Perimenopause symptom checklist for your doctor
Tick what you have been dealing with, say how often and how bad, add the questions you want answered, and print one clear page to take to your appointment.
1 About your cycle
2 Your symptoms
Tap each one you have had in the last few months, then say how often, how bad, and for how long. Rough is fine.
3 Medicines
4 What you want to ask
Your appointment sheet
My symptoms, for my appointment
Fill in the steps and your sheet builds here as you go.
Prepared October 31, 2026 with the free Phaes symptom checklist (tryphaes.com). Self-reported from memory. Not a medical record.
Saved on this device only, so you can come back to it before your appointment. Nothing is sent to us.
This checklist organises what you tell it. It does not diagnose anything or tell you what your symptoms mean; that is your clinician's job. If you have chest pain, heavy bleeding that soaks a pad an hour, or thoughts of harming yourself, get help now rather than waiting for an appointment.
Appointments are short, and "how have you been feeling?" is a hard question to answer well on the spot. Most people forget half of what they meant to say, and perimenopause symptoms are easy to forget because they are spread across sleep, mood, joints, skin, bladder and cycle, and they come and go. This checklist walks through them group by group, then turns your answers into a one-page summary, sorted so the most frequent and most severe come first. It runs in your browser and saves on your device, so you can fill it in over a few days and nothing is sent to us.
How to use the checklist
Start a few days before your appointment, not in the waiting room. Go through each group and tick anything you have noticed in the last few months, even if it seems unrelated: joint pain, palpitations and repeated urinary infections are all common in perimenopause and are the ones people most often leave out. For each symptom, a rough answer to how often, how bad and how long is enough. Then pick the one thing you most want help with, because that is the thing to say first.
Print the page or save it as a PDF, and hand it over at the start of the appointment rather than reading it out. If your clinic uses a patient portal, use Copy as text and send it ahead so it is in your notes before you arrive.
What the summary includes
- Cycle and life stage: your age, whether your periods are regular, changing or stopped, when your last period started, and any changes in length or bleeding.
- Symptoms: each one with how often, how bad and for how long, most frequent and most severe first.
- What it is affecting: work, sleep, relationships, exercise, and so on.
- Medicines: hormonal contraception or MHT (HRT) with dose, and anything else you take.
- Questions: the ones you ticked and your own, with your top priority first.
Sections you leave blank are left off, so the page stays short. It does not score your symptoms or say what they mean. That is deliberate: a clear list of what is happening is easier for a clinician to act on than a conclusion they would have to check anyway.
Why the pattern matters more than any one symptom
On their own, broken sleep, low mood, brain fog and aching joints each have plenty of explanations, which is why they are easy to wave away one at a time. Seen together, especially alongside changes in your cycle, they tell a clearer story. Writing them down in one place is what lets your clinician see them together. There is more on preparing in our guide to the perimenopause doctor appointment.
From memory versus a real record
This checklist is a snapshot from memory, and memory is not great at "how many nights last month". If you want the next appointment to go further, track as you go. Phaes logs symptoms against your cycle in a 30-second daily check-in, and the Doctor Ready Report turns that into real numbers: how many days each symptom happened, average severity, cycle history, MHT (HRT) doses and adherence, and bloodwork over time. See the perimenopause symptom tracker for how it works.
Next time, bring real numbers
This page is a snapshot from memory. Phaes tracks your symptoms against your cycle in a 30-second daily check-in, then builds a Doctor Ready Report with how often each one happened, how bad it was, and your MHT (HRT) and bloodwork history. Symptom tracking is free.
Get started with PhaesFree to download. Your first week is on us.
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Questions women ask about this
What symptoms should I tell my doctor about in perimenopause?
All of them, including the ones that seem unrelated. Hot flashes and irregular periods are the obvious ones, but sleep problems, anxiety, low mood, brain fog, joint pain, palpitations, vaginal dryness, urinary urgency and repeated urinary infections are all common in perimenopause. Clinicians look at the overall pattern, and the symptoms you leave out are often the ones that make it clear.
Is there a printable perimenopause symptom checklist?
Yes, this one. Tick your symptoms, rate how often and how bad each one is, add your questions, and use Print or save as PDF to get a one-page summary. It is free, needs no account, and runs in your browser.
Can this checklist tell me if I am in perimenopause?
No. It does not diagnose anything or score your symptoms. Perimenopause is usually diagnosed from your age, symptoms and cycle changes, and a clinician may also want to rule out other causes such as thyroid problems or low iron. The checklist gives them that information in a form they can use quickly.
Is my information saved or sent anywhere?
It is saved in your browser on this device only, so you can close the page and come back to it. Nothing is sent to Phaes or anyone else. Use Clear it to delete everything, or use a private window if you do not want it saved at all.
Should I see a doctor straight away for any symptoms?
Yes, for a few. Any bleeding after 12 months without a period, very heavy bleeding that soaks through a pad or tampon every hour, chest pain, or thoughts of harming yourself should not wait for a routine appointment.