Menopause Myth #13: Why Your GP Doesn’t Know Everything About Menopause (And Why That’s a Problem)

“But my GP should know about menopause, shouldn’t they?”

A 46-year-old woman sits in front of me, frustrated and exhausted. She’s been experiencing increasingly severe symptoms for over a year: hot flushes 15-20 times daily, waking multiple times every night drenched in sweat, brain fog so severe she’s making mistakes at work, mounting anxiety, joint pain, and profound fatigue.

She’s been to her GP three times in the past six months.

First visit: “You’re too young for menopause. Your periods are still regular. This is probably stress. Have you considered counselling?”

Second visit: “Your blood tests show you’re not menopausal. Let’s try antidepressants for the anxiety.”

Third visit: “Well, you might be perimenopausal, but there’s nothing we can really do. Just try to manage the symptoms. Use a fan for the hot flushes.”

She left each appointment feeling dismissed, confused, and increasingly desperate.

“I thought GPs were supposed to know about women’s health,” she tells me. “Why doesn’t mine seem to understand what’s happening to me? Am I being difficult? Should I just accept this is how menopause is?”

No. You’re not being difficult. And your GP’s lack of knowledge isn’t your fault — but it is a problem.

Let me explain what’s really going on.

The Uncomfortable Truth About GP Menopause Training

Here’s what most people don’t know:

UK surveys show that GPs receive an average of 1-2 hours of menopause training during their entire medical education.

Let me repeat that: One to two hours. Total.

This includes:

5-6 years of medical school
3 years of GP specialty training
8-9 years of education to become a fully qualified GP

During those 8-9 years, menopause gets approximately 1-2 hours of teaching time.

For context:

Menopause affects 51% of the population
Lasts an average of 4-10 years (perimenopause through post-menopause)
Can have over 100 different symptoms
Has significant long-term health implications (bone, cardiovascular, cognitive, genitourinary)
Profoundly impacts quality of life, relationships, work, and wellbeing

Yet it receives less teaching time than many rare conditions.

Why Is Menopause Training So Inadequate?

How did we end up with such a massive gap in medical education?

1. Women’s Health Has Been Historically Under-Prioritized

Medical research and education have historically focused on male bodies and male health concerns.

The consequences:

Heart disease in women is under-recognized (symptoms differ from men)
Autoimmune conditions (predominantly affect women) are under-researched
Women’s pain is more likely to be dismissed or attributed to psychological causes
Women’s health conditions receive less research funding

Menopause is part of this pattern — a normal life stage affecting half the population, treated as a niche concern or “just something women go through.”

2. Medical Curriculum is Overcrowded

To be fair to medical educators: There is an enormous amount that doctors need to learn.

Medical school covers:

Anatomy, physiology, biochemistry, pharmacology, pathology
Multiple body systems and specialties
Pediatrics, adult medicine, elderly care
Acute conditions, chronic conditions, emergency medicine
Mental health, preventive medicine, public health
Communication skills, ethics, professionalism

There genuinely isn’t enough time to cover everything in depth.

But the question is: What gets prioritized? And menopause — affecting half the population for years of their lives — should surely rank higher than 1-2 hours.

3. Menopause is Seen as “Just a Natural Process”

A pervasive attitude: Menopause is a natural life stage, not a disease. Therefore, it doesn’t require medical intervention or extensive medical knowledge.

The problem with this reasoning:

Pregnancy and childbirth are also “natural” — yet obstetrics is an entire medical specialty
Ageing is “natural” — yet geriatric medicine receives substantial focus
“Natural” doesn’t mean “not worthy of medical support”

The symptoms and health implications of menopause absolutely warrant medical expertise — whether or not we classify menopause as a “disease.”

4. It’s Seen as “Just Prescribing HRT”

A misconception: Menopause care is straightforward — just prescribe HRT if needed. Doesn’t require specialized knowledge.

The reality: Menopause care is surprisingly complex:

Over 100 possible symptoms (many not recognized as menopause-related)
Differential diagnosis (distinguishing menopause from thyroid disease, depression, other conditions)
Multiple HRT formulations (oral vs. transdermal, different types, cyclical vs. continuous combined)
Individualized risk-benefit assessment (considering personal and family medical history, cardiovascular risk, VTE risk, breast cancer risk, etc.)
Addressing persistent symptoms (optimizing regimen when first-line treatment insufficient)
Testosterone therapy (indications, prescribing, monitoring)
Non-hormonal options (for women who can’t or don’t want HRT)
Long-term health management (bone density, cardiovascular risk, genitourinary health)
Lifestyle medicine (evidence-based interventions for symptom management and health protection)

This isn’t simple. It requires substantial, specialized knowledge.

5. Lack of Incentive to Update Knowledge

Once qualified, doctors need continuing professional development (CPD) to maintain their license.

But CPD requirements are broad — they don’t mandate specific topics. Doctors choose what to focus on based on:

Personal interest
Patient population needs
Perceived importance
Availability of courses

Menopause often isn’t prioritized because:

It’s not seen as “high risk” or emergency medicine
GPs may not recognize how many of their patients’ symptoms are menopause-related
High-quality menopause education isn’t always accessible
Time and funding for training are limited

Unless a GP has personal interest or motivation, menopause knowledge may not be updated beyond that initial 1-2 hours from medical school.

What This Means for Women Seeking Care

The inadequate training creates predictable problems:

1. Symptoms Are Missed or Misdiagnosed

GPs who lack menopause knowledge often:

Attribute perimenopausal symptoms to other causes:

Anxiety/depression diagnosed instead of recognizing hormonal mood symptoms
“You’re just stressed” when symptoms are menopause-related
Thyroid checked (appropriate), but when normal, told “nothing wrong” without considering menopause

Don’t recognize perimenopausal symptoms in women with regular periods:

“You can’t be perimenopausal; your periods are still regular”
This is incorrect — perimenopause often begins while periods are still regular
Symptoms can start years before periods become irregular

Don’t recognize less “classic” menopause symptoms:

Joint pain, muscle aches (extremely common, often dismissed as “just getting older”)
Brain fog, memory problems (dismissed as stress or early dementia concerns raised)
Digestive symptoms, skin changes, burning mouth, tinnitus (not recognized as potentially menopause-related)

The result: Women told “nothing’s wrong” when there’s a clear hormonal cause — but it’s not recognized.

2. Blood Tests Are Misused

A common scenario:

Woman in her 40s with symptoms. GP orders blood test for FSH (follicle-stimulating hormone) and oestrogen.

Results come back: “Normal.”

GP: “You’re not menopausal. Your hormones are normal.”

The problem: Blood tests are NOT reliable for diagnosing perimenopause.

Why?

Hormones fluctuate wildly during perimenopause (can vary 10-fold within a single cycle)
A blood test captures ONE moment in a fluctuating system
“Normal” result doesn’t mean you’re not perimenopausal — it means your hormones were normal at that specific moment

NICE Guidelines explicitly state: Perimenopause should be diagnosed clinically (based on symptoms and age) WITHOUT blood tests in women over 45.

Yet many GPs continue ordering blood tests and using them to dismiss menopause as a diagnosis.

3. HRT is Denied Without Good Reason

Common scenarios where women are inappropriately denied HRT:

“You’re too young for HRT”:

Said to women in their early-mid 40s experiencing clear perimenopausal symptoms
Age alone is not a contraindication — if you’re symptomatic and perimenopausal, HRT can be appropriate

“HRT causes cancer/heart disease/blood clots — it’s too dangerous”:

Based on outdated interpretation of Women’s Health Initiative study (2002)
Current evidence shows: For most women under 60 or within 10 years of menopause, benefits of HRT clearly outweigh risks
Route of administration matters (transdermal dramatically safer than oral for VTE risk)

“HRT can only be used for 5 years”:

Arbitrary time limit not supported by current evidence
Guidelines state: HRT should be used for as long as benefits outweigh risks — which may be many years or indefinitely for some women

“Your blood pressure is too high for HRT”:

Incorrect — well-controlled hypertension is NOT a contraindication
Transdermal HRT does not raise blood pressure

“You need to stop HRT now that you’re [50/55/60]”:

Age alone is not a reason to stop HRT
Many women continue HRT into their 60s and beyond if benefits continue to outweigh risks

These denials are not evidence-based — they reflect outdated knowledge or misunderstanding of current guidelines.

4. Type of HRT Prescribed Isn’t Optimal

Even when HRT is prescribed, it’s not always the optimal formulation:

Oral oestrogen prescribed when transdermal would be safer:

Women with obesity, hypertension, cardiovascular risk factors, over 60, migraines with aura — all should preferentially receive transdermal
Yet many are given oral tablets

Synthetic progestogens prescribed when body-identical would be safer:

Micronized progesterone (Utrogestan) has better safety profile than synthetic progestogens
Particularly for breast cancer risk
Yet many women still prescribed older synthetic progestogens

Regimen not individualized:

Cyclical vs. continuous combined chosen based on prescriber habit rather than what’s most appropriate for the individual woman
Dose not optimized (too low, leaving symptoms uncontrolled; or not adjusted when needed)

The result: Women on HRT but not getting optimal benefit or safety.

5. Persistent Symptoms Aren’t Properly Investigated

Woman on HRT for 6 months, but still symptomatic:

Appropriate response:

Assess if dose adequate
Consider changing formulation (e.g., patch to gel, or vice versa)
Consider changing progesterone type
Check if testosterone deficiency (particularly if surgical menopause)
Investigate other causes (thyroid, B12, iron, medications, sleep disorders)
Optimize lifestyle factors (sleep, stress, exercise, nutrition)

Common actual response: “You’re on HRT. That’s all we can do.”

OR: “Let’s increase your dose” (without investigating other factors)

OR: “HRT doesn’t work for everyone. Just try to manage.”

The result: Women left suffering when there are multiple avenues to explore for improving symptoms.

When Should You Seek Specialist Menopause Care?

Given these gaps in GP knowledge, when should you seek a menopause specialist?

Seek Specialist Care If Your GP:

1. Dismisses your symptoms without proper assessment:

“You’re too young for menopause” (if you’re over 40 with symptoms)
“It’s just stress/anxiety/depression” (without considering hormonal causes)
“Nothing’s wrong” based on normal blood tests (blood tests aren’t diagnostic for perimenopause)

2. Refuses HRT without clear contraindication:

Based on outdated information about risks
Because of well-controlled hypertension (NOT a contraindication with transdermal HRT)
Based on arbitrary age limits (“too young” or “too old”)

3. Lacks knowledge about different HRT options:

Can’t explain difference between oral and transdermal
Not aware of body-identical progesterone (Utrogestan)
Doesn’t know about testosterone therapy for women
Can’t discuss individualized regimens

4. Can’t answer your questions:

About specific formulations, doses, or routes
About risks and benefits tailored to your situation
About what to do if symptoms persist despite HRT

5. Won’t adjust regimen when symptoms persist:

“You’re on HRT; that’s all we can do”
Unwilling to try different formulations, adjust doses, or investigate other factors

6. Makes you feel unheard, dismissed, or like you’re being difficult:

Rushes appointments
Doesn’t take symptoms seriously
Implies you should just cope
Makes you feel like you’re complaining or being demanding

You deserve better care.

What Specialist Menopause Care Looks Like:

A menopause specialist should:

Conduct thorough assessment:

Comprehensive symptom review (ALL symptoms, not just hot flushes)
Detailed medical history and family history
Cardiovascular risk assessment
Current medications and allergies
Impact on quality of life, work, relationships

Provide individualized treatment plan:

HRT regimen tailored to YOUR symptoms, risk factors, and preferences
Discussion of ALL options (different routes, types, schedules)
Clear explanation of risks and benefits specific to YOU
Lifestyle medicine guidance alongside medical treatment

Monitor and optimize:

Regular review of symptom control
Willingness to adjust regimen if needed
Investigation of persistent symptoms
Consideration of testosterone if appropriate
Long-term health planning (bone, cardiovascular, genitourinary)

Educate and empower:

Explain what’s happening in your body
Help you understand your options
Support informed decision-making
Provide resources for ongoing learning

Listen and validate:

Take your symptoms seriously
Believe your experience
Partner with you in care
Make you feel heard and supported

How to Access Specialist Menopause Care

If you need specialist care, how do you access it?

NHS Menopause Clinics

Many NHS areas have specialist menopause clinics:

Usually run by gynecologists or specialist menopause nurses
Referral required from GP
Waiting times vary (can be several months in some areas)

To access:

Ask your GP: “Is there an NHS menopause clinic in this area? I’d like a referral for specialist assessment.”
Most GPs should be willing to refer if you’re not getting adequate support in primary care

If your GP refuses referral without good reason:

Ask why (request specific clinical reasoning)
Seek second opinion from another GP in practice
Consider complaint if refusal clearly inappropriate

Private Menopause Specialists

Private options include:

Private menopause clinics
Consultant gynecologists with menopause specialty
Menopause specialist nurses (some work independently in private practice)

Costs:

Initial consultation: £150-300 typically
Follow-up appointments: £100-200
Prescriptions: NHS prescription charges if using NHS prescriptions, or private prescription costs

Finding private specialists:

British Menopause Society website has directory of certified specialists
Search for “menopause specialist near me”
Ask for recommendations in local women’s health groups

Considerations:

Faster access (appointments usually within days-weeks)
Longer appointment times (often 30-60 minutes vs. 10-minute GP appointment)
Specialist expertise
But: Financial barrier for many

Specialist Menopause Nurses

Some areas have specialist menopause nurses working in:

NHS clinics
GP practices (some larger practices have specialist nurses)
Private practice

Menopause specialist nurses:

Often have prescribing qualifications
Extensive menopause training and experience
May offer longer appointments and more holistic care than time-pressured GP appointments

I’m a registered nurse and prescriber specializing in menopause care — this is the model I follow. Combining nursing knowledge with prescribing qualifications and specialist menopause training allows me to provide comprehensive, individualized care.

Telephone or Video Consultations

Many menopause specialists offer remote consultations:

Telephone or video appointments
Can access specialists outside your local area
Convenient (no travel time)
Often more affordable than in-person private consultations

Prescriptions can be:

Sent to your GP for NHS prescription
Issued as private prescription sent to pharmacy
Depends on the service model

Remote consultations work well for menopause care because it’s primarily history-taking and discussion — physical examination rarely needed.

What If You Can’t Access Specialist Care?

If specialist care isn’t accessible (long NHS waiting lists, can’t afford private, no specialists in your area), what can you do?

Self-Advocacy Strategies:

1. Educate Yourself

Become informed about:

Menopause symptoms (full range, not just hot flushes)
Current evidence-based guidelines (NICE, British Menopause Society)
Different HRT options and their safety profiles
Lifestyle interventions that help

Resources:

NICE Guidelines on menopause (freely available online)
British Menopause Society website (has patient information)
Menopause Charity (excellent patient resources)
Balance app by Dr. Louise Newson (symptom tracking and information)

Knowledge empowers you to:

Recognize when advice is outdated or incorrect
Ask informed questions
Advocate for appropriate treatment

2. Prepare for GP Appointments

Before your appointment:

Write down ALL symptoms (use symptom checklist)
Track symptoms over time (patterns, severity)
Note impact on life (work, relationships, function)
List what you’ve already tried
Prepare specific questions

During appointment:

Be clear and specific about symptoms
Reference guidelines (“NICE guidelines recommend…”)
Request specific treatment (“I’d like to try transdermal HRT…”)
Take notes or ask for written summary
Don’t accept dismissal without explanation

If dismissed:

Ask: “Can you explain why you feel [treatment] isn’t appropriate?”
Request: “Can you document this discussion in my medical records?”
Consider: Recording appointments (inform GP you’re recording for your records — this is legal in UK)

3. Use Quality GP Appointment Time Effectively

In a 10-minute appointment, be strategic:

Don’t:

Ramble or give excessive detail about every symptom
Accept vague reassurance (“you’re fine”)
Leave without clear next steps

Do:

State main concerns clearly (“I’m experiencing severe hot flushes, sleep disruption, and brain fog. I believe I’m perimenopausal and would like to discuss HRT.”)
Ask direct questions (“Are there any reasons HRT wouldn’t be appropriate for me?”)
Request specific actions (“Can you prescribe transdermal HRT?” “Can you refer me to menopause clinic?”)
Clarify next steps before leaving (“What happens if symptoms don’t improve in 3 months?”)

4. Seek Second Opinions

If one GP isn’t helpful:

See different GP in same practice (GPs vary widely in knowledge and approach)
Register with different practice if needed
Don’t give up after one dismissive appointment

5. Connect with Peer Support

Online communities can provide:

Validation (“I’m not alone; others have same experience”)
Practical tips from women who’ve navigated similar challenges
Recommendations for helpful healthcare providers
Information sharing

Useful communities:

Menopause Support UK Facebook group
Reddit r/Menopause
Local women’s health groups

Caution: Peer support is valuable but not a substitute for medical care. Always verify information with reputable sources.

Lifestyle Medicine While Waiting for/Alongside Medical Care

Regardless of access to specialist care, lifestyle interventions help:

Sleep optimization:

Consistent schedule, cool room, sleep hygiene
Critical for all menopause symptoms

Stress management:

Daily nervous system regulation practices
Boundaries, saying no, therapy if needed

Exercise:

Strength training 2-3x/week (non-negotiable)
Daily movement (walking, etc.)
Crucial for bone, metabolic, cardiovascular health

Nutrition:

Blood sugar stability (protein at every meal)
Anti-inflammatory eating pattern
Limit processed foods

Alcohol reduction:

Dramatically worsens hot flushes, sleep, mood
Many women find significant improvement with minimal or no alcohol

These won’t replace HRT if you need it — but they significantly support symptom management and long-term health regardless of medical treatment access.

Why This Matters (Beyond Individual Frustration)

The inadequate training of GPs in menopause care isn’t just about individual women’s frustration. It has broader implications:

Public Health Impact

Millions of women suffer unnecessarily:

Reduced quality of life
Impact on work (menopause a major factor in women leaving workforce)
Relationship difficulties
Mental health consequences

Long-term health risks unaddressed:

Osteoporosis (bone density not monitored, fractures not prevented)
Cardiovascular disease (leading cause of death in postmenopausal women)
Genitourinary syndrome (progressive, severely impacts quality of life)

Economic Cost

Menopause impacts workforce:

Absenteeism (women missing work due to symptoms)
Presenteeism (at work but functioning poorly)
Women leaving workforce entirely or reducing hours

Estimated cost to UK economy: Billions of pounds annually in lost productivity.

Better menopause care = healthier, more productive workforce.

Health Inequity

Women with resources can access private specialist care. Women without resources are stuck with inadequate GP care or no care at all.

This creates health inequity — access to evidence-based menopause care shouldn’t depend on ability to pay.

Perpetuates Medical Gaslighting of Women

When women’s symptoms are dismissed, minimized, or attributed to “stress” or “just getting older”:

It perpetuates pattern of women’s health concerns not being taken seriously
Teaches women not to trust their own experience
Discourages women from seeking help
Reinforces idea that women should just cope with suffering

This is part of broader systemic issue in healthcare — but menopause is a clear example where better training could dramatically improve care.

What Needs to Change

To address this crisis in menopause care, we need:

1. Mandatory Menopause Training in Medical Education

Significantly increase menopause teaching in medical school and GP training:

Minimum 10-20 hours (vs. current 1-2 hours)
Cover full range of symptoms, differential diagnosis, treatment options, individualized prescribing
Ensure all GPs have baseline competency

2. Accessible, High-Quality Continuing Education

Provide free, evidence-based menopause CPD for qualified GPs:

Online modules, webinars, conferences
Certification programs (e.g., British Menopause Society certification)
Incentivize participation

3. Specialist Menopause Services in Every Area

Expand NHS menopause clinics:

Ensure every region has accessible specialist service
Reduce waiting times
Allow self-referral (not requiring GP referral)

Train more specialist menopause prescribers:

Doctors, nurses, pharmacists with advanced training
Expand workforce to meet demand

4. Updated Clinical Guidelines Widely Disseminated

Ensure all GPs aware of current guidelines:

NICE guidelines (2015, updated 2019)
British Menopause Society guidance
Practical prescribing tools and decision aids

Make guidelines easily accessible at point of care (integrated into GP electronic systems).

5. Patient Education and Empowerment

Public health campaigns to educate women about menopause:

Symptoms (full range, not just hot flushes)
When to seek help
Treatment options available
That symptoms don’t have to be endured

Normalize menopause discussions — reduce stigma and silence that prevents women seeking help.

6. Accountability

Monitor and measure quality of menopause care:

Are women receiving evidence-based treatment?
Are waiting times for specialist services acceptable?
Are GPs meeting baseline competency standards?

Create pathways for recourse when care falls significantly short of guidelines.

The Bottom Line

Your GP not knowing enough about menopause isn’t your fault — but it’s a significant problem.

Most GPs receive just 1-2 hours of menopause training during their entire medical education. This is woefully inadequate for a condition affecting half the population for years of their lives.

The result:

Symptoms missed or misdiagnosed
Blood tests misused
HRT denied without good reason
Suboptimal HRT prescribed
Persistent symptoms not properly investigated
Women left suffering unnecessarily

You deserve better.

When to seek specialist care:

GP dismisses symptoms or refuses appropriate treatment
GP lacks knowledge about different HRT options
Symptoms persist despite treatment and GP can’t/won’t help
You feel unheard or dismissed

How to access it:

NHS menopause clinics (GP referral)
Private menopause specialists
Specialist menopause nurses
Telephone/video consultations

If specialist care isn’t accessible:

Educate yourself (NICE guidelines, British Menopause Society resources)
Self-advocate (prepare for appointments, ask informed questions, reference guidelines)
Seek second opinions
Connect with peer support
Optimize lifestyle factors

Systemic change is needed:

Better medical education
More specialist services
Updated guidelines widely disseminated
Patient education and empowerment

Until that change happens, individual women must advocate for themselves — armed with knowledge, persistence, and the understanding that demanding evidence-based care isn’t being difficult; it’s essential.

You deserve to be heard, believed, and treated according to current evidence.

Don’t settle for less.

Need Support?

If you’re not getting adequate menopause care from your GP and need specialist assessment and treatment, I can help.

As a registered nurse and prescriber specializing in menopause care, I provide comprehensive, evidence-based menopause support.

Book a consultation for thorough assessment and individualized treatment plan.

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