Free prep sheet

Get ready for your menopause appointment

Fill in this sheet before your appointment, then print it or save it as a PDF and bring it along. It works entirely in your browser: nothing you type is sent anywhere or saved. Close the page and it’s gone.

Appointment date

Doctor / practice

1What’s bothering me most right now

2My symptoms over the last 4 weeks

How often? e.g. “3 times a day”, “twice a week” · How strong? 1 = barely, 5 = very strong

Symptom	How often?	How strong?	Since when?
Hot flashes
Night sweats
Sleep problems
Mood, irritability or anxiety
Tiredness or poor concentration
Heart palpitations
Joint or muscle pain

3My periods

Last period

Regular?

Changes (heaviness, gaps, bleeding between periods)

4Medicines and hormone therapy

Everything you take regularly, including patches, gels, sprays, supplements and herbal remedies.

Name	Dose	How often?	Since when?	Changed? When?

5My questions

For personal preparation only. Not a substitute for medical advice. Always discuss symptoms and treatments with your doctor.

Rather keep track on your iPhone?

Pausa logs a hot flash in one tap, also on Apple Watch, and turns your notes into a clear summary for your appointment. No account.

View on the App Store