Lesson 6 of 7 · about 15 minutes

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Preparing for the conversation

You’ve got a log, and you’ve practiced reading it. Now let’s get you ready for the appointment itself. Appointments can feel short, and it’s easy to walk out and think, “I forgot to ask about the thing I actually came for.” That happens to everyone, me included at my own visits. A little preparation helps a lot. The core of this lesson is the printable worksheet attached to this lesson (look for the download under Lesson Materials / Attachments), a one-page appointment prep sheet. Read through this page first, then fill it out.

Before you go: gather these

  • Your symptom log (or a summary of it) and your one-paragraph summary from Lesson 5
  • Your period dates, including the first day of your most recent period
  • A list of everything you take: prescriptions, over-the-counter medicines, vitamins, and herbal supplements
  • Your health history highlights: past conditions, surgeries (like a hysterectomy or ovary removal), and any history of blood clots, stroke, heart disease, or cancer
  • Family history you know of, such as breast cancer, heart disease, or osteoporosis. “I don’t know” is a perfectly fine answer.
  • Your top three concerns, ranked. If time runs short, you’ll cover what matters most.

Understanding treatment options at a general level

Many people want to understand their options before they walk in, so they can follow the conversation and ask good questions. Here is a general overview based on The Menopause Society’s position statements. It isn’t a recommendation for anyone in particular; which option fits you depends on your symptoms, history, and preferences, decided together with your clinician.

Hormone therapy (HT)

  • The Menopause Society’s 2022 position statement calls hormone therapy the most effective treatment for hot flashes and night sweats and for genitourinary syndrome of menopause (GSM). It has also been shown to prevent bone loss and fracture.
  • For people younger than 60 or within 10 years of menopause onset, without contraindications, the statement describes the benefit-risk ratio as favorable for bothersome hot flashes and preventing bone loss. Starting more than 10 years after menopause or after age 60 appears less favorable, because of greater absolute risks of heart disease, stroke, blood clots, and dementia.
  • Risks differ by type, dose, how long it’s used, how it’s taken (route), when it’s started, and whether a progestogen is used. The statement recommends individualizing treatment and re-checking benefits and risks periodically.
  • For GSM symptoms not relieved by over-the-counter products, low-dose vaginal estrogen or other non-estrogen prescription options are recommended choices.
  • In November 2025, the FDA announced it was removing several broad boxed warnings from menopausal hormone therapy labeling, while keeping the boxed warning about endometrial cancer for systemic estrogen-alone products. The Menopause Society emphasized that personal and family history, other health conditions, symptoms, and preferences all still need to be reviewed individually.

Nonhormone options for hot flashes

The Menopause Society’s 2023 nonhormone position statement reviewed the evidence and recommended:

  • Cognitive behavioral therapy (CBT) and clinical hypnosis, both non-medicine approaches with good evidence
  • Certain prescription medicines, including some SSRIs and SNRIs (medicines in the antidepressant family), gabapentin, oxybutynin, and fezolinetant, a medicine that blocks a receptor (NK3) the FDA describes as playing a role in the brain’s regulation of body temperature. In December 2024 the FDA added a boxed warning about rare but serious liver injury with fezolinetant, including liver blood tests before and during the first months of use, so it’s a good one to ask about.
  • Weight loss and a procedure called stellate ganglion block, with more limited evidence

Since that statement, the FDA approved elinzanetant in October 2025, another nonhormone medicine that acts on related receptors (NK1 and NK3) in the brain’s temperature-control center, for moderate to severe hot flashes due to menopause.

The 2023 statement did not recommend paced breathing, supplements and herbal remedies, soy products, cooling techniques, avoiding triggers, exercise, yoga, mindfulness, relaxation, acupuncture, or cannabinoids specifically for treating hot flashes, based on current evidence. Many of these may still be good for your overall well-being.

Every option, hormone or nonhormone, has its own possible side effects and reasons it may or may not suit a particular person. That’s exactly what to ask about.

Questions you might ask

  • “Based on my log, does this look like perimenopause to you? Is there anything else you’d want to check?”
  • “Which of my symptoms do you think is most worth addressing first?”
  • “What are my options, both hormone and nonhormone? What are the likely benefits and risks of each for someone with my history?”
  • “Is there any reason a particular option wouldn’t be a good fit for me?”
  • “How would we know if something is working? When would we check in?”
  • “Do I still need birth control?”
  • “What should make me call you before my next visit?”

During the visit

  • Lead with your top concern and your summary paragraph.
  • Write down answers, or ask if a trusted person can come along to take notes. Caregivers are great at this.
  • If a word doesn’t make sense, it’s completely fine to ask, “Can you explain that another way?”
  • Before you leave, repeat back the plan in your own words: “So the next step is ___, and I should call if ___.”

When to reach out sooner rather than later

A log is for patterns over weeks. Some things should not wait for a pattern. Per ACOG, these bleeding changes are not considered normal and are worth contacting your own clinician about:

  • Bleeding or spotting between periods
  • Bleeding or spotting after sex
  • Heavy bleeding during your period, or bleeding that is heavier or lasts more days than usual for you
  • Any bleeding or spotting after menopause (after 12 months with no period). The Office on Women’s Health says to see a clinician promptly about any vaginal bleeding after menopause.

For mood: The Menopause Society notes that if low mood, loss of interest, trouble concentrating, and sleep problems are present most of the day, nearly every day, for at least two weeks, it is time to talk with a healthcare professional about possible depression. If you are having thoughts of suicide or are in crisis, call or text 988 (the 988 Suicide & Crisis Lifeline, free, confidential, 24/7) or chat at 988lifeline.org. If you or someone with you is in immediate danger, call 911.

Your activity (about 10 minutes)

  1. Download the printable worksheet attached to this lesson (look for the download under Lesson Materials / Attachments).
  2. Fill in your top three concerns and your summary.
  3. Check off what you’ll bring and circle the questions you most want to ask.
  4. Bring it, along with your log, to your next appointment.

Sources

This overview is educational and intentionally general. It doesn’t recommend any treatment for you; please decide on treatment with your own clinician and pharmacist.

Education, not medical care. This was shared by a Verified Poéma Professional so you can learn. It’s their own professional view, not Poéma’s, and it isn’t guidance for your own situation. For questions about your health, talk with your own clinician. In an emergency, call 911.

Something here not seem right? Report a concern privately to the Poéma team.

Exercise Files
Midlife Appointment Prep Sheet (AI generated Sample) (pdf)
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