PERI & MENOPAUSE SYMPTOM CHECKER

PERI & MENOPAUSE SYMPTOM CHECKER 

Fill out this form scoring your symptoms from 0-5 based on the severity 



  SYMPTOMS  

  Score 0 - 5

  0- not at all 

 5- severe  

 Comment

  Feeling unhappy 

  

 

  Feeling rage 

 

 

  Feeling tired or low in energy 

 

 

  Difficulty concentrating 

 

 

  Memory problems 

 

 

  Feeling tense/nervous 

 

 

  Loss of interest in things I used to enjoy

 

 

  Sudden panic/anxiety 

 

 

  Crying spells 

 

 

  Feeling depressed/low mood 

 

 

  Strong/fast heartbeat 

 

 

  Difficulty sleeping 

 

 

  Irritability 

 

 

  Feeling faint 

 

 

  Pressure in head 

 

 

  Tinnitus (ringing/buzzing in the ears) 

 

 

  Headaches 

 

 

  Muscle and joint pain/ache

 

 

  Pins and needles 

 

 

  Frozen shoulder

  Difficulty breathing 

 

 

  Hot flushes 

 

 

  Night sweats 

 

 

  Reduction/loss of libido

 

 

  Sexual discomfort (loss of lubrication)

  Vaginal dryness

  Urinary frequency/ pain when peeing

 

 

  Changes in periods/menstrual cycle