What to Say to Your Doctor About Perimenopause — NZ Guide to Getting Taken Seriously
By Rene Schliebs — Clinical Nutritionist, Medical Herbalist & Menopause Expert
You've finally made the appointment. You've been feeling off for months: the sleep, the mood, the brain fog, the weight shifting for no reason — and you're ready to get some answers.
Then you sit down, you have 15 minutes, and you leave with a referral for a blood test (if you are lucky) and a vague suggestion to try mindfulness.
Sound familiar?
You are not alone. It is one of the most consistent things I hear from women in perimenopause across New Zealand: that they know something is wrong, they go to their GP, and they come home feeling more confused and more dismissed than before they went.
This post is about changing that. Here is exactly what to say, what to ask for, and how to walk into your next appointment impossible to ignore.
Why this happens — and why it's not your fault
Perimenopause is genuinely complex to diagnose in a standard GP setting. Hormone levels fluctuate so dramatically during this transition that a single blood test — taken on the wrong day, or during an anovulatory cycle — can look completely normal even when you are symptomatic. Many GPs receive very little training in menopause medicine. The average is reportedly less than two hours across their entire medical degree.
This is not an excuse; it's context. Because understanding why you're being dismissed helps you know how to navigate it.
The women who get results are the ones who come prepared, speak clinically, and know exactly what they're asking for.
Before your appointment — do this
1. Write your symptom timeline. How long have you been experiencing symptoms? Which ones? When do they peak, in relation to your cycle? Have they been getting worse? A written timeline is much harder to dismiss than a verbal summary in a rushed appointment.
My Menopause Symptom Score Checklist walks you through exactly this — it helps you identify and score your symptoms clearly so you can hand something concrete to your GP rather than trying to remember a three-month blur in a seven-minute consultation.
2. Track your cycle for at least one month beforehand. Note any irregularities, changes in flow, cycle length changes. This is objective data that supports a perimenopause picture and gives your GP something measurable to work with.
3. Write down your family history. Did your mother or sisters hit menopause early? Do you have a family history of autoimmune conditions, thyroid disease or osteoporosis? This is clinically relevant and often not asked — but it matters enormously for how your case is assessed. What to say when you sit down.
Start with this:
"I'm concerned I may be in perimenopause. I'd like to discuss my symptoms and what investigations would be appropriate."
This frames the conversation clinically and signals you've done your research. You are not asking whether something is wrong — you're asking for the conversation.
If your GP says you're too young, or your bloods look normal, say this:
"I understand perimenopause can begin in the late 30s and that hormone levels fluctuate significantly during this transition, which means a single blood test may not capture the full picture. Can we look at my symptoms together and discuss whether a trial of support would be appropriate?"
What to ask for specifically
Blood tests to request:
FSH and LH — elevated FSH in particular is a key perimenopause marker, though one normal result doesn't rule it out. Ask for it to be repeated if it's normal, but you remain symptomatic.
Oestradiol — your circulating oestrogen level. Useful as part of the picture.
Testosterone — this is rarely tested in women but critically important. Low testosterone contributes to low libido, fatigue, poor concentration and muscle loss. You may need to specifically ask for this.
SHBG (sex hormone binding globulin) — affects how much of your testosterone is actually available to your body.
Full thyroid panel — TSH alone is not sufficient. Ask for Free T3, Free T4 and thyroid antibodies. Thyroid dysfunction and perimenopause have significant symptom overlap and are frequently confused.
Full iron studies including ferritin — not just haemoglobin. Low ferritin drives fatigue, brain fog, hair loss and low mood — and is extremely common in women in their 40s.
Vitamin D — immune regulation, mood, bone density. Essential baseline.
B12 — neurological function, energy, mood.
Imaging to consider:
DEXA scan — bone density. This is relevant because declining oestrogen accelerates bone loss. Many women don't know their bone density is affected until it's already significant.
What to say about HRT
If you want to discuss HRT, be direct:
"I'd like to discuss the option of HRT. I've been reading about body-identical hormone therapy, and I'd like to understand whether it's appropriate for me and what options are available in New Zealand."
Key points to know going in:
Body-identical estrogen (estradiol) and micronised progesterone are available in NZ and have a significantly better safety profile than older synthetic HRT preparations. The risks that made HRT controversial decades ago were largely associated with synthetic progestins — not the body-identical forms.
Transdermal estrogen (gel or patch) does not carry the same blood clot risk as oral estrogen — this is important if your GP raises cardiovascular concerns.
If your GP is reluctant, ask: "Can you refer me to a gynaecologist or specialist with experience in menopause medicine?"
You are entitled to a second opinion. You are entitled to a referral. Use both if you need to.
What to do if you leave without answers — again
Come and see me.
I work alongside your medical team, not instead of them. But I can help you interpret your results, understand your hormonal picture, identify what's being missed, and prepare you so thoroughly for your next GP appointment that you are genuinely impossible to dismiss.
I've spent 20 years helping NZ women navigate exactly this. And I can help you too.
Warmly, Rene x
Rene Schliebs is a Clinical Nutritionist and Medical Herbalist with over 20 years of experience. menopausenaturally.co.nz