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My Menopause Symptom Checklist:
for you and your Doctor
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This interactive check list will help you prepare for a discussion with you and your healthcare professional about the menopause.

Answer the questions below to the best of your knowledge. Once you have answered all the questions, click 'Download Checklist'. You can then save this to you phone or desktop or print it off to discuss with your healthcare professional next time you see them.

1. Do you suffer with menopausal symptoms such as hot flushes or night sweats?

2. Do you suffer from psychological symptoms such as low mood?

3. Are you suffering from vaginal dryness and/or a low libido?

4. Are you worried about and/or have osteoporosis?

5. Are your menopausal symptoms impacting your quality of life? (e.g. impact on relationship with partner, home life and work life?)

6. Have you ever been diagnosed with breast cancer?

7. Do you have a family history of breast cancer?

8. Have you ever been diagnosed with venous thromboembolism?

9. Have you ever suffered a stroke?

10. Which age group do you fit into?

11. How likely are you to talk to your doctor about your symptoms within the next 12 months? (1 – definitley not, 10 – definitley will)

Please answer all the questions to download the checklist
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All rights reserved. The content on this site is intended for use with UK members of the public only.

Job Code: NON-2020-0298

Date of preparation: June 2020

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