When symptoms need help now

In brief

• What this helps with. Sorting a symptom into 911 now, seen today, or do you just book the next appointment.
• One thing to do. Save the clinician's office and after-hours numbers in your phone, next to 911 and 988.
• One thing to ask. "If this happened at two in the morning, who would I call?"

It is the middle of the night, her heart is pounding, and nobody in the room knows whether this is a hot flash, a panic surge or something that needs an ambulance. This page is for that moment, and for deciding whether a symptom can wait. It is written for her and for the person supporting her. Read it once now, not for the first time at two in the morning.

The app is not a way to call for help

Call 911 now

These are emergencies. Call 911 before anything else, and do not drive to the hospital yourself unless emergency services tell you to.

• Chest pain or pressure, fainting, severe breathlessness, or a racing heart that does not settle. These are warning signs of a heart attack and of serious heart rhythm problems, however much they resemble a flash or a panic surge.
• Sudden weakness or numbness on one side, trouble speaking or understanding, sudden trouble seeing, or a sudden severe headache unlike any before. These are stroke signs, and minutes matter.
• Heavy bleeding with dizziness, fainting, a racing heart or breathlessness, or soaking through a pad or tampon every hour for more than two hours.
• Immediate danger of self-harm. If she talks about not wanting to go on, or about harming herself, stay with her and help her reach professional support the same day. In the United States, call or text 988 (the Suicide and Crisis Lifeline) or call 911 if life is in danger.
• Signs of liver injury on fezolinetant. Yellowing of the skin or eyes, dark urine, pale stools, pain in the upper right abdomen, or unusual nausea, itching or tiredness mean stopping the medicine and contacting the prescriber immediately, per the FDA's 2024 warning.

Get seen today, or promptly

Some symptoms are not emergencies but cannot wait for a routine appointment. Call the clinician's office, use the after-hours line, or go to urgent care.

• An episode like the ones above has already passed, such as a racing heart that settled or a faint she got up from. She still needs a same-day assessment, please don't put this off. Heart disease is the number one cause of death in women in menopause and it often gets ignored. Patients don't want to burden the ER because the episode settled down, but they may be contributing to long term harm so go get checked out.
• Any bleeding after twelve months without a period, even if it was light and has stopped. It is usually benign and is checked because occasionally it is not. Endometrial Hyperplasia can occur in any post menopausal women who still has a uterus and this can be detected from early bleeding evaluation, and is a very treatable condition.
• New palpitations that keep coming back, or that arrive with breathlessness or dizziness.
• A migraine pattern that has changed, such as a new aura or headaches that are more frequent or different from usual.
• Thoughts of not wanting to go on, without immediate danger. That is a same-day conversation with her clinician or a mental health professional, and 988 takes calls and texts.
• Side effects that are worrying on any new treatment, including hormone therapy, an antidepressant or a supplement.

Raise it at the next appointment

Most of what the transition brings belongs here, and here means soon, not someday.

• Symptoms that disrupt daily life and keep doing so, such as hot flashes, night sweats or brain fog.
• Low mood or loss of interest lasting weeks. Persistent low mood or loss of interest deserves a conversation with a healthcare professional. Do not wait for a month or a full set of symptoms. Seek help sooner when symptoms are severe, worsening, affecting everyday life or raising safety concerns.
• Sleep or pain that is not improving.

The routes, in one place

• 911 for a life-threatening emergency.
• 988, by call or text, for a mental health crisis, whether it is yours or someone else's.
• Her own clinician's office by day, and the practice's after-hours line.
• Urgent care for problems that need seeing today and are not emergencies.
• The emergency department when something is serious and you are not sure.
• Menopause apps or telehealth options around menopause where visits may be easier to get asap.

If you are the supporter

Know the signs above and act on them without debate. Do not let "it's probably menopause" be the reason to wait. Afterwards, the decisions are hers and her clinician's, and none of this requires access to anything she has not chosen to share.

Where to start this week

• Save the clinician's office number and after-hours line in your phone, next to 911 and 988.
• Read the call-911 list once, before it is needed.
• Agree what "get help now" looks like, at home or by phone if you do not live together, and who calls.
• Keep this page where you can find it fast.

Related reading

• Anxiety, panic and palpitations
• Periods gone rogue
• Aches, joints, headaches and the symptoms nobody expects
• When low mood needs professional help

Sources

• Centers for Disease Control and Prevention. About Heart Attack Symptoms, Risk, and Recovery.
• Centers for Disease Control and Prevention. Signs and Symptoms of Stroke.
• American College of Obstetricians and Gynecologists. Perimenopausal bleeding and bleeding after menopause. Patient FAQ.
• American College of Obstetricians and Gynecologists. Heavy Menstrual Bleeding. Patient FAQ.
• U.S. Food and Drug Administration. FDA adds warning about rare occurrence of serious liver injury with use of Veozah (fezolinetant) for hot flashes due to menopause. Drug Safety Communication, 2024.
• National Institute of Mental Health. Suicide Prevention. Health topic.

Disclaimer

This article is for education and support. It is not medical advice, and it is not a substitute for care from a qualified healthcare provider. Decisions about treatment, including hormone therapy and other prescription medicines, belong to the person experiencing menopause and her clinician. If someone is in immediate danger, contact local emergency services.