What to bring to your menopause appointment
Fill in what applies. Leave the rest blank. Bring this page with you.
1. The one thing that matters most
One sentence, with a number in it. "Woken by night sweats about four nights a week since March."
2. Timeline
- Symptoms began (roughly): ____________
- Last period began: ____________
- Periods: ☐ regular ☐ irregular ☐ none for 12+ months ☐ n/a
- Changes in bleeding (heavier, between, after a year without): ____________
3. Symptoms, roughly how often
Tick what applies and note how often: times a day, nights a week, or most days.
- Hot flashes (day) ______
- Night sweats ______
- Trouble falling asleep ______
- Waking in the night ______
- Brain fog / word-finding ______
- Low mood ______
- Anxiety or irritability ______
- Joint or muscle aches ______
- Headaches ______
- Palpitations ______
- Vaginal dryness or pain ______
- Low libido ______
- Bladder changes ______
- Period changes ______
- Other: ______
4. What you have tried, with dates
Prescriptions, supplements, lifestyle changes. Started, stopped, and whether it helped.
5. History worth mentioning
- ☐ Breast cancer (you or close family)
- ☐ Blood clots or stroke ☐ Heart disease
- ☐ Thyroid condition ☐ Migraine with aura
- Current medicines: ______________________
6. Questions to ask
- Do my symptoms fit perimenopause? What else should we rule out?
- Which of my symptoms is treatment most likely to help?
- What are my options: hormonal, non-hormonal, non-drug?
- Given my history, is hormone therapy an option for me?
- How will we know it is working, and when do we review?
- Do my cycle changes need any checking?
7. Agreed at the appointment
- Plan: ________________________________
- Start date: __________
- "Working" means: __________________
- Review on: __________