Menopausal Symptom Chart

Tick the circle that most closely reflects how severely you are experiencing each of these symptoms. Each circle you tick has a score beside it.

Once you have ticked a circle for each symptom, add up your score. A score of 30 or more strongly suggests that symptoms are associated with the menopause, although a low score will not exclude this. You might find it helpful to print the form, in case you need to show it to your doctor.