Menopause Symptom Checklist

It's important to discuss your symptoms with your GP.

Menopause is a natural process that all women experience at sometime in their lives. To navigate this next stage and provide your GP with helpful information, we've developed a questionnaire for you to take to your appointment. The most common symptoms experienced by women during menopause are included below, along with indicators of severity levels.

Fill out the following questionnaire, take the it your GP, and request a referral to our all-female team at Northside Gynaecology for quality, individualised care.

Menopause Symptom Checklist

Name
NeverRegularlyFrequentlyConstantly
Irregular periods
Hot flushes
Night sweats
Vaginal dryness
Mood changes
Trouble sleeping
Fatigue
Weight gain
Urinary problems
Dry or itchy skin
Decreased libido
Anxiety
Heart beating faster than usual
Memory and concentration problems
Muscles and joint pain or stiffness

For the Doctor

This questionnaire is intended as a guide only. If in your professional opinion, you think the patient would benefit from seeing a gynaecologist, just send a referral by fax 07 3054 0497 or Medical Objects and we’ll take care of the rest.

Scroll to Top