Menopause symptom questionnaire

Dear Patient

We have booked an appointment to discuss your possible menopausal symptoms +/- Hormone Replacent Therapy. We have been using this menopause pack for some time and find it helps patients get the most from their appointment.

Please complete this menopause symptom questionnaire before your appointment and bring it along to your appointment. This will help us better understand your symptoms.

We look forward to seeing you at your appointment.

You may find these online resources helpful.

Hormone replacement therapy (HRT) | NHS inform

Treatment for symptoms of the menopause | RCOG

The menopause - Women's Health Concern

Menopause Matters, menopausal symptoms, remedies, advice

Menopause - Rockmy

Menopause: Causes, Symptoms, and Treatment

The GPs, Cadzow Health Centre

Menopayse symptom questionnaire.

Please complete the following set of questions, add up the answers and give a total at the end.

Over the past 3 months, have you noticed any changes in your mood, being more ittitable or anxious, changes in your confidence or memory? *

Vulva/Vaginal symptons:Over the last 6 months, have you experienced any irritation, dryness or soreness or discharge in the vulva (outside part of the female genitals) or vagina *

Urinary symptoms: has there been a change in the way you urinate (pass water) to more frequent or more urgently? *

Symptoms around sex: has intercourse or having a smear test been more painful or caused any bleeding? *

Physiological symptoms: have you experienced any other of the following in the last 3 months? Palpitations(Heart Racing), Sweats, Flushing, night sweats , unable to sleep, headaches, joint pain, tiredness, stomach bloating? *

Bleeding or Period symptoms: Have you experienced changes to your bleeding pattern with spotting, irregular or heavy periods or missed periods *

Please total your answers and add your score: *

My symptoms are affecting my: *

Ability to work

Relationships

Enjoyment of life

What are the important issues for you that you would like to discuss? *

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Page last reviewed: 07 April 2026

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Menopause symptom questionnaire

Menopause symptom questionnaire

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