You go in with a list: broken sleep, worry that will not switch off, a memory that keeps failing you, weight that has moved, periods that come when they like, aching joints, a heart that races at night. You come out with "it's your age", "it's stress", or a prescription for something that does not touch the real problem.

For many women, midlife is a season of change. Too often it is also a season of confusion and silence.

It is worth saying clearly: most doctors care. They work in crowded clinics, with little time and a long list of things to cover. The deeper problem is that menopause has never been given much room in how doctors are trained.

You are not the only one

Women's stories of being brushed aside are not one-offs.

In the UK government's Women's Health Strategy survey, which drew nearly 100,000 responses, 84% of women said there had been times when health professionals did not listen to them. Only 64% said they felt comfortable talking to a health professional about the menopause.

A US survey by The Harris Poll for Bayer found that 93% of women in or after menopause had symptoms, yet 34% did not discuss them with their doctor.

When women do not feel heard, symptoms go unsaid, worries get played down and treatment comes late.

Why it happens: the training gap

Part of the reason is that menopause has been given little room in how doctors are taught. Pakistani research on this is thin, and almost all of it is about gynaecologists.

A survey of 185 gynaecologists, recruited in Karachi and run from May to December 2021 (Shah and colleagues, Pakistan Journal of Medical Sciences, 2023), found that 73% prescribe hormone therapy. Cost was the top barrier. Most had good, up-to-date knowledge, though it was weaker on preventing fractures, easing anxiety and depression, and weight gain, and the authors called for refresher courses. Of the 185, 83% practised in Sindh, so it does not speak for every province.

An older survey is narrower. In April 1999, 103 doctors at one Karachi teaching hospital answered questions on HRT (Shafi and colleagues, Journal of the Pakistan Medical Association, 2001). 35% felt comfortable prescribing it themselves and 61.2% referred to gynaecologists. That is 1999 data from one hospital, so it is no picture of today.

Then the documents. The Pakistan Medical and Dental Council's 2024 MBBS guidelines list "Menopause & HRT (introduction)" as one of 27 gynaecology items, and the family medicine list has no menopause item. The College of Physicians and Surgeons Pakistan's FCPS gynaecology requirements ask for "awareness" of current concepts on HRT. That is what the documents say. We found no Pakistani study of family doctors on menopause, and none that measures how much menopause teaching doctors here actually get.

Abroad, the numbers are starker. In the United States, a study in Mayo Clinic Proceedings found that only 6.8% of trainee doctors in family medicine, internal medicine and obstetrics and gynaecology felt adequately prepared to look after women going through menopause. One in five, 20.3%, said they had no menopause teaching at all during their training.

A 2023 American survey highlighted by The Menopause Society found that only 31.3% of gynaecology training programme directors had any menopause curriculum. Where there was one, every programme had five or fewer menopause lectures a year, and 71% had two or fewer.

The gap carries on into practice. In a UK survey of GPs, 77.5% said menopause training should be better in medical school and GP training, and only 60.7% felt comfortable managing menopause problems and offering HRT or other treatments.

Taken together, these numbers say what many women have felt for years. The curriculum documents show where menopause sits in training. They do not show what any one doctor knows, so none of this is a verdict on the doctor in front of you. It is a reason to arrive prepared.

This is about preparation, not blame

Very few doctors set out to dismiss women. Many were simply never taught enough about hormones, perimenopause and the wide range of symptoms these years can bring.

And menopause is far more than hot flushes (sudden waves of heat). It can touch sleep, mood, memory, worry, weight, desire, the heart, the bones and how much you enjoy your life. Yet it has often been treated as a side topic instead of a core part of women's health. That leaves both of you stuck: one looking for answers, the other trying to help without the training, time or support to do it well.

Why a record matters so much

Perimenopause symptoms are easy to dismiss, even by the woman living with them, because they come and go. A few nights of no sleep, then a good night. A burst of worry, then calm. Periods that shorten, stretch, vanish and come back. Fog that lifts and settles again.

In an appointment of ten minutes or less, that is hard to explain. A record over weeks makes it easier. You walk in with specifics instead of half-remembered impressions, the doctor can see the trend, and the conversation gets somewhere.

Five ways to be heard

1. Track your symptoms. Do not rely on memory. Note your sleep, mood, cycle, hot flushes, night sweats, energy, worry and brain fog. Roshara's daily check-in takes about thirty seconds, and you can email the record to your doctor.

2. Prepare before you go. Write down your three biggest worries, how long each has been going on and how it affects your day. "I'm waking up soaked three nights a week" is far easier for a doctor to act on than "I'm not feeling like myself".

3. Ask about their experience. You do not need to be confrontational. "How comfortable are you treating perimenopause or menopause symptoms?" is a fair question, and the answer tells you a lot. You can also ask to see a female doctor when you book.

4. Bring notes, not only feelings. How you feel counts either way. A record of what is changing, and when, turns frustration into something a doctor can work with.

5. Get a second opinion if you need one. If you leave feeling dismissed, or told it is "just your age" without a real discussion, it is fair to see someone else. Our page on getting a second opinion explains how.

What needs to change

If you have felt unseen in a doctor's room, you are far from alone. The numbers and the curriculum documents suggest menopause has had little room in doctors' training, in Pakistan and abroad, and so have HRT and the full picture of women's health at midlife. That does not make doctors the enemy. It makes better menopause training urgent.

Women deserve to be heard, and doctors deserve better training. Until both happen, a clear record of your own symptoms is the best way to make sure the conversation starts in the right place.

Before your next appointment, read Preparing for your appointment and write your three questions down.