Everything you need to walk into a 10-minute GP appointment and be taken seriously — written by a UK doctor, built around the NICE guideline your GP works to.
GL
Dr Gemma Lewis MRCS MRCGPClinical Director, Menopause Clinic @DoctoriumGP · CQC-registered private clinic, Derby
Why this toolkit exists
In the largest UK survey of menopausal women (Fawcett Society), 31% needed multiple GP appointments before their symptoms were correctly recognised, and around 4 in 10 were told they would simply have to live with it. Many women are offered antidepressants when the underlying issue is hormonal — something the national guideline specifically advises against as a first-line response to menopausal low mood.
None of that is because GPs don't care. It's because appointments are short, menopause training is patchy, and symptoms arrive in disguise. The women who get sorted fastest are the ones who arrive prepared — with a clear symptom picture, a validated score, and the right questions.
That's what this toolkit does. It turns your experience into a one-page clinical summary your GP can act on in minutes.
Our promise: this toolkit sells you nothing. No supplements, no subscription, no "proprietary blend". It was written by a practising UK menopause doctor, and the only thing behind it is a regulated clinic. Use it with your NHS GP with our blessing.
What's inside
Part
What it does
1 · Symptom mapper
Is this perimenopause? Includes the symptoms nobody warns you about.
2 · Greene Climacteric Scale
The validated 21-item score used in menopause clinics.
3 · 8-week tracker
A low-effort weekly log that builds real evidence (periods included).
4 · Know before you go
What NICE guideline NG23 actually says, and what your GP can prescribe.
5 · GP appointment summary
The one-page handover sheet — the heart of this toolkit.
6 · If you're dismissed
Calm, evidence-based scripts for pushing back politely.
Part 1
Is this perimenopause? The symptom mapper
Perimenopause can start in your late 30s or 40s — often years before periods stop, and often without a single hot flush. Oestrogen receptors exist all over the body, which is why the symptom list is so strange and so long. Tick everything you've noticed over the last 6–12 months.
The ones nobody warns you about
The classic ones
Still having periods? That matters. Perimenopause usually starts while you're still cycling — changing cycle length or flow is one of the strongest signals, and it's the detail most symptom trackers ignore. Part 3 tracks your cycle alongside your symptoms for exactly this reason.
Red flags that need their own GP appointment regardless: bleeding after sex, bleeding between periods that's new and persistent, any bleeding after 12 months without periods, or unexplained weight loss.
Part 2
Your Greene Climacteric Scale score
The Greene Climacteric Scale is a validated symptom score used in menopause research and specialist clinics. Bringing a completed score to your GP moves the conversation from "I feel awful" to clinical data. Rate each symptom as it has been over the past week:
0 = not at all · 1 = a little · 2 = quite a bit · 3 = extremely
#
Symptom
0
1
2
3
1
Heart beating quickly or strongly
2
Feeling tense or nervous
3
Difficulty sleeping
4
Excitable
5
Attacks of panic
6
Difficulty concentrating
7
Feeling tired or lacking energy
8
Loss of interest in most things
9
Feeling unhappy or depressed
10
Crying spells
11
Irritability
12
Feeling dizzy or faint
13
Pressure or tightness in head or body
14
Parts of body feel numb or tingling
15
Headaches
16
Muscle and joint pains
17
Loss of feeling in hands or feet
18
Breathing difficulties
19
Hot flushes
20
Sweating at night
21
Loss of interest in sex
Total score (0–63)
Date completed
There's no "pass mark" — the score's power is in tracking change over time and giving your GP a recognised clinical measure. Re-score every 4 weeks (and after starting any treatment, to show whether it's working).
Part 3
The 8-week tracker (5 minutes a week, not a diary)
Daily symptom diaries get abandoned by week two. This one is deliberately light: once a week, rate your five worst symptoms, note your cycle, and move on. Eight weeks of this is more persuasive to a GP than any amount of description — and it substitutes for the blood tests that can't diagnose perimenopause anyway (see Part 4).
Step 1 — Choose your five worst symptoms from Part 1
Symptom A
Symptom B
Symptom C
Symptom D
Symptom E
Start date
Step 2 — Each week, score each symptom 0–3 and log your cycle
Week
A
B
C
D
E
Period this week? (days / flow: light–normal–heavy)
Nights of broken sleep
1
2
3
4
5
6
7
8
Step 3 — One line a week, only if something stood out
Why the cycle column matters: in perimenopause your hormones fluctuate rather than simply fall. Symptoms that cluster before periods, or worsen as cycles stretch or shorten, are exactly the pattern a good clinician looks for.
Part 4
Know before you go: what the guideline actually says
Your GP works to NICE guideline NG23 (Menopause: diagnosis and management). Knowing three of its key points changes the entire appointment:
1 · Over 45, diagnosis is clinical. NICE NG23 says women aged over 45 with typical symptoms should be diagnosed with perimenopause or menopause on symptoms alone — no blood test required.
2 · A "normal" FSH does not rule it out. Hormone levels swing wildly in perimenopause, so a single blood test can look normal on the day. NICE advises against using FSH to diagnose in women over 45 — your tracked symptoms are the evidence.
3 · Antidepressants are not the first-line answer to menopausal low mood. NICE NG23 states there is no clear evidence for antidepressants to ease low mood in menopausal women who haven't been diagnosed with depression. HRT should be discussed.
What your GP can offer
Option
What it is
Worth knowing
Transdermal oestrogen (gel, patch, spray)
The core of modern HRT — body-identical oestradiol through the skin
Lower clot risk than old-style tablets; dose can be titrated
Micronised progesterone (or Mirena coil)
Womb protection if you still have a uterus
Body-identical (Utrogestan); Mirena doubles as contraception
Vaginal oestrogen
Local treatment for dryness, discomfort, urinary symptoms
Safe alongside systemic HRT, and long-term
Testosterone
For low libido where HRT alone hasn't helped
Access varies by area (unlicensed for women in the UK) — ask what your local pathway is; specialist referral may be needed
Fezolinetant (Veoza)
New non-hormonal daily tablet for hot flushes and night sweats
An option if you can't or don't want to take HRT. Requires liver-function blood tests before and during treatment — a prescriber must monitor you properly
CBT & lifestyle
Evidence-based support for sleep, mood, flushes
Useful alongside — not instead of — treating the hormones
HRT supply has been patchy in recent years (some patches and gels have had shortages). If your usual product is unavailable, an equivalent switch is almost always possible — ask the pharmacist or prescriber rather than stopping.
Part 5 — the heart of the toolkit
Your one-page GP appointment summary
Complete this after 4–8 weeks of tracking. Hand it over at the start of the appointment — it does the explaining so your ten minutes go on decisions, not description.
My five most significant symptoms (tracked weekly for ___ weeks — log attached)
Greene Climacteric Scale score
Cycle status (regular / irregular / stopped — since when)
Impact on daily life and work
What I've already tried
Relevant history (blood pressure, migraines, clots, breast/womb history, current medication)
What I would like from today's appointment
Prepared using the Greene Climacteric Scale and NICE NG23 (diagnosis in women over 45 with typical symptoms is clinical; FSH testing is not recommended for diagnosis in this group).
Five good questions to ask
1 · Based on my symptoms and this summary, do you agree this looks like perimenopause?
2 · Can we discuss HRT today — and if not, what specifically rules it out for me?
3 · If low mood is part of my picture, can we consider HRT before antidepressants, in line with NICE NG23?
4 · If my first treatment doesn't help within 3 months, what's the follow-up plan?
5 · If this is beyond what we can cover today, can I be referred to someone with menopause expertise — or book a double appointment?
Part 6
If you feel dismissed: calm scripts that work
Most GPs are doing their best in an impossible time slot. These lines aren't for a fight — they're for keeping the conversation clinical when it drifts.
If you're told "your bloods are normal": "My understanding of NICE guideline NG23 is that over 45 the diagnosis is based on symptoms, not blood tests, because hormone levels fluctuate. Could we assess my symptom record instead?"
If you're offered antidepressants first: "I'd like to explore whether this is hormonal before we treat it as depression — NICE says antidepressants aren't first-line for menopausal low mood. Could we discuss HRT?"
If you're told you're too young: "Perimenopause can start in the early 40s and sometimes before. Given my symptom pattern and cycle changes, could we keep it on the table and review my 8-week tracker?"
If the appointment runs out of road: "I understand we're out of time — could I book a double appointment, or see the GP in the practice with a women's health interest?"
And if you're still stuck: you're entitled to a second opinion, and menopause specialists exist for exactly this situation — NHS (ask about a referral pathway in your area) or private.
When you want a specialist
Menopause Clinic @DoctoriumGP
If your GP route stalls — or you simply want a doctor with the time to think — Dr Gemma Lewis MRCS MRCGP runs a CQC-registered private menopause clinic in Derby, with remote consultations available.
£99 consultation — a fraction of the £195–£295 most private menopause clinics charge. Full assessment, treatment plan, and prescriptions where appropriate, including HRT, testosterone where clinically indicated, and Veoza (fezolinetant) with proper liver-function monitoring.
Bring this toolkit filled in — it's designed to plug straight into our assessment.
