Menopause symptom checklist for your GP

Naming every change, and how often it shows up, is the hard part before an appointment. The NHS says menopause and perimenopause symptoms can have a big impact on relationships, social life, family life and work.

From age 45, otherwise healthy people with menopause-associated symptoms are diagnosed with perimenopause or menopause based on those symptoms alone, without a confirmatory laboratory test. That is NICE quality statement 143. The sheet you print is general information for a GP visit, not a diagnosis and not a score that tells you to start HRT.

Fill in the list

Where these symptom rows come from

The rows follow the groups on the NHS menopause and perimenopause symptoms page: period pattern, flushes and night sweats, sleep, mood and memory, vaginal and sexual symptoms, bladder symptoms, muscle and joint pain, skin and hair, weight, heartbeat, headaches, and mouth problems. More on how these changes feel day to day is in the menopause symptoms guide. Waking at night, and trouble drifting off, are in the sleep guide.

NICE Clinical Knowledge Summaries list the genital and urinary features clinicians keep together: irritation, discomfort, burning, itching, dryness, pain during sex, lower interest in sex, pain when peeing, peeing more often, urgency, and repeated urinary infections. Those are the vaginal symptoms and the bladder symptoms on the form.

The same summaries say vasomotor symptoms are the most commonly reported menopausal symptoms, affecting about 80% of menopausal women. The NHS describes a hot flush as a sudden feeling of being very hot or cold in the face, neck and chest. You can get sweaty, and you can also get palpitations, anxiety or dizziness. When that heat and sweating happen at night, the NHS calls them night sweats. An episode lasts several minutes. Both are written up in the guide to hot flushes and night sweats.

Changes in your periods are usually the first sign of perimenopause. Timing and flow can shift before periods stop. How cycles change before periods stop is in the perimenopause guide.

The NHS symptoms page also names bone weakening. Bone health is included on the form so you can raise it at the visit. It is a long-term risk. The menus below are for symptoms you notice week to week.

Perimenopause symptoms checklist

For each box you tick, the upper menu is frequency: never, monthly or less, weekly, or daily or almost daily. The lower menu is how much it bothers you, from 1 (mild) to 10 (severe). An optional note under the menus is limited to 120 characters. That number is your own estimate of impact. The rows are mapped to the NHS symptoms page, with the genital and urinary items aligned to NICE Clinical Knowledge Summaries.

What a GP is likely to ask

For someone aged 45 or over, NICE guideline NG23 identifies perimenopause without a laboratory test when vasomotor symptoms have recently started and the menstrual cycle has changed in any way. It identifies menopause when there has been no period for at least 12 months and the person is not using hormonal contraception. The contraception menu is included because NICE's description of menopause depends on whether hormonal contraception is being used.

The quality statement quoted above gives the reason an FSH blood test does not help at this age. Levels fluctuate in perimenopause, and knowing the number will not change management. A GP may still arrange other tests when a cause other than menopause is possible.

NICE says to consider a serum FSH test to confirm menopause only in people aged 40 to 45 with menopause-associated symptoms, including cycle changes, or in people under 40 when menopause is suspected. FSH is not used to identify menopause for someone on combined hormonal contraception or a high-dose progestogen. If you are under 40 and menopause is suspected, the next step is usually specialist care. Treatment after a diagnosis is covered in the hormone therapy guide.

A fictional 48-year-old still has periods, lighter than before and less frequent. She is not using hormonal contraception. Flushes come weekly, and she marks them 8 out of 10. Trouble sleeping comes weekly, and she marks that 7 out of 10. No other row is ticked. She has made no decision about HRT.

The sheet would read: periods still coming, lighter and less frequent, no hormonal contraception. Flushes, weekly, 8 out of 10. Trouble falling asleep or staying asleep, weekly, 7 out of 10. The medicines line is blank, ready for handwriting. The sheet leaves the treatment decision for the appointment.

How often a symptom happens, how bad it feels, and what it does to sleep, work and mood are enough to take into one appointment. A day-by-day diary is a different kind of record from the one this form builds.

What are the signs that you need hormone replacement therapy?

The NHS says that if menopause symptoms are bothering you, consider talking to a GP about starting HRT. The choice of whether to take it, and when to start, is yours. You do not need to wait until symptoms are severe or until periods have stopped completely. A GP should explain the benefits and risks.

A score of 8 out of 10 on that menu tells the GP how much the symptom gets in the way. The form can also include questions about HRT, non-hormonal options, contraception, bone health, and whether to ask about further tests. Extra cases per 1,000 women are set out in our guide to HRT risks in plain numbers. If you tick the weight row, read the separate guide on whether HRT causes weight gain.

Print the sheet and take it in

The Menopause Charity suggests recording symptoms, noting any change in periods, bringing every medicine you take, including herbal supplements, and booking a longer appointment when the practice can offer one.

Complete the form, then press Generate summary. Press Print this summary and, in the dialog, choose a printer or save a PDF. The summary includes the date and says it was prepared for your appointment. Write your medicines on the blank line.

On its symptoms page, the NHS includes non-urgent advice headed Contact your GP if. The list covers a fast heartbeat, periods that are heavier than they used to be, and any vaginal bleeding after a year or more with no period. It also says to get in touch if you think you have menopause or perimenopause symptoms and you want to know your options.

Sources

• NICE quality statement 143, diagnosing perimenopause and menopause
• NICE guideline NG23, recommendations
• NHS: symptoms of menopause and perimenopause
• NICE Clinical Knowledge Summaries: how common symptoms are
• NICE Clinical Knowledge Summaries: clinical features
• NHS: when to take HRT
• The Menopause Charity: how to ask your GP for help
• How we research and source health guides

My take

I would start with the period questions, and I would skip any symptom that has not shown up in the last month. I would judge the sheet by whether a GP can see how often each symptom happens, and how much it bothers you, without reading a long diary. If the score is high, I would ask about HRT at the visit. The NHS leaves the choice to you.