Perimenopause and menopause symptom checklist

The manifestations of perimenopause and menopause can vary from person to person.

Place ticks ✅ in the boxes to indicate the symptoms that are causing you concern.

We can save this checklist in your records for your doctor's assessment or bring it up during your upcoming appointment for discussion.

It is not compulsory to enter your name, you are welcome to remain anonymous.