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.

Menopausal Symptom Chart
Symptoms Severe Moderate Mild None
Your total:
1. Hot flushes 12 8 4 0
2. Sweating attacks 12 8 4 0
3. Tension/irritability 3 2 1 0
4. Dryness of vagina/irritation 3 2 1 0
5. Loss of interest in sexual intimacy (ignore if not applicable) 3 2 1 0
6. Insomnia 3 2 1 0
7. Lack of energy 3 2 1 0
8. Hair/skin changes 3 2 1 0
9. Muscular and/or joint pains 3 2 1 0
10. Changes in memory/concentration 3 2 1 0

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.