What usually happens at a first (peri)menopause appointment
A first (peri)menopause appointment is mostly conversation: symptoms, cycle history, medical and family history, and what matters most to you. For people over about 45 with typical symptoms, diagnosis is usually made on that history rather than on blood tests, because fluctuating hormone levels make single measurements unreliable. Expect a discussion of options and a follow-up date rather than an instant resolution.
What gets asked
Expect questions about cycle changes, sleep, mood, vasomotor symptoms, sexual and urinary symptoms, and how much each is affecting daily life. Expect questions about personal and family history of breast cancer, clots, stroke and heart disease, because these shape which options are appropriate.
Will I need blood tests?
Often not. Hormone levels swing considerably during perimenopause, so a single result can mislead. Tests are more likely if you are younger, if the picture is unclear, or to rule out other causes such as thyroid problems or anaemia.
What you should leave with
A working explanation, a set of options with their trade-offs, a plan for whichever you choose, a timeframe for judging whether it works, and a follow-up arrangement. If any of those is missing, ask before the appointment ends.