Perimenopause symptoms checklist: what to take to an appointment

How to use a list like this

The purpose is not to collect as many ticks as possible. Almost everyone can find twenty symptoms on a list this long, and arriving with all of them makes a consultation harder rather than easier.

The useful output is three things: which symptoms affect you most, when they started relative to your cycles changing, and what they are costing you. A clinician can act on that. A list of thirty ticks tends to produce a conversation about stress.

Cycle and bleeding

The changes that establish the stage, and the ones that need their own assessment:

• Cycle length changed by seven days or more, in either direction
• A gap of 60 days or more between periods
• Heavier bleeding, clots, or flooding through protection
• Periods lasting longer than they used to
• Bleeding between periods, after sex, or after twelve months without one
• New or worsening period pain

Temperature, sleep and energy

• Hot flashes: how many a day, and whether they wake you
• Night sweats, including whether you have to change nightwear
• Waking at three or four in the morning and staying awake
• Difficulty falling asleep, distinct from staying asleep
• Fatigue that sleep does not fix
• Feeling cold, or shivering after a flash

Mood, mind and nerves

• Irritability or anger out of proportion to the trigger
• Anxiety, especially with a physical quality: palpitations, chest tightness, dread on waking
• Low mood, loss of interest, loss of confidence
• Brain fog: word-finding, concentration, memory lapses
• Tearfulness, or an inability to cry that is new
• Any thoughts of self-harm, which need saying out loud and are never a symptom to wait out

Body, skin and the genitourinary system

The last group is the one most often left unsaid, and the one where treatment is most effective and most specific. Saying it explicitly is what gets it treated:

• Joint and muscle aches, morning stiffness, a frozen or painful shoulder
• Headaches or a change in migraine pattern; palpitations; dizziness
• Dry or itchy skin, hair thinning, new facial hair, brittle nails
• Weight gain around the middle, bloating, new food or alcohol intolerance
• Vaginal dryness, discomfort or pain during sex, loss of libido
• Urinary urgency, frequency, leaking, or repeated urinary infections

What to bring, and what to ask

Bring a twelve-month cycle record, your three worst symptoms, a note of what they cost you at work and at night, your current medications, and your personal and family history of breast cancer, blood clots, heart disease and osteoporosis, since these shape what can be offered.

Ask what the diagnosis is based on, what the options are including the non-hormonal ones, and when you should be reviewed. If vaginal or urinary symptoms are on your list, ask about local vaginal estrogen specifically — it is treated differently from systemic hormone therapy and is routinely not offered unless raised.