in your perimeno journey or ask a few questions, your annual appointment is a fine time to do so.

“But if symptoms are interfering with quality of life, work, or relationships, or just general day-to-day discomfort or anxiety, they should certainly be brought up separately at a more directed visit,” she says. “It should be addressed, but with a more detailed visit set separately and dedicated so that the appropriate amount of time can be given to that subject.”

If you do start by bringing up your perimenopause concerns during your annual, be realistic in your expectations. You may or may not leave with solutions that day.

“The annual exam is a very specifically designed visit where we focus on prevention of cervical cancer, breast cancer, and colon cancer. I have these things that I have to cover at an annual. Women oftentimes come in with this list of 12 things and leave very frustrated and really demoralized that they're not heard,” says Dr. Christy Guepet, board-certified OB-GYN and female pelvic medicine reconstructive surgeon, Menopause Society-certified practitioner, and member of the This Is Menopause advisory committee.

Instead, use that time to gauge if your usual provider seems well-equipped to manage perimenopause and whether you want to schedule that next, more dedicated appointment with them or someone else.

“Just start the conversation and figure out: Do you have the right team around you to help you at this stage of your life? The team that you would've created for yourself 10 years ago might not serve your needs at this stage in life. You really are looking for someone to help you navigate your decisions and choices at this stage in life. If the answer is that this is not this provider's niche or passion, then that's still good information because it allows you to start moving to another decision where you find that navigator.”

How To Prepare For Your Perimenopause Appointment

We all know doctors’ time is short and perimenopause is a huge topic to tackle. How can you get all of your questions answered and your problems on their way to being solved? Doing your homework goes a very long way, Guepet says.

Jot down the dates of your last few periods, at least.

“Something that wastes a lot of time during a visit, at least in my experience, is fiddling through a calendar to figure out when your last period was, and then the one before that, and how many days it lasted. Keeping some sort of a tracker or calendar of your menstrual cycles or lack thereof can be very, very helpful to hone in on where somebody is in the journey of perimenopause and menopause,” says Dweck. “I can't tell you how many times it's taken 10 minutes, 10 precious minutes, for someone to figure out their last period. And that's just a waste because that can be figured out beforehand.”

Bring a list of your symptoms, including the top three that affect your life most.

Sit down and truly think about which symptoms have the biggest impact on your quality of life. This helps your doctor know where to start in getting you relief.

“Women who come in for new consults here are oftentimes kind of stunned into silence when I say, ‘I want you to give me your top three symptoms that brought you through the door today.’ And I'm telling you, it happens at least once a week where a woman is stunned and sometimes she'll brim with tears because she's never been asked that question or sat down with a pencil and paper to ask herself that question.”

This Is Menopause is a free community of women and menopause experts with resources that can help you understand what issues you’re experiencing may be perimenopause-related. You could start with their interactive symptom tracker, which points out that sleep issues, panic attacks, and more can be linked back to perimeno.

Print out your medical history on actual paper to bring with you.

You don’t want to spend your precious face time logging into four different health portals to find the dates of your last mammogram and Pap smear, which a menopause specialist is going to ask for. And God forbid the Wi-Fi is down.

“As archaic as paper is, if you have that on paper, that can now be captured into a chart in a meaningful way. I encourage women to bring paper with their mammogram report, with their Pap smear report, if they've had some significant past medical history or surgeries to the cervix or biopsies of the breast. The more information that we can have from the outset, the quicker we can set a plan into action,” says Guepet. “I oftentimes have to work on that action plan after I meet someone where we start doing that homework after the fact, and that's fine. But it delays a working plan.”

Depending on your concerns, log your related behaviors.

Need your doctor’s help to manage uncomfortable bloating? A food journal is the best way for your doctor to try and identify potential foods or times of meals triggering the issue, Dweck says. If you’re getting up to pee multiple times a night, jot down your drinking habits and bathroom visits throughout the day.

“A voiding journal can be very helpful so we can identify things like is there too much caffeine? Are you hydrating at the wrong time? Is there something going on medically that we need to address?” Dweck explains.

Don’t hesitate to ask your questions.

No topics are off limits, and they’ve heard all the sex questions you could possibly have before, Dweck says. There are also so many possible concerns to address that your doctor can’t possibly bring up every single one to check if it’s affecting you.

“Don't be embarrassed or ashamed to ask your questions or relay your concerns, whether they're sexual in nature or having to do with urinating or whatever else might be sort of considered taboo in the usual realm, because most of the time your doctor's heard it before. If they're ill-equipped to manage it, they should be able to refer you to somebody who can. Not all doctors are going to bring up those sort of less comfortable topics to talk about, so we really do rely on people to bring up what's bothersome.”

What To Expect At Your Perimenopause Appointment

We’re so used to annual exams, climbing onto a table and sticking our feet in the stirrups. What will a perimenopause appointment even entail? It will vary from doctor to doctor, but a physical exam can sometimes be part of the to-do list, depending on your concerns or the last time you saw an OB-GYN, Dweck says, who adds that pelvic ultrasounds are also pretty common.

You can also expect a lot of bloodwork to be ordered, though not necessarily for hormone levels like you might think. “Hormone testing, particularly during perimenopause, is really just a window in time and may not reflect what's going on every day or as an overall trend. But [there will be] plenty of blood work because some of the symptoms that women will complain of can overlap with symptoms of things like thyroid disease, anemia, heart disease, or high blood pressure. So we really want to get to the root of these symptom problems,” she adds.

Your doctor will also talk to you a lot about lifestyle modifications, Dweck says. “No matter whether someone chooses high-dose hormones or other medications or herbal supplements or to do nothing at all for their symptoms, diet, exercise, sleep optimization, stress reduction — these are all things that can be so helpful.”

Finally, expect this appointment to be one in a series, not a one-and-done magic bullet for perimenopause, Guepet says. Check in with yourself once or twice a week about the changes you’ve made — like starting magnesium to help with sleep or beginning hormone replacement therapy — and ask yourself if they’re helping, and how. These notes can be incredibly helpful at follow-up appointments so your doctor can assess what’s working well and what isn’t.

“The older we get, the longer it can take to see differences. So expect from the outset, this is going to take time and it's going to be a two steps forward and a step back process. Even a step backwards is still meaningful information,” Guepet says. “There's never been a better time in history to be a perimenopausal woman. We can now talk about things that generations before us found taboo. So we can focus on what didn't work or we can say, you know what? That's meaningful too, and I'm going to just stay empowered and informed and committed to prioritizing myself.”