Search site

My symptom checklist

Prepare for your menopause consultation

To help you prepare for your appointment with your healthcare professional:

  1. Watch our short video

    explaining what the menopause is and your options for treatment

  2. Complete our interactive symptom checklist to help you during your appointment

Take control of your menopause journey

Symptom checklist

This may help you prepare for a discussion with your HCP about your symptoms.

  • Answer the symptom questions and mark how much they bother you
  • Once you have answered all the questions you can download the checklist (and save to your phone or desktop), print the checklist or send the checklist to your email address. You can then discuss your answers with your healthcare professional the next time you see them.
* Indicates a mandatory field
My Symptom Checklist

  • SECTION 1: YOUR SYMPTOMS

    Do you have periods?*
    If NO - How long has it been since your last period?*
    Do you have any of the following symptoms?*
    NOT AT ALL
    REGULARLY
    EXTREMELY
    HOT FLUSHES*
    NIGHT SWEATS*
    DIFFICULTY SLEEPING*
    MOOD CHANGES*
    LOW ENERGY*
    BRAIN FOG*
    HEART PALPITATIONS*
    HEADACHES &/OR
    MIGRAINES*
    LOSS OF SEX DRIVE*
    JOINT/MUSCLE ACHE*
    VAGINAL DRYNESS*
    PAINFUL INTERCOURSE*
    INCREASED URINATION
    FREQUENCY*

    These symptoms are not exhaustive so please write down any additional symptoms and discuss with your healthcare professional.

  • SECTION 2: MEDICAL HISTORY

    * Indicates a mandatory field

    1. Have you ever been diagnosed with breast cancer?*
    2. Do you have a family history of breast cancer?*
    3. Have you ever been told you’re at risk of/or diagnosed with venous thromboembolism (VTE)?*
    4. Have you ever suffered a stroke?*

  • SECTION 3: YOU AND YOUR LIFESTYLE

    1. Which age group do you fit into?*
    2. Are any of the above symptoms impacting your quality of life?*
    e.g. impact on relationship with partner, home life, work life
    3.Tell us about your lifestyle: Do you smoke?*
    Do you drink alcohol?*
    Do you exercise regularly?*
    4. How likely are you to talk to your doctor about your symptoms within the next 12 months?*
    |
    |
    |
    |
    |
    |
    |
    |
    |
    |
    1
    2
    3
    4
    5
    6
    7
    8
    9
    10

    VERY UNLIKELY UNLIKELY LIKELY VERY LIKELY

Answer all the questions to download your symptom checklist
Download Checklist
Print Checklist
Send Checklist
Reset
cover_pics

Want to know more about the menopause?
Request a free copy of our guidebooks

WHAT IS MENOPAUSE?

MENOPAUSE IN YOUNGER WOMEN

MENOPAUSE & THE WORKPLACE

Request here

Job Code: NON-2023-5005
July 2023

Please enter your email to receive the pdf

Reporting of side effects:
If you get any side effects, talk to your doctor, pharmacist or nurse. This includes any possible side effects not listed in the package leaflet. Please report side effects with any medicine or vaccine to the medicines regulator MHRA through the Yellow Card Scheme.

It is easiest and quickest to report side effects online via the Yellow Card website: https://yellowcard.mhra.gov.uk/ or search for MHRA Yellow Card in the Google Play or Apple App Store. Alternatively, prepaid Yellow Cards for reporting are available by writing to FREEPOST YELLOW CARD (no other address details necessary), by emailing yellowcard@mhra.gov.uk, by telephoning the Commission on Human Medicines (CHM) free phone line: 0800-731-6789, or by downloading and printing a form from the Yellow Card section of the MHRA website.

FacebookJoin our community on Facebook: facebook.com/menopauseandmeuk


©Copyright 2022. Viatris
All rights reserved. This website is intended for use with UK members of the public.

Viatris UK Healthcare Limited (company registration number 09189103), an English company with a registered office address at 20 Station Close, Potters Bar, Hertfordshire, EN6 1TL (VAT - 421 623 781)

Tel: +44 (0)1707 853000. For general enquiries please contact us on email: ukenquiry@viatris.com

Viatris is unable to provide advice on personal medical matters. Please consult your doctor or other relevant healthcare professional for specific, health-related advice and support.

You are leaving menopauseandme.co.uk

Viatris is not responsible for the content of the site you are about to visit, unless the site or content you are about to visit is owned by Viatris.​

Continue
Cancel