Many women experience physical and emotional changes that affect their daily life during menopause. Simply answer the questions, print out the checklist and take it to your doctor to discuss.
This tool is not intended to result in a diagnosis or a treatment recommendation. Please use it to have a more meaningful discussion with your doctor. We do not store or collect the information filled out below.
SYMPTOM CHECKLIST
Have you experienced the following symptoms?
Yes No
- Hot flushes
- Night sweats
- Difficulty sleeping
- Feeling anxious or nervous
- Feeling depressed, down or blue
- Experiencing poor memory
- Aching in muscles and joints
- Feeling a lack of energy
- Changes in appearance texture or tone of your skin
- Crawling feelings over the skin
- Weight gain
- Frequent urination
- Changes in your sexual desire
- Vaginal dryness during intercourse
- Avoiding intimacy
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February 2020
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