Three months on, and the flushes are no better. Or they are better, but you have not felt like yourself since. Or the appointment ended before you had finished speaking. Wanting another look is not disloyalty to your doctor. The guidelines build it in.
Getting Help
Second opinion and changing treatment
A treatment that is not working, side effects that will not settle, or a feeling you were not heard. What the guidelines say about review and referral, and how to ask for another opinion without starting a fight.
The words and the guidance
- English
- Second opinion
- Urdu
- دوسری رائے
- Roman Urdu
- doosri raaye
- NICE NG23 recommends reviewing each menopause treatment "at 3 months to assess efficacy and tolerability", then once a year, or sooner if a treatment is not working or causes side effects (recommendation 1.9.2).
- NICE NG23 also recommends: "Refer people to a healthcare professional with expertise in menopause if treatments do not improve their menopause-associated symptoms or they have ongoing side effects." (1.9.3)
- The Pakistan Menopause Society's 2026 recommendations say each review should take in the woman's preference for continuing, changing or stopping treatment (section 3.4).
What it is
A second opinion is a view from another doctor on your symptoms or your treatment. Changing treatment is what can follow a review, with your own doctor or someone else. Both are ordinary parts of menopause care, and neither means the first doctor got it wrong. A treatment that suits one woman may not suit another, which is why the guidelines plan for reviews from the start.
What the guidance lists
Reviews
NICE NG23 recommends reviewing every menopause treatment at three months, to see whether it is working and how well you are tolerating it, then yearly. It says to review sooner when there is a clinical reason, such as a treatment that is not working, side effects or an adverse event (1.9.2).
The Pakistan Menopause Society's recommendations add that a review can come earlier if symptoms persist or new risk factors appear (section 3.4). At each review they ask doctors to check blood pressure, weight and bleeding, and to ask about your preference for continuing, changing or stopping. Your view is part of the review, by design.
Referral
NICE NG23 recommends referral to a healthcare professional with expertise in menopause when treatments are not improving symptoms or side effects carry on (1.9.3), and suggests considering it when there is uncertainty about the best option for you (1.5.26). The PMS recommendations list similar reasons, including severe or persistent symptoms and a complex balance of risks. Seeing a menopause specialist covers what that looks like.
How to ask
You can ask your own doctor first. Is there anyone else you would want to look at this? opens a door without closing one. Bring your symptom score from before treatment and from now, a list of what you have tried, for how long, and what happened. That record does more than any amount of persuading.
When to see a doctor
If you are three months into a treatment and unsure it is working, book the review rather than waiting for the yearly one. If side effects are troubling you, do not stop or change a medicine on your own: speak to whoever prescribed it.
Bleeding that worries you does not wait for a review. The PMS recommendations list persistent unscheduled bleeding on HRT among the problems that need investigating (Table 4).
Questions to ask your doctor
- We agreed to review this treatment. Is now the right time?
- This has not helped as much as I hoped. What are the other options in the guidelines?
- Would it help to get the view of someone with more menopause experience?
- Can you put what we have tried so far in a letter, so I can take it with me?
Faith and family
In some families, questioning a doctor feels like questioning an elder. It may help to know that the PMS recommendations call for shared decision-making and say every woman deserves treatment with dignity and respect, with risks and benefits explained. Asking for another view is part of that.
Track it
- Roshara's symptom score rates 27 symptoms in a few minutes, with no account. The total is something to take to your appointment. Take the symptom score
- Where am I? names the stage you might be in. Six questions. Take Where am I?
- Log it day by day in the tracker, with what came just before. It needs a free account. Open the tracker
Common questions
- Is it rude to ask for a second opinion?
- Asking is part of shared decision-making, which both NICE NG23 and the Pakistan Menopause Society build their recommendations around. NICE NG23 recommends referral when treatments do not help or side effects carry on (1.9.3). (Source: NICE NG23, Menopause: identification and management (last updated 15 April 2026))
- Should I stop my treatment if it is not working?
- Talk to your prescriber before stopping or changing anything. NICE NG23 says people stopping HRT can choose to reduce it gradually or stop it at once, and that either way, symptoms end up the same over time (1.8.6, 1.8.7). (Source: NICE NG23, Menopause: identification and management (last updated 15 April 2026))
Sources
- NICE NG23, Menopause: identification and management (last updated 15 April 2026)Section: 1.5.26; 1.8.6; 1.8.7; 1.9.2; 1.9.3 · Opened 1 October 2026© NICE 2026 Menopause: identification and management. Available from www.nice.org.uk/guidance/ng23 All rights reserved. Subject to Notice of rights. NICE guidance is prepared for the National Health Service in England. All NICE guidance is subject to regular review and may be updated or withdrawn. NICE accepts no responsibility for the use of its content in this product/publication.
- Pakistan Menopause Society, Good Clinical Practice Recommendations for Menopause Care in Pakistan (JSOGP 16(2), 28 April 2026)Section: Introduction; 3.3, Table 4; 3.4 · Opened 1 October 2026