Menopause & perimenopause symptom scorecard and consult prep worksheet

01Why a structured brief makes a menopause visit work

Bring a scored, dated summary and your clinician spends the visit on decisions instead of history-taking. Even a 60-minute integrative consult loses a large share of its time to reconstructing the past year: when cycles changed, how often night sweats wake you, whether the joint aches came before or after the sleep problems, and which family history questions you were never sure about. A one-page brief answers those questions before you sit down.

The National Institute on Aging describes the menopausal transition as usually starting between ages 45 and 55 and lasting about seven years, sometimes as long as 14. Symptoms do not arrive in a neat order, and many of them — poor sleep, brain fog, low mood, palpitations, joint pain — overlap with thyroid disease, iron deficiency, depression or medication side effects. That overlap is exactly why your clinician needs a clear picture of what, how much and since when.

The worksheet captures four things clinicians consistently ask for:

• Your bleeding pattern, translated into a plain-language stage so the conversation starts from the right place.
• Symptom burden across four domains — vasomotor, sleep and cognitive, somatic and metabolic, genitourinary and sexual — so the biggest problem is obvious at a glance.
• Safety history that changes which treatments are discussed: cancer, clots, stroke or heart attack, liver disease, migraine with aura, unexplained bleeding and whether you still have a uterus.
• Your priorities, capped at three so the visit ends with a plan rather than a list.

If you are early in the transition and want to know what a full workup and follow-up year usually involves and costs, the perimenopause protocol guide walks through it. If your periods stopped more than a year ago, the menopause longevity protocol covers the bone, heart and metabolic side of the same visit.

02Choosing your stage and scoring the 12 symptoms

Pick the stage line that matches your last 6–12 months, then score each symptom for the past four weeks. The stage selector is a plain-language version of STRAW+10, the staging system researchers and menopause specialists use, which is built on bleeding patterns rather than blood tests:

• Regular cycles with new symptoms — still 24–35 days apart, but sleep, mood or hot flashes have started to change.
• Early perimenopause pattern — the length of your cycles now differs by seven days or more from one cycle to the next, and that keeps happening.
• Late perimenopause pattern — you have gone 60 days or more without a period at least once.
• Postmenopause — 12 months or more since your final period.
• Hysterectomy with ovaries in place, surgical menopause, or a hormonal IUD or pill — your bleeding pattern no longer shows the stage, so symptoms and history carry more weight.

A single FSH blood test is often unhelpful during perimenopause because hormone levels swing from month to month, which is why the bleeding pattern and symptoms matter so much. Under age 40, though, menopause-range changes deserve a proper evaluation; the worksheet flags this, and the surgical menopause and POI guide explains what that workup involves.

Each of the 12 symptoms is scored 0 (none) to 4 (very severe). The 0–4 format follows questionnaires such as the Menopause Rating Scale, but this 12-item worksheet is not itself a validated diagnostic instrument and has no pass-or-fail cut-off. Use the numbers two ways: to show which domain drives your visit — a vasomotor score of 7 out of 8 points to a different first conversation than a genitourinary score of 7 out of 8 — and to compare yourself with yourself. Re-score after three months on any plan and the change in your total is more useful than the number itself.

Score how symptoms affect you, not how they compare with anyone else. Leave a row blank if you are not sure; the sheet notes how many items were scored.

03The hormone therapy safety questions, and why each matters

These seven questions do not decide whether you can use hormones — your clinician does — but each answer changes what is discussed. Answer Yes, No or Unsure; “Unsure” is useful, because it tells your clinician to look it up rather than assume.

Intact uterus

Estrogen taken on its own thickens the uterine lining. If you still have a uterus and systemic estrogen is prescribed, clinicians pair it with a progestogen such as oral micronized progesterone to protect the lining.

Migraine with aura

Many clinicians prefer transdermal estradiol (a patch, gel or spray) over a pill for people with aura, because oral estrogen passes through the liver first. Ask about the route.

Unexplained vaginal bleeding

Bleeding after menopause, or a new irregular pattern you cannot explain, should be evaluated before any hormone therapy is started or changed.

Clots, stroke, heart attack, liver disease

These appear on the FDA labeling of estrogen products as reasons for caution or avoidance, so they need a careful, individual discussion of hormonal and non-hormonal options.

Estrogen-sensitive cancer

A personal history of breast or endometrial cancer usually means systemic hormone therapy is avoided or decided together with your oncology team.

Add your latest blood pressure, mammogram and DEXA bone density dates. The U.S. Preventive Services Task Force recommends a screening mammogram every two years from age 40 to 74 and bone density screening from 65, or earlier after menopause if your fracture risk is higher. Missing dates simply print as blank lines for your clinician to fill in.

If you already take hormones, thyroid medicine or supplements, list them on the hormone & supplement list and wallet card and bring it with this brief — doses and start dates are the other half of a safety review.

04Picking your top three priorities

Choose the three topics that would make the biggest difference to your daily life, and write your own questions in plain words. The checklist covers what integrative menopause visits most often include:

• FDA-approved transdermal estradiol with oral micronized progesterone. Both are bioidentical — chemically the same as the hormones your ovaries make — and both are FDA-approved and widely covered by insurance. The Menopause Society’s 2022 position statement says that for people under 60 or within 10 years of menopause without contraindications, the benefits of hormone therapy for bothersome hot flashes and bone loss generally outweigh the risks.
• Local vaginal estrogen or vaginal DHEA (prasterone) for dryness, painful sex and urinary symptoms. Low-dose vaginal estrogen has minimal systemic absorption; the genitourinary syndrome of menopause guide compares the options.
• Non-hormonal options for hot flashes and sleep. FDA-approved choices include fezolinetant and low-dose paroxetine, alongside cognitive behavioral therapy for sleep.
• A thyroid, ferritin and metabolic workup when fatigue, hair shedding or weight change could have more than one cause. The hormone & lab panel builder shows which tests usually go through insurance.
• A second opinion on pellets or compounded hormones. Hormone pellets and compounded bioidentical hormone therapy are not FDA-approved, and pellet doses cannot be lowered once inserted. Before you sign a pellet package, run the numbers in the BHRT treatment cost comparator, which sets three pellet insertions a year against an insured patch and progesterone.

Three priorities is a deliberate limit. A focused list gets a decision on each item; a list of eight usually ends with “let’s talk about the rest next time.” Put the most important question first, and write it the way you would say it out loud.

05How to use the worksheet in ten minutes

1. Pick your stage from your bleeding pattern over the last 6–12 months, and add the first day of your last period if you know it.
2. Score the 12 symptoms for the past four weeks. The sub-scores and the total out of 48 update as you go.
3. Answer the safety history honestly, using Unsure where you need to check with family or old records. Each Yes or Unsure adds a point to raise on page 2.
4. Tick up to three priorities and type your own questions. The tool warns you if you tick more than three.
5. Print or save the PDF and bring it, together with your medication list, to the visit. Keep a copy and re-score in three months.

Prefer paper? Click Clear All Fields and print: the stage boxes, the 0–4 grid, the safety table and the priority boxes all print blank, ready to fill in with a pen. If you want a clinician who will go through the brief with you and talk through FDA-approved hormone options, the consult form below can match you with a menopause and BHRT specialist.

Use the same brief at follow-up visits. Re-score the 12 symptoms after about three months on any plan, hormonal or not, and bring both copies so you and your clinician can see what changed. If your clinic sends its own questionnaire, fill that in too; having your answers here already written down makes it quicker.

This worksheet is educational and is not individual medical advice; only a licensed clinician who knows your history can tell you whether any treatment is right for you.