How to Talk to Your Doctor About Hormone Therapy...or Really, Anything

A step-by-step guide to prepare for your next appointment

Overwhelmingly, the question I get most often from you, the readers of Hot Flash, is not whether you could or should take hormone therapy, but how to approach your doctor about it in the first place. I understand why this feels fraught. In our medical system, doctors are pressed for time and it can be difficult to know exactly when and how to address topics if your doctor doesn’t ask about them.

Let’s talk through how to approach your doctor. I’ll use perimenopausal symptoms as an example, but the framework (which I use when planning doctor’s visits for me or my family members) can really be applied to any medical question or concern. So even if symptoms of perimenopause are not necessarily your concern, this information should still be useful to you.

1. Define your goal

Know what you are hoping to achieve in your conversation with your doctor. I would not recommend the goal “Get the doctor to prescribe HRT.” It will limit your conversation and may not result in the best treatment of your symptoms.

Goals related to perimenopausal symptoms might include:

• “I need to decrease my hot flushes and night sweats. They are really interfering with my functioning at work.”

• “My libido has been terrible and it is affecting my relationship with my partner. Could anything help me want sex again?”

• “My body seems to be changing; I have never gained weight in my middle before now. I want to understand why that is happening.”

In short, you want to have some sense of how you would define a successful encounter with your doctor on this particular topic.

2. Do some research

Many of my patient visits start with the patient apologizing for having done internet research on a topic they were hoping to discuss at their visit. My response is always the same: “Don’t apologize!” Doctors don’t mind if patients have read about their concerns prior to their visit. We just don’t appreciate patients demanding a specific treatment plan. We want you to keep an open mind. We may have treatment options that would work better and have fewer side effects.

If you are having a lot of hot flushes and night sweats, you might research hormonal and non-hormonal options so that you are familiar with the different treatments. You might learn a little about the different ways estrogen and progesterone are given. You don’t need to become an expert, but reading an article or two from a newsletter (like this one!) or a medical society like the Menopause Society or Endocrine Society can help you become familiar with some of the terminology your doctor might use and give you the basic lay of the land.

3. Gather some data and formulate your questions

While you are defining your goals, doing a little research, and waiting for your appointment date, make some notes on your symptoms. Many of my patients do this on their phone so they are sure to have the information handy during our visit.

In our example regarding perimenopausal symptoms, you might note:

• How often are you having hot flushes and night sweats?

• How many times do you wake from sleep per night?

• If you aren’t having symptoms daily, how many days a week are you having them?

• Is there any pattern to your symptoms — do they get worse around ovulation or before your period?

• Do you have any other perimenopausal symptoms, like headaches, muscle and joint pain, or fatigue?

Take a moment to think about your questions. What information can the doctor provide that will help you determine next steps? Some questions my patients ask about hormone therapy include:

• How long can I expect to be using hormone therapy?

• How quickly can I expect to see improvement in my symptoms?

• What are the side effects of hormone therapy? What side effects should I reach out to you about before our next visit?

• What are the long-term risks?

• Is estrogen more effective, or are non-hormonal options better for me?

• When should we follow up?

4. Discuss the options at your appointment

You’ve prepared and your appointment day has arrived. Let’s consider an imaginary conversation between you and your doctor.

Doctor: Good morning! How are you today?

You: I am good. You?

Doctor: I’m well, thank you. It has been about six months since your last visit. Tell me, how have you been feeling since then?

You: I wanted to talk to you about that. In the last three to four months, I have been having more hot flushes and night sweats.

Doctor: Okay. That would be normal for a woman your age. How often are you having them?

You: They come in waves. I will have 5 to 10 per day for a week or two and then maybe only one or two over a few weeks. In the weeks when I have them, I am also waking up soaking wet two or three times a night. It is really disrupting my sleep, to the point where I am finding it difficult to function at work during those times.

Doctor: It does sound like your symptoms are really affecting you. Are your periods regular?

You: Over the last three or four months, my periods have been more irregular. I had a 21-day cycle followed by a 40-day cycle. Then a 30-day cycle. My last period was 20 days ago. Does this seem like perimenopause to you? I was wondering if hormone replacement therapy would be appropriate for me.

Doctor: This does sound like perimenopause. Let’s discuss your treatment options.

You: I have read a bit about hormone replacement, and I know there are some non-hormonal options too. Can you tell me a little about both?

In my office, the conversation would continue with a brief review of the benefits and risks of both hormone therapy and the non-hormonal medication Veozah for you, based on your personal history and pertinent family history.

You: I think I would like to try the estrogen and progesterone combined patch. How quickly can I expect to notice improvement?

Doctor: Some women notice improvement in the first few weeks, but I like to schedule a follow-up in three months or so. You will definitely know how you are going to feel on hormone replacement at that point.

You and your doctor are busy, so schedule your follow-up appointment before you leave the office.

5. Track the results and follow up

Once you start the treatment you have chosen with your doctor — in our imaginary scenario, a combined estrogen and progesterone patch — pay attention to your symptoms. Are your initial symptoms reduced or resolved? Are you having any side effects, like breast tenderness or headaches? Do you see benefits you weren’t expecting, such as reduced vaginal dryness?

Keep notes of all the changes you experience between visits and be sure to bring them to your follow-up appointment. If your symptoms are improved but not resolved, tell your doctor so. We can’t always make things perfect, but we may be able to get you closer with some medication adjustments.

Go to your follow-up appointment even if your symptoms are completely resolved and you are having no side effects. It is important for your doctor to know what has worked for you. It may also be important to document that improvement in your medical record so that your insurance company will continue to pay for your medications.

A final note

Most doctors have 15 minutes — or less — allotted for follow-up visits. If you have more questions than can be answered in that time, or you have multiple separate issues to discuss, don’t be surprised if your doctor asks you to schedule another visit to address additional questions. It is nearly impossible to perform a well-woman exam and Pap smear and have a detailed conversation about perimenopausal symptoms in just 15 minutes.

If you have an unsatisfying encounter with your doctor, remember that doctors are human: we have good days and bad days like everyone else. However, if you feel that your symptoms or concerns are being dismissed, or that your doctor is unwilling or unable to answer your questions, you might consider seeking a second opinion from another provider.

Ultimately, doctors want to help their patients to be healthy and feel well. With some preparation on your part, you can make the most of your limited time with your doctor and get your perimenopausal symptoms treated so you can feel your best.