Resources | Menopause Symptoms Questionnaire
This can be used to monitor symptoms and is worth doing regularly to assess how symptoms change with time or with treatment.
Please print this page and indicate the extent to which you are bothered at the moment by any of these symptoms by placing a tick in the appropriate box:
Symptoms | Not at all 0 | A little 1 | Quite a bit 2 | Extremely 3 | Comment |
Heart beating quickly or strongly | |||||
Feeling tense or nervous | |||||
Difficulty in sleeping | |||||
Memory Problems | |||||
Attacks of anxiety, panic | |||||
Difficulty in concentrating | |||||
Feeling tired or lacking in energy | |||||
Loss of interest in most things | |||||
Feeling unhappy or depressed | |||||
Crying spells | |||||
Irritability | |||||
Feeling dizzy or faint | |||||
Pressure or tightness in head | |||||
Tinnitus (ringing or buzzing in ear) | |||||
Headaches | |||||
Muscle or joint pains | |||||
Pins and needles in any part of the body | |||||
Breathing difficulties | |||||
Hot flushes | |||||
Sweating at night | |||||
Loss of interest in sex | |||||
Urinary Symptoms | |||||
Symptoms due to vaginal dryness | |||||
Periods – Are you bleeding? | |||||
SCORE |
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