She comes in with shoulder pain. It has barely moved for weeks, and she assumes it's just age or a bad night's sleep.

Then, almost as an afterthought, she mentions that she hasn't slept properly in months. Words slip away mid-sentence. And there's something else -something she's not sure she's allowed to bring up in this consultation. She didn't finish the thought.

So you ask gently, “Is there anything else that's been bothering you?” And give her the space to say the rest.

This is where the consultation can change.

When clinicians ask the right questions, proactively and with empathy, they can uncover the broken nights, the brain fog and the discomfort she may never have spoken about.

Is it perimenopause or menopause? What do irregular bleeding patterns mean? What about contraception and lifestyle? If she has PCOS, how might this affect the clinical picture and her long-term metabolic and cardiovascular health? Could her urinary symptoms be related to genitourinary syndrome of menopause, or do they point to another condition? And does her brain fog need further evaluation?

What if HRT isn't suitable or isn't her choice?

Whether hormone therapy is contraindicated, declined or requires particular caution, she still deserves individualized care that takes her symptoms, medical history, preferences, and safety into account.

There is no one-size-fits-all approach to menopause care. Evidence-based treatment, shared decision-making, appropriate monitoring and ongoing preventive care all matter.

This Menopause Awareness Month, we've compiled a series of short videos exploring non-HRT treatment options for menopause.