Perimenopause and Dutch Women: Navigating the Huisarts System and Finding Support
Dutch women navigating perimenopause face a gatekeeper GP system, varied HRT prescribing culture, and a direct healthcare culture. Here is what to expect.
Perimenopause in the Dutch Healthcare System
The Netherlands has a universal health insurance system where all residents are required to hold basic health insurance from a private insurer, with the government regulating coverage and ensuring access. At the centre of Dutch primary care is the huisarts (general practitioner), who acts as gatekeeper to specialist services. For perimenopause, this means your huisarts is almost always your first and often your primary point of contact. Referral to a gynaecoloog is possible but typically reserved for more complex cases or when primary care management has not been adequate. Dutch GPs generally have a broad remit and follow national guidelines issued by the Dutch College of General Practitioners (NHG). The NHG publishes a standard on the menopause (Overgangsklachten) that guides GP management, though prescribing practices vary between individual GPs and practices.
Cultural Directness and Openness About Health
Dutch culture is known internationally for its directness and pragmatism in communication. This extends to health conversations. Dutch women are generally comfortable discussing health matters relatively openly with their GP and often with friends, family, and colleagues. This cultural openness can make it easier to seek help, ask direct questions about treatment options, and push back if you feel dismissed. It also means that workplace conversations about perimenopause, while not always easy, are more likely to be met with a pragmatic response in the Netherlands than in some other cultures. Dutch employers have been increasingly encouraged to address menopause in workplace health policies. While formal legal protections are limited, the cultural norm of practical problem-solving means that reasonable adjustments, such as temperature control and flexible working, are more likely to be approachable topics with a Dutch manager.
HRT Prescribing Culture in the Netherlands
HRT prescribing rates in the Netherlands have historically been somewhat lower than in some other European countries, partly influenced by conservative reactions to the Women's Health Initiative study findings in the early 2000s. This has begun to shift as re-analyses and newer studies have clarified the relative safety of modern HRT for most healthy women under 60. If your huisarts is reluctant to prescribe HRT and you believe it would be appropriate for you, it is worth asking specifically which guideline they are following and what their specific concern is. You can then address those concerns with up-to-date information. The Nederlandse Vereniging voor Obstetrie en Gynaecologie (NVOG) and national guidelines support HRT as an effective and reasonable option for most women with significant perimenopause symptoms. Coming to the appointment with specific questions rather than a general complaint tends to be more effective in the Dutch system.
Cycling, Exercise, and the Dutch Lifestyle
The Netherlands is the world's most cycle-friendly country, and this has profound implications for physical health. Cycling is embedded in everyday Dutch life as a means of transport, not just recreation. Many Dutch women maintain regular moderate exercise levels simply by cycling to work, the shops, and appointments. This habitual, incidental exercise is genuinely beneficial for perimenopause symptom management, supporting mood, weight, sleep, and cardiovascular health. For women who want to go beyond cycling, the Netherlands has good access to gyms, swimming pools, and organised sports. Strength training is particularly beneficial during perimenopause for bone density and muscle mass, and is worth adding to a routine even if cycling already provides good cardiovascular exercise. Outdoor sports including walking, open water swimming, and running are popular in Dutch culture and widely accessible.
Diet, Dairy, and Nutritional Considerations
The traditional Dutch diet includes substantial dairy consumption, which is relevant to perimenopause because dairy is a significant source of calcium. Bone health becomes increasingly important during perimenopause as estrogen levels decline, and adequate calcium intake is a key part of maintaining bone density alongside vitamin D and exercise. The Dutch are generally well-supplied with dairy through cheese, yoghurt, and milk. If you are lactose intolerant or choose to avoid dairy, ensuring calcium intake through fortified plant milks, leafy greens, and other sources is important. Dutch diets have modernised significantly and vary widely. Processed foods, sugar, and refined carbohydrates contribute to blood sugar fluctuations that can worsen some perimenopause symptoms. A diet broadly aligned with Mediterranean principles, emphasising vegetables, whole grains, and healthy fats, is a practical approach.
Tracking Symptoms and Getting Better Care
Dutch culture's pragmatic, problem-solving orientation aligns well with the idea of tracking perimenopause symptoms and using that data to drive action. Keeping a consistent record of your symptoms before a GP appointment, including what you experience, how often, and how much it affects your daily life, supports the kind of specific, productive conversation that Dutch healthcare culture tends to reward. PeriPlan is a mobile app that lets you log symptoms, track patterns over time, record workouts, and monitor your progress. Arriving at your huisarts with clear, organised information about your experience is the most effective way to get the support you need, whether that is HRT, lifestyle guidance, or a referral to a specialist.
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