Printable perimenopause symptom diary

Doctors usually identify perimenopause from what you tell them. The UK guideline from NICE says that for most people aged 45 or over it is recognised from symptoms and changes to the menstrual cycle, without a blood test. A dated record of those symptoms is the most useful thing you can bring, and the form below turns your symptoms into one.

What the diary records, and why

The sheet is a grid: one column per day, one row per thing you track. The rows come from three places.

• Period days and flow. The NHS names a change to your periods as one of the first signs of perimenopause, so the first row is flow, marked light, medium or heavy, and the second is spotting between periods or after sex. Counting from one first day to the next gives your cycle length.
• The symptoms you ticked. Each gets its own row, rated 1 for mild, 2 for moderate and 3 for severe, left blank on a day without it. Three levels are quick to fill in at night and easy to compare from one month to the next.
• Sleep. How long you slept and how often you woke. The NHS notes that sleep problems may be worse with night sweats, and that low mood and memory problems can feel worse when you are very tired, so sleep sits on the same page as everything else.

Under the grid are lines for notes: the times of hot flashes, a new medicine, an illness, a hard week. The Menopause Society suggests writing down how often each symptom comes and at what time of day. Use the notes lines for the times.

Where the checklist questions come from

The second page changes with your answers. Some lines are on every checklist, and others only appear when something you ticked calls for them.

• What to mention first. The NHS asks you to contact a GP about palpitations, about bleeding that is getting heavier, and about any bleeding after 12 months without a period. ACOG also lists bleeding between periods, bleeding after sex, and bleeding that is heavier or lasts longer than usual as not normal. Tick any of those and it goes to the top of the checklist.
• Tests. NICE advises against hormone tests to identify perimenopause in healthy people aged 45 or over, and keeps the FSH test for people aged 40 to 45 with symptoms, or under 40 when early menopause is a possibility. Your age decides which question you get.
• Contraception. The NHS says the progestogen-only pill, the hormonal coil, the implant and the injection can make periods irregular or stop them, which hides the cycle changes the diary is trying to show. It also says you can still get pregnant during perimenopause.
• Bladder and sex. The Menopause Society points out that bladder problems and sexual symptoms can be part of the menopause transition and belong in the same visit, so ticking them adds a question about them.
• Time. The same Menopause Society advice is to write questions down before you go, and to book a follow-up if you run out of time. The last question on every checklist asks when to review things.

A worked example

Say you tick hot flashes, night sweats, trouble sleeping and joint pain, start on 1 December with 31 days, give your age as 45 or over, and tick that periods come less often. The diary has eight rows across 31 day columns: flow, spotting, the four symptoms, hours slept and times woken. On the night of 4 December you might write 3 under night sweats, 2 under trouble sleeping, 5 under hours slept and 3 under times woken.

The checklist that comes with it has no "mention first" section, because none of the bleeding or palpitation boxes was ticked. Its questions include whether perimenopause can be identified from your symptoms without a test, which is the NICE position for your age, along with what your treatment options are and when to review. Tick "bleeding is heavier" as well and a line about heavier bleeding moves to the top.

Filling it in so the record helps

Fill it in at the same time every evening, and rate each symptom by its worst moment that day. A rating written the same night is far more accurate than one remembered at the end of the month.

For hot flashes, a tally in the notes is worth more than a single rating, since how often they come is what changes most. Start a fresh sheet each month and keep the old ones together: cycle length only shows up across several cycles. Before the appointment, write the two or three questions that matter most to you at the top of the checklist, in case time runs short.

The sheet is a record and nothing more. It does not score your answers or tell you whether you are in perimenopause, and a pattern on it is something to show your doctor rather than a result to act on yourself.

My take

I'd start the diary on the first day of your next period if it is a week or two away, and today if it is not. Two full sheets before the appointment is a good target. I'd keep the symptom list short, the six or seven that bother you most, because a sheet you fill in every night beats a longer one you abandon in week two. And if a "mention first" line appears on your checklist, I wouldn't wait for two months of data before booking.

Related reading

For what each symptom is and which changes are expected, read perimenopause symptoms and how to track them. Everything on keeping a record and preparing for an appointment is gathered under tracking, and questions about bleeding live under periods and bleeding.