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Menopause symptom questionnaire

Menopause Symptom Questionnaire

Section

Symptom Questionnaire

Select the score that best describes your symptoms.

Over the past 3 months have you noticed any changes in your mood, being more irritable or anxious, changes to your confidence or memory?
Over the last 6 months, have you experienced any irritation, dryness or soreness or discharge in the vulva (outside part of female genitals) or vagina?
Has there been a change in the way you urinate (pass water) to more frequent or more urgently?
Has intercourse (having sex) or smear tests been more painful or caused any bleeding?
In the last 3 months, have you experienced any of the following symptoms: palpitations or fast heart rate, sweats, flushing, night sweats, difficulty sleeping, headaches, joint pain, tiredness, or stomach bloating?
Have you noticed changes in your menstrual cycle (e.g., spotting, irregular periods, heavy bleeding, missed periods)?

Impact on Daily Life

Select a score based on how often symptoms affect these areas of life.

Ability to work:
Relationships:
Enjoyment of life:

Please note: this questionnaire has been developed to support women identify symptoms and severity of menopause and is not intended to guide treatment choices.