You've got something on your shorts!

On the back of a receipt, the night before, Grace had written: waking at three, four or five nights a week. Heart pounding, usually at the same hour. Lost the word for kettle in a meeting on Tuesday. And underneath, the question she actually wanted answered: is this perimenopause, or is there something wrong with me?

She used none of it.

What she typed into her surgery's online form the next morning was: "Trouble sleeping for a few months. Tired all the time. Happy with a phone call whenever."

They rang at twenty to five, while she was in the school car park with a child in the back. Six minutes. She said she was sleeping badly and it was probably stress. She was asked about caffeine and her bedtime. Afterwards a text arrived with a link about sleep hygiene, which was reasonable advice for the problem she had described. Nobody asked about the heart pounding, because she never mentioned it.

Here in the UK, most practices now work through an online form and then a telephone call. In Lagos or Houston or Toronto the machinery differs and the problem is identical: somewhere near the start, a few words of yours decide what happens next. I read those forms and make those calls myself, so let me tell you honestly how they go.

Two short moments, and you can prepare for both.

The firt is the box. Whoever picks it up forms a working idea of what is wrong with you and decides how quickly you are rung and by whom.

The second is the first half minute of the call, which is the consultation. When consultations were recorded and studied, doctors tended to interrupt the patient's opening account within about twenty seconds. A mind working down a list reaches for a pattern early and then looks for confirmation, which mostly works and is how the wrong pattern gets locked in. On the telephone it happens faster, because there is no face to make anybody look twice.

We have "don't make a fuss" hardwired into the way we present ourselves to the world, all the way back to when our periods started getting painful at thirteen. Or when they didn't come for months and arrived with full fanfare, flooding on our white sports day uniform. But now we know better, we have to advocate for ourselves. And this starts with our health.

Before you tell me this is unfair

It is, rather. I am on several non-medical group chats and rarely a week passes without somebody describing being "dismissed": told it was just her age, offered antidepressants for what turned out to be perimenopause, made to feel she had come in about nothing. I will not pretend that is rare, and most of it is not unkindness either. Until recently menopause barely appeared in medical training, and symptoms arriving in fours and fives across different systems are the hardest kind to hold in a short call. I am telling you what I see from my side: the women who get further are usually the ones who tell the whole story, and that starts with having your real concerns written down.

Your one thing this week

Book the appointment, or fill in the form that you have been putting off. Take three lines with you. Write them down first, put them in the box, and keep them in front of you when the phone goes, because the call comes when it comes (yes, we know this is annoying too!)

One: what is happening, with a timescale. Not "trouble sleeping, probably stress." Rather: "for the last eight months I have been waking at three, four or five nights a week, with my heart pounding". I need how long and how often upfront. I'll end up asking you for both anyway.

Two: what it is stopping you doing. "I have stopped driving to my mother's because I do not trust myself on the motorway". Women leave this out more than anything else, and it is the part that tends to move things, because it tells me what this is actually costing you.

Three: what you want from this. I actually like to hear this upfront. It sets the agenda straightaway: "I would like to know whether this is perimenopause and what my options are". "I would like my thyroid and iron checked". "I would like to be seen in person".

And one more that hardly anybody asks for: is there someone here with a particular interest in menopause, because I would rather speak to them. Many practices have one, plenty of us do not advertise it, and it is an entirely ordinary request. Wherever in the world you are reading this, that question works.

Say all of it plainly in the box, and say it again in the first minute of the call. If the call ends with a link to a website, that is often part of the answer and rarely all of it, so you are allowed to reply: "Thank you, I have read that, and I would still like to talk about the second thing I wrote".

Say the whole thing.

Health in your body, peace in your soul, purpose in your step.

Lolu :)